A DELPHI STUDY: EXPLORING SAUDI FACULTY
AND STUDENT PERCEPTIONS OF THE FACTORS
PROMOTING NURSING STUDENT
RETENTION AND SUCCESS
A dissertation submitted to the Kent State University College of Nursing in partial fulfillment of the requirements for the degree of Doctor of Philosophy
by
Homood A. Alharbi
August 2015
Dissertation written by
Homood A Alharbi
Diploma in Nursing, Burraidah Health Institute, Saudi Arabia, 1999
B.S.N., The University of Jordan, Jordan, 2004
M.S.N., Griffith University, Australia, 2006
Ph.D., Kent State University, USA, 2015
Approved by ______, Chair, Doctoral Dissertation Committee Barbara L. Drew ______, Member, Doctoral Dissertation Committee Carol A. Sedlak ______, Member, Doctoral Dissertation Committee Carolyn J. Murrock ______, Member, Doctoral Dissertation Committee Martha C. Merrill ______, Member, Doctoral Dissertation Committee Alicia Crowe Accepted by ______, Director, Joint Ph.D. in Nursing Program Mary K. Anthony ______, Dean, College of Nursing Barbara Broome
ii
© Copyright, 2015 by Homood A Alharbi
All Rights Reserved
iii
DEDICATION
I dedicate this work to all those who supported my educational efforts over the years including: my caring parents, my loving wife, my wonderful children, my brothers and sisters, and my deceased brothers.
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ACKNOWLEDGEMENTS
I would like to thank the many people behind this work. I would like to send my sincerest appreciation to my dissertation advisor, Dr. Barbara L. Drew who was a tireless supporter of this research from the beginning, reading draft after draft. Special thanks and acknowledgements to my dissertation committee: Dr. Carol A. Sedlak, Dr. Carolyn J.
Murrock, and Dr. Martha C. Merrill; and my graduate faculty representative, Dr. Alicia
Crowe.
My deepest appreciation to Dr. Ahmad Aboshaiqah, the dean of nursing college at King
Saud University (KSU) for his support during the data collection of my dissertation. I would also like to thank the Curriculum Committee members in the nursing college at
KSU and the students who participated in this study.
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TABLE OF CONTENTS
Page
DEDICATION…………………………………………………………………………....iv
ACKNOWLEDGMENTS…………………………………………...………………...….v
LIST OF CONTENTS …………………………...………………………………………vi
LIST OF TABLES …………………………...………………………………………...viii
CHAPTER I. INTRODUCTION ...... 1 Purpose of the Study...... 4 Background...... 6 Theoretical framework...... 15 Significance of the Study...... 16 Research Questions...... 17
II. REVIEW OF LITERATURE ...... 19 Overview of Undergraduate Student Retention and Success ...... 19 Concepts Related to Student Retention and Success...... 20 Factors Contributing to Student Retention and Success...... 23 Summary...... 41
III. METHODOLOGY ...... 45 Setting and Subjects...... 46 Procedures for Data Collection...... 47 Plans for Data Management and Analysis...... 55 Human Subjects...... 63
IV. RESULTS ...... 65 Analyses...... 65 Results in Phase I...... 65 Results in Phase II...... 89 Summary…………………………………………………………………………..112
V. DISCUSSION ...... 114 Results and Existing Literature…………..………………………………………...115 Limitations of the Study…………….………………………………………..….....148 vi
Conclusions…………….……………………………………………………..…...149 Directions for Future Research…………….……………………………..…...... 151 Implication of the Study…………….………………………………………..……152
REFERENCES ...... 156
APPENDICES A. List of Factors Promote Student Retention and Success...... 177 B. Faculty Recruitment E-mail Text ...... 181 C. Factors Promoting Student Retention and Success Survey/ 1st Delphi Round………………………………………………………………....183 D. Informed Consent to Participate in a Research Study/Students...... 189 E. Factors Promoting Student Retention and Success /Student survey...... 192 F. Demographic Data Form: Faculty Survey ...... 200 G. Demographic Data Form: Student survey ...... 202
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LIST OF TABLES
Table Page
1. Demographics Characteristics of Experts’ Panelists...... 66
2. Results from Round One for the Importance of Factors Promoting Retention and Success………………………………………………………..68
3. Results from Round Two for the Importance of Factors Promoting Retention and Success………………………………………………………..73
4. Results from Round Three for the Importance of Factors Promoting Retention and Success...... 78
5. Consensus about Factors Importance was Achieved in these Factors…….……………………………………………………………………..…83
6. Frequencies Statistics for Students’ Employment Status………………………….….90
7. Student Perceptions about the Important Of Factors Promote Retention and Success..…………………………………………………….…..91
8. Responses for the First Open-Ended Question……………………………………….97
9. Responses for the Second Open-Ended Question……………………….……….....101
10. Comparing Faculty Perceptions with Students Perceptions……………………...... 108
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Alharbi, Homood, Ph.D. August, 2015 NURSIN
A DELPHI STUDY: EXPLORING SAUDI FACULTY AND STUDENT PERCEPTIONS OF THE FACTORS PROMOTING NURSING STUDENT RETENTION AND SUCCESS
Director of Dissertation: Barbara L. Drew
Student retention and success are major concerns for nurse educators and society, particularly given the need to address the global nursing shortage. Many studies have identified factors that promote student retention and success. However, it is unknown if these factors are culturally relevant to nursing education in Saudi Arabia. The purpose of this study was to determine Saudi faculty and student perceptions of the factors that promote nursing student retention and success in Saudi Arabia. This study had two phases. The first phase used a Delphi technique to examine the perceptions of an expert panel of Saudi faculty. The panel was asked to rate factors, identified by their own responses to an open-ended question and by an extensive review of the literature, in terms of their importance to student retention and success. This phase produced a list of 67 factors. The second phase examined students’ perceptions using the factors identified by consensus of the expert panel. The results indicated that seven of the 67 factors were not considered important by the students. Furthermore, students added 25 factors they believed to be important. While faculty members focused on the importance of academic factors in a manner that is similar to their Western counterparts, students attended to the impact of the culture on retention and success.
CHAPTER ONE
INTRODUCTION
Introduction and Statement of the Problem
Today’s global nursing shortage is having an adverse impact on health systems around the world (Oulton, 2006). Many factors have exacerbated this problem, including student recruitment and retention (Oulton, 2006). In Saudi Arabia, national culture has negatively impacted nursing student recruitment. The perception of nursing in the Saudi society is that it attracts poor, under-educated foreign women (Mebrouk, 2008; Miller-
Rosser, Chapman & Francis, 2009). Many women associate nursing with long working hours, working with males (a culturally challenging prospect), and the worry that they might not be able to get married since they would not have time for their family obligations (Al-Omar, 2004). El-Gilany and Al-Wehady (2001) found that 98% of Saudi female nurses preferred not to care for male patients, which suggests that there is a cultural obstacle to the nursing profession in this country. Moreover, many male secondary and university students in Saudi Arabia “perceived the role of the nurse as an extension of the physician with little or no role in disease detection and prevention”
(Jackson & Gary, 1991, p. 1). Jackson and Gary also found that 69% of male students indicated that they would not marry a nurse. The dominance of such negative images of the profession in Saudi Arabian culture for decades has created many challenges for recruiting Saudi nursing students (Hasan & Gupta, 2013). Thus, the country’s nursing
1 2 profession has relied primarily on migrants from North America, the United Kingdom,
Australia, South Africa, Malaysia, and from other Middle Eastern countries (Hasan &
Gupta, 2013).
Little attention was given to recruiting Saudi nurses until the 1990 Gulf War, when a sudden mass departure of migrant nurses and other workers almost paralyzed the
Saudi healthcare system (Al Hosis, Plummer, & O’Connor, 2012). Consequently, the government started to implement a “Saudization Policy” (Al Hosis et al., 2012). The objective of this policy was to issue a national call to encourage Saudi nationals to occupy vacancies and to fill key positions when expatriates left the country (Al Hosis et al., 2012; Miller-Rosser et al., 2009). In addition, several organizations, including Saudi universities, have provided international scholarship programs for Saudis to study nursing overseas (Almalki, FitzGerald, & Clark, 2011). As a result, many Saudi nurses travelled overseas to earn master’s and doctoral degrees in order to qualify them to take over positions held by foreign nurses (Miller-Rosser, Chapman, & Francis, 2006).
Despite these efforts, a shortage of Saudi nurses still exists. When Al Hosis et al.
(2012) examined the number of Saudi nurse managers in seven hospitals in the Kingdom; they found that 95.55% were non-Saudi. In addition, the number of Saudi nurses employed by the Ministry of Health (MOH) is 45% of the total workforce; just 17% of nurses in the military hospitals are Saudi; while in private hospitals, only 4% of the nursing staff are Saudi (Abu-Zinadah, 2011; Ministry of Health, 2011).
The second contributory factor to the shortage of Saudi nurses is student retention. Two of the big universities in the Kingdom, King Saud University and
Dammam University, accepted a total of 1251 students of both genders in 2007 (Ministry
3 of Health, 2007). King Saud University accepted 885 students and Dammam University accepted 366 students. Considering the fact that undergraduate nursing students need five years to graduate (four academic years and a fifth internship year), these students were expected to graduate in 2011. However, in 2011, King Saud University graduated
210 students and Dammam University just 80, which makes a total of 299 graduates of both genders (Ministry of Health, 2011). This indicates poor retention of nursing students. Jeffreys (2004) classified the reasons for leaving nursing education as either academic failure or personal reasons such as a student’s attitudes, values, and beliefs about learning. This means that academic success enhances student retention. Both student retention and student success are concepts of interest to this study.
Student retention and success are major concerns for the government, nurse educators, nursing schools, and society in their efforts to address the nursing shortage
(Jeffreys, 2004). The significant shortage of Saudi nurses requires nursing educators to design strategies for facilitating student retention and success based on empirical evidence (Jeffreys, 2004). According to Astin’s (1999) Student Involvement Theory, involvement of students in the learning process enhances college retention/persistence rate, academic success, and personal development.
The National Survey of Student Engagement is an annual survey launched in
2000 in the United States to assess the extent to which students are involved in educational practices and to predict Student College retention (NSSE, 2014). However, this survey cannot be used to study student retention in the nursing setting in Saudi
Arabia due to the cultural differences (Alamri, 2011; Hamdan, 2014; Razek & Coyner,
2011), the different education policy (Aljughaiman & Grigorenko, 2013; Alzamil, 2014;
4
Rugh, 2002), and the fact that it is not a nursing-specific instrument. The relationship between culture and nursing student retention was explained by Jeffreys (2004) as follows: “a student’s cultural values and beliefs unconsciously and consciously guide thinking, decisions, and actions that ultimately affect nursing student retention” (p.167).
There is no empirical study of the strategies that promote student retention and success in the Saudi setting. This study has, therefore, examined the factors that promote student retention and success in a nursing program in Saudi Arabia. Using the Delphi technique, a list of factors was identified that promote student retention and success from the Saudi faculty perspectives. Saudi students then gave their perspectives, and added other factors to the list that they believed to be important to student retention and success. The final outcome of the study was a list of items promoting student retention and success that were culturally relevant to nursing in Saudi Arabia.
Purpose of the Study
The purpose of this study was to determine Saudi faculty and student perceptions of the factors promoting student retention and success that are culturally relevant to the nursing setting in Saudi Arabia. The study was conducted in two phases. Phase I examined the Saudi faculty perceptions about factors promoting student retention and success using a Delphi technique. The final product of the Delphi method was a list of factors promoting student retention and success in the nursing setting in Saudi Arabia.
Phase II examined the students’ perceptions of the importance in promoting student retention and success of the factors developed during Phase I. Third and fourth year nursing students of both genders from the nursing college, King Saud University were recruited for this phase. Students responded to the Delphi-developed questionnaire that
5 was designed as a Likert-scale with a five-point response choice, on which 1 = strongly unimportant, 2= unimportant, 3= neutral, 4= important, and 5= strongly important. This was intended to indicate whether there was any inconsistency between student perception and faculty perception. The study’s findings could be used as a framework to address items promoting student retention and success in the nursing setting in Saudi Arabia.
The Curriculum Committee of the nursing college of King Saud University was recruited as expert panelists to give their perceptions of the factors promoting student retention and success. The panel included six of the ten members of the faculty who were recruited as “curriculum experts”, and who represented the four different departments in the college (Medical Surgical, Maternity, Psychiatric, Management and
Leadership). Both genders were represented.
There were three rounds of the Delphi. For the first Delphi round, panelists responded to two open-ended questions about factors promoting student retention and success in the first section of the questionnaire. Then, panelists responded to a prepared list of factors that were identified by a systematic review of the literature, to be supportive of students’ retention and success. The experts rated the importance of each factor on a Likert-scale with a five-point response choice, on which 1 = strongly unimportant, 2= unimportant, 3= neutral, 4= important, and 5= strongly important. Data from the first round were analyzed and summarized and presented to the panelists in the second round to review. The statistical feedback included the group mean rating of each item, the minimum and maximum ratings, the standard deviations, and the frequencies of ratings for each item by the panel members.
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Then, data from the second round were analyzed and summarized following the same procedure as in the first round, and presented to the panelists in the third round to review. In addition, panelists were asked to add factors that they believed to be important but which were not included in the list of factors. In the third round, data from the second round were analyzed for consensus among panelists about the importance of the factors in promoting student retention and success. The six panelists reach a consensus about the importance of 67 factors.
In the second phase of the study, 76 undergraduate nursing students were recruited to give their perceptions about factors promoting student retention and success.
In the first part of the survey, students responded to two open-ended questions about factors promoting student retention and success. Then, students responded to a prepared list of factors developed by consensus of the faculty members in the Delphi procedure.
Students were asked to rate the importance of each factor on a Likert-scale with a five- point response choice, on which 1 = strongly unimportant, 2= unimportant, 3= neutral, 4= important, and 5= strongly important.
Background
In this section I will discuss the history, learning culture, higher education policy, and nursing education of Saudi Arabia in order to address the cultural and political setting of the study. However, there is a dearth of current articles and texts on the nursing profession in Saudi Arabia. As a consequence, the author failed to meet the recommendation of having citations less than five years old in the literature review.
History of Saudi Arabia
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Founded by Abdul-Aziz bin Saud in 1932 (Telmesani, Zaini, & Ghazi, 2011), the
Kingdom of Saudi Arabia is geographically the largest Arab country in Western Asia, and one of the largest in the Middle East (Aldossary, While, & Barriball, 2008). It is also a nation with one of the biggest oil reserves in the world (Alamri, 2011). The production of oil has given rise to one of the most rapid socioeconomic growths in recent years, with a significant impact on health and lifestyle (Khatib, 2011). As a result of advancements in both healthcare and social services, as well as compulsory vaccination, life expectancy increased from 52 years in 1970 to 72 years in 2005 (Aldossary et al., 2008).
Learning culture in Saudi Arabia
Culture is a way of life of a particular group of individuals that includes attitudes, behaviors, beliefs, customs, habits, ideas, language, practices, rituals, and values (Heyn,
2013). In this section, I will discuss the culture of urban Saudi Arabia and will cover the religion of the country, family structure, politics, and education.
Religion. In Saudi Arabia, “Islam is not just a religious ideology; rather, it is a social system embracing detailed prescriptions regarding every aspect of people’s life”
(Gazzaz, 2009, p.11). It is almost impossible to overemphasize the impact of the religion on the overall culture of Saudi Arabia (Heyn, 2013). Saudi culture is collectivistic, and it is hard to understand without an adequate grasp of Islam (Heyn, 2013). All Saudi people are Arab Muslims (Pharaon, 2004). The language of Saudi Arabia is Arabic, which is the language of the Quran, the book containing the scriptures of Islam (Heyn, 2013).
Family. The extended family is the most important social institution in Saudi
Arabia (Long & Maisel, 2010). In Saudi culture, there is great emphasis on the needs, attitudes, and objectives of the family, as opposed to individualistic societies where
8 personal goals are often more important than family goals (Long & Maisel, 2010). In
Saudi culture, grandparents are highly respected and play a major role in decision-making on family issues (Ali, Saba, Liu, & Humedian, 2004). In addition, the family is the main source of financial and emotional support (Ali et al., 2004), not only in childhood but continuing into adulthood. When in need of help or advice, Saudis seek support from their family and/or very close friends (Ali et al., 2004).
Politics. The Kingdom’s national constitution is the Holy Quran (the words of
God as revealed to Prophet Muhammad) and Sharia (Islamic laws) which both serve as the law of the land (Gazzaz, 2009). In addition, the Sunnah is a model of life presented by Prophet Muhammad. Both the Quran and the Sunnah provide the foundation for
Sharia. The King and the royal family are the controlling political power in the country
(Gazzaz, 2009). Saudi people do not vote, and political parties or national elections are not permitted (Long & Maisel, 2010). The King, with assistance from religious scholars, will consult the Quran and Sharia in order to make legal decisions (Heyn, 2013).
Education. The education system in Saudi Arabia is influenced by the principles of Islam, and students are taught about Islam in their classrooms from an early age
(Heyn, 2013). School curricula in Saudi Arabia are based on only one school of Islamic thought, the Hanbali, which is named after Ahmed Bin Hanbal (Hamdan, 2014). Bin
Hanbal was a Muslim scholar and a great Imam who helped to provide only one of the main interpretations of the main texts, the Holy Quran and the Prophet’s (Peace Be upon
Him) narrations (Hamdan, 2014). This approach of embracing only one school of
Islamic thought educates students to think rigidly, to exclude diversity, and narrow the essence of the Islamic faith, especially given the evidence of diversity in the Quranic
9 texts and in the Prophet’s (Peace Be Upon Him) narrations (Hamdan, 2014). However, if students were exposed to a range of Islamic perspectives, such as the Hanafi or Maliki, according to Hamdan (2014), it would enhance their understanding of Islam and expand their critical-thinking skills.
