INTRODUCTION:

Professional nurse, a multidisciplinary health care team member plays a vital role in the delivery of health care services. She performs numerous tasks, from providing fundamental healthcare to assisting surgeons with advanced and critical procedures. Hence, they require specific education, knowledge and skills to function effectively in variety of health care delivery settings.¹

The primary aim of nursing education system is to prepare nursing professionals who are competent in delivering the care to meet changing needs of patients and society. The nursing curriculum is focusing on link between theory and clinical practice, and consequently prepares students to develop self directed learning skills, self reliance, the ability to utilize different intellectual, interpersonal and practical skills to make judgments and resolve problems.²

Nursing faculty strive to prepare qualified nurses who think critically in order to elicit and interpret information, integrate multiple sources of data; solve clinical problems, make sound clinical judgment and provide scientific rationale for their decision making process. It is important that the teachers learn to use a variety of teaching methodologies in order to cater for range of learning needs and requirements that are present within most class environments.^{3, 4} Of all innovative instructional methods, problem based learning is one of the most exciting and powerful teaching and learning approach that have appeared in the recent years. PBL has perhaps attracted the most attention from educators in professional fields such as medicine, nursing, engineering and education etc.⁵ It was evident from scientific literatures that Problem Based Learning (PBL) is one of the most appropriate educational approaches which will enable the students to equip themselves with necessary skills and abilities in comprehensive manner to function independently in health care settings. In lieu of above facts, PBL is a widely used teaching and learning method in number of academic settings across the globe, especially in medical and allied health sciences universities. In PBL the learner is playing center role in teaching learning process with the aim of integrating learning with practice.^{6, 7}

The teaching and learning methods are in an ever evolving field requiring regular and timely update that will benefit both learners as well as teachers. Teaching involves a unique challenge of conveying knowledge or information within a confined time period in such a manner that it is retained, remembered and effectively interpreted by a learner. This evolution has resulted in compelling reforms in the field of education, with transformation from subject based teaching to the practice of interactive, problem based and student centered learning.⁸ Thus the present communication was undertaken to assess awareness, attitude and perception on PBL among the nurse educators.

MATERIAL AND METHODS;

It was a non experimental research, where descriptive design with cross sectional survey approach was carried out at 11 Nursing Institutes (school/college), located in and around the Ahmednagar district, Maharashtra. The nurse educators awareness, attitude and perception on PBL was explored, a sample comprising 87 nurse educators was interviewed by using a non probability, purposive sampling technique. The nurse educators who are not interested to participate and availed leave to attend Faculty Development Programme’s (FDP’s/CNE’s) and who possess the Diploma in Nursing Education and Administration qualification (DNEA) were not included in the study.

Expert validated and pre tested structured questionnaire was the main tool used to collect data. It consists of Section A – Socio Demographic profile (05 items), Section B – Dichotomous questionnaire (11 items) for assessment of awareness on PBL, Section C – Rating scale (25 items) to assess attitude and Section D – Rating scale to (15 items) assess the perception. Each items was rated on Likert scale ranging from 1 – 5 (with 1= strongly disagree, 2 = disagree, 3 = neutral/undecided, 4 = agree and 5 = strongly agree respectively). The awareness level was categorized based on obtained scores as ‘Poor, Average and Good’ and attitude and perception were classified as ‘Negative, Neutral and Positive’. The study was approved by IRC/IEC of Pravara Institute of Medical Sciences (Deemed University), Loni (Bk). After seeking permission from concerned authority; an informed consent was obtained to all participants before data collection. Further, the responses were voluntary; and no probing questions were asked.

The data were expressed using descriptive statistics such as mean, standard deviation and mean percent for continuous variables; and frequency, percentage for categorical variables. These were to understand the distribution of subjects on socio demographic and other variables to assess the awareness, attitude and perception on PBL among the nurse educators. The inferential statistics like chi square test was used to find the association between the variables. The probability value P <0.05 was considered statistically significant. The statistical software SPSS version 10 was employed for the analysis.

