Problem Based Learning on Nurse Students' Achievement and Critical Thinking Skill

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1 Problem Based Learning on Nurse Students' Achievement and Skill Somporn Santiprasitkul MNS, MSc. * Kanjanee Sithivong, MEd.** Orathai Polnuengma, MEd. * Rationale Learning reform is the heart of change in process of education in Thailand. The important purpose of the reform is to potentially develop learners critical thinking. Training for skill and process of thought are main policy of educational management in Thailand. According to Act of National Education in 1999 and additional correction in 2002, educational administrators and teachers have to provide students to get skillful, process of thought, management, confront with situation and be able to integrate their knowledge for prevention and solving problems. Lecturers have to pass on knowledge decreasingly and comply students to participate their learning. The students should be motivated to be responsible on self learning and take scientific process to seek for their knowledge by the true experience which correlate in the real life. Teachers have to stimulate students to learn effectively practice by themselves. Teachers have to change their roles to be facilitators as a student center s process which rely on critical thinking. However, learners have to change their familiar situation from sitting down for listening teachers to be active learner, preparedness to learn, curiously enthusiastic students, identify their own choice to correct problems with freedom of thought and able to evaluate themselves. Critical thinking is the first needed skill for nurse students (Australian Nursing Council :online). It is the advance process of cognitive domain for decision making upon caring patients. The affective disposition of a critical thinker includes being inquisitive, systematic, judicious, truth seeking, analytical, open-minded, and confident in reasoning (Facione, Facione, & Giancarlo (2000). Nurse Education Institute should have policy to promote student to be active learner by getting critical thinking since they are nurse student. Teachers should have various techniques for teaching by emphasizing students to think and solve problem which are very importance. Intelligence in real life involves not only learning how to do things effectively and efficacy but also meaningfully learning, the capacity to deal with new novelty and be able to identify, adapt and interact with the environments properly. Problem based learning is the method which teach student to learn by simulated situation. The new atmosphere of learning will promote student to be reasonable learner. They will get freedom to explain their thoughts without scaring and take relaxation during learning. These make students get self confidence and self esteem. Problem based learning process is the best method for teaching nurse students underneath nursing care context. It is the method to make student to be active learner, enthusiastic person to seek for answering the question or solving problem. The method makes *Assistant Professor **Associate Professor School of Nursing, Mae Fah Luang University, ChiangRai, Thailand 1

2 the meaningful of learning and make the learner to develop skill to thinking critically as well as able to learn life long (Kammanee, 2003) Teaching and learning by focusing problem based on the belief that learners will build up their knowledge themselves. Seeking for knowledge by problem based and simulated situation which is purposively design and selection. By the way, it is harmonious with course objective and curricula. The principle of problem based learning is able to stimulate learner to search knowledge in many dimension and have to integrate their old knowledge, new knowledge including skill and learning behavior. Researchers serve as lecturer in School of Nursing, we do believe that nurse who have skill to thinking, will be critically competencies. The process of teaching-learning which is provided learning would be based on 2 factors. The first, input, learner s role have to change from listener to thinker, seeker, searcher and abridger. The second, process, provide teachinglearning method to be problem based learning which lead to the students achievement and critical thinking Researcher think that the first year nurse students are alike white clothes which we can paint whatever we want them to be. Thus, teacher have to give opportunity for students to practice themselves to systematically think since they come in the nurse profession which this process should be focused on student centered. Researcher is interesting to study nurse students achievement so researcher study the outcome by using problem based learning process. Objective 1. to study the first year of nurse students achievement after problem based learning process. 2. to compare the critical thinking score after undergone problem based learning process with before learning on Local Wisdom and Health Care course for the first year nurse students. Research Methodology Population and samples are the first year nurse students in Bachelor program of Nursing, Mae Fah Luang University in Thailand who enrolled the Local Wisdom and Health care, the second semester, academic year The sample was purposive selection by voluntarily first year nurse students to participate in the study. 1. Instrument : there were consisted of 3 instruments 1.1 Problem based learning guideline : Teaching and learning guideline draft for problem based learning method was developed by researchers. Researchers had revised the guideline draft after meeting and discussing with facilitators. 1.2 Multiple choices test 120 items which was content validity by 16 lecturers by 1 score for the corrected choice and 0 for uncorrected choices. 1.3 Test : Researcher used Sriprapai Intrachai s Critical Thinking Test which have 80 items which consisted of 5 topics, each topic had 16 items. The topics were Inference (5 multiple choices), Recognition of 2