As a result of following one school of Islamic thought only, according to Hamdan
(2014), Saudi “students continue to learn from a very young age that knowledge and
‘truth’ are fixed, that all claims to truth are either black or white, and that what is taught in school or university is therefore unquestionable” (p.312). Consequently, neither students nor teachers are encouraged to be critical thinkers (Hamdan, 2014). In addition, in the Saudi education system, males and females are separated in classes and are taught by instructors of the same gender (Heyn, 2013). In Saudi classrooms, teachers are highly respected, and students must raise their hands to ask or answer questions (Heyn, 2013).
Thus, undergraduate Saudi students found “the loose discussion-style” of United States classrooms shocking (Heyn, 2013). Another barrier to effective educational practices is the bureaucracy in higher education in Saudi Arabia (Alamri, 2011). As discussed earlier, the Ministry of Higher Education controls the whole learning process (required subjects, required numbers of contact hours per subject, required learning outcomes, and required texts) which limits academic freedom in the country (Hamdan, 2014). Effective educational practices as defined by Chickering and Gamson (1987) include the following actions by the professor: he or she “(1) encourages contact between students and faculty,
(2) develops reciprocity and cooperation among students, (3) encourages active learning,
(4) gives prompt feedback, (5) emphasizes time on task, (6) communicates high expectations, and (7) respects diverse talents and ways of learning” (p. 2)
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Despite the “continuing dominance of rote memorization and passive learning in the Saudi education system, there are also many reasons for optimism” (Hamdan, 2014, p. 312). One such development is the establishment of the King Abdulaziz and His
Companions Foundation for the Gifted (Mawhiba), a new independent center that aims to promote talent and innovation through curriculum reform (Hamdan, 2014). This reform involves both the Ministry of Education for grades K-12 and the Ministry of Higher
Education (universities and colleges). Among its innovative measures is the facilitation of online-learning, which is encouraging teachers and students to look beyond the traditional teaching approach (Hamdan, 2014). Nonetheless, changes in Saudi culture always come slowly; thus, the major characteristics of the education system are likely to endure for some time for cultural and political reasons (Hamdan, 2014).
The healthcare system
The Saudi government has dedicated enormous resources to improving healthcare, aiming to provide a free and accessible service for all its citizens (Aldossary et al., 2008; Jadelhack, 2012). The total expenditure on health in Saudi Arabia is 6.9 percent of the gross domestic product (MOH, 2011). The health system is controlled and regulated by the Ministry of Health (MOH) through the Saudi Council of Health
Specialties (SCHS). The MOH aims to provide preventive, curative and rehabilitative services (Aldossary et al., 2008; Jadelhack, 2012; Khatib, 2011). In addition to the
Ministry of Health, other governmental agencies provide healthcare services, including the Ministry of Interior, the Ministry of Defense and Aviation, the Saudi Arabian
National Guard, and the Hospital Universities (Hasan & Gupta, 2013).
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Higher education in Saudi Arabia
Education for All. The Ministry of Higher Education (MOHE) was established in 1975 to implement the Kingdom's higher education policy (Hamdan, 2014; Rugh,
2002). The Higher Education Council makes proposals relative to the overall policy of higher education and supervises the application of state policy in scientific research
(Smith & Abouammoh, 2013). The Prime Minister is the president of the Council
(SACM, 2013). The Saudi higher educational policy aims to ensure that education programs meet the religious, economic, and social needs of the country and eliminate illiteracy among Saudi adults (SACM, 2013). Thus, the government of the Kingdom of
Saudi Arabia emphasizes the global goal “Education for All,” and has dedicated substantial financial resources to it for all Saudi citizens (Rugh, 2002). The rapid increase in oil production in Saudi Arabia in the period 1975–2007 resulted in a significant increase in education spending (Khatib, 2011). Since education is highly subsidized, all Saudi students at all levels pay no tuition fees, and university students receive monthly stipends (Rugh, 2002). In addition, students who are studying at private colleges are subsidized half of their tuition fees (Elyas & Picard, 2013). Moreover, free on-campus accommodation is provided to students who come from remote areas (Elyas
& Picard, 2013). The education system in the country operates under strict gender segregation from the first grade all the way through higher education (Elyas & Picard,
2013).
However, due to the limited number of Saudi faculty members, the post- secondary system is heavily dependent on non-Saudi teachers (Rugh, 2002). To address the shortage of Saudi faculty members, the Kingdom has invested heavily in the creation
12 of a wide educational infrastructure (Alamri, 2011; Onsman, 2011), expanding from just
10 government universities in 1975 to more than 24 in 2011. There were also 18 primary school teachers’ colleges for men, 80 primary school teachers’ colleges for women, 37 colleges and institutes for health, 12 technical colleges, and 26 private universities and colleges in 2011 (Alamri, 2011; Onsman, 2011).
Scholarship Program. In 2005, the MOHE established the King Abdullah
Scholarship Program (Alamri, 2011). The program aims to decrease the shortage of
Saudi faculty members, and to prepare skilled workers needed for workplace (Alamri,
2011). There are now about 70,000 Saudi students sponsored by this program studying different disciplines at baccalaureate, master’s, and doctoral level in many countries around the world (Alamri, 2011). Most of these students are in the United States of
America, the United Kingdom, Australia, and Canada (Alamri, 2011). Furthermore, students who cannot afford private university fees, are sponsored by the King Abdullah
Scholarship Program (Alamri, 2011).
Centralized Education System. Because of the current shortage of Saudi faculty members and the high number of non-Saudi professors, education in the country is centralized by the government to help standardize procedures and practices (Hamdan,
2014). Thus, committees in the ministries of education and higher education decide the proper content of textbooks and basic courses (Rugh, 2002). Hence, education in the country is heavily dependent on one or a few textbooks; and course content is usually delivered through a lecturing approach that stresses rote memorization (Hamdan, 2014).
Another significant barrier to effective learning is the lack of research funds (Alamri,
13
2011). Hence, scientific conferences and scientific journals are limited or absent in most departments (Alamri, 2011).
Accreditation and Assessment. To improve higher education in the country, the
MOHE established the National Commission for Academic Accreditation and
Assessment (NCAAA) in 2004, which is responsible for the quality assurance and accreditation standards for public and private higher education institutions (NCAAA,
2010). NCAAA aims to ensure: (1) the quality of student learning outcomes, (2) the management and support services provided within institutions, and (3) the contributions to research and the communities served by post secondary institutions, are equivalent to high international standards (NCAAA, 2010).
A mixed-methods study (self-administered questionnaires and focus-group discussion) study was done to examine the impact of implementing NCAAA standards on the quality of medical education in Qassim University (Al Mohaimeed, Midhet,
Barrimah, & Saleh, 2012). Data were collected after two years of implementing NCAAA standards and compared to the quality of medical education prior to accreditation.
Results suggested significant improvements in the quality of medical education in the
College. There was significant improvement on the National Saudi Selection Exam
(SLE), which is organized by Saudi Commission for Health Specialties.
Nursing Education in Saudi Arabia
The Ministry of Health (MOH) in collaboration with World Health Organization
(WHO) established the first Health Institute Program in 1958 in Riyadh, Saudi Arabia
(Tumulty, 2001). Fifteen Saudi males who had elementary school preparation were recruited to a one-year program that prepared them to work as nurses’ aides. Another
14 two Health Institute Programs were subsequently opened in Riyadh and in Jeddah
(Tumulty, 2001). Both men and women who graduated from these Health Institutes were recruited as nurses’ aides (Miller-Rosser et al., 2006). In Saudi Arabia, however, males and females do not attend the same schools. In 1975, there were 27 health institutes for both genders; by 1980 the number had increased to 32 (Miller-Rosser et al., 2006). In
1976, the MOH extended the one-year program to three years and opened more institutes, which recruited students with secondary school preparation (Miller-Rosser et al., 2006).
Thus, the College of Nursing at King Saud University established a Bachelor of Science in Nursing (BSN) in 1976 and a Master of Science in Nursing in 1987 (Tumulty, 2001).
However, these programs are limited to female students. By 1980, nurse education in
Saudi Arabia was composed of two levels, technical nursing (from the health institutes) and professional nursing (from the university). The technical nurses studied for three years and obtained a Diploma in Nursing (DN). A Saudi technical nurse is the equivalent of a Licensed Practical Nurse (LPN) in the United States (Miller-Rosser et al., 2006).
In the 1990s, after the enactment of the Saudization policy, the total numbers of health institutes in the country were 33, 17 health institutes for females and 16 for males
(Miller-Rosser et al., 2006). In 1992, junior colleges were initiated to train high-school graduates to the level of a diploma in nursing (Abu-Zinadah & Banjar, 2006). In 2001, the College of Nursing and Allied Health Sciences at King Abdul-Aziz Medical City,
Riyadh, established a Bachelor of Science in Nursing (BSN) program for females only.
The BSN program was provided in two streams. Stream I was for traditional female students who wanted to pursue a career in nursing, whereas the Stream II program was established for those females who previously held a Bachelor of Science Degree and
15 wanted to have a second-degree in nursing. The first 12 BSN-prepared female nurses graduated from the College of Nursing and Allied Health Sciences, Riyadh in 2004
(Miller-Rosser et al., 2006). Furthermore, in 2004 King Saud University started a BSN program for men.
Despite the evidence that student retention is a significant factor in the nursing setting in Saudi Arabia, no study had examined the factors that contribute to the dropout rate. This study was the first to examine the factors that contribute to nursing student retention and success in Saudi Arabia.
Theoretical framework
The theory described served as a beginning framework for factors that were believed to contribute to student retention and success. However, there are some limitations to committing to a theoretical framework to guide a Delphi study. Thus, I used this theory as a framework for collecting data, but this did not mean that I was committed to remaining exclusively with this theory.
Astin’s Student Involvement Theory
Student involvement theory focuses on behaviors that influence or describe student engagement. Student involvement refers to “the amount of physical and psychological energy that the student devotes to the academic experience” (Astin, 1999, p. 518). This theory focuses primarily on the behaviors in which a student engages while participating in campus organizations, interacting with faculty and peers, attending campus events, and time spent studying. Uninvolved students, in contrast, spend limited time with other students, seldom interact with faculty, are not involved in extracurricular
16 activities, and spend insignificant time on campus. Astin (1999) outlines five postulates for the involvement theory: “involvement is investment of physical and psychological energy in various objects; it occurs along a continuum; it has both quantitative and qualitative features; the amount of student learning and personal development is directly proportional to student involvement; and effectiveness of educational policy and practice is directly related to its capacity to increase student involvement.” (Astin, 1999, p. 519).
Astin’s Student Involvement Theory is based on a longitudinal study of college dropouts (Astin, 1975, 1999), which explored factors in the college environment that affect students’ persistence in college. Factors that contribute to students’ retention in the college suggested student involvement, whereas those that contribute to student dropout suggested a lack of involvement. Astin discussed some of the environmental factors that contribute to student retention. These include: place of residence, honors programs, undergraduate research participation, social fraternities and sororities, academic involvement, student-faculty interaction, athletic involvement, and involvement in student government. Even though the theory could be culture-bound, it was a useful starting-point to identify the factors that may contribute to student retention and success in the nursing setting in Saudi Arabia.
Significance of the Study
This study examined the faculty and student perceptions of what promotes student retention and success in BSN nursing programs for both men and women. I focused on only the items that were within the institution’s control such as academic issues, campus resident, and financial support. Those factors that were out of the institution’s control such as family educational background were less emphasized.
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From the perceptions of faculty and student, the researcher inferred some of the best practices influencing student retention and success in the nursing setting in Saudi
Arabia. Retention and success of nursing students will contribute substantially to the alleviation of the nursing shortage. This study is significant because it has the potential to help Saudi faculty and administrators in programs of nursing to identify the best strategies to enhance student retention and success within the context of Saudi Arabia.
By understanding other professors’ and students’ perceptions of the instructional practices that influence student retention and success in nursing programs, faculty can use this information to help improve their courses. After an extensive literature search, it appeared that this was the first study that examined the factors promoting student retention and success in nursing education in Saudi Arabia, as defined by nursing professors and by both genders of nursing students.
This study will serve as the foundation for continued research that aims to address student retention and success in the nursing setting in Saudi Arabia. Future research could examine how the items identified by the Delphi process predict student retention and success in a nursing setting in Saudi Arabia.
Research Questions
This study addressed the following research questions:
What are the factors influencing nursing student retention and success as
perceived by a panel of expert nursing faculty in Saudi Arabia?
What are the factors influencing nursing student retention and success as
perceived by undergraduate nursing students in Saudi Arabia?
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What are the differences and/or similarities between the perspectives of a
panel of expert nursing faculty and the undergraduate nursing students in
regard to the factors influencing nursing student retention and success?
Definition of Terms
Student retention: in this study, student retention was defined as the continuous enrollment in the nursing program until the completion of the degree (Jefferys, 2007).
Student success: in this study, student success was defined as the completion of the BSN program graduation requirements and passing the nursing license exam (Jefferys, 2007).
CHAPTER TWO
REVIEW OF THE LITERATURE
The purpose of this chapter is to provide an overview of the factors promoting undergraduate student retention and success. In this chapter, I focused on the items within the control of the institution, such as campus residency; influences that were out of the institution’s control, such as family and educational background, were not discussed.
In addition, I did not address items that were less relevant to the nursing setting in Saudi
Arabia, such as ethnicity and race. Most of the research studies examined in this chapter had been conducted in Western countries; however, I specifically identified studies that had been done in Saudi Arabia. In addition, most of the research studies undertaken in
Saudi Arabia refer to medical, rather than nursing education.
Overview of Undergraduate Student Retention and Success
Student retention is a concern for nurse educators. It is a dynamic and multidimensional phenomenon that is influenced by a combination of multiple factors
(Jeffreys, 2004). For the purposes of this study, student retention was defined as continuous enrollment in the nursing program until the completion of the degree
(Jeffreys, 2004). Student success was defined as the completion of the BSN program graduation requirements and passing the nursing license exam (Jeffreys, 2004). Thus, student retention and success were related concepts that addressed how students gain a
BSN degree.
19 20
Approaches that address students’ retention matter, and they matter most during the critical first year of college (Tinto, 2007). Student retention has become big business in higher education (Tinto, 2007). There are now a number of conferences, edited volumes, and journals dedicated to the subject. There are also surveys that predict student success such as the National Survey of Student Engagement (NSSE)
Questionnaire (Kuh, 2001), and the Community College Survey of Student Engagement
(Tinto, 2007).
Concepts Related to Student Retention and Success
Concepts such as student involvement, social and academic integration, and engagement are usually mentioned in the literature when student retention and success are discussed. These concepts are based on longitudinal studies that examined the factors that predict student retention (student involvement), on a model that discussed the processes of interaction between the student and the institution that lead to student retention in higher education (social and academic integration), or on research findings that studied the best educational practices that contribute to undergraduate student success (student engagement).
Student involvement
Astin’s student involvement theory is based on a longitudinal study of college dropouts (Astin, 1975, 1999), which explored factors in the college environment that affected students’ retention. Factors that contribute to students’ retention in college suggested that student involvement in the learning process is critical, whereas variables correlated with student dropout suggested a lack of involvement. Student involvement
21 refers to “the amount of physical and psychological energy that the student devotes to the academic experience” (Astin, 1999, p. 518). This theory focuses primarily on the behaviors in which a student engages while participating in campus organizations, interacting with faculty and peers, attending campus events, and spending significant time studying. Uninvolved students, in contrast, spend limited time with other students, seldom interact with faculty, are not involved in extracurricular activities, and spend an insignificant amount of time on campus. Astin (1999) outlined five postulates for the involvement theory: “involvement is the investment of physical and psychological energy in various objects; it occurs along a continuum; it has both quantitative and qualitative features; the amount of student learning and personal development is directly proportional to student involvement; and the effectiveness of educational policy and practice is directly related to its capacity to increase student involvement” (Astin, 1999, p. 519).
Social and academic integration
The educational sociologist, Vincent Tinto, introduced a theoretical model called
“social and academic integration” that explains the processes of interaction between the individual and the institution that leads to student retention in higher education (Tinto,
1975). This model is also called “Tinto’s institutionally oriented model” or “social and academic integration”. Tinto distinguished between academic dismissal (involuntary dropout) and voluntary withdrawal. Tinto claimed that academic dismissal is associated with grade performance, whereas voluntary dropout is related to a lack of congruency between the individual and the intellectual climate of the institution. According to Tinto, students depart when they find themselves unable to adhere to the structural rules and
22 requirements of the institution. This model focuses on first year college experience, especially the nature of student-faculty interaction outside the classroom, which contributes to student college retention (Tinto, 2007).
Engagement
Kuh, Kinzie, Schuh, and Whitt (2005) introduced the concept of “student engagement”, which addresses the educational practices that contribute to undergraduate student success. This model is based on the findings of a project called Documenting
Effective Educational Practice (DEEP), in which the researcher asked “strong-performing institutions” to report what they did to promote student success. Strong-performing institutions were selected on the basis of two criteria: higher scores than predicted on the
National Survey of Student Engagement (NSSE) and the higher than predicted graduation rates. A total of 20 institutions participated in this project. The research teams visited the participating institutions on two occasions. Prior, during, and after the visits, research teams studied hundreds of online or written documents, such as institutions’ policies, organizational charts, accreditation reports, and campus publications. Also, the team attended many institutional events, such as faculty senate meetings, lectures, campus forms, and students’ government meetings. In addition, the research team interviewed faculty members, students, staff, and others about the areas that contributed to student success. After the first meeting, the research team prepared a report about what it learned from the institution in regard to best practices that contributed to the students’ success with a request for feedback. Then, a research team of two or three members, with at least one of whom having visited the campus in the first visit and at least one who did not.
Following the two visits, the research team studied the two visit reports and analyzed the
23 data by theme. Findings suggested that student engagement has two key components that contribute to student success (Kuh et al., 2005). First, student success is more likely to occur as students increase the time and effort they put into their studies and other activities (Kuh et al., 2005). Second, student success is more likely to occur when the academic institution allocates resources and organizes learning opportunities and services to encourage students to participate in and benefit from such activities (Kuh et al., 2005).
Thus, this project suggested that students’ success is a combination of institutional support and the student’s effort to succeed.