RESULTS:

Socio Demographic Characteristics:

out of 87 nurse educators surveyed, nearly half (47%) were 26 – 30 years of age, majority (61%) was female, while (53%) of them educated up to bachelor degree and (47%) had post graduate qualification. Majority (69%) of educators were Tutor/Clinical instructors, while (52%) of them had more than 3 years of work experience whereas remaining (48%) had less than 3 years of work experience.

Sources of awareness on PBL:

It was noticed that higher percent (40%) of nurse educators got awareness through nursing curriculum followed by continuing nursing education programmes (23%) and informal discussions with colleague’s (20%) which interprets the significance of method of teaching and learning in nursing curriculum.

Awareness of PBL:

Awareness of nurse educators regarding PBL shows that most (>90%) were well aware that ‘PBL develop skills like problem solving, critical thinking and communication’, it was noticed that the educators knows ‘it’s a good instructional method’, and ‘the expected outcome of PBL is retention of information, self directed and active student leaning’.

Attitude on PBL:

Attitude of the study subjects regarding PBL is shown in Table. 1. In the present study, it was found that the overall attitude mean score was (103.21±11.44) which is 85% of total score indicates nurse educators had positive attitude on PBL. The nurse educators had highest level (86%) of attitude in the aspects of ‘motivation to learning’ and lower level (79%) on ‘enhancing self directed learning’ respectively. The overall perception mean score was (63.04±8.55) which is 84% of total score indicates nurse educators under study had positive perception on PBL.

Table. 1. Mean scores of Attitude and Perception on PBL N=87

SN	Areas	Mean	SD	Mean%
I	Attitude on PBL
1	Motivation to Learning	13.24	1.46	86
2	Enhancement of Problem solving	17.33	2.13	85
3	Enhancement of Critical thinking	21.63	2.77	80
4	Developing communication	17.26	1.91	85
5	Developing effective group collaboration	25.06	3.42	83
6	Enhancing self directed learning	08.64	1.61	79
	Overall	103.21	11.44	85
II	Perception on PBL	63.04	8.55	84

Perceived Barriers for PBL:

It was observed that higher percent (21%) of nurse educators felt the significant barrier of PBL is that ‘most students do not actively participate’ followed by (14%) felt it was ‘time consuming’ and (11%) echoed the ‘lack of guidance from tutor’ was a barriers for PBL. A mere percent (<6%) perceived that ‘lack of adequate learning resources’, ‘negative attitude towards PBL’ and ‘inability of students to cope with PBL’ was a barrier for PBL. Moreover (37%) of them felt the combination of these factors as a barrier for PBL. Table. 2. There was a statistically significant association was found between attitude and perception on PBL with socio demographic characteristic like education (x²=3.97) at p<0.05 level.

Table. 2. Perceived barriers of PBL N=87

SN	Perceived barriers of PBL	No	Percent
1	Most students do not actively participate	18	21
2	Lack of guidance from the tutor	10	11
3	Lack of adequate learning resources	05	06
4	Time consuming	12	14
5	Experience of great workload	02	02
6	Inability of students to cope with PBL	03	03
7	Negative attitude towards PBL	05	06
8	Combination of barriers	32	37

The table. 3. shows that almost all educators (97%) believed the ‘PBL motivates to do self learning’, (90%) of them were with the opinion of ‘PBL enhances effective communication and helps in sharing opinion with others’ and ‘stimulates systematic and critical thinking’ among student community and (87%) with the opinion of ‘PBL helps in using organized ways of assessing and analyzing problem’. However (18%) of participants felt ‘PBL does not help to find out best ways of solving problem’ and ‘does not provides effective feedback’; while a mere percent (10%) of participants disagree that ‘PBL develops effective teamwork’.