3 Assumption (2 multiple choices), Deduction (2 multiple choices), Interpretation (2 multiple choices) and Evaluation of Argument (2 multiple choices). All the test had to be complete within 60 minutes. The reliability of the test was done and Cronbach coefficient was.73. The 3 levels of critical thinking score were separated by percentile. 75 percentile was high critical thinking score, percentile was moderate critical thinking score and <25 percentile was low critical thinking score. 2. Participation preparedness 2.1 Facilitator preparation by being informed about their roles as facilitator and help students to make right decision and also explaining guideline of problem based learning process. 2.2 Learner preparation by being introduced course objectives, teaching and learning activities, evaluation methods. 3. Data Collection Data collection was conducted by the researchers after the research project was approved by the academic committees of School of nursing. The steps were as follow: 1. The researchers informed the students who enrolled in the Local Wisdom and Health Care course about the research project. The voluntarily students were participated in the study. They were informed about their right to withdraw from the study at any time and that would not affect the course achievement. The study results will be reported as a group. 2. The samples were asked to respond to The questionnaire before starting the course. 3. The problem based learning process was employed during the 3 month Local Wisdom and Health Care course. 4. All students, both students and samples, were measured by using multiple choices in the 65 items for mid term examination and 75 items in final examination to evaluate their achievement. 5. The samples completed The questionnaire after the course was finished. Data Analysis Demographic data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation). Learning achievement was analyzed using percentage and T-score of the 140 items. Critical thinking was analyzed using descriptive statistics (frequency, percentage, mean, standard deviation, and percentile). Paired t test and chi square test were used to compare critical thinking before and after the problem based learning process. Results Demographic data Most of the students were female (96.81%), aged 19 years old (63.84%), got first semester grade from 3.00 to 4.00 (62.77%). Learning Achievement Learning achievement in the Local Wisdom and Health Care course after the problem based learning process revealed that the highest score was 88.79% and the lowest score was 3

4 70.33%. The average score was ± From the aforementioned percentage, the highest T-score was 76 and the lowest T-score was 24. Researchers decided to give 4 grades and most of the students got grade B+ and B (41.49%) equally. (Table 1) Table 1 Frequency and Percentage of T scores, Score Percentage, and Grade for students achievement (N = 94) T score Score Percentage Grade Frequency Percentage A B B C Results revealed that critical thinking after ( ) the problem based learning process was higher than before ( ) the process conducting (t = 4.443, p <.05) (Table 2). Results was shown statistically significant higher critical thinking after undergone problem based learning process compared with the score before the problem based learning process in two domains: Inference (t = 2.288, p <.05) and Recognition of Assumption (t = 6.287, p <.05) (Table 3). Table 2 Comparing mean and standard deviation of critical thinking score on before and after the problem based learning process N t test p value After PBL Before PBL Table 3 Comparing mean and standard deviation of critical thinking score of each domain before and after the problem based learning process Before PBL After PBL t test p value Inference Recognition of Assumption Deduction Interpretation Evaluation of Argument