Factors Contributing to Student Retention and Success
Jeffreys (2004) proposed a conceptual model called Nursing Undergraduate
Retention and Success (NURS). This model is based on previous research findings, and proposes multiple factors that may either increase or decrease the likelihood of student success and retention in nursing college. These factors include: student profile characteristics, student affective, academic, environmental, social and academic integration, and outside surroundings (Jeffreys, 2004). I used this model as a structure to organize this chapter.
Student profile characteristics
The factors that influence retention include a student’s characteristics prior to beginning a nursing course. These include age, gender, first language, prior educational experience, family background, and enrollment status (Jeffreys, 2004). Since the sample of this study included only Saudi nursing students, ethnicity and race were less applicable to the population of interest. Similarly, BSN students in Saudi Arabia are required to study full time, so enrollment status is less relevant to this project. In addition, prior
24 educational experience and family background were out of an institution’s control, so I did not discuss these variables in this review. However, I reviewed studies that discuss the relationship between age, high school GPA, ACT or SAT tests, gender, first language, and student retention and success.
As adolescent learners, young student nurses (under 21 years of age) are more prone to encounter challenges in identity development, transition to university life, coping strategies and support (Shepherd, 2008). Thus, educators need to consider the differing needs of students across the age range, especially those going through the transition into adulthood. Younger nursing students reported that support during their first year in nursing college helped them to overcome the challenges of the transition period more often than older students (Wright & Wray, 2012). Students highlighted support from their peers and senior students as important. Furthermore, Cowin and
Johnson (2011) reported that students with more life experience (older students) are more likely to be retained and succeed in nursing college. Similar findings were reported by
Wray, Barrett, Aspland, and Gardiner (2012). Thus, student age could be a predictor for success and retention in nursing colleges in Saudi Arabia.
In a private U.S. Midwestern university study, Conner, Daugherty, and Gilmore
(2012) investigated how pre-college standardized test scores such as the American
College Testing (ACT) and the Scholastic Aptitude Test (SAT) can predict student retention and graduation. Findings from 3338 students who entered the university between fall 2001 and fall 2005 suggested that the pre-college standardized test scores can predict student retention and graduation. In another study, Ullmer (2012), after surveying 144 students who enrolled in the economics college at Western Carolina
25
University during three semesters in spring 2006, fall 2006, and spring 2007, found that high school grade point average (GPA) and SAT scores predict students’ success.
Similarly, a student’s high school GPA and ACT scores are the best predictors of retention and have great influence on first-year academic performance (Allen, Robbins,
Casillies, & Oh, 2008).
Instead of the ACT or SAT tests used in the U.S., all students who apply to universities and colleges in Saudi Arabia need to take tests provided by the National
Center for Assessment in Higher Education (Qiyas) in order to be accepted (Qiyas,
2011). Qiyas provides two tests for high school students: the General Aptitude Test
(GAT), and the Achievement Test. The GAT measures a student’s capacity for learning in general, regardless of any specific skill in a certain subject or topic (Qiyas, 2011). The test measures skills in reading comprehension, recognizing logical relations, problem solving based on basic mathematical notions, and inference (Qiyas, 2011). The
Achievement Test is designated for students entering science colleges. This test covers the key concepts of five courses: biology, chemistry, physics, mathematics and English.
The score on each one of the five courses is worth 20% of the final grade (Qiyas, 2011).
A longitudinal study conducted at the King Saud Bin Abdul Aziz University for
Health Sciences in Riyadh over three years (2007–2010) measured the extent to which preadmission criteria predicted college success (Al Alwan, Al Kushi, Tamim, Magzoub,
& Elzubeir, 2013). These criteria, which included high school GPA, GAT, and the
Achievement Test, were found to significantly predict college GPA in undergraduate health sciences colleges and colleges of medicine. Similarly, in three government medical schools in Saudi Arabia, the same preadmission criteria were found to predict
26 college GPA (Albishri, Aly, & Alnemary, 2012). The most important predictor in this study was the Achievement Test. In a retrospective cohort study at King Fahad Medical
City, however, Al-Rukban, Munshi, Abdulghani, and Al-Hoqail, (2010) reported that the
Achievement Test was the only significant predictor of college GPA among preadmission criteria.
Most research findings in Western settings indicated that female nursing students completed the program at higher rates than male students (Herrera, 2013; McLaughlin,
Muldoon, & Moutray, 2010; Mulholland, Anionwu, Atkins, Tappern, & Franks, 2008).
Research findings suggested that male nursing students were more likely to leave the college than females because they view nursing as more appropriate for women
(McLaughlin, Muldoon, & Moutray, 2010). Similar findings have been reported in nursing programs in Saudi Arabia (Mebrouk, 2008; Miller-Rosser et al., 2009). Thus, gender may predict student retention and success in the Saudi nursing setting. In contrast, other authors (Pryjmachuk, Easton, & Littewood, 2009; Stickney, 2008) have documented an absence of any relationship between nursing student retention and gender in the United Kingdom.
Students whose first language is not the same as that used in school will have special academic needs (Jeffreys, 2004). In Saudi Arabia, nursing students are taught in the English language (Aldossary et al., 2008; Rugh, 2002), whereas during their secondary education they will have been instructed in Arabic. Nursing colleges in Saudi use the English language as a medium of instruction since the required textbooks are in written in English (Alhussain, 2009; Suliman & Tadros, 2011). In addition, the English language is needed to prepare future nurses for the workplace, as many hospitals’ policies
27 require that all written and verbal communication among staff be in English, while
Arabic should be used to communicate with patients (Alhussain, 2009; Suliman &
Tadros, 2011). In Saudi Arabia, English is a compulsory subject in intermediate schools
(from 12 to 15 years of age) through to secondary school (15 to 18 years of age), and is the only foreign language taught at these school levels (British Council, 1980). Even though English is taught at an early stage, 67.6% of undergraduate female nursing students at different levels of the nursing program at King Saud Bin Abdulaziz
University, Saudi Arabia, reported a fear of communicating in English (Suliman &
Tadros, 2011).
Students may therefore, encounter challenges in adjusting to the academic rigors of college, and may be more likely to drop out. However, in a study conducted at King
Saud University, Saudi Arabia, Abdulghani et al. (2014) reported that students who work harder to improve their English language through studying in groups and getting help from senior students and tutors were more successful in their academic courses, as measured by tests scores. In addition, students who spent more time translating medical terminology from Latin to English and then to Arabic scored higher in academic achievement, as measured by tests scores. Thus, nursing students could overcome the language barrier if they were to work harder to improve their language skills, which would in turn improve retention and success rates.
Student affective factors
Affective factors include students’ self-care, self-efficacy, values, and beliefs about learning (Jeffreys, 2004). Student affective factors are different from student profile characteristics because affective factors may change with time (Jeffreys, 2004).
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There is a relationship between students’ self-care and their retention and success in college (McDonough, 2013); indeed, self-care is the second most important factor after study habits (Gardner, Deloney, & Grando, 2007). Self-care strategies reported by students included exercise, stress management, having enough rest, and proper health, in addition to a positive attitude toward maintaining a balanced life (McDonough, 2013).
Similar findings have been reported by De Ridder et al., (2012).
Self-efficacy has a strong relationship with academic success and retention
(Jeffreys, 2004). According to Bandura (1982), self-efficacy is the capacity to judge one’s own ability to perform a task within a specific domain. This means that the way people judge their capabilities affects their motivation and behavior in performing a task
(Bandura, 1982). In education, perceived academic self-efficacy concerns students’ view of their capability to master different areas of coursework (Bandura et al., 2001).
Students with high self-efficacy are more likely to be motivated to learn and persist in college, and to gain from the experience (Jeffreys, 2004, 2007).
In a longitudinal study conducted in the United Kingdom, McLaughlin, Moutray, and Muldoon (2008) found that self-efficacy is a significant predictor for academic success and retention in nursing students. Similar findings were reported among undergraduate psychology students at a midwestern university in the U.S. (DeWitz,
Woolsey, & Walsh, 2009), and in undergraduate Information System (IS) students at private institutions in Taiwan (Weng, Cheong, & Cheong, 2010).
In Saudi Arabia, students’ views of education are generally influenced by the collectivist norm of the culture (Hamdan, 2014), which may negatively impact their collaborative learning experience. For instance, Razek and Coyner (2011) studied the
29 experiences of Saudi students attending universities in the United States. The results indicated that Saudi students may lack the skills to make new friends outside their friendship ties, which affects their abilities to work collaboratively in small groups.
Similarly, Alkhalaf, Nguyen, Nguyen, and Drew (2013) found that students reported dissatisfaction with their experiences of working in their groups. However, the findings of Razek and Coyner (2011) could be related to their English language barriers, whereas the findings of Alkhalaf et al. (2013) may reflect the limitations of working in groups in general where students may encounter interpersonal conflicts (Bradshaw & Lowenstein,
2011).
However, many studies have suggested an absence of relationship between the
Saudi collective cultural norm and group collaboration, and suggested that Saudi students found that collaborative learning helped them to learn better than individual learning. For instance, Abdulghani et al. (2014) found that Saudi medical students work collaboratively in small groups to help each other overcome their English language barriers, and learn the course content better than through individual learning. In addition, many studies conducted in Saudi medical schools found that students learned better in small groups in subjects delivered through a Problem Based Learning approach than through individual learning in a Lecture Based Learning approach (Albarrak, Mohammed, Abalhassan, &
Almutairi, 2013; Meo, 2013; Suleman, Iqbal, Alsultan, & Baig, 2010). Similar research findings were reported in some Western settings where group learning helped students to accomplish complicated tasks more effectively than individual learning (Dohaney &
Kennedy, 2009; Kirschner, Paas, & Kirschner, 2009b). A literature review suggested that working in small groups helps students distribute the cognitive load among the team
30 members and allows them to work on a task that they would otherwise find difficult
(Kirschner, Paas, & Kirschner, 2009a). Thus, collaborative learning may help Saudi students to learn and succeed in nursing college.
Academic factors
Academic factors include students’ personal study habits, class attendance, and general academic services (Jeffreys, 2004). Other academic factors that may influence undergraduate nursing students’ retention and success include academic preparation for pre-college students for the college learning environment and academic advising (Habley,
Bloom, & Robbins, 2012), first-year transition programs (Braxton et al., 2014), NCLEX-
RN preparation and a medical terminology course (McDonough, 2013), and online courses (NSSE, 2014). I am dividing these factors into factors that are under the student’s control and factors that are institutional.
Factors that are under the student’s control. Astin (1999) used the term
“academic involvement” to refer to the extent to which students work hard at their studies, the number of hours they spend studying, their degree of interest in their courses, and good study habits. Astin stressed both the quantity (number of studying hours) and quality (study with reflection and comprehension of what is studied) of time spent studying. As discussed earlier, Astin found that involved students are more likely to continue their studies. In the same vein, Kuh et al. (2005) used the term “academic challenge” to refer to the amount of time a student spends preparing for class, reading assigned books and other materials, and writing reports and papers. Research findings suggest that the most important factor that helps undergraduate students succeed in the nursing program is personal study habits (Gardner et al., 2007). Examples of good study
31 habits reported by students included spending more hours studying, avoiding distractions, managing their time, preparing for tests more thoroughly; making charts and note cards, completing assignments before the due date, attending class, and familiarizing themselves with the lecture material. Similar findings were reported by Hafford-Letchfield (2007) and O’Gara, (2009).
Factors that are under institutional control. There is evidence that attendance is positively correlated with retention and success as opposed to absenteeism, which is positively correlated with attrition (Currie et al., 2014; Gardner et al., 2007; McCarey,
Barr, & Rattray, 2007). Freshmen students may underestimate the importance of attending class, and this may negatively affect their attendance rates. Thus, Jeffreys
(2004) suggested that beginner students need to be educated about college attendance policies and how important it is to minimize absenteeism.
Research findings suggest that students who use academic library services and other library resources on at least one occasion during the academic year are more likely to have higher GPA and retention than their peers who did not (Soria, Fransen, &
Nackerud, 2014). Similar findings were reported by Grallo, Chalmers, and Baker (2012) and Needham, Nurse, Parker, Scantlebury, and Dick (2013). Thus, general academic services, such as university libraries and computer laboratories, are needed to facilitate student success.
High school students need to be academically prepared before they enter college
(Habley et al., 2012). The preparation program may include single or multiple placement tests to match students’ performance level to the appropriate courses and colleges
(Habley et al., 2012). Students rated pre-college preparation at the top of a list of 42
32 student and institutional characteristics influencing attrition (Habley et al., 2012).
Nonetheless, it is estimated that only 25% of students entering college in U.S. are prepared to succeed there (Habley et al., 2012). As a result of poor student preparation, one third of students leave college during the first year (Habley et al., 2012).
To prepare pre-college students for the college learning environment and increase retention, King Saud University, Riyadh established a Preparatory Program in 2009 for the first year college students (Preparatory Year, 2009). This program lasts one year, and students are required to finish it with a GPA of no less than 3 out of 5. Students can choose one of the following tracks:
Medical Track: this track includes the colleges of Medicine, Dentistry,
Pharmacology, Applied Medical Sciences, Nursing and Emergency
Medicine.
Engineering and Scientific Track: this includes the colleges of
Engineering, Information Technology and Computer Sciences,
Architecture and Planning, Business Administration, and Agriculture and
Nutrition Sciences.
Humanities Track: this includes the colleges of Arts, Education, Laws and
Political Sciences, Tourism and Archaeology, Languages and Translation,
and teaching colleges.
At the end of the academic preparatory year, students are placed in their colleges if they meet the criteria set by each college and approved by the Admission and
Registration Deanship (Preparatory Year, 2009). For instance, all Medical Track students are placed in their colleges according to their Preparatory Year GPA only, without
33 considering their high school GPA, GAT, or Achievement Test scores (Preparatory Year,
2009). However, starting from the 2015/2016 academic year, Medical Track students will be placed in their colleges according to their Preparatory Year GPA, high school
GPA, GAT, and Achievement Test scores (Preparatory Year, 2009). Thus, the current admission to nursing programs is more competitive because it is based only on the preparatory year GPA.
The aim of the Preparatory Program is to: (a) enhance students’ self-confidence, leadership skills and initiative; (b) help students to develop skills in information technology, English language, and mathematics; (c) enhance students’ skills in communication, learning, thinking, and research; (d) encourage innovation, creativity and self-development; (e) prepare students to succeed academically and maximize their involvement in university life; and (f) improve students’ health awareness and physical fitness (Preparatory Year, 2009).
No study has yet examined the effectiveness of the Preparatory Program in regard to student retention and success. However, the advice provided to pre-college students in the Preparatory Program has helped Saudi students to meet their academic, psychological, and social needs (Tashtoush, 2012). Students reported that the advice offered helped them to choose the appropriate academic field. Female students sought out advice about their psychological needs, such as anxiety or stress, more often than males. With regard to social needs, students mentioned that the advice given helped them chose an appropriate residence (Tashtoush, 2012). Similarly, academic advice during the preparatory year helped students to maintain an even stress level throughout the whole year (Al-Daghri et al., 2014).
34
In a literature review that examined reports about retention in nursing and midwifery programs, Cameron, Roxburgh, Taylor, and Lauder (2011) found that students who meet with their adviser on a regular basis are more satisfied with their learning experience and get more out of college. Researchers found that freshmen students are usually overwhelmed by the academic demands, particularly when it comes to knowing how to produce assignments. However, academic advice may help them to overcome these demands and enhance success and retention rates (Cameron et al., 2011).
Academic advice is a decision-making process in which students realize their maximum educational potential through communicating with an adviser (Braxton et al., 2014).
During this interaction, both the student and the faculty adviser develop a plan of study that is congruent with the student’s interests and abilities (Kuh et al., 2005; McKendry,
Wright, & Stevenson, 2014). The target of advising is to help students become effective agents for their own lifelong learning and personal development (Habley et al., 2012).
Universities that do not have a preparatory year for first year students, could have first-year transition programs to help freshmen students adapt to a new learning environment (Braxton et al., 2014; Habley et al., 2012; Leese, 2010; McKendry et al.,
2014). First-year transition programs help students to learn the history, traditions, educational programs, academic requirements, and student life of the institution (Habley et al., 2012). These programs vary from college to college according to the institution and the students’ needs (Habley et al., 2012). They have been shown to be effective in enhancing freshmen students’ retention and success (Habley et al., 2012). Leese (2010) found that students’ perceptions about their transition programs were varied, but most students emphasized the perceived need to be an independent learner. In addition,
35 students reported the need for more structured activities on campus to help them to fit in.
Moreover, students claimed that they needed more support from their professors, with clear instructions about what was expected. Thus, McKendry (2012) suggests having pre-entry activities to introduce freshmen to their college and program, to clarify expectations, and to smooth the transition. Peer support, especially from those who have experienced the learning environment in question, is crucial for freshmen students’ success and retention (McKendry et al., 2014).
There is evidence that a fear of not being able to pass the National Council
Licensure Examination (NCLEX-RN) is one of the factors that decreases nursing student retention rates (McDonough, 2013). Students have studied for many years to become nurses, and have spent a considerable amount of money, time, and effort to complete a nursing program. Worrying about not passing this exam may, therefore, prevent them from continuing in nursing college (McDonough, 2013). In addition, McDonough (2013) found that many undergraduate nursing students in a Southwest Mississippi baccalaureate nursing program had a hard time reading and comprehending nursing texts because of the high reading level and medical terminology. Thus, the researcher conducted a preparation course to improve students’ skills in test-taking strategies for the NCLEX-RN exam and to enhance their knowledge of medical terminology. Research findings suggested that the preparation course improved student retention, success, and licensure exam pass rates (McDonough, 2013). These findings are consistent with others (Higgins,
2005; Sutherland, Hamilton, & Goodman, 2007) who found that a NCLEX-RN preparation course improved nursing student retention. In Saudi Arabia, all health care providers, including nurses, are required to pass the license exam provided by the Saudi
36
Commission for Health Specialties (SCHS, 2014). However, no study has examined the relationship between passing the license exam and student retention and success.
One of the indicators for students’ engagement in the NSSE survey (2014) is the availability of online courses in the college program. Hamdan (2014) examined the effect of online courses on student engagement in the learning process in Saudi Arabia.