Table. 3. Nurse Educators attitude on PBL (Item Wise analysis) N=87

SN	Items	Strongly Agree (5)	Agree (4)	Undecided(3)	Disagree (2)	Strongly Disagree (1)
SN	Items	N (%)	N (%)	N (%)	N (%)	N (%)
I	Motivation to Learning
1	Motivates to work on assignments	32 (37)	43 (49)	4 (5)	8 (9)	-
2	Maximizes learning opportunities for searching the information	43 (49)	38 (44)	4 (5)	1 (1)	1 (1)
3	Motivates to do self learning	52 (60)	32 (37)	3 (3)	-	-
II	Enhancement of Problem solving
4	Helps to think more possibilities for problem solving	43 (49)	33 (38)	3 (3)	7 (8)	1 (1)
5	Helps to find out best ways of solving problem	32 (37)	40 (46)	4 (5)	11 (13)	-
6	Helps to look at concepts and ideas from different angle	32 (37)	37 (43)	10 (11)	8 (9)	-
7	Helps in using structured/organized ways of assessing and analyzing problem	36 (41)	41 (47)	6 (7)	3 (3)	1 (1)
III	Enhancement of Critical thinking
8	PBL analyze situation in different ways	43 (49)	37 (43)	5 (6)	2 (2)	-
9	Helps to think in different ways	42 (48)	36 (41)	6 (7)	3 (3)	-
10	Stimulates critical thinking	46 (53)	32 (37)	6 (7)	2 (2)	1 (1)
11	Helps to think systematically	35 (40)	43 (49)	5 (6)	4 (5)	-
12	Helps to get new perspectives of problem	33 (38)	45 (52)	6 (7)	3 (3)	-
IV	Developing communication
13	Promotes sharing of opinion with others	40 (46)	39 (45)	7 (8)	1 (1)	-
14	Fosters oral and written communication skill	29 (33)	39 (45)	7 (8)	12 (14)	-
15	Encourages to express own opinion in group	37 (43)	41(47)	3 (3)	6 (7)	-
16	Enhances effective communication with others	30 (34)	49 (56)	4 (5)	4 (5)	-
V	Developing effective group collaboration
17	Helps in being more involved with the classmates	27 (31)	47 (54)	8 (9)	3 (3)	2 (2)
18	Helps in collaborating with others effectively	26 (30)	51 (59)	7 (8)	3 (3)	-
19	Develops effective teamwork	29 (33)	41(47)	7 (8)	9 (10)	1 (1)
20	Has effective team interaction	34 (39)	39 (45)	6 (7)	8 (9)	-
21	Contributes to teaching each other	32 (37)	40 (46)	6 (7)	6 (7)	3 (3)
22	Gets effective feedback	29 (33)	32 (37)	11 (13)	13 (15)	2 (2)
VI	Enhancing self directed learning
23	Become much more responsible for self learning	44 (51)	35 (40)	4 (5)	2 (2)	2 (2)
24	More focus on the own learning needs	43 (49)	35 (40)	4 (5)	-	5 (6)

Table. 4. Nurse Educators Perception on PBL (Item Wise analysis) N=87

SN	Items	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree
SN	Items	N (%)	N (%)	N (%)	N (%)	N (%)
1	PBL promotes students critical thinking and reasoning	41(47)	43 (49)	-	2 (2)	1 (1)
2	PBL sessions provided more learning fun	24 (28)	40 (46)	13 (15)	8 (9)	2 (2)
3	PBL sessions fulfills the learning objectives	24 (28)	54 (62)	7 (8)	1 (1)	1 (1)
4	PBL gives better factual knowledge	27 (31)	45 (52)	8 (9)	7 (8)	-
5	PBL helps to work with different social and cultural group people during this activity	43 (49)	33 (38)	8 (9)	2 (2)	1 (1)
6	Working in a group was better than working alone	40 (46)	37 (43)	4 (4)	5 (6)	1 (1)
7	PBL encourages the students on independent learning	28 (32)	40 (46)	9 (10)	7 (8)	3 (3)
8	PBL changes the perception of learning	26 (30)	44 (51)	9 (10)	6 (7)	2 (2)
9	PBL makes the learner reacts positively to criticism	30 (34)	40 (46)	11(13)	6 (7)	-
10	PBL has ability to change the view in light of new information obtained	29 (33)	46 (53)	9 (10)	3 (3)	-
11	PBL makes the concept clear	26 (30)	41 (47)	9 (10)	9 (10)	2 (2)
12	PBL provides feedback and helps to improve attitude	20 (23)	55 (63)	7 (8)	4 (5)	1 (1)
13	PBL considers the cognitive and motivational characteristics	29 (33)	48 (55)	8 (9)	2 (2)	-
14	PBL requires the facilitator should be broad minded and well developed intellectually	44 (51)	37 (43)	5 (6)	1 (1)	-
15	PBL enables students to see things practically	32 (36)	45 (52)	5 (6)	5 (6)	-