5 According to the level of critical thinking, the results were shown that the high level (26.60%) and moderate level (45.74%) of critical thinking after the problem based learning process were higher than the high level (25.53%) and moderate level (42.55%) of critical thinking before the process of learning. Moreover, the percentage of overall critical thinking level after and before the problem based learning process were difference significantly ( 2 = , p <.05). (Table 4). Table 4 Chi square tests of critical thinking levels before and after the problem based learning process Levels After PBL Before PBL N % N % 2 High Moderate Low * * p <.05 When the classification of critical thinking level and analyzing critical thinking score were done, the result was found that the score among high, moderate and low level groups after PBL were difference from the score before PBL significantly (t = , p<.05; t =26.272, p<.05; t= , p<.05, respectively) (table 5) Table 5 The critical thinking level before and after the problem based learning process Before PBL After PBL t test p value High Moderate Low According to students opinion of PBL process in the course, they expressed their opinions that they enjoyed learning in the course (51.06%), had learned each other and could manage as team working (39.36) and learned how to solve problem. (table 6) 5

6 Table 6 The opinion of problem based learning in the course Students opinion* total percentage 1. Enjoyable atmosphere Team working and collaboration Problem solving Self assertion Analyzing situation Self learning and searching Active learning Discipline Gaining knowledge * 1 student expressed more than 1 opinion Discussion Most of the nurse students achievement were B+ and B grade, the highest score was 88.79% and the lowest was 70.33%. We found that the achievement was not different from the last year taught by lecture which was harmonious as Beers study (2005) which was administered to both groups of students, lecture and PBL. Both the pretest and posttest scores of the two groups were compared using an independent t test, and no statistically significant difference was found in the scores of the two groups. The results of this study support the null hypothesis: that there is no difference in objective test scores based on teaching The average score of critical thinking after problem based learning process was from 80 full scores. According to percentile score, we found that the most level of critical thinking score was moderate level which was not different from Kampak(1996) and Ratanakomol et al (1999) who found that the critical thinking score of nurse students were moderate level score. It was because nursing curricula are reading intensive which are obstacle of critical thinking. Moreover, clinical assignments have not been taught in class. Regarding lecturing, students get used to be covering their thought by teachers. When they have learned by using student centered, they might not be familiar to learn by themselves. However, the students satisfaction on PBL was 51% which they thought that they were enjoy learning and ever get bored during learning and, the same as Kocaman, Dicle and Ugar (2009) who found that PBL made the learners preparedness for self learning and they feel apart of teaching and learning process and make them enjoyable. Conclusion This research is concluded that PBL impact on gaining knowledge and critical thinking skills. The process is highly motivated students to treat the problem as their own. Thus PBL is worth considering for learning style which is self direct learning and able to encourage student to be thinker critically, This process makes students gain their knowledge and experience to search various credible resources for solving problem by their own methods. They are able to generate and integrate new information into their problem solving. The important outcome of PBL process is provided students to be lifelong learners. 6

7 REFERENCES Australian Nursing Council. (2001). Retrieved September 19, Available: Beers G W.(2005). The Effect of Teaching Method on Objective Test Scores:Problem-Based Learning Versus Lecture. Journal of Nursing Education. 44( 7): Facione, N.C.; Facione, P.A.; & Giancarlo, C.A. (2000). The disposition toward critical thinking : Its character, measurement, and relationship to critical thinking skill. Retrieved September 19, 2011, Available: Kampak, K. (1996). The relationship between focusing on the real situation and ability of critical thinking in nurse students. Unpublished master's thesis Chulalongkorn University, Bangkok, Thailand. Kammanee, T.(2008). Science of teaching knowledge for effectiveness of teaching and learning process (8 th ed.). Bangkok: Chulalongkorn Printing Kocaman, G, Dicle, A and Ugar,A. (2009). A Longitudinal Analysis of the Self-Directed Learning Readiness Level of Nursing Students Enrolled in a Problem-Based Curriculum. Journal of Nursing Education, May, 48(3) : Oldenburg, N L., Hung W C. (2010). Problem Solving Strategies Used by RN-to-BSN Students in an Online Problem-Based Learning Course. Journal of Nursing Education. 49(4):

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