The findings suggested that students taking online courses were more involved in the learning process than those in lecture-based classes. Participants reported that they had more frequent opportunities to interact with classmates and professors. In addition, students reported that this teaching approach allowed them to reflect on their learning process, which enhanced their understanding of the course material. These findings suggested that online courses helped students get involved in the learning process and, as
Astin (1999) suggests, involved students are more likely to remain and succeed in college. Similarly, Willekens (2010) found that online student-faculty interaction increased the likelihood of student success through greater use of technology.
Environmental factors
The external factors that contribute to student retention and success include socialization, financial status, family responsibilities, working hours, employment responsibilities, campus residency (living), and athletic involvement (Jeffreys, 2004). In a grounded theory study, Rausch and Hamilton (2006) investigated the factors that influenced 20 university freshmen to withdraw prior to the end of their first year at two
U. S. Midwestern universities. The reasons included stressful environment, bill payment, lack of socialization and adjustment difficulties such as the absence of friends and separation from family. Other researchers found that the lack of financial support and
37 family obligations (children and school) competed for student time and inhibited academic performance in nursing school (McDonough, 2013; Shelton, 2003).
There was evidence that living on campus substantially increases a student’s chances of retention and college success (McDonald & Preston, 2010; Schudde, 2011).
Residents were more likely than commuters to become involved in extracurricular activities, such as athletics; and to express satisfaction with their undergraduate experience, particularly in terms of student friendships, faculty-student relations, institutional reputation, and social life (Astin, 1999). In addition, athletic involvement was associated with satisfaction in four areas: the institution’s academic reputation, the intellectual environment, student friendships, and institutional administration (Astin,
1999). There was evidence that students who were involved in athletic activities were more likely to remain and succeed in college (Eckert, Grimm, Roth, & Savage, 2010;
Mazerolle & Dodge, 2014).
Social and academic integration
The Nursing Undergraduate Retention and Success model outlined the importance of social and academic integration in students’ decisions to remain in college (Jeffreys,
2004). Social and academic integration referred to the interaction between the student and the social system of the college, especially during the critical first year (Jeffreys,
2004; Tinto, 2007). Social and academic interaction was achieved through formal and informal faculty interaction, group collaboration, and active learning (Jeffreys, 2004).
Students with high social interaction were less likely to be isolated and more likely to be involved in the learning process (Tinto, 2007).
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Student-faculty interaction referred to the availability of faculty to advise students both in and outside class (Kuh et al., 2005), and was one of the indicators of college student retention (Cejda, & Hoover, 2010). Shoepe (2014) found that university students rated student-faculty interaction at the top of the list of the factors that contribute to their engagement in the learning process. Student-faculty interaction in and out of the classroom affects both academic quality and student performance (Shelton, 2003). The more frequent the informal interactions that show caring and warmth, the more likely students were to remain in college and obtain a degree (Shelton, 2003). Students who persisted in a nursing program had significantly greater perceived faculty support, both psychological and functional, than those who withdrew either voluntarily or because of academic failure (Shelton, 2003). Functional support in this study was conceptualized as monitoring academic progress, helping with course content and study skills, referring students for appropriate learning support and counseling services, and providing help for students preparing for licensure examinations (Shelton, 2003). Psychological support included faculty being approachable, correcting students without criticizing them, being respectful to students, listening, acknowledging students’ efforts, and being patient
(Shelton, 2003). Nevertheless, McDonough (2013) reported some barriers to effective student-faculty interaction, which include students’ fear and anxiety about approaching faculty, lack of time for faculty to meet students, and large class sizes that impact negatively on the time available for student-faculty interaction in and out of the classroom.
In a Carnegie National Nursing Education Study, Benner and colleagues discovered that many current educational practices do not engage students in the learning
39 process (Benner, 2010). Thus, the author called for radical curriculum reform in nursing education through student centered teaching and learning approaches as the way to prepare graduate nurses. In this study, Benner and colleagues (2010), also reported that many students complained about the amount of information given in the class via
PowerPoint presentations, where the students’ role was to sit, watch the slides go one after the others, and agree with everything that teachers were saying without actual engagement. A few hours later students were not able to recall most of the information given in the lectures.
In contrast, the Documenting Effective Educational Practice (DEEP) project suggested that active learning strategies that engage students in critical thinking about the subject matter improve student success and retention rates (Kuh et al., 2005). Popkess
(2010) found that undergraduate nursing students in an active learning environment had higher engagement levels than those in passive learning environments. Similarly, undergraduate nursing students in a Southwest Mississippi baccalaureate nursing program reported that they learned more when they were active learners in the classrooms, in clinical settings, and/or through simulation learning (McDonough, 2013).
Research findings with undergraduate nutrition students at Pepperdine University, USA indicated different strategies for active learning, including discussion integrated into the lecture, hands-on activities, and experiential learning events (Shoepe, 2014). To integrate active learning strategies into classrooms, faculty need to set clear expectations, design effective evaluation strategies, and provide helpful feedback (Shoepe, 2014). In the
Active Learning Environments Scale (ALES) adapted by Teaching Learning and
Technology Group (TLT Group, 1998) and revised by Popkess (2010), active learning
40 includes: (1) developing a presentation to give to other students in the class; (2) producing one or more drafts of an assignment before completing the final version; (3) studying notes, handouts, and/or readings prior to coming to class sessions; and (4) participating in case studies or problem-solving exercises in class.
Outside surroundings factors
In the NURS conceptual model proposed by Jeffreys (2004), outside surroundings factors exist outside the academic setting and the individual student’s personal environment, and can contribute to student retention. The nursing profession is impacted by its public image and salaries (Jeffreys, 2004). In Saudi Arabia, the public view that nursing is less important than the work of physicians, impacts nursing student recruitment and retention (Mebrouk, 2008; Miller-Rosser et al., 2009). This public image also affects recruitment and attrition in the nursing profession (Mebrouk, 2008; Miller-
Rosser et al., 2009).
The public value and image of the profession may affect students’ decisions to remain in nursing college (Last & Fulbrook, 2003). Using the Delphi technique, Last and
Fulbrook (2003) explored why undergraduate nursing students in Britain leave their nursing program. In the first phase, the researchers conducted focus groups and one-to- one interviews to gather multi-professional views (nursing educators, nursing managers, doctors, and qualified nurses) about the reasons why students leave. In the second phase, a questionnaire was developed from the data derived from the interviews. Finally, the questionnaire was administered to 32 student nurses in their final year who were recruited as “expert panelists” to give their understanding of why others had left the program.
Most of the students felt that the action and behavior of other professionals suggested that
41 nurses and nursing students were not valued. For example, “mentors not having time for them, tutors not supporting them, other professionals ignoring them, placements not being prepared for them, and unsuitable learning environments led them to the conclusion they were not valued” (Last & Fulbrook, 2003, p. 455).
To examine the knowledge, attitudes, and intentions of Saudi high school students towards nursing as a future profession, Al-Omar (2004) recruited 479 male and female high school students in Riyadh city, Saudi Arabia. Only 5.2% of the participants identified nursing as their preferred future profession, whereas the majority indicated that their preferences were computer science, followed by medicine, and then teaching.
Students noted that these specialties earned higher salaries than nursing. In addition, the long working-hours, poor community appreciation of the profession, and night shifts deterred students from choosing nursing.
However, the American College Test (ACT) 2010 report presented data from earlier ACT studies, which indicated three important factors promoting college student retention (ACT, 2010). These were academic support, imagining one’s future, and student involvement. Thus, providing a day-long workshop for pre-college students about the opportunities and future of nurses may help to improve student recruitment and student retention. Such a workshop could discuss the education requirements, employment opportunities, and payment incentives.
Summary
Student retention and success had been studied intensively in Western settings, but little attention had been given to this topic in the Saudi higher education system, especially in the nursing context. Nevertheless, research findings suggested that multiple
42 factors interact to increase or decrease nursing student retention and success. Some of these factors were out of the control of the nursing college, so the institution had a limited ability to deal with them, while others can be addressed by the college to enhance student retention and success. This review focused on the factors that institutions could influence in order to increase the likelihood of student retention and success. Factors that were applicable to the nursing context in Saudi Arabia are emphasized during this literature review, while less applicable factors were discussed in passing. This literature review yielded a list of 41 items that were used in the first Delphi round. The list is available in
Appendix A. However, those items were revised into actionable items that the college can carry out to enhance student retention and success.
The factors promoting undergraduate nursing student retention and success were grouped into six categories: student profile characteristics, student affective issues, academic, environmental, social and academic integration, and outside surroundings.
Student profile characteristics included age, gender, language barrier, high school GPA,
GAT, and Achievement Test scores. Young nursing students may face challenges in their transition to university life, thus, a first-year transition or preparatory program could help students adapt to university life during the first academic year. The current preadmission criteria to the nursing college in King Saud University do not include high school GPA, GAT, and Achievement Test scores. Including these criteria to the current preadmission requirement may help in predicting student retention and success. In addition, knowledge of GPA increase the likelihood that appropriate supports would be provided for the student. There was evidence that English language was a barrier to
43
Saudi students’ retention in nursing college. Hence, intensive English language courses could also contribute to student success.
Student affective factors included self-efficacy, self-care, and cultural beliefs and values. Students with high self-efficacy were more likely to be motivated to persist in college and gain from the experience. A program that emphasizes self-care strategies was believed to be helpful to undergraduate nursing students in decreasing their stress level and increasing their chance of retention and success. Research findings had suggested that a group collaboration approach might help nursing students learn better compared to the individual learning approach that was the dominant teaching practice in the college.
Academic factors included a student’s personal study habits, attendance, general academic services, academic preparation, academic advice, NCLEX-RN exam preparation, medical terminology course, and online courses. Students who attended their classes and had good personal study habits were more likely to achieve their academic goals. Institutions that ensured the viability of their general academic services, such as university libraries, advisory services, and computer laboratories were more likely to help students to succeed. In addition, students who met with their academic adviser on a regular basis were shown to have greater retention and success rates. Both
NCLEX-RN exam preparation and medical terminology courses had been shown to improve students’ retention and success.
Environmental factors included campus residency, athletic activities, socialization, financial status, family responsibilities, working hours, and employment responsibilities.
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Institutions that help students to overcome these challenges were more likely to create an environment for student retention and success in college.
Social and academic integration factors included student-faculty interaction, group collaboration, and active learning. Positive student-faculty interaction created an academic environment that enhanced students’ involvement in the learning process.
Group collaboration could outweigh individual learning and may be beneficial in a Saudi setting. Saudi professors could increase the chance of student success and retention by actively engaging students in the learning process.
Outside surroundings factors included the public value and image of the nursing profession. Nursing administration could implement an orientation program for
Preparatory Year students at King Saud University to improve the image of the profession, especially among men. This could increase the rate of student enrollment in nursing college, and the retention of those students after entering the program.
CHAPTER THREE
METHODOLOGY
Introduction
This study utilized a mixed method approach to examine Saudi faculty and students perceptions of the factors promoting student retention and success in the nursing setting in Saudi Arabia. The study was accomplished through two phases. In Phase I, a
Delphi technique was used to explore the faculty members’ perception about factors promoting students retention and success. The Curriculum Committee of the nursing college of King Saud University was contacted by emails with a request to participate as expert panelists. Six of the ten members agreed to participate in this study and remained throughout the three rounds of the data collection. The final product of the Delphi method was a list of factors promoting students retention and success. The list was used in Phase II to examine students’ perceptions of factors promoting student retention and success. A total of 76 undergraduate nursing students from both genders participated in this study. Students rated the importance of each factor in terms of promoting student retention and success by responding to a questionnaire. The questionnaire was designed as a Likert scale with a five-point response choice, on which1= strongly unimportant, 2 = unimportant, 3 = neutral, 4 = important, and 5 = strongly important. In addition, students had the option of adding other factors to the list that they felt to be vital. These additional items were analyzed using a qualitative descriptive approach.
45 46
Research Questions
This study addressed the following research questions:
What are the factors influencing nursing student retention and success as
perceived by a panel of expert nursing faculty in Saudi Arabia?
What are the factors influencing nursing student retention and success as
perceived by undergraduate nursing students in Saudi Arabia?
What are the differences and/or similarities between the perspectives of a
panel of expert nursing faculty and the undergraduate nursing students in
regard to the factors influencing nursing student retention and success?
Setting and Subjects
The data were collected from the Nursing College, King Saud University,
Riyadh, Saudi Arabia. Established in 1967, King Saud University was the first established public university in Saudi Arabia (Al Shawwa, 2012). King Saud University is located in the capital city, Riyadh. It is the largest university in the Kingdom, and its staff and students are drawn from the different regions of the country (Al Shawwa, 2012).
For the Delphi technique, the Curriculum Committee in the nursing college at King Saud
University served as expert panelists to give their perceptions of the factors that contribute to student retention and success. The committee includes ten members of the faculty who were selected as “curriculum experts,” and represent the four departments in the nursing college (Medical Surgical, Maternity, Psychiatric, Management and
Leadership). Both genders are represented. Six faculty members agreed to participate in this study.
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A total of 76 third- and fourth-year undergraduate nursing students (from the 5th to 8th academic levels) from both genders agreed to participate in this study. These students were included to provide their perceptions about the factors that helped them to succeed and remain in college during the critical first year. In addition, they were selected because they were believed to be more knowledgeable about the university environment than first- and second-year students. Since this was a descriptive study and no inferential statistics were calculated, power analysis to estimate the desired sample size was not needed (Munro, 2001). However, the total number of students at the
Nursing College of King Saud University ranged from 350–400 as a total of both genders in the third and fourth years, excluding the internship students because they were not on campus. All third- and fourth-year male and female nursing students in the nursing college were asked to participate in the study.
Procedures for Data Collection
The data collection was conducted in two phases. The first phase was to examine the faculty members’ perceptions about the factors promoting student retention and success using a Delphi technique. In the second phase, undergraduate nursing students in the college were recruited to give their perceptions about the factors promoting student retention and success.
In the first phase, after official approval by the Institutional Review Boards (IRB) of Kent State University and the Dean of the nursing college in King Saud University, a request email was sent by the researcher to the Curriculum Committee members in the nursing program, to invite them to participate in this study as expert panelists. The request email included the directions for completion of the survey and the survey itself
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(see Appendix B). Expert panelists had two weeks to respond to the email request. Six faculty members returned the survey for the first round and these participants were retained throughout the three rounds. Communication between the researcher and the panelists was conducted by email so that no expert could exert an undue influence over the opinions of others (Nieswiadomy, 2008). Participants were known to the researcher, but were anonymous to the other panelists to encourage frankness of response (Dalkey,
1969; Hasson, Keeney, & McKenna, 2000).
The survey had two sections (see Appendix C). In the first section, expert panelists were asked to respond to two open-ended questions. The two questions were:
1. What are the top five factors that promote student retention?
2. What are the top five factors that promote student success?
The second section started on a new page, and asked the expert panelists to rate a list of 41 factors promoting student retention and success in a nursing program in Saudi
Arabia. The list of factors was identified from a systematic review of the literature about the factors promoting student retention and success. Faculty members gave their perceptions about the importance of the factors in promoting student retention and success through responding to a questionnaire that was designed as a Likert-scale with a five-point response choice, on which 1= strongly unimportant, 2 = unimportant, 3 = neutral, 4 = important, and 5 = strongly important.
Data were managed using IBM’s SPSS version 22 to save time and create greater flexibility for a multiple-round study. The returned surveys were analyzed and summarized to prepare statistical feedback to be used in the second round. The statistical feedback included the group mean rating of each item, the standard deviations, the
49 minimum and maximum ratings, and the frequencies of ratings for each item by the panel members. In addition, each panel member was reminded about his/her rating of each item in the previous round. There were three rounds of data collection.
For the second phase of the study (students’ pereceptions), two research assistants
(RAs) were recrruited by the researcher to collect the data. One RA collected the data from female students, while the other RA collected the data from male students. Both
RAs were clerk staff who had no power over students. Consent forms and the surveys were distributed to the students, who were asked to sign the consent form and complete the survey if they were willing to participate (see Appendix D). The consent forms and surveys were distributed and returned in separate envelopes. Students had 20 minutes to complete the survey (see Appendix E). After this time, the research assistants collected the surveys and consent forms. Students had the option to return blank or incomplete surveys in the envelopes. Thus, the research assistant had no knoweldge about who had participated in the study and who had not.
Demographic questionnaire
Prior to starting the Delphi study, panelists completed a demographic questionnaire requesting their nationality, age, gender, educational background, and years of educational experience (see Appendix F).
Similarly, prior to completing the survey, students completed a demographic questionnaire requesting their age, gender, academic level, high school GPA, GAT,
Achievement Test, current GPA, work status, and previously earned college degree (see
Appendix G).
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The Delphi technique
The Delphi technique was developed by workers at the RAND Corporation during the beginning of the Cold War to forecast the impact of technology on warfare
(Dalkey & Helmer, 1963). The Delphi technique is a data collection procedure that recruits a panel of experts to complete a series of questionnaires focusing on the experts’ opinions, predictions, or judgment about a particular topic (McKenna, 1994;
Nieswiadomy, 2008). The Delphi method differs from other surveys in many aspects.
First, researchers using the Delphi method are not looking for experts’ opinions only but aiming to gain a consensus of these opinions (ALHussain, Murphree Jr, & Bixler, 2012;
Polit & Beck, 2004). In addition, a Delphi technique involves multiple iterations/rounds to reach consensus without the need for face-to-face interviews. Responses to each round of questionnaires are analyzed, summarized, and returned to the experts with a new questionnaire (McKenna, 1994). The panels are then required to reformulate their opinions in light of the previous round’s results (McKenna, 1994). The process of response-analysis-feedback-response is carried out for three rounds until a general consensus is achieved (Polit & Beck, 2004).
McKenna (1994) discussed some key characteristics of the Delphi method which include: (1) the use of a panel of experts for obtaining data; (2) participants do not meet in face-to-face discussions; (3) the use of sequential questionnaires and/or interviews; (4) the systematic emergence of a concurrence of judgment/opinions; (5) the guarantee of anonymity for subjects’ responses; (6) the use of frequency distributions to identify patterns of agreement; and (7) the use of two or more rounds between which, a summary
51 of the results of the previous round is communicated to and evaluated by panel members
(p.1222).
