Research paper from: Kerstin EL, Nilson & Margareta Stomberg “Nursing

students motivation toward their studies – a survey study. “BMC Nursing 2006.

Accessed on 21st June 2008, http:www.biomedcentral.com/1472-6955/7/6

Received : 3rd August 2007

Accepted : 25th April 2008

Published : 25th April 2008

 Nursing Students Motivation Toward Their Studies
– A Survey Study

The words evidence - based practice have become part of our everyday

vocabulary. Evidence based practice definition by Oxford English dictionary

(1984) as clearness, indication, sign, facts making for conclusion, in support of

information given. While Sacket et. Al (1997) defined evidence - based practice

as the conscientious, explicit and judicious use current best evidence in making

decision about the care of the individual patients.

In this millennium of health care services, most the practices in the health

care organization are based on research study, which can produce positive

outcome towards delivery of appropriate teaching learning activities and patient

care according to the need and cost effective.

Rycroft – Malone et al (2004) said, evidence is primary research finding

based on systematic review which has being identified by individual searching

sources themselves and their opinion and result of quality improvement

programmers. Whilst, Banning (2005) claimed that evidence is developed and

used broadly into practice, mainly because of more people are well educated,

increase public awareness in this period, the greater concentration productivity

and cost effectiveness in delivering high quality in health care. This lead to need

for access of current scientific knowledge and the ability of the individual

practitioner to think critically about the use of the knowledge to achieve the

optimum outcomes of patient.

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The demand for evidence based decision making is heightened because

demand for healthcare is outstripping resources available for providing the care.

Individuals working in a health and social care setting need to be able to critically

appraise current researches for much different reasons. Stated by Cormack

(2000) critical appraisal is the process of assessing and interpreting evidence by

systematically considering its validity, results and relevance. Before appraising

any research it is important to remember to be impartial and not prejudice toward

the research.

Critical appraisal, sometimes referred to as critiquing, is more about

looking for strength and weaknesses in a study and making a balanced

decision about what has been presented in the publication. If all studies that had

weaknesses were ignored then there would be no evidence to use in future

practice. Being able to identify confident flaws in studies can ensure the next

study to become more valid. According to Burns (2000) who discussed the term

critique and conclude that to be critical means to make are judgment of the value

or worth of a piece of literature or art and it is in the context that critically

appraising research should be considered.

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 Nursing Students Motivation Toward Their Studies
– A Survey Study

This paper focusing on a study of nursing students’ motivation toward

their studies. The aim of this paper is to critique a chosen piece of research from

the Bio Medical central published in 2008. This study is very useful for healthcare

worker especially nurses. Nursing is striving for evidence-based practice;

involving finding, Critiquing and applying the evidence within the practice.

According to Parahoo (1997) nurses should be able to understand and critique

research literature relating to their particular area practice and recognize the

important and relevance to practice for the improvement of patient care.

Critiquing research involve a careful examination of all aspects of a study in order

to judge its strengths, limitations meaning and significance.(Hek, 1996). Polite &

Beck (2004) suggested that nurses are encouraged to use evidence in their

profession; this will ensure that appropriate care is given to the patient with cost

effective. This support by Regan (1998), stated providing an excellence and

effective nursing care for patient is the basic of evidence based practice.

Therefore I would like to critically analyze on this research paper, give a

recommendation and apply the finding and suggestion into my practice setting.

The topic of research is Nursing Student Motivation Toward Their Studies

– a survey study. The title clearly and concisely described the content of the

research. The title provides readers what the study is about and the type of study

and it is a survey study. A research articles title needs to attract the reader and

encourage reading of the whole article, but needs to be short enough to exactly

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describe what it is about (Cormack, 1996; Parahoo, 1997). This chosen topic is

relevant to my working place is including whatever influences our choices and

creates direction, intensity and persistence in our behavior and thinking

(Kelly,2003). The title is appropriate because of the importance of motivation

and result. Secondly to analyze nursing students estimation of their degree of

motivation during different semester and motivation can also enhance their

learning.

There are two researcher for this paper, who are Kerstin EL Nilson from

School of life Science, University of Skovde Sweden And Margareta I Warren

Stomberg from Institute of Health and Care Science,The Sahlgrenska academy

at Coteberg , Coteberg Sweeden. Both of the researchers are from the same

country. The background of the researcher who undertook this study has not

been mentioned; however the departments where they are attached to are

clearly stated.

The abstract addressed clearly and concisely summary of the study,

mentioning the aim, method, result and conclusion, thus enticing the readers to

continue to read the full article. According to Hek & Moule (2006) abstract is a

brief summary of piece of research which identifies the stages of the research

process. The good abstract gives a overview of the study is clearly identified

earlier on. They explain how they will access information from the selected

participants in the form of questionnaires which enable the reader to decide if

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– A Survey Study
they wish to read on further to completely understand what they did, and the

reader does not have to search for the core element of the study.