The table. 4. shows that most of educators (94%) perceived that ‘PBL requires the facilitator should be broad minded and well developed intellectually’, (90%) felt ‘PBL sessions fulfills the learning objectives’ further (88%) of them echoed that the ‘PBL enables them to see things practically’. Majority (87%) of educators viewed that ‘PBL helps to work with different social and cultural group people during this activity’ and (86%) believes that ‘PBL changes the perception of learning and improves the independent learning’. However, only a less significant percent (10%) of educators felt ‘PBL does not make the concept clear’.

DISCUSSION:

The nursing faculties are obliged to prepare competent nursing professionals who think critically and make sound judgments in the field, for which there is a need for a conducive teaching and learning environment and qualified educators. It was noticed from the study the nurse educators had graduate and post graduate nursing education at equal proportion, and had significant work experience in teaching.

Problem based learning is an innovative and challenging approach in nursing education where it emphasizes application of knowledge and skills to the solution of problems rather than recall of facts. It was evident from study that most of nurse educators were aware about PBL, and their source of awareness on PBL was curriculum, informal discussions with colleagues and continuing nursing education programmes etc. Khumalo MF and Gwele NS also observed the similar results that 95% of respondents had awareness on PBL, and they became aware of PBL from sources like informal discussions with colleagues and attending the workshops or conferences on PBL.⁹

Majority of nurse educators had positive perception and valued the importance of PBL as a teaching and learning method in nursing curriculum. The educators were mostly positive about the effectiveness of PBL such as ‘motivation to learning, enhances the problem solving and critical thinking and improves communication’. These findings were congruent with Khumalo MF and Gwele NS views that PBL enhances the lifelong learning, enhances intellectual and problem solving abilities of learners.⁹

The findings indicate that majority of nurse educators believed that though the PBL is an effective instructional strategy for imparting nursing education, while there was a felling that the students do not actively participates in PBL which is a major obstacle in PBL approach. This finding was consistent with results of another study carried out by Vahidi RG, Azamian A and Valizadeh S that the most important barrier was the lack of knowledge and skills in group work and active interaction by students.¹⁰

Alongside, significant portion of participants felt the lack of training and inadequate learning resources were also the significant barriers for implementation of PBL in nursing. Similarly, Rakhudu AM also found in his study that inadequate learning resources and professional support were the crucial factors for ineffective utilization of PBL in teaching and learning process.¹¹In lieu of this, it is important that the nurse educators are updated with PBL approach, where the training on PBL method is essential to develop skills and to overcome barriers, and implement the method in effective manner.

CONCLUSION:

The results of study highlights that the nurse educators had better understanding, and attitude towards PBL method. It was believed that the learning through PBL is very beneficial for learners to improve the problem solving skills, critical thinking ability, communication skills and team work etc. However the nurse educators need to upgrade the knowledge, skill in appropriate implementation of PBL and initiate corrective measures to compact the barriers in effective implementation. The PBL method is in initial stages in our nursing field and in curriculum, the combination of conventional lecture learning with PBL could be effective way of teaching and learning in nursing sciences.

ACKNOWLEDGEMENT:

The authors express sincere thanks to the Pravara Institute of Medical Sciences (DU), Loni (Bk), the Principal’s of various nursing institutes at Ahmednagar dist, and the nurse educators for their kind cooperation and support.

ETHICAL CLEARANCE:

The study was approved by the Institutional Ethics Committee/Review Committee (Ref No: PMT/PIMS/RC/2013/21) of Pravara Institute of Medical Sciences (Deemed University), Loni (Bk), Ahmednagar, Maharashtra.

SOURCE OF FUNDING:

Nil; it was a self funded study.

CONFLICT OF INTEREST:

No potential conflict of interest relevant to this article was reported.

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Received on 12.01.2015 Modified on 08.02.2015

Asian J. Nur. Edu. and Research 5(2): April-June 2015; Page246-250

DOI: 10.5958/2349-2996.2015.00048.8