There is no universal agreement about what constitutes consensus. However,
Loughlin and Moore (1979) suggest that consensus should consist of agreement by 51% or more of the panelists; Sumsion (1998) recommends 70%; others have suggested 75%
(Keeney, Hasson, & McKenna, 2006; McKenna & Hasson, 2002); while Green, Jones,
Hughes, and Williams (1999) suggest 80% agreement among participants. Even though setting a percentage level to determine what constitutes a consensus is the standard in
Delphi studies (Williams & Webb, 1994), other researchers rely on the spread of scores or standard deviation for each question from the mean average score (Jones & Hunter,
1995; Passannante, Restifo & Reichman, 1993). A wide spread of scores from the mean indicates a weak consensus among panelists, while a narrow spread of scores indicates a strong consensus (Jones & Hunter, 1995; Passannante et al., 1993). Nevertheless, it is worth mentioning that consensus does not mean the correct answer has been found; it simply means that consensus has been achieved among a panel of participants (Watson,
McKenna, Cowman, & Keady, 2008).
Sampling in the Delphi method
The Delphi technique does not use a random sample to represent the target population, but rather recruits “experts” as panel members (Watson et al., 2008). Experts are “informed individuals” specializing in the field or who have knowledge about the subject (Watson et al., 2008).
There is no universal agreement on the proper size of the panel (Watson et al.,
2008). Panels have ranged in size from four to more than 3000 participants (Cantrill,
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Sibbald, &Buetow, 1996); Hogarth (1978) and Mitchell (1991), however, suggest six to
10 experts. Nevertheless, Clayton (1997) indicates that by rule of thumb, five to 10 is appropriate for heterogeneous groups and 15 to 30 for homogeneous ones. However, researchers need to consider the purpose of the investigation (Cantril et al., 1996) and the time constraints when deciding the panel size (Watson et al., 2008). The larger the panel, the more time is needed to follow up the experts’ responses (Watson et al., 2008). In addition, the larger the sample size, the poorer the response rate tends to be (Watson et al., 2008).
Reliability and validity of the Delphi method
In any research study, the researcher needs to ensure the reliability and validity of the data (Hasson et al., 2000; Watson et al., 2008). However, there is no evidence of the reliability of the Delphi method (Watson et al., 2008). No study has examined whether the results would be the same if the same information were given to two or more panels from the same field (Hasson et al., 2000; Watson et al., 2008). However, validity is also an issue in Delphi method (Hasson et al., 2000; Watson et al., 2008). Threats to validity in the Delphi technique arise from pressures put on panel members to change their opinions according to the group response (Hasson et al., 2000; Watson et al., 2008).
However, if experts are knowledgeable about the subject, content validity is more likely to be obtained (Hasson et al., 2000; Watson et al., 2008). In addition, it is assumed that the successive rounds increase concurrent validity (Hasson et al., 2000; Watson et al.,
2008).
To ensure the accuracy of Delphi results, the researcher needs to clarify the questions and respondent instructions, follow up with non-respondents, pre-test the
53 survey, accurately code the survey information, and record the data correctly (Mitchell,
1991). In addition, the selection of the panel members should be based on knowledge of the topic and diversity of perspective (Watson et al., 2008). If panelists feel that their contributions are valued, they are more likely to persist until the end of the study
(Mitchell, 1991).
Advantages of the Delphi technique
The Delphi method is useful “when the problem does not lend itself to precise analytical techniques, but can benefit from subjective judgments on a collective basis”
(Rice, 2009, p.164). Because the experts do not need to meet for formal meetings, the
Delphi method saves time and expense (Nieswiadomy, 2008; Polit & Beck, 2004). In addition, since the experts are not required to meet face-to-face, one persuasive or prestigious expert cannot influence the opinions of the others (McKenna, 1994; Polit &
Beck, 2004). The e-Delphi is a newer approach that uses advanced technology (email, or completing an online form) to collect data, which saves time, that the researcher can then use during the multiple rounds (Watson et al., 2008).
Limitations of the Delphi technique
The Delphi method is time-consuming for researchers (Polit & Beck, 2004).
Attrition/poor response rate is a big concern with the Delphi technique (McKenna, 1994;
Polit & Beck, 2004; Watson et al., 2008). Researchers are usually concerned about “what constitutes a consensus,” that is, how many participants need to agree before the researcher can make a conclusion about consensus (Polit & Beck, 2004). However, many
54 researchers believe that 51% is an acceptable consensus (McKenna, 1994; Watson et al.,
2008).
Mixed Method Research
Mixed Method Research is formally defined as “the class of research where the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, concepts, or language into a single study” (Johnson & Onwuegbuzie, 2004, p.17). The goal of mixed method research is to draw from the strengths and minimize the weaknesses of each method (Creswell, Klassen, Plano Clark, & Smith, 2011; Johnson &
Onwuegbuzie, 2004). In a single study, the researcher could use both qualitative and quantitative methods to investigate the same phenomenon using both inductive and deductive logic to achieve a better understanding. Thus, researchers will consider viewing the truth from both subjective and objective points of view for a comprehensive understanding of the phenomenon. In this design, the first method will make a significant contribution to the second, and thus enrich the findings. Hence, this design will be helpful in facilitating the breadth and depth of understanding of Saudi students’ perception of about factors influencing student retention and success.
There are four designs of mixed method research: Convergent, Sequential,
Embedding, and Multiphase (Creswell et al, 2011; Terrell, 2012; Venkatesh, Brown, &
Bala, 2013).
Convergent designs: this approach is used when both qualitative and
quantitative approaches are equally emphasized. The researcher may mix both
approaches in the data analysis and/or data interpretation sections to compare and
contrast the two datasets.
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Sequential design: this integration involves using results of one approach
to inform data collection in the other approach. For instance, a researcher may
use results from interviews in a qualitative study to develop an instrument used to
collect data in a quantitative study.
Embedding design: this approach is used when one of the approaches is
more important than the other. Thus, the researcher could use the secondary
priority dataset to support the results discussion in the larger primary dataset. For
instance, in this study, I used the qualitative data about student perceptions of
factors influencing student retention and success to explain the mechanism behind
the differences in perceptions between students and faculty. In this study the
“point of interface” occurred in the data collection, since one instrument was used
to collect both quantitative and qualitative data. Also, mixing of the qualitative
and quantitative approaches happened in the data interpretation section.
Multiphase designs: occurs when researcher has used multiple projects
and linked them together by a common purpose.
Limitations of Mixed Method Research
Mixed method research studies are often expensive and time-consuming
(Johnson & Onwuegbuzie, 2004). In addition, mixed method studies need expertise and are challenging for novice researchers. However, looking at the advantages of mixed method design for this study, we argue that its benefits outweigh its limitations.
Plans for Data Management and Analysis
Quantitative Data
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Details of the Delphi method for this study. The Delphi method had been used to study factors influencing student success (Larcara, 2011; Manning, 2010). In
Larcara’s (2011) study, Delphi was used to examine what motivates adjunct faculty to teach online courses. Consensus was achieved on 32 items, including competitive pay, respect between adjuncts and full-time faculty, a guarantee of work, opportunities for asynchronous development, and informal and formal peer collaboration. In Manning’s
(2010) Delphi study, an expert panel of 16 faculty at a southeastern community college in the US was recruited to give their perceptions about factors that influence student retention and success. Five best practices were obtained: (1) Providing clear and concise course policies and guidelines; (2) Providing clear and ongoing expectations and instructions; (3) Providing clear, prompt feedback on questions, assignments, and grades;
(4) Providing relevant content and resources; (5) Providing opportunities for independent student learning.
Before starting the first Delphi round in this study, the list of factors that were identified through a review of the literature that were reported in Chapter 2, was pre- tested. I have revised the list to make actionable those items that the college can implement to increase student success. For example, the item that mentions that knowledge of medical terminology may increase undergraduate nursing student success is revised to read, “having a medical terminology course may help student success”. This list of items was emailed to six faculty members in the college who were not part of the study panel for review to determine the time needed to complete the survey and ensure clarity/readability of questions.
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The survey had two sections. In the first sections, expert panelists were asked to respond to two open-ended questions. The two questions were:
1. What are the top five factors that promote student retention?
2. What are the top five factors that promote student success?
The second section started on a new page on which expert panelists were asked to rate a list of 41 factors that promote student retention and success in a nursing program in
Saudi Arabia. The list of factors was identified from a systematic review of the literature about the factors promoting student retention and success. Faculty members gave their perceptions about the importance of the factors that promote students’ retention and success through responding to a questionnaire that was designed as a Likert-scale with a five-point response choice, on which1= strongly unimportant, 2 = unimportant, 3 = neutral, 4 = important, and 5 = strongly important.
Responses to this round were analyzed, summarized, and returned to the experts with a new questionnaire (Polit & Beck, 2004). Feedback from each round was prepared in statistical form that included the group mean rating of each item, the minimum and maximum ratings, the standard deviation, the frequencies of the item for the panel; and the individual was reminded about his/her rating the item in the former round (Hasson et al., 2000). For each item, I gave the panelists these statistical measures to help them retain or revise their previous ratings. These statistics enabled the experts to see where their response located in relation to that of the group (Schmidt, 1997). The mean is the sum of all scores divided by the total number of scores (Polit & Beck, 2004). The standard deviations provided an indication of the spread of the individual responses to a given item (Polit & Beck, 2004). A large standard deviation indicated large variations in
58 panelists’ rating of that item; in contrast, a small standard deviation reflected small variations in panelists’ rating of that item, which indicated consensus (Watson et al.,
2008).
Data were managed using IBM’s SPSS version 22 to save time and create greater flexibility for a multiple-round study (Hasson et al., 2000). Double data entry testing of the frequencies and the ranges in the descriptive statistics was used to assess for outliers and missing data. Confidentiality of participants’ identities was maintained by assigning a code to each one and then entering their data into the created dataset. Descriptive statistics such as the mean, the standard deviation, the frequencies, and the minimum and maximum rating of each item were calculated.
As in the first round, the survey in the second round comprised two sections. In the first section, participants rated the list of factors that were used in the first round plus the factors that were added by the expert panelists. In the second section, experts were asked to add factors that they believed to be important to student retention and success, but were not included in the list. Data from the second round were analyzed following the same procedure as in the first round. Responses to this round were analyzed, summarized, and returned to the experts with a new questionnaire to be used in the third round.
In analyzing the third round, any factor with an agreement level of more than 68% in this round indicated that consensus had been achieved for that factor. Hence, at least four out of the six panelists needed to rate a factor with either 3 (important) or 4 (very important) for consensus to be achieved.
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Students’ perceptions. To obtain student perceptions, participants rated the list of faculty-identified factors influencing student retention and success that was developed using the Delphi method. A Likert-scale was used with a five-point response choice of 1 to 5, with 1= strongly unimportant, 2 = unimportant, 3 = neutral, 4 = important, and 5 = strongly important.
Data were managed using a new dataset for students’ data. Also, double data entry testing of the frequencies and the ranges in the descriptive statistics was used to assess for outliers and missing data. Descriptive statistics, such as the mean and the standard deviation of each factor were calculated. In analyzing the students’ perceptions, any factor with a mean equal or more than 3.5 were considered an important factor for student retention and success from the students’ perspectives.
Qualitative Data
Students added other items they believed to be vital to the list developed during the Delphi rounds. These additional items were analyzed using a qualitative descriptive approach. As Sandelowski (2000) described it, qualitative description is a method of describing phenomena. However, Sandelowski (2010) corrected this description by stating that a qualitative descriptive approach is a method that enables the researcher to go beyond description of the phenomenon into the interpretation of the data. The qualitative descriptive design has been used in many nursing research studies (Bohman &
Borglin, 2014; Brobeck, Odencrants, Bergh, & Hildingh, 2014; Munce et al., 2014). As in any other qualitative approach, the data collection techniques in qualitative descriptive design include structured open-ended questions, focus-group interviews, and observations
60 of targeted events/populations (Sandelowski, 2000). Qualitative descriptive studies are often analyzed using a content analysis approach (Sandelowski, 2000).
Data Management. Data were managed manually by using different types of highlighters to draw attention to the most important themes (Morse & Field, 1995). In addition, index cards were used to categorize concepts according to the emerged themes
(Morse & Field, 1995).
Data analysis. Data were analyzed according to the content analysis approach.
The first phase is that of comprehending, in which the researcher immerses himself in the data to become familiar with it (Morse & Field, 1995). This step requires reading the transcripts multiple times, using the thematic data analysis procedure to highlight emerging categories or themes. In the second, synthesizing phase, the researcher starts writing a short description of the emerging phenomena. In this phase, the researcher focused on the differences between subjects in regard to the interesting phenomena. In the third, theorizing phase the researcher seeks the most coherent and simple explanation that best fits the data. Finally, the researcher links the new findings to the existing literature to develop themes that richly describe the phenomenon of interest (Morse &
Field, 1995).
In the course of this study, I read the added items many times to familiarize myself with them. Then, I highlighted the emerging categories or themes (group of words with similar meaning). The responses of the students fit naturally into the six categories proposed by Jeffreys (2004), thus, the researcher wrote down key words or phrases from the responses and placed them into the categories. These categories included: student profile characteristics, student affective, academic, environmental,
61 social and academic integration, and outside surroundings thus, the researcher wrote down key words or phrases from the responses and placed them into the categories.
Finally, themes that indicated students’ perception of the factors promoting retention and success were developed. The themes were used to compare students’ and faculty’s perceptions of the factors that promoting student retention and success.
Rigor in Qualitative Approach. Rigor in qualitative approach can be enhanced through credibility, transferability, dependability and confirmability (Denzin & Lincoln,
2011). I discussed these terms and the procedure that I used to ensure that these concepts had been addressed in this study.
Credibility. Also called trustworthiness, occurs when the researcher is confident in the truth of the data and its interpretation (Morse & Field, 1995). It requires prolonged engagement with participants, prolonged observation, member checks, and that both participants and researchers are experts in the topic. In this study, the students were experts in their experience of the factors promoting retention and success.
Transferability. Also called applicability, this is the extent to which findings can be transferred to other settings or groups (Morse & Field, 1995). In quantitative studies, this is called generalization of the findings or external validity. In this study, the researcher described the settings, populations, and demographics of participants to help readers judge the transferability of the findings to other settings or groups. Thus, the findings are specific to nursing education in Saudi Arabia; whether these findings can be applied to other countries is to be determined by the reader, however.
Dependability. This refers to the stability of the data over times and conditions
(Denzin & Lincoln, 2011). It assumes that if the study were repeated in the same
62 location, with the same participants and using the same methods, similar results would be obtained (Denzin & Lincoln, 2011). In order to address the dependability issue, I explained the data collection and analysis procedure to help a future researcher repeat the study if needed.
Objectivity/confirmability. Since data are collected and analyzed by humans, investigator bias is a concern in qualitative studies (Denzin & Lincoln, 2011).
Researchers need to take steps to ensure that the findings represent the data and are not biased by their own experiences and characteristics. Thus, the researcher should admit his or her own predisposition (beliefs, attitudes, values, and experiences) before data collection, and compare them to the findings to ensure objectivity of the data (Denzin &
Lincoln, 2011). In addition, the researcher can ensure this by line-line coding, and audit trail during data analysis (Denzin & Lincoln, 2011).
Comparing perceptions
One of the aims of this study was to examine the differences and/or similarities between the perspectives of a panel of expert nursing faculty and the undergraduate nursing students about the factors influencing nursing student retention and success. The list of factors arrived at by consensus of faculty and answered by students had six subscales: student profile characteristics, cultural factors, student affective factors, academic factors, environmental factors, social and academic integration, and outside surroundings. Each of the five subscales was measured through many questions in this list. The list of factors rated by faculty and students were measured through a Likert scale with a five-point response choice (1 = strongly unimportant to 5 = strongly important). Each item was analyzed alone through its rating by faculty or students.
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Hence each item’s score ranged from 1 to 5. With faculty perceptions, factors that had been rated by at least four out of the six panelists with either a 3 or 4 in round 3 were considered important for student retention and success, whereas items with less than that were considered unimportant. Similarly, with student perceptions, any item with a mean score equal to or more than 4 was considered important; whereas items with less than that were considered unimportant. Factors added by students to the list were considered important for student retention and success and were added to the list of factors students believed to be important. In comparing and contrasting the nursing expert faculty and student perceptions of the factors influencing student retention, a table with mean and standard deviation of each item was created.
Human Subjects
Approval of the study was obtained from the Kent State University Institutional
Review Board (in the U.S.) and the Saudi Arabian nursing college. In addition, explanation of the study and informed consent were provided to and obtained from the participants before starting the study (Friedman, Furberg, & DeMets, 1998). The three principles of ethics in this study were:
Respect for persons: This principle outlines that participants have the right to
participate or not to participate in the study (Trochim, 2007). Thus, in this study,
informed consent was obtained; both faculty and students had the right to
withdraw at any time without penalty, and were not forced to participate. The
students in this study were not considered vulnerable, but due to the teacher-
student power balance, students could feel coerced into participating. Thus,
students were approached for consent by one of the clerk staff--someone who had
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no power over students. Faculty and students who refused to participate were not
punished. The data obtained from the participants were used only for this study.
Faculty members were known to the researcher but anonymous to the other
panelists. Students were not required to give their names when answering the
survey. Data collected from faculty members were emailed to the PI and were
stored in the PI’s computer, which was password protected. Data from students
were collected by the research assistants and sent by FedEx in a sealed envelope
to the PI. The questionnaires were kept in a secure closet in Kent State
University, Henderson Hall, room 351, and only the research team had access to
them.
Beneficence: This principle specifies that the researcher should do good and does
no harm (Trochim, 2007). The study was safe for participants and the risks of
harm were minimal. While the participants in the study might not directly
benefit, there are possible benefits for future students and faculty.
Justice: This principle suggests that study’s risks and benefits are equal between
participants (Trochim, 2007). Thus, the benefits and burden of the research were
equal for all participants. This study was an exploratory design with minimal
harm to all participants.