The study appears to be well designed and clearly states its aims. If the

aims are clearly laid out, then the other aspects of its design will follow (Cormack

1996). The study objectives are clearly stated in the abstract and text of the

article that is has been well researched and a literature review has been

undertaken and giving it credibility.

Qualitative approach was used in this study as it done on human attitude

and behaviors’ changes. Qualitative research is usually used when knowledge

about a certain issue or matter is not adequate. Participants are able to express

their feelings and experiences about a certain issue or phenomena in their own

words.

According to Morse & Field (1999). qualitative research helps to make

sense of reality, to describe and explain the social world and to develop

explanatory models and theories. Baldwin and Nail (2000) defined qualitative

research as a method of advertising research – emphasized the quality of

meaning in consumer perceptions and attitudes, for example, in – depth interview

and focus groups.

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Qualitative study is a systematic, subjective approach to describes life

experiences and give the meaning. Disadvantages of qualitative research is that

the researchers acknowledge any subjective feelings they have about a

phenomenon, and critically reflect and acknowledge their own assumptions and

understandings about the phenomena under investigation ( Jackson, Daly &

Chang 2003).

A literature review is an evaluation report of information found in the

literature related to selected area of study. According to Hek & Moule (2006) a

literature review is a written piece of work that examines and summarizes a

particular subject in some detail. Reason for reviewing a literature is to find out

what has been or what research finding has been done for the previous research

studies to overcome the similar problem by following the step in research

process (Dempsey & Dempsey, 1996). These processes involve the strategies,

methodology, data collection, data analysis, discussion and recommendation for

future practice. This also show to readers that the authors are well aware of any

other research undertaken which may be similar, therefore indicating the

relevance of them undertaking their study, as if they were repeating a study that

had already been undertaken it would be a waste of time, resources and effort

(Parohoo,1997).

A literature review in this research paper is cited from total of 24

references, 16 references are primary sources meanwhile 6 are secondary. As

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stated by Mc Burney & White (2004) Primary sources are original materials, they

are from the time period involved and have not been filtered through

interpretation on, meanwhile secondary sources are accounts written after the

fact with the benefit of hindsight. They are evaluations and interpretations of

primary sources. Secondary sources are not evidence, but rather commentary on

and discussion of evidence.

This research also using broad variety of literature sources such as books,

journal, article and statistical analysis and time span from April to May 2006. A

thorough and current literature review is presented in which the researchers

recognize the current state of knowledge and needs for additional research.

The research design is a plan of how the research will proceed. (Hek &

Moule,2006). The design had been used for this study is a survey study. Survey

study is conducted in the light of presumed causes. Researchers will follow their

subject forward in time and look for an effect which is due to the presumed cause.

According to Burn & Grove (2001) survey studies are usually used in two ways

within scientific thought. It is used in a broad sense to mean any descriptive or

correlation study. In this sense, survey is used to describe a technique of data

collection in which questionnaires or personal interviews are used to gather data

about identified population. Data were collected by both of the researchers. One of

the researchers at random attended a voluntary lecture in a nursing program at a

medium – sized university in mid – Sweden to give information about the study after

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– A Survey Study
informed consent from the students who were present and willing to participate in

the study. The complete questionnaires were collected during the same lecture.

The arrangement of information about the study procedures and measures is

generally adequate to understand how the data were collected and measured. Data

collections for this study are by questionnaire. Questionnaire is very popular

research tool and one which is of immense use to researcher (Leininger 1985).

While Morse (1999) said that questions, from those which are highly structured to

those which are totally open, can be devise to answer a huge variety of research

question. Open questions can provide a wealth of rich information, but they are more

time consuming than closed questions to respond to analyzed (Kerlinger & Lee.

2000). The potential benefit of using questionnaire to collect research data relate to

the effective use to the researcher as it can reduced costs, access to a worldwide

sample, as to a large sample at one time and reduced researcher bias. (Hek &

Moule, 2006).

Although the researcher has only provided a small amount of information of

their data collection and fail to provide information relating to what question were

asked, the tools that were used to collect the data were suitable for the study.

Reliability and validity of the data collection method used are important as they

afford credibility to the data collection tool and subsequent research findings. As

suggested by Polit & Beck (2006) a valid and reliable instrument will measure what

is expected to measure and be consistent or dependable in measuring what is

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– A Survey Study
designed to measure. A valid instrument will therefore measure what it is supposed

to measure, and a reliable instrument will always measure what is supposed to

measure ( Robson, 2002).

The participants for this study are Nursing Students from semester one to six,

there are six groups. Off total 597 possible participating students 315 were present

at randomly chosen / visited lectures. All students present were offered to participate

and all of them accepted to participate, accordingly the response rate was 100%.

