Associations between baccalaureate nursing students' perceptions of educational environment and HESI™ scores and GPA

Summary

Background

Students' perceptions of their educational environment have been found to be related to their approaches to learning and learning outcomes. Educational environment is just beginning to be researched in nursing education with the vast majority of studies focusing on the clinical educational environment. Perception of educational environment has been shown to influence student implementation of a specific learning style and influences educational outcomes such as program completion and GPA. There is a need for sound research that explores the relationship, if any, between perceptions of environment and outcomes.

Objective

To explore the relationship between baccalaureate nursing student (BSN) perception of educational environment (SPEE) and objective learning outcomes.

Design

Retrospective correlational descriptive study.

Setting

Private School of Nursing in the Southwest.

Participants

Convenience sample of 62 graduating baccalaureate students.

Methods

All graduating BSN students were invited to complete the Dundee Ready Education Environment Measure (DREEM) through the online survey application Qualtrics™. A total of 62 students completed the DREEM survey. These results were compared with each student's GPA and HESI™ score.

Results

A total of 62 students completed the survey for an overall response rate of 57%. There was no correlation between total SPEE and nursing grade point average (NGPA) or HESI™ exit scores. Conclusions: Based on this study at this institution, it appears that students' performance was not influenced by SPEE. One of the major implications of this study is the possibility that an “acceptable” SPEE (one that is neither exceptional nor terrible) may not significantly influence student outcomes. Exploring this relationship has theoretical as well as practical implications as educators seek to determine the effectiveness of educational interventions. Student perception of learning environment is measured in various ways at the majority of institutions. It has been assumed that an educational environment that is ranked high by students result in increased learning. However, as the science of nursing education advances, educators need to determine if and how these perceptions relate to actual learning outcomes. As academicians, we need to be concerned with the relationship between learning outcomes and environment in order to create the most effective learning environment.

Introduction

According to Broome, Ironside, and McNelis (2012), national attention is focused on the nursing shortage and the ability of nurse educators to provide a workforce that can meet the demanding and increasingly complex needs of a growing population. There is a need for an increase in sound research within the science of nursing education, specifically, research geared toward pedagogical effectiveness, relevance and cost-effectiveness (Broome, Ironside, and McNelis, 2012). Nurse educators strive to create a student-focused environment conducive to learning and student evaluation of courses and faculty are often included in promotion and tenure requirements. Schools often seek to gauge and improve student experience, and one important aspect of the educational experience is the student's unique perception of the educational climate. Student perception of academic or educational environment is often measured in an attempt to answer several questions: To what extent does the educational climate presently affect objective learning outcomes? If an institution improves the academic environment, will the change objectively improve learning and learning outcomes? Which aspects of educational environment should an institution change to improve educational outcomes while maintaining cost-effective interventions?

Students' perception of their educational environment (SPEE) has been found to be associated with their approaches to learning and learning outcomes. SPEE has been shown to influence student implementation of a specific learning style and influences educational outcomes such as program completion and grade point average (GPA) (Biggs and Tang, 2011). An important early study, Lizzio, Wilson and Simons (2002), explored the question, “Does the type of academic environment within which students are asked to learn have any real impact on how they approach their learning and the quality of outcomes they are able to achieve? Or will students ‘do well’ and ‘not so well’ irrespective of their environment?” (Lizzio, Wilson and Simons, 2002, p. 27). The researchers confirmed that three elements of the learning environment under the instructor's control (clear goals, good teaching and appropriate assessment) were significant predictors of academic achievement (F [5, 1847] = 141.85, p < 0.0001). A number of other studies have found similar results (Bengtsson and Ohlsson, 2010, Elison-Bowers et al., 2008, Haarala-Muhonen et al., 2011, Leufer, 2007, Soemantri et al., 2010.

The majority of educational environment research in nursing has been focused on the clinical educational environment and has focused on student perceptions without exploring these perceptions in relation to actual academic outcomes (Berntsen and Bjørk, 2010, Soemantri et al., 2010). Studies have also explored the clinical environment and its relationship to learning in new nursing graduates (Muldowney and McKee, 2011, Sand-Jecklin, 2009). In their integrative literature review, Pitt et al. (2012) reviewed studies that focused on factors that influenced nursing students' academic and clinical performance. Of the 44 studies that met the inclusion criteria, several looked at demographic variables, student personality and behavior factors, and admission qualifications. However, there was not one study in this integrative literature review that explored the educational environment as a factor related to students' academic and clinical performance (Pitt et al., 2012).

Smedley and Morey (2010) utilized the Clinical Learning Environment Inventory (CLEI) to explore senior Bachelor of Nursing (BSN) students' perceptions of the clinical environment. The CLEI looks at six areas of environment, personalisation, student involvement, task orientation, teaching innovation, individualisation, and student satisfaction. The students were given the survey immediately following their clinical experience (actual) and then again 2 weeks later to represent their ideal (preferred) clinical experience. The authors found that although there were overall high scores in all six of the measured domains on the actual clinical experience, the preferred clinical experience was significantly greater in all domains when compared with the preferred experience. Personalisation and student involvement were identified as paramount in creating an effective clinical environment (Smedley and Morey, 2010). While this study provides insight into student perceptions, it does not link these perceptions with actual outcomes. How will increasing student involvement and personalisation improve students' actual performance?

Newton et al. (2012) administered a modified CLEI to three cohorts of undergraduate nursing students to explore perceptions in two types of clinical learning environments. The school had developed a preceptorship partnership model with a healthcare organization that consisted of a clinical nurse educator and preceptors who were openly engaged in precepting nursing students. One group completed all their clinical experiences within this institution, while the other group rotated through many healthcare institutions. The only significant difference between the two groups was in the area of student centredness. The student group that completed the clinical requirement within the preceptorship partnership institution rated student centeredness significantly higher (p. < 0.001) than their traditional counterparts. The authors concluded “there seems to be two necessary conditions for effective learning in clinical placements” (Newton et al. p. 2338). The authors suppose that the continuity of a clinical leader and a student centered environment will enhance student clinical learning. However, the study only looked at student perception. There was not an objective academic outcome or a measure of actual learning. Learning cannot be measured or supposed through student perceptions.

There is a paucity of research exploring the relationship between students' perceptions of total academic environment (didactic and clinical) and objective learning or academic outcomes within nursing education. The majority of studies that have focused on student perceptions assumed that higher perceptions were indicative of higher learning. Studies that have explored outcomes and educational environment tend to have utilized self-reported results from participants as the sole outcome measure. Methodologically, these outcomes, due to the self-report bias, are not as valid or strong as using objective outcomes found in the student record. To the researchers' knowledge, there has not been a study exploring the relationship between baccalaureate (BSN) SPEE and objective (not self-reported) learning outcomes. Therefore, this study was performed to explore the relationship, if any, between BSN students' SPEE and nursing grade point average (NGPA) and Health Education Systems Incorporated (HESI™) exit exam scores.