CHAPTER FOUR
FINDINGS AND RESULTS
Analyses
The purpose of this study was to determine Saudi faculty and student perceptions of the factors promoting student retention and success that are culturally relevant to nursing education in Saudi Arabia. The study was accomplished in two phases. In this chapter, I present the results of these phases, starting with a description of the faculty experts and their perceptions about factors promoting student retention and success.
Following that, I describe the students and their reactions to the list of faculty-rated factors. Finally, the perceptions of the faculty experts and the students are compared.
Results in Phase I
Description of faculty experts
Most of the expert panelists were non-Saudi females. Only one panel member was Saudi and two were male (see Table 1). The post-secondary system is heavily dependent on non-Saudi teachers because of the limited number of Saudi faculty members (Alamri, 2011; Onsman, 2011). The majority of participating faculty members in this study were from Arab countries, such as Egypt and Jordan, constituting around
66% of the sample. The proportion of females on the expert panel is consistent with the nationwide gender distribution of nurses working in the MOH (80%; MOH, 2011).
Participants’ ages ranged from 44 to 59 years (M=52).
65 66
All faculty experts were educated as PhDs with 50% also having post-doctoral training. Nearly 84% of the participating faculty members had more than 15 years of teaching experience and 50% served for 6–10 years on the Curriculum Committee.
Hence, the faculty on the panel had sufficient knowledge and expertise to express an opinion about the factors promoting student retention and success.
Table 1 Demographics Characteristics of Expert Panelists ______Characteristics Frequency Percent Cumulative Percent ______National Saudi 1 16.7 16.7
Egyptian 3 50.0 66.7
Jordanian 1 16.7 83.3
Filipino 1 16.7 100
Gender
Male 2 33.3 33.3
Female 4 66.7 100
Years of Educational Experience
6-10 1 16.7 16.7
> 15 5 83.3 100
Years of Curriculum Committee Experience
< 1 year 1 16.7 16.7
1-5 1 16.7 33.3
6-10 3 50 83.3
11-15 1 16 100
67
Round One
Round one of the Delphi survey consisted of three sections. The first section contained demographic survey items. In the second section, expert panelists were asked to respond to two open-ended questions: 1) what are the top five factors that promote student retention? and 2) what are the top five factors that promote student success? The third section started on a new page on which expert panelists were asked to rate a list of
41 factors that promote student retention and success in a nursing program in Saudi
Arabia. The factors listed were identified from a systematic review of the literature about the influences on student retention and success. Faculty members indicated their perceptions about the importance of the factors promoting student retention and success by responding to a questionnaire designed as a Likert-scale with a five-point response choice with 1 = strongly unimportant, 2 = unimportant, 3 = neutral, 4 = important, and 5
= strongly important (see Appendix C).
Six surveys were returned, which constituted a 100% participation rate. Data were managed using IBM’s SPSS Version 22 (Munro, 2001) to save time and create greater flexibility for a multiple-round study (Hasson et al., 2000). Double data entry testing of the frequencies and the ranges in the descriptive statistics was used to assess for outliers and missing data. Descriptive statistics such as the mean, the standard deviation, the frequencies, and the minimum and maximum rating of each item were calculated.
The anonymity of participants was maintained by assigning a code to each, which was then entered in the created dataset.
Responses to round one items were analyzed, summarized, and returned to the experts with a new questionnaire for round two (Schmidt, 1997). Feedback from each
68 round was prepared for the panel members in a tabular format that included the group mean rating of each item, the minimum and maximum ratings, the standard deviation, and the frequencies of ratings of each item. The participants were also reminded of his or her rating of the item in the former round (Hasson et al., 2000). The statistics, such as mean and standard deviation (SD), enabled the experts to see where their response was located in relation to that of the group (Schmidt, 1997). A large standard deviation indicated large variations in panelists’ rating of that item; in contrast, a small standard deviation reflected small variations in panelists’ rating of that item, which indicated consensus (Watson et al., 2008).
Factors obtained from the open-ended questions were added into the appropriate categories used in the list of factors. The analysis yielded 26 additional factors that expert panelists believed promoted student retention and success. The experts actually listed more than 26 factors, but many were identical or nearly identical to the factors listed in Section III of the survey. The unique 26 factors were added, bringing the list of factors in Round Two to 67. Table 2 shows the results of the survey questions in Round
One, including the means and standard deviations. Factors that came out of the open- ended questions were assigned “____” in Table 2.
Table 2 Results from Round One for the Importance of Factors Promoting Retention and Success Item number M SD Min Max Frequency Student Profile Characteristics
1. Special support for younger students, such as 4.7 .51 4 5 4 5 5 4 5 5 mentoring programs 2. Senior students in the college mentor first-year 4.5 .54 4 5 4 5 5 5 4 4 students
69
Table 2 Results from Round One for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 3. Students’ attributes ______4. Family support ______Admission criteria include: 5. High school GPA 4.1 .98 3 5 4 5 5 5 3 3 6. General Aptitude Test (Qiyas/ General Test) 4.5 .55 4 5 4 4 5 5 5 4 7. Achievement Test scores (Qiyas/ Scientific 4.7 .51 4 5 4 5 5 5 5 4 Test) Student Affective Factors:
Workshops and presentations for first-year students to emphasize skills to care for themselves such as:
8. Stress management 4.1 .75 3 5 3 4 5 5 4 4 9. Benefits of exercising 4.3 .51 4 5 4 4 5 5 4 4 10. Caring for health 4.5 .54 4 5 4 4 5 5 4 5 11. Self-esteem (trusting their decision to be ______nurses) 12. Positive attitudes about academic commitment ______13. Self-motivation ______14. Willingness to learn ______15. Self-initiative ______Academic Factors
16. Clear and concise course policies and 5.0 .0 5 5 5 5 5 5 5 5 guidelines 17. Clear and ongoing expectations from the 5.0 .0 5 5 5 5 5 5 5 5 course materials 18. Clear, prompt feedback on questions, 5.0 .0 5 5 5 5 5 5 5 5 assignments, and grades 19. Relevant content and resources 4.8 .4 4 5 5 5 5 5 4 5
70
Table 2 Results from Round One for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 20. Opportunities for independent student learning 4.8 .4 4 5 4 5 5 5 5 5
21. Interactive and updated ______courses/curriculum/program 22. Workshops for first-year students about 4.8 .51 4 5 5 4 5 5 4 5 effective preparation for class 23. Intensive English language courses 4.8 .4 4 5 5 4 5 5 5 5 24. Emphasizing college attendance policies and 4.8 .4 4 5 5 5 5 5 4 5 the importance of attending classes 25. The Preparatory Year program at KSU 4.1 1.1 2 5 4 5 5 5 4 2 26. Academic advice during the Preparatory Year 4.6 .81 3 5 5 5 5 5 3 5 at KSU 27. SCFHS’s Prometric exam preparation course 4.8 .41 4 5 5 5 5 5 4 5 for fourth year students 28. A medical terminology course in the first year 4.7 .51 4 5 5 4 5 5 4 5 curriculum 29. Online courses 3.8 1.4 1 5 4 4 1 5 4 5 30. Facilitating study groups 4.7 .51 4 5 4 4 5 5 5 5 31. Greater accessibility to the King Saud 4.8 .4 4 5 4 5 5 5 5 5 University libraries 32. Ensuring the availability of and accessibility to 4.7 .51 4 5 4 5 5 5 4 5 computer laboratories 33. Adequate and accessible learning resources ______34. Objective and valid assessment, evaluation of ______student’s performance 35. Enjoyable learning experiences and materials ______36. Vary teaching methods to meet student needs ______37. Providing hands on training ______38. Encourage students to ask questions ______Environmental Factors
71
Table 2 Results from Round One for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 39. Greater student involvement in athletics 4.3 .81 3 5 4 3 5 5 4 5 activities 40. Students clubs that facilitate social interaction 4.5 .83 3 5 3 5 5 5 5 4 41. Part-time employment on the campus for 4.1 .75 3 5 4 4 5 5 3 4 students 42. Greater availability of campus residences 4.1 .93 3 5 3 3 5 5 4 5 43. Improved campus transportation services 4.5 .83 3 5 3 4 5 5 5 5 44. Healthy academic environment ______45. Health care work experience ______46. Peer support ______Social and Academic Integration Factors
47. Student-faculty interaction 4.6 .51 4 5 4 4 5 5 5 5 48. When a faculty member is a good role model ______for students 49. Acknowledge when students have done well ______50. Correct students’ mistakes and bad behavior ______without belittling them 51. The quality of academic advising 4.8 .4 4 5 5 5 5 5 4 5
52. Assessing students’ needs ______53. Smaller class size (less than 20 students in the 4.0 1.4 2 5 5 2 m 5 5 55 class) 54. Being active learners in the classrooms 5.0 .0 5 5 5 5 5 5 5 5 Students can be active learners through:
55. Developing presentations to give to other 4.3 .51 4 5 4 4 5 5 4 4 students in the class 56. Producing one or more drafts of an assignment 4.3 .51 4 5 4 4 5 5 4 4 for faculty review and feedback before completing the final project
72
Table 2 Results from Round One for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency Providing workshops to help student to increase skills in:
57. Taking notes 4.3 .51 4 5 4 4 5 5 4 4 58. Preparing for class 4.3 .51 4 5 4 4 5 5 4 4 59. Exam taking skills 4.5 .54 4 5 5 4 5 5 4 4 60. Critical thinking 4.8 .4 4 5 5 4 5 5 5 5 61. Engaging in extracurricular activities ______62. Engagement in community service ______63. Academic engagement ______Outside Surroundings Factors Cultural factors:
64. Students in the preparatory program who are 4.0 1.5 1 5 5 4 5 5 4 4 interested in nursing spend a day at a University Hospital alongside a practicing RN 65. A day-long workshop for preparatory students 4.5 .54 4 5 5 4 5 5 4 4 at KSU about opportunities for nurses in the country (education requirements, employment opportunities, and payment incentives) 66. Full understanding and acceptance for nursing ______as a profession 67. Students need to feel that they are parallel with ______their colleagues in other university programs (feeling of justice instead of inferiority)
Round Two
The survey in the second round comprised two sections. In the first, participants rated the list of factors included in the first round plus the factors that were added by the
73 expert panelists. In the second section, experts were asked, again, to add factors that they believed to be important to student retention and success but had not been included in the list. A total of six participants returned Survey Two, which constituted a 100% participation rate. Data from the second round were analyzed following the same procedure as in the first. Responses to this round were analyzed, summarized, and returned to the experts with a new questionnaire to be used in the third round. No additional factors were added to the list in this round. However, expert panelists rated the importance of the 67 factors with regard to student retention and success. Table 3 shows the results from the survey questions in Round Two, including the means and standard deviations.
Table 3
Results from Round Two for the Importance of Factors Promoting Retention and Success Item number M SD Min Max Frequency Student Profile Characteristics
1. Special support for younger students, such as 4.6 .51 4 5 4 4 5 5 5 5 mentoring programs 2. Senior students in the college mentor first-year 4.5 .54 4 5 4 5 5 5 4 4 students 3. Students’ attributes 4.1 .75 3 5 4 5 4 5 4 3 4. Family support 4.1 .4 4 5 4 4 4 5 4 4 Admission criteria include: 5. High school GPA 4.3 .81 3 5 4 5 5 5 4 3 6. General Aptitude Test (Qiyas/ General Test) 4.0 .89 3 5 4 4 3 5 5 3 7. Achievement Test scores (Qiyas/ Scientific 4.0 .89 3 5 4 4 3 5 5 3 Test) Student Affective Factors:
74
Table 3
Results from Round Two for the Importance of Factors Promoting Retention and Success
Item number M SD Min Max Frequency Workshops and presentations for first-year students to emphasize skills to care for themselves such as:
8. Stress management 4.1 .75 3 5 3 4 5 5 4 4 9. Benefits of exercising 4.3 .51 4 5 4 4 5 5 4 4 10. Caring for health 4.5 .54 4 5 4 4 5 5 4 5 11. Self esteem (trusting their decision to be 4.3 1.2 2 5 5 4 5 5 5 2 nurses) 12. Positive attitudes about academic 4.5 .54 4 5 4 5 4 5 5 4 commitment 13. Self-motivation 3.8 1.1 2 5 5 2 4 5 4 3 14. Willingness to learn 4.6 .51 4 5 5 4 4 5 5 5 15. Self-initiative 4.3 .51 4 5 5 4 4 5 4 4 Academic Factors
16. Clear and concise course policies and 4.8 .4 4 5 5 5 4 5 5 5 guidelines 17. Clear and ongoing expectations from the 5.0 .0 5 5 5 5 5 5 5 5 course materials 18. Clear, prompt feedback on questions, 5.0 .0 5 5 5 5 5 5 5 5 assignments, and grades 19. Relevant content and resources 5.0 .0 5 5 5 5 5 5 5 5 20. Opportunities for independent student 4.5 .54 4 5 4 4 4 5 5 5 learning 21. Interactive and updated 4.8 .4 4 5 5 5 5 5 5 4 courses/curriculum/program 22. Workshops for first-year students about 4.6 .51 4 5 5 4 5 5 4 5 effective preparation for class 23. Intensive English language courses 4.8 .4 4 5 5 4 5 5 5 5 24. Emphasizing college attendance policies and 5.0 .0 5 5 5 5 5 5 5 5 the importance of attending classes
75
Table 3
Results from Round Two for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 25. The Preparatory Year program at KSU 3.5 1.2 2 5 4 2 4 5 4 2 26. Academic advice during the Preparatory Year 4.6 .51 4 5 5 4 5 5 4 5 at KSU 27. SCFHS’s Prometric exam preparation course 5.0 .0 5 5 5 5 5 5 5 5 for fourth year students 28. A medical terminology course in the first year 4.6 .51 4 5 5 4 5 5 4 5 curriculum 29. Online courses 4.3 .51 4 5 4 4 4 5 4 5 30. Facilitating study groups 4.6 .51 4 5 4 4 5 5 5 5 31. Greater accessibility to the King Saud 4.8 .4 4 5 4 5 5 5 5 5 University libraries 32. Ensuring the availability of and accessibility 4.6 .51 4 5 4 5 5 5 4 5 to computer laboratories 33. Adequate and accessible learning resources 4.3 .51 4 5 5 4 4 5 4 4 34. Objective and valid assessment, evaluation of 4.8 .4 4 5 5 5 5 5 5 4 student’s performance 35. Enjoyable learning experiences and materials 4.8 .4 4 5 5 4 5 5 5 5 36. Vary teaching methods to meet student needs 4.6 .51 4 5 5 4 5 5 5 4 37. Providing hands on training 4.6 .51 4 5 5 4 5 5 5 4 38. Encourage students to ask questions 4.6 .51 4 5 5 4 5 5 5 4 Environmental Factors
39. Greater student involvement in athletics 4.6 .51 4 5 4 5 5 5 4 5 activities 40. Students clubs that facilitate social interaction 4.6 .51 4 5 4 5 5 5 5 4 41. Part-time employment on the campus for 4.3 .51 4 5 4 4 5 5 4 4 students 42. Greater availability of campus residences 4.3 .81 3 5 4 3 5 5 4 5 43. Improved campus transportation services 4.6 .51 4 5 4 5 5 5 5 4
76
Table 3
Results from Round Two for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 44. Healthy academic environment 4.6 .51 4 5 4 4 5 5 5 5 45. Health care work experience 3.8 1.1 2 5 4 5 4 5 3 2 46. Peer support 3.8 1 2 5 4 2 4 5 4 3 Social and Academic Integration Factors
47. Student-faculty interaction 5.0 .0 5 5 5 5 5 5 5 5 48. When a faculty member is a good role model 4.5 .83 3 5 5 4 5 5 5 3 for students 49. Acknowledge when students have done well 4.8 .4 4 5 5 4 5 5 5 5 50. Correct students’ mistakes and bad behavior 4.5 .54 4 5 5 4 5 5 4 4 without belittling them 51. The quality of academic advising 5.0 .0 5 5 5 5 5 5 5 5 52. Assessing students’ needs 4.5 .83 4 5 5 4 5 5 5 3 53. Smaller class size (less than 20 students in the 4.5 1.2 2 5 5 2 5 5 5 5 class) 54. Being active learners in the classrooms 4.8 .4 5 5 5 4 5 5 5 5 Students can be active learners through:
55. Developing presentations to give to other 4.0 1.2 2 5 4 2 5 5 5 3 students in the class 56. Producing one or more drafts of an 4.3 .51 4 5 4 4 5 5 4 4 assignment for faculty review and feedback before completing the final project Providing workshops to help student to increase skills in:
57. Taking notes 4.3 .51 4 5 4 4 5 5 4 4 58. Preparing for class 4.3 .51 4 5 4 4 5 5 4 4 59. Exam taking skills 4.5 .54 4 5 5 4 5 5 4 4 60. Critical thinking 4.8 .4 4 5 5 4 5 5 5 5 61. Engaging in extracurricular activities 4.6 .51 4 5 5 4 5 5 4 5
77
Table 3
Results from Round Two for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 62. Engagement in community service 4.5 .83 3 5 5 4 5 5 4 3 63. Academic engagement 4.3 .51 4 5 5 4 4 5 4 4 Outside Surroundings Factors Cultural factors:
64. Students in the preparatory program who are 4.0 1.5 1 5 5 4 5 5 4 4 interested in nursing spend a day at a University Hospital alongside a practicing RN 65. A day-long workshop for preparatory students 4.5 .54 4 5 5 4 5 5 4 4 at KSU about opportunities for nurses in the country (education requirements, employment opportunities, and payment incentives) 66. Full understanding and acceptance for the 4.6 .51 4 5 5 4 5 5 5 4 nursing as a profession 67. Students need to feel that they are parallel 4.6 .81 3 5 5 3 5 5 5 5 with their colleagues in other university programs (feeling of justice instead of inferiority)
Round Three
As in the second round, the survey in the third round comprised two sections. In the first, participants rated the list of factors that were used in the first round plus the factors that were added by the expert panelists. In the second section, experts were asked to add factors that they believed to be important to student retention and success, but were not included in the list. A total of six returned Survey Two, which constituted a
100% participation rate. In analyzing the third round, any factor with an agreement level
78 of more than 68% indicated that consensus had been achieved for that factor. Hence, at least four out of the six panelists needed to rate a factor as either 3 (important) or 4 (very important) for consensus to be achieved. No new factors were added by the experts in this round. A 100% agreement level was achieved in 52 out of the 67 factors; an 84% agreement level was achieved in 12 factors, while a 68% agreement level was achieved in three factors only. Table 4 shows the results from the survey questions in Round Three, including the means, standard deviations, and agreement level.