However, the response rate in relation to the whole student population was thereby

53 % distributed to 18% male students and 82% female students. The questionnaire

was one given to at the 1st, 2nd, 3rd, 4th, 5th and 6th semester. The students mean age

was 27 years the 1st , 2nd and 3rd semester, 29 years 4th semester, 28 years 5th

semester and 32 years the 6th semester. The mean motivation score over all

semesters was 6.3. The motivation score for each semester is shown in fig. 1.

The researcher did a logically good job of adhering to basic ethical principle in

the conduct of their research by obtained informed consent from the participants.

One of the most important ethical rules governing research on human is that

participants must give their informed consent before taking part in a study. Inform

consent means that subjects have adequate information regarding the research, are

capable of comprehending the information and have the power of free choice,

enabling them to consent voluntarily to participate in the research or decline

participation (Polit & Hungler, 1993). As supported by Lahmeyer (2006) informed

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consent is a process that anyone who participates in clinical research study will go

through. The informed consent process informs those considering a clinical research

study of objectives, procedures, anticipated risks and benefits of the study.

In this study no appropriate steps taken by the researcher to preserve the

privacy of the participants. Only written consent given by the participant. No

physical harm, discomfort or psychology distress. The participants not is deceived in

anyway because they were fully aware of the participating in the study. The research

being approved by the Head of the Institute at the University but still not monitored

by any Institutional Review Board or other similar ethics committee.

Based on the research article, the finding for this paper presented in clear

and systematic way. It is reliable, valid and trustworthy. According to Gerrish &

Lacey (2006) reliable is a generic term that reflects a measure’s consistency and

reproducibility meanwhile valid is the extent to which the instrument and procedure

actually determine what they declare to measure. The researcher also presented

through discussion for this study and significant findings were outlined clearly,

identified and discussed in detail. Categories occurred in the data are summarized in

table 1. A category can accordingly be measured as positive value category as well

as a negative valued category. It was reliable, valid and trustworthy because: during

analyzing phase the analysis were separately by the two researcher and there after

compared to avoid influence of the researchers pre-conceptions of the issue in

question, awareness of the risk followed the research process. All data were stored

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in database and processed using the Statistically Package for the Social Sciences

(SPSS version 14.0). The data were sorted into the same categories as in

questionnaires. The statistical calculations included frequency count, mean value,

percentage and standard deviation.

Non parametric Kruskal Wallis Test was used in comparing the graded

motivation between the semesters. Mantel test was applied for the comparison

between sexes and motivation with the background variable. Datas were further

analyzed according to a gender perspective and a motivating score value < 4 and >6

as well as the extreme valuest of a 0 or 10 score. The reliability of this instrument

accurate reflects the true score of the attribute investigated. The open-ended

question in the questionnaire were inductively analyzed in a systematic distillation

through analysis of verbal or written data in order to describe and quantify specific

phenomena in to fewer contents–related categories sharing the same meaning.

Results of the study are presented in table format and there are 1 figure and 3

tables for each different result. The researchers done well in presenting the result of

the study. The presentation was straight forward and succinct and was enhanced by

the inclusion of a good table and figures. The statistical analyses were also

reasonably well done. Figure 1 the researcher focused the motivation score for each

semester. The means score differed significantly between semesters. In table 1

researcher focused on categories emerged from the analyzed data are summarized.

A category can accordingly be measured as positive valued as well as negative.

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Each individual could answer more than one reason for their graded motivation

score. Table 2 researcher have identified low motivation and the explanation /

statements where frequencies of responses scored <4. Meanwhile table 3 described

categories emerged as explanation for high motivation where frequencies of

responses scored > 6.

A limitation of the study also has been mentioned by the researcher. Stated

by Polit & Beck (2006) a reviewer should be somewhat wary if discussion section fail

to point out any limitations. Researchers are the best position to detect and assess

the impact of sampling deficiencies practical constrains, a quality problems and so

on, and it is a professional accountability of alert readers to these difficulties. The

researcher also reported both expected and unexpected findings. The limitation in

this study was; using rating scale might see as a limitation as it just grades the

student’s opinions about their motivation. The limitation of comparing students from

different semesters was self limited by students attaining the same curriculum,

studying at the same university, and no organizational changes were done during

the study period.

The results from this study are shows potential, further investigation is

needed to replicate its positive outcomes before dramatic changes in the

performance of students nurses can be recommended in Malaysia. The aim was to

analyze the nursing students degree of motivation at different semester their

education and identify reasons for the motivated grade. Take note that this study

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has shown, nursing students mostly graded their motivation positively different

throughout their entire education that the students graded their motivation quite

similar during first to third semester. However there was a small difference during

the fourth to sixth semester. Mean value respectively well distributed in figure 1. It’s

agreed by Mc Evan & Goldenberg (1999) it would be expected that the motivation

should be graded more high for the first and the last semester just when just before

entering employment.