Table 4
Results from Round Three for the Importance of Factors Promoting Retention and Success Item number M SD Min Max Frequency Student Profile Characteristics
1. Special support for younger students, such as 4.6 .51 4 5 4 4 5 5 5 5 mentoring programs 2. Senior students in the college mentor first-year 4.5 .54 4 5 4 5 5 5 4 4 students 3. Students’ attributes 4.5 .54 4 5 4 5 5 5 4 4 4. Family support 4.1 .4 4 5 5 4 4 5 5 5 Admission criteria include: 5. High school GPA 4.3 .81 3 5 4 5 5 5 4 3 6. General Aptitude Test (Qiyas/ General Test) 4.0 .89 3 5 4 4 3 5 5 3 7. Achievement Test scores (Qiyas/ Scientific 4.0 .89 3 5 4 4 3 5 5 3 Test) Student Affective Factors:
Workshops and presentations for first-year students to emphasize skills to care for themselves such as:
8. Stress management 4.1 .75 3 5 3 4 5 5 4 4 9. Benefits of exercising 4.3 .51 4 5 4 4 5 5 4 4 10. Caring for health 4.5 .54 4 5 4 4 5 5 4 5
79
Table 4
Results from Round Three for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 11. Self esteem (trusting their decision to be 4.5 .83 3 5 5 4 5 5 5 3 nurses) 12. Positive attitudes about academic 4.6 .51 4 5 4 5 5 5 5 4 commitment 13. Self-motivation 4.0 1.1 2 5 5 2 4 5 4 4 14. Willingness to learn 4.6 .51 4 5 5 4 4 5 5 5 15. Self-initiative 4.3 .51 4 5 5 4 4 5 4 4 Academic Factors
16. Clear and concise course policies and 4.8 .4 4 5 5 5 4 5 5 5 guidelines 17. Clear and ongoing expectations from the 5.0 .0 5 5 5 5 5 5 5 5 course materials 18. Clear, prompt feedback on questions, 5.0 .0 5 5 5 5 5 5 5 5 assignments, and grades 19. Relevant content and resources 5.0 .0 5 5 5 5 5 5 5 5 20. Opportunities for independent student 4.5 .54 4 5 4 4 4 5 5 5 learning 21. Interactive and updated 4.8 .4 4 5 5 5 5 5 5 4 courses/curriculum/program 22. Workshops for first-year students about 4.6 .51 4 5 5 4 5 5 4 5 effective preparation for class 23. Intensive English language courses 4.8 .4 4 5 5 4 5 5 5 5
24. Emphasizing college attendance policies and 5.0 .0 5 5 5 5 5 5 5 5 the importance of attending classes 25. The Preparatory Year program at KSU 4.1 .75 3 5 4 5 4 5 4 3
80
Table 4
Results from Round Three for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 26. Academic advice during the Preparatory Year 4.8 .4 4 5 5 4 5 5 5 5 at KSU 27. SCFHS’s Prometric exam preparation course 5.0 .0 5 5 5 5 5 5 5 5 for fourth year students 28. A medical terminology course in the first year 4.6 .51 4 5 5 4 5 5 4 5 curriculum 29. Online courses 4.3 .51 4 5 4 4 4 5 4 5 30. Facilitating study groups 4.6 .51 4 5 4 4 5 5 5 5 31. Greater accessibility to the King Saud 4.8 .40 4 5 4 5 5 5 5 5 University libraries 32. Ensuring the availability of and accessibility 4.6 .51 4 5 4 5 5 5 4 5 to computer laboratories 33. Adequate and accessible learning resources 4.5 .54 4 5 5 4 5 5 4 4 34. Objective and valid assessment, evaluation of 4.8 .4 4 5 5 5 5 5 5 4 student’s performance 35. Enjoyable learning experiences and materials 4.8 .4 4 5 5 5 5 5 5 4 36. Vary teaching methods to meet student needs 4.8 .51 4 5 5 4 5 5 5 4 37. Providing hands on training 4.8 .51 4 5 5 4 5 5 5 5 38. Encourage students to ask questions 4.6 .51 4 5 5 4 5 5 5 4 Environmental Factors
39. Greater student involvement in athletics 4.6 .51 4 5 4 5 5 5 4 5 activities 40. Students clubs that facilitate social interaction 4.6 .51 4 5 4 5 5 5 5 4 41. Part-time employment on the campus for 4.3 .51 4 5 4 4 5 5 4 4 students 42. Greater availability of campus residences 4.3 .81 3 5 4 3 5 5 4 5 43. Improved campus transportation services 4.6 .51 4 5 4 5 5 5 5 4 44. Healthy academic environment 4.6 .51 4 5 4 4 5 5 5 5
81
Table 4
Results from Round Three for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 45. Health care work experience 4.1 1.0 2 5 4 5 4 5 3 2 46. Peer support 3.8 .98 2 5 4 2 4 5 4 4 Social and Academic Integration Factors
47. Student-faculty interaction 5.0 .00 5 5 5 5 5 5 5 5 48. When a faculty member is a good role model 4.8 .40 4 5 5 4 5 5 5 5 for students 49. Acknowledge when students have done well 4.8 .40 4 5 5 4 5 5 5 5 50. Correct students’ mistakes and bad behavior 4.5 .54 4 5 5 4 5 5 4 4 without belittling them 51. The quality of academic advising 5.0 .0 5 5 5 5 5 5 5 5 52. Assessing students’ needs 5.0 .00 5 5 5 5 5 5 5 5 53. Smaller class size (less than 20 students in the 4.5 1.2 2 5 5 2 5 5 5 5 class) 54. Being active learners in the classrooms 5.0 .0 5 5 5 5 5 5 5 5 Students can be active learners through:
55. Developing presentations to give to other 4.0 1.2 2 5 4 2 5 5 5 3 students in the class 56. Producing one or more drafts of an 4.3 .51 4 5 4 4 5 5 4 4 assignment for faculty review and feedback before completing the final project Providing workshops to help student to increase skills in:
57. Taking notes 4.3 .51 4 5 4 4 5 5 4 4 58. Preparing for class 4.3 .51 4 5 4 4 5 5 4 4 59. Exam taking skills 4.5 .54 4 5 5 4 5 5 4 4 60. Critical thinking 4.8 .4 4 5 5 4 5 5 5 5 61. Engaging in extracurricular activities 4.6 .51 4 5 5 4 5 5 4 5 62. Engagement in community service 4.5 .83 3 5 5 4 5 5 4 3
82
Table 4
Results from Round Three for the Importance of Factors Promoting Retention and Success (continued) Item number M SD Min Max Frequency 63. Academic engagement 4.3 .51 4 5 5 4 4 5 4 4 Outside Surroundings Factors Cultural factors:
64. Students in the preparatory program who are 4.3 .81 3 5 5 4 3 5 4 5 interested in nursing spend a day at a University Hospital alongside a practicing RN 65. A day-long workshop for preparatory students 4.6 .54 4 5 4 5 5 5 4 4 at KSU about opportunities for nurses in the country (education requirements, employment opportunities, and payment incentives) 66. Full understanding and acceptance for the 4.6 .51 4 5 5 4 5 5 5 4 nursing as a profession 67. Students need to feel that they are parallel 4.6 .81 3 5 5 3 5 5 5 5 with their colleagues in other university programs (feeling of justice instead of inferiority)
Results of Delphi
Table 5 shows the summary of three rounds including the means, standard deviations, frequencies, and the agreement level. Consensus was achieved in all of these factors. However, when factors are listed thus, “___”, this indicates that they were added by the experts and were not rated in that round.
83
Table 5 Consensus about Factors Importance was Achieved in these Factors
Factors Round1 Round2 Round 3 M SD M SD M SD Frequency Agr %
Student Profile Characteristics
1. Special support for younger students, 4.7 .51 4.6 .51 4.6 .51 4 4 5 5 5 5 100 such as mentoring programs.
2. Senior students in the college mentor 4.5 .54 4.5 .54 4.5 .54 4 5 5 5 4 4 100 first-year students.
3. Students attributes. ______4.1 .75 4.5 .54 4 5 5 5 4 4 100
4. Family support. ______4.1 .4 4.1 .4 4 4 4 5 4 4 100
Admission criteria include:
5. High school GPA 4.1 .98 4.3 .81 4.3 .81 4 5 5 5 4 3 84
6. General Aptitude Test (Qiyas/ General 4.5 .55 4.0 .89 4.0 .89 4 4 3 5 5 3 68 Test)
7. Achievement Test scores (Qiyas/ 4.7 .51 4.0 .89 4.0 .89 4 4 3 5 5 3 84 Scientific Test)
Workshops and presentations for first-year students to emphasize skills to care for themselves such as:
8. Stress management 4.1 .75 4.1 .75 4.1 .75 3 4 5 5 4 4 84
9. Benefits of exercising 4.3 .51 4.3 .51 4.3 .51 4 4 5 5 4 4 100
10. Caring for health 4.5 .54 4.5 .54 4.5 .54 4 4 5 5 4 5 100
11. Self esteem (trusting their decision ______4.3 1.2 4.5 .83 5 4 5 5 5 3 84 to be nurses)
84
Table 5 Consensus about Factors Importance was Achieved in these Factors (continued)
Factors Round1 Round2 Round 3 M SD M SD M SD Frequency Agr %
12. Positive attitudes about academic ______4.5 .51 4.6 .51 4 5 5 5 5 4 100 commitment
13. Self motivation ______3.8 1.1 4.0 1.09 5 2 4 5 4 4 84
14. Willingness to learn ______4.6 .51 4.6 .51 5 4 4 5 5 5 100
15. Self-initiative ______4.3 .51 4.3 .51 5 4 4 5 4 4 100
Academic Factors
16. Clear and concise course policies and 5.0 .0 4.8 .4 4.8 .4 5 5 4 5 5 5 100
guidelines
17. Clear and ongoing expectations from 5.0 .0 5.0 .0 5.0 .0 5 5 5 5 5 5 100
the course materials
18. Clear, prompt feedback on questions, 5.0 .0 5.0 .0 5.0 .0 5 5 5 5 5 5 100
assignments, and grades
19. Relevant content and resources 4.8 .4 5.0 .0 5.0 .0 5 5 5 5 5 5 100
20. Opportunities for independent student 4.8 .4 4.5 .54 4.5 .54 4 4 4 5 5 5 100
learning
21. Interactive and updated ______4.8 .4 4.8 .4 5 5 5 5 5 4 100
courses/curriculum/program
22. Workshops for first-year students 4.8 .51 4.6 .51 4.6 .51 5 4 5 5 4 5 100
about effective preparation for class
85
Table 5 Consensus about Factors Importance was Achieved in these Factors (continued)
Factors Round1 Round2 Round 3 M SD M SD M SD Frequency Agr %
23. Intensive English language courses 4.8 .4 4.8 .4 4.8 .4 5 4 5 5 5 5 100
24. Emphasizing college attendance 4.8 .4 5.0 .0 5.0 .0 5 5 5 5 5 5 100
policies and the importance of
attending classes
25. The Preparatory Year program at 4.1 1.1 3.5 1.2 4.1 .75 4 5 4 5 4 3 84
KSU
26. Academic advice during the 4.6 .81 4.6 .51 4.8 .4 5 4 5 5 5 5 100
Preparatory Year at KSU
27. SCFHS’s Prometric exam preparation 4.8 .41 5.0 .0 5.0 .0 5 5 5 5 5 5 100
course for fourth year students
28. A medical terminology course in the 4.7 .51 4.6 .51 4.6 .51 5 4 5 5 4 5 100 first year curriculum
29. Online courses 3.8 1.4 4.3 .51 4.3 .51 4 4 4 5 4 5 100
30. Facilitating study groups 4.7 .51 4.6 .51 4.6 .51 4 4 5 5 5 5 100
31. Greater accessibility to the King Saud 4.8 .4 4.8 .4 4.8 .4 4 5 5 5 5 5 100 University libraries
32. Ensuring the availability of and 4.7 .51 4.6 .51 4.6 .51 4 5 5 5 4 5 100 accessibility to computer laboratories.
33. Adequate and accessible learning ______4.3 .51 4.5 .54 5 4 5 5 4 4 100 resources
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Table 5 Consensus about Factors Importance was Achieved in these Factors (continued)
Factors Round1 Round2 Round 3 M SD M SD M SD Frequency Agr %
34. Objective and valid assessment, ______4.8 .4 4.8 .4 5 5 5 5 5 4 100 evaluation of student’s performance.
35. Enjoyable learning experiences and ______4.8 .4 4.8 .4 5 4 5 5 5 5 100 materials
36. Vary teaching methods to meet ______4.6 .51 4.8 .51 5 4 5 5 5 4 100 student needs
37. Providing hands on training. ______4.6 .51 4.8 .4 5 4 5 5 5 5 100
38. Engaging in extracurricular activities ______4.6 .51 4.6 .51 5 4 5 5 4 5 100
Environmental Factors
39. Greater student involvement in 4.3 .81 4.6 .51 4.6 .51 4 5 5 5 4 5 100 athletic activities
40. Students clubs that facilitate social 4.5 .83 4.6 .51 4.6 .51 4 5 5 5 5 4 100 interaction
41. Part-time employment on the campus 4.1 .75 4.3 .51 4.3 .51 4 4 5 5 4 5 100 for students
42. Greater availability of campus 4.1 .93 4.3 .81 4.3 .81 4 3 5 5 4 5 84 residences
43. Improved campus transportation 4.5 .83 4.6 .51 4.6 .51 4 5 5 5 5 4 100 services
44. Healthy academic environment ______4.6 .51 4.6 .51 4 4 5 5 5 5 100
45. Health care work experience ______3.8 1.1 4.1 .98 4 5 5 5 3 3 68
46. Peer support ______3.8 1.0 3.8 .98 4 2 4 5 4 4 84
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Table 5 Consensus about Factors Importance was Achieved in these Factors (continued)
Factors Round1 Round2 Round 3 M SD M SD M SD Frequency Agr %
Social and Academic Integration Factors
47. Student-faculty interaction 4.6 .51 5.0 .0 5.0 .0 5 5 5 5 5 5 100
48. When faculty member is a good role ______4.5 .83 4.8 .4 5 4 5 5 5 5 100 models for students
49. Acknowledge when students have ______4.8 .4 4.8 .4 5 4 5 5 5 5 100 done well
50. Correct students’ mistakes and bad ______4.5 .54 4.5 .54 5 4 5 5 4 4 100 behavior without belittling them
51. The quality of academic advising 4.8 .4 5.0 .0 5.0 .0 5 5 5 5 5 5 100
52. Assessing students’ needs ____ 4.5 .83 4.5 .83 5 4 5 5 5 3 84
53. Smaller class size (Less than 20 4.0 1.4 4.5 1.2 4.5 1.2 5 2 5 5 5 5 84 students in the class)
54. Being active learners in the 5.0 .0 5.0 .0 5.0 .0 5 5 5 5 5 5 100 classrooms
Students can be active learners through:
55. Developing presentations to give to 4.3 .51 4.0 1.2 4.0 1.2 4 2 5 5 5 3 68 other students in the class
56. Producing one or more drafts of an 4.3 .51 4.3 .51 4.3 .51 4 4 5 5 4 4 100 assignment for faculty review and feedback before completing the final project
Providing workshops to help student to increase skills in:
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Table 5 Consensus about Factors Importance was Achieved in these Factors (continued)
Factors Round1 Round2 Round 3 M SD M SD M SD Frequency Agr %
57. Taking notes 4.3 .51 4.3 .51 4.3 .51 4 4 5 5 4 4 100
58. Preparing for class 4.3 .51 4.3 .51 4.3 .51 4 4 5 5 4 4 100
59. Exam taking skills 4.5 .54 4.5 .54 4.5 .54 5 4 5 5 4 4 100
60. Critical thinking 4.8 .4 4.8 .4 4.8 .4 5 4 5 5 5 5 100
61. Engaging in extracurricular activities ______4.6 .51 4.6 .51 5 4 5 5 4 5 100
62. Engagement in community service ______4.5 .83 4.5 .54 5 4 5 5 4 4 100
63. Academic engagement ______4.3 .51 4.5 .54 5 4 5 5 4 4 100
64. Students in the preparatory program 4.0 1.5 4.3 .81 4.3 .81 5 4 3 5 4 5 84 who are interested in nursing spend a day at a University Hospital alongside a practicing RN
65. A day-long workshop for preparatory 4.5 .54 4.5 .54 4.6 .51 5 4 55 4 5 100 students at KSU about opportunities for nurses in the country (education requirements, employment opportunities, and payment incentives)
66. Full understanding and acceptance ____ 4.6 .51 4.6 .51 5 4 5 5 5 4 100 for the nursing as a profession
67. Students need to feel that they are _____ 4.6 .81 4.6 .81 5 3 5 5 5 5 84 parallel with their colleagues in other university programs. (Feeling of justice instead of inferiority!)
Note. Agr % = agreement level. ___factors were added by the experts and were not rated in this round.
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Results in Phase II
Description of student participants
In the second phase of the study, 250 eligible undergraduate nursing students were contacted to participate in the study. Seventy-six returned the survey, a response rate of 30.4%. Most of the respondents (53%) were 5th-level (3rd college year). The 6th- level students made up almost 27% of the sample, whereas 7th and 8th level (4th year of college) comprised 3 % and 16% of the respondents, respectively. Sixty-three percent of participating students were female.