This study result highlights the need of understanding the students’ situation

and their need of tutorial support. Nurses who base as many of their clinical decision

as possible on scientifically document information are being professionally

accountable to their client and are helping nursing to achieve its own professional

identity. The fact that the students were the subject of this study might influence their

attitude in a positive direction giving more positive statements in the open-ended

questions. According to Bandura A (1982) implies that students possibility to

perceive their own competencies and ability is a positive impact motivation factor.

This result indicated the importance of providing the students tutorial support in a

broader perspective than just academic achievement, for example by promoting

flexibility in planning personal study programmed (Janhonen & Vanhanan,2000), this

also emphasizes the teachers’ and the university’s responsibility to support the

students during their education especially when their motivation for the studies

lacking as motivation has huge impact on learning outcome. The publication of

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research finding does not ensure that practitioners will use those (Gerrish & Lacey,

2006). Achieving evidence-based practice is complex responsibility.

The reason why it is so difficult to implement research finding has to be

explore when there is strong evidence to support a change in practice. According to

Hek & Moule (2006) practical reason act as barriers to implementation the research

findings include not working in a culture where debate, reflection and critical

awareness are encouraged and not having a culture that embraces change. Certain

requirements are essential for successful implementation of evidence – based

practice. They include a practice setting that promotes the use of knowledge,

systems that support practitioner’s access to the knowledge and practitioners who

are willing to examine their current practice and consider alternative to the practice.

Individual working in practice setting with these components witness that knowledge-

based practice improved client outcomes, imparts a feeling of professionalism and

enriches job satisfaction (Barsteiner, 1996). However, numerous studies have

documented reports of substantial barriers to research utilization. In additional

Barsteiner (1996) the most frequently report barriers are a sense of insufficient

authority to change practice, inadequate administrative support, difficulty in gaining

access to research findings and staff discomfort with critiquing research and

determining its clinical relevance.

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According to the researchers of this paper, the study shows the need to

improved nursing students motivation. There are nursing students mainly grading

their motivation positive and similar distributed throughout the entire education. The

most important motivation factor was intrinsic and goal oriented namely for

becoming a nurse. The nursing students mentioned intrinsic motivation factors as

explanation for their degree of motivation. This result highlights the need of

understanding students’ situation and their need of tutorial support. The

organizations of the program need to be developed in co-operation with the student

to match content courses and the students’ different degree of motivation during

their academic years. In prospective study we will follow the degree of motivation in

a group of students (one class) during the entire three years of study.

In future, we expert nurses to be more motivated , love their job and caring

with their hearts and minds; identify client’ actual and potential health problem; and

develop research – based strategies. There is a strong motivation among nurses to

apply the findings of the research to their practice through evidence – based nursing.

Client- centered outcomes are increasingly becoming the focus of health care in an

era of cost containment. When care is provided based on the current best evidence,

interventions will be more effective and will result in improved clients’ outcomes.

Controversies will always take place but we have to practice in what we believe and

carry it out with a clear conscience. According to Klosser T. (2005) a combination of

good evidence with good experience make a good practice, that is the reason why

the result of this study is important to analyze as well as understand the level of the

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students’ nurses motivation specifically at the location the study has been done by

the researchers.

In my view as a health provider, we are encouraged to read more journals,

online search for evidence - base articles or research on good evidence with validity

and reliability. Health care professionals and nurses must look for solutions, choices

and outcomes for effective patient’s care. According to Polit ,Beck & Hungers

(2001), a professional health care worker have to read widely and think critically ,

practice a theory based on reliability evidence and attend professional conferences

to promote research utilizations. Therefore the Malaysian Nurse Association can

begin an active role to promoting evidence – base practice in nursing practice

through a regularly continuous Professional Development such as Continuous

Medical Education and Continuous Nursing Education. (CME & CNE).

The paradigm shift in health care has more recently focused on evidence

based practice (EBP) as an approach used to guide decisions regarding care.

Sakette et al. (1997, p. 2) defined evidence-based medicine as `.....the

conscientious, explicit and judicious use of current best evidence in making

decisions about the care of the individual patients’. Rycroft-Malone et al. (2004)

asserts that the best evidence integrates knowledge from various sources which

include knowledge from research, clinical experience, patient and client

experience, and local context.

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The need for integrating knowledge from various sources is important

because research evidence must match with patient’s experience and

preference. Doebbeling et al. (2006) ( Higgs J., & Jones M., 2000). Applying

evidence without critical thinking might lead to harm. On the other hand not

applying evidence when it is appropriate might also lead to harm. (Zelm , 2006).

(3985 words)

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