The students’ ages ranged from 20 to 39 years, with a mean of 23.5 years. This wide range of ages is likely, due to some students with diplomas in nursing returning for further education to earn their BSN degree. GAT scores ranged from 60–98%, with a mean of 78%. However, almost half of the students (48.5%) did not remember their
GAT score. This could be because some students held diplomas, and a long time had elapsed since they finished their GAT. Similarly, with the Achievement Test, more than the half the students (58.2%) did not remember their score. However, reported
Achievement Test scores ranged from 65–91%, with a mean of 78%. For High School
GPA, scores ranged from 71 to 99%, with a mean of 91%. Of the students, 31% did not remember their High School GPA. Current GPA ranged from 2 to 4.97, with a mean of
3.9 out of 5. For the highest earned degree, around 63% (n=42) had a high school degree and 37.3% (n=25) had a nursing diploma. Half of the students reported having a part- time job. Working hours ranged from one to more than 20 hours per week (see Table 6).
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Table 6 Frequencies Statistics for Students’ Employment Status ______Characteristics Frequency Percent Cumulative Percent ______Employment Status
Employed 35 52.20 52.2
Unemployed 32 47.80 100.0
Employment Hours per week
0 32 47.8 47.80
1-5 4 6.0 53.70
6-10 11 16.40 70.10
11-15 3 4.50 74.6
16-20 9 13.40 88.10
> 20 8 11.90 100
Students’ perception of factors promoting retention and success
As noted in Chapter 3, any factor with a mean equal to or greater than 3.5 was considered important for student retention and success from the students’ perspectives
(see Table 7). The results indicate that seven out of the 67 factors were not considered important by the students including
#2 (mean = 3.44) encouraging senior students in the college to mentor first-year
students,
#6 (mean = 3.28) the importance of considering GAT score as one of the
admission criteria,
#7 (mean = 3.44) consideration of the Achievement Test score as one of the
admission criteria,
#25 (mean = 3.37) the Preparatory Year program at KSU,
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#26 (mean = 3.41) academic advice during the Preparatory Year at KSU,
#30 (mean = 3.32) facilitating study groups, and
#56 (mean = 3.43) allowing students to be active learners through producing one
or more drafts of an assignment for faculty review and feedback before
completing the final project.
The remaining 60 factors were perceived as important for promoting student retention and success.
Table 7
Student Perceptions about the Important of Factors Promote Retention and Success
Factors Min Max M SD Student Profile Characteristics
1. Special support for younger students, such as 1 5 3.54 1.36 mentoring programs 2. Senior students in the college mentor first-year students 1 5 3.44 1.19
3. Students attributes 1 5 3.61 1.13
4. Family support 1 5 3.70 1.10
5. Admission criteria include: High school GPA 1 5 3.52 1.26
6. Admission criteria include: General Aptitude Test 1 5 3.28 1.24 (Qiyas/ General Test) 7. Admission criteria include: Achievement Test scores 1 5 3.41 1.17 (Qiyas/ Scientific Test)
Student Affective Factors:
8. Workshops and presentations for first-year students to 1 5 3.63 1.08 emphasize skills to care for themselves such as: Stress management
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Table 7
Student Perceptions about the Important of Factors Promote Retention and Success
(continued)
Factors Min Max M SD 9. Workshops and presentations for first-year students to 2 5 3.73 0.99 emphasize skills to care for themselves such as: Benefits of exercising
10. Workshops and presentations for first-year students to 1 5 3.70 1.01 emphasize skills to care for themselves such as: Caring for health
11. Self-esteem (trusting their decision to be nurses) 2 5 3.71 1.00 12. Positive attitudes about academic commitment 1 5 3.63 1.17 13. Self-motivation 1 5 3.69 1.10 14. Willingness to learn 1 5 3.77 1.09
15. Self-initiative 1 5 3.72 1.14 Academic Factors
16. Clear and concise course policies and guidelines 1 5 3.61 1.06
17. Clear and ongoing expectations from the course 1 5 3.69 1.06 materials 18. Clear, prompt feedback on questions, assignments, 2 5 3.82 1.04 and grades 19. Relevant content and resources 1 5 3.78 0.98
20. Opportunities for independent student learning 1 5 3.60 1.06
21. Interactive and updated courses/curriculum/program 1 5 3.69 1.04
22. Workshops for first-year students about effective 1 5 3.52 1.05 preparation for class 23. Intensive English language courses 1 5 3.69 1.08
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Table 7
Student Perceptions about the Important of Factors Promote Retention and Success
(continued)
Factors Min Max M SD 24. Emphasizing college attendance policies and the 1 5 3.60 1.06 importance of attending classes 25. The Preparatory Year program at KSU 1 5 3.37 1.10
26. Academic advice during the Preparatory Year at KSU 1 5 3.41 1.09
27. SCFHS’s Prometric exam preparation course for 1 5 3.58 1.18 fourth year students 28. A medical terminology course in the first year 1 5 3.52 1.24 curriculum 29. Online courses 1 5 3.54 1.00 30. Facilitating study groups 1 5 3.32 1.08 31. Greater accessibility to the King Saud University 1 5 3.60 0.97 libraries 32. Ensuring the availability of and accessibility to 1 5 3.54 1.16 computer laboratories 33. Adequate and accessible learning resources 1 5 3.54 1.21 34. Objective and valid assessment, evaluation of 1 5 3.57 1.16 student’s performance 35. Enjoyable learning experiences and materials 1 5 3.63 1.11 36. Vary teaching methods to meet student needs 1 5 3.52 1.11 37. Providing hands on training 2 5 3.74 1.07
38. Encourage students to ask questions 1 5 3.79 1.14
Environmental Factors
39. Greater student involvement in athletics activities 1 5 3.57 1.13
40. Students clubs that facilitate social interaction 1 5 3.60 1.10
41. Part-time employment on the campus for students 1 5 3.60 1.07
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Table 7
Student Perceptions about the Important of Factors Promote Retention and Success
(continued)
Factors Min Max M SD 42. Greater availability of campus residences 1 5 3.60 1.05
43. Improved campus transportation services 1 5 3.63 1.18
44. Healthy academic environment 1 5 3.76 1.09
45. Health care work experience 1 5 3.60 1.08
46. Peer support 1 5 3.69 1.05
Social and Academic Integration Factors
47. Student-faculty interaction 1 5 3.58 1.08 48. When a faculty member is a good role model for 1 5 3.61 1.15 students 49. Acknowledge when students have done well 1 5 3.85 1.03
50. Correct students’ mistakes and bad behavior without 1 5 3.73 1.10 belittling them 51. The quality of academic advising 1 5 3.57 1.09 52. Assessing students’ needs 1 5 3.54 1.25 53. Smaller class size (less than 20 students in the class) 1 5 3.63 1.07
54. Being active learners in the classrooms 2 5 3.72 1.08
55. Students can be active learners through: developing 1 5 3.53 1.00 presentations to give to other students in the class
56. Producing one or more drafts of an assignment for 1 5 3.43 1.17 faculty review and feedback before completing the final project 57. Providing workshops to help student to increase skills 1 5 3.67 1.13 in taking notes
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Table 7
Student Perceptions about the Important of Factors Promote Retention and Success
(continued)
Factors Min Max M SD 58. Providing workshops to help student to increase skills 1 5 3.61 1.07 in preparing for class
59. Providing workshops to help student to increase skills 1 5 3.61 1.14 in exam taking skills 60. Providing workshops to help student to increase skills 1 5 3.76 1.05 in critical thinking 61. Engaging in extracurricular activities 1 5 3.58 1.09
62. Engagement in community service 1 5 3.61 1.07 63. Academic engagement 1 5 3.61 1.11
Outside Surroundings Factors
Cultural factors:
64. Students in the preparatory program who are 1 5 3.52 1.31 interested in nursing spend a day at a University Hospital alongside a practicing RN 65. A day-long workshop for preparatory students at KSU 1 5 3.69 1.17 about opportunities for nurses in the country (education requirements, employment opportunities, and payment incentives)
66. Full understanding and acceptance for the nursing as a 1 5 3.69 1.21 profession
67. Students need to feel that they are parallel with their 1 5 3.77 1.09 colleagues in other university programs (feeling of justice instead of inferiority) Note. Factors were not important from students’ perceptions.
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Findings from open-ended questions
The purpose of the two open-ended questions was to learn about the participants’ pure perspectives before they read the list of factors. However, factors added by students and already included in the list, were omitted from the analysis to avoid redundancy.
Responses to these open-ended questions were analyzed using content analysis. In the first phase, “comprehending”, the researcher immersed himself in the data through reading the students’ answers multiple times. In the second phase, “categorization”, the researcher highlighted the emerging categories or themes (group of words with similar meaning).
The responses of the students fit naturally into the six categories proposed by
Jeffreys (2004), thus, the researcher wrote down key words or phrases from the responses and placed them into the categories. These categories included: student profile characteristics, student affective, academic, environmental, social and academic integration, and outside surroundings: for example: “presence of good friends around me encourage me to be the best” (Participant #13). The researcher used the keyword “having a good friend” in the social and academic integration category. As another example, in response to factors that promote retention, Participant #1 stated “good practice environment (rarely seen in hospital).” Similarly, (Participant #25) used the phrase
“comfortable practice environment.” The researcher used the key word “practice environment” for the two responses. However, as this item was available in the list of factors, this response was omitted. For words that had the same meaning, the researcher used the keywords of the responses that appeared more often in the text. For example,
Participant #18 used the phrase “good lifestyle” in response to the factors that promote
97 success; however, others (Participants #4, 9, and 12) used the phrase “having good health.” Thus, the phrase “having good health” was used and placed into student affective factors. The responses that included more than one theme were assigned to the appropriate categories. For instance, Participant #1 stated that “good practice in labs and hospitals.” The researcher separated the two responses into phrases, “good practice in labs” and “good practice in hospitals” and placed them into the academic factors.
At the beginning of the categorization phase, the researcher added another category “miscellaneous” in case some of the emerging themes did not fall into the six categories. However, since all the themes did fall into one of the six categories, the miscellaneous category was deleted. The actual number of times that each factor appeared in the participant responses is indicated in parentheses beside the words (see
Table 8). The responses were ordered according to how frequently they appeared.
Categories of responses to Open-Ended Question #1: “What are the top five factors that promote student retention?” (See Table 8).
Table 8
Responses for the First Open-Ended Question
Responses Profile Affec Acad Envir Socia Outsid Nursing reputation (15) X Saudi culture (13) X Family problems (12) X Having good friends (9) X Loving nursing (8) X Helpful teachers (7) X Time of the class (7) X Difficulty of courses (6) X Course content (6) X
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Table 8
Responses for the First Open-Ended Question (continued)
Responses Profile Affec Acad Envir Socia Outsid Curriculum (5) X Nursing future (5) X Good staff (5) X Freely choosing the major (7) X Feedback on the assignments X and exams (2) Years of study (1) X The possibility of getting a X master degree (1) Note. Student Profile Characteristics= Profile. Student Affective= Affec. Academic= Acad Environmental= Envir. Social and academic integration= Socia. Outside surroundings= Outsid.
From the above categorization, 11 new factors that promote student retention were synthesized. These were:
Outside surrounding factors:
1. Saudi culture negatively impacts nursing student retention. For example,
Participant #2 listed “social factor” as impacting student retention.
However, Participant #10 listed “Saudi culture.” Participant #24
mentioned “social issue” while others reported (participant #3, 6, 7, 9)
“social culture” as negatively impacting retention.
2. Nursing reputation negatively impacts the retention of nursing students.
For instance, Participant #28 listed “nursing reputation” as one factor
affecting retention. There was no more elaboration in this category
because students listed this phrase without explanation. However, in
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Chapter One, the impact of nursing reputation on the nursing profession
in the country was discussed.
3. Students who believe in the nursing future were more likely to remain in
the college. For instance, Participant #13 listed “Presence of a successful
career in the future” as a factor promoting retention. Participant #21 gave
an example of this category by stating: “When it is easy to find a job.”
Student profile characteristics:
4. Students who encounter family problems due to enrollment in nursing
college are less likely to remain in the college. This factor was brought
up by female students only. For example, Participant #15 reported
“having no family problem to be a nurse” as one factor promoting
retention. This student clearly stated what she meant by “family
problem.” However, most of the students listed family problems as one
of the factors impacting retention without elaboration.
5. Students who love nursing and caring are more likely to remain in
college. Different phrases were used by participants in reporting this
category. For example, Participant #12 listed “loving nursing”, whereas
Participant #13 stated “loving her major.” Participant #21 reported
“having interest in the profession”, and Participant #14 stated “students
who love nursing.”
Environmental factors:
6. Having good friends encourages students to stay in college, promoting
retention. For example Participant #13 stated that “presence of positive
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friends around you that encourage you to be the best” as one of the
factors promoting retention.
7. Having good staff promotes retention. For example, Participant #21
stated that “when staff are very friendly and helpful” in response to
factors that promote retention.
Academic factors:
8. Freely choosing the major promotes retention. For example, Participant
#36 reported “choosing, not being forced to choose the major.”
9. “Difficulty of courses negatively impacts student retention.” Participant
#59.
10. Time of the class promotes retention. For example, Participant #22
believed that “appropriate course schedule” promotes retention.
Social and academic integration:
11. Students believed that “helpful teachers” promote retention. Participant
#15 reported that having “good teachers” helps in promoting retention.
The following categories were not themes since fewer than three students brought them up them: feedback on the assignments and exams (2); years of study (1); and the possibility of achieving a master degree (1). However, the category “course content/curriculum” overlapped with the list of factors developed in phase I of the data collection in this study. Expert panelists believed that enjoyable courses promote retention. Similarly, Participant #21 reported that “interesting courses” promotes retention. Since this factor is included in the list, it was not omitted from the data synthesis here.
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Categories of responses to Open-Ended Question #2: “What are the top five factors that promote student success” (see Table 9).
Table 9 Responses for the Second Open-Ended Question Responses Profile Affec Acad Envir Socia Outsid Enough sleep (12) X Going to sleep early (10) X More practice time in the hospitals X (10) Having breakfast (9) X Coming early to the class (9) X Using all resources, including X textbooks, PowerPoint presentation slides and the handouts, for studying (9) More information about SCFHS’s X license exam (9) More practice time in the labs (9) X Course contents/materials X Note-taking (8) X Focusing on the class (8) X More workshops for students (8) X Minimal distraction in the class (8) X No cell phones in the class (8) X Having a short break during the class X time (8) Having good health (8) X Reading the materials (8) X Reviewing previous years exams (7) X
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Table 9 Responses for the Second Open-Ended Question (continued) Responses Profile Affec Acad Envir Socia Outsid More quizzes (7) X Having a goal (7) X Working hard to achieve the goal (6) X Note. Student Profile Characteristics= Profile. Student Affective= Affec. Academic= Acad Environmental= Envir. Social and academic integration= Socia. Outside surroundings= Outsid.
From the above categorization, 14 new factors that promote student retention were synthesized. These were:
Student affective factors:
1. Having a goal promotes student success. For this category Participant #13
stated “knowing what I want in the future” as promoting student success.
2. “Working hard to achieve the goal help student success.” Participant #34.
3. Having good health promotes success. For this category, Participant #18
stated “having a healthy lifestyle” as a factor promoting student success.
For students to succeed, they need to come to the class prepared, which includes:
4. Reading the materials. For instance, Participant #14 stated “reviewing the
materials before the class”; similarly, (Participant #36) used the phrase
“study the material before coming to the class.”
5. “Having enough sleep and going to sleep early.” Participant #18.
6. Having breakfast. For example, Participant #37 reported “having breakfast
before coming to the class to help focus with the teacher.”
7. “Coming early to the class.” Participant #36.
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8. Focusing on the class. For this category, Participant #22 stated “high
concentration level in the class” and Participant #36 listed “focusing with
the teacher in the class.”
9. Minimizing distractions (e.g., no cell phones in the class). For this category,
Participant #22 stated “high concentration level in the class”, whereas
Participant #36 used the phrases “no cell phone in the class” and “focusing
with the teacher.”
Academic factors:
10. More practice time in the hospitals and the labs promote success. For
example, Participants #22 and 61 reported “having more practice in the
hospitals and in the labs” as promoting success and they both used the same
phrase in response to the factors that promote success.
11. Using all resources, including textbooks, PowerPoint presentation slides, and
the handouts, for studying. Some students used the phrases “studying from
the textbooks.” Whereas others stated “studying from the books besides the
PowerPoint presentation slides and/or the handouts.
12. Having a short break during the class time promotes success. For instance,
(Participant #8) specified that by stating: “giving five minutes break during
the class.”
13. “Reviewing previous years’ exams helps student success.” Participant #14.
14. “More quizzes promote success.” Participant #61.
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Two categories overlapped with the list of factors developed in phase I of the data collection: taking notes in the class and needing more information about SCFHS’s license exam help student success. These categories were included in the list of factors, thus, these categories were omitted from the synthesis.
For the category of providing workshops for students, many students used this phrase, but did not elaborate on it. In other words, what do students need workshops for?
However, in the list of factors, expert panelists suggested that workshops be provided for the students; for instance, providing workshops to help students increase skills in: taking notes, preparing for class, exam taking skills, and critical thinking.
Comparison of categories of responses to open-ended questions
There was overlap in the categories/responses in the two open-ended questions, especially in the academic factors. For instance, students added some academic factors they believed promoted retention, and they added other or the same academic factors which they believed promoted success. This suggests that academic success enhances student retention since students who academically failed will be dismissed (Tinto, 1975).
Consequently, the student retention rate would decline. On the other hand, students who are happy with their institution’s environment would be involved in campus activities, increasing the likelihood of success (Astin, 1999). This is what Jefferys (2004) meant when he argued that retention and success are interrelated.
Nevertheless, there were factors that were perceived as uniquely important for either retention or success. For instance, factors that promote retention were outside surrounding/cultural factors, a student’s personal characteristics, social and academic integration, and environmental factors. This suggests that factors that promote retention
105 were mostly “non-academic factors.” Conversely factors that promote success were mainly related to academic issues and student affective characteristics. In other words, the amount the student invests in learning predicts student success (Astin, 1999).
The analysis of the open-ended questions yielded 25 factors that were added to the list of responses students perceived to be important in promoting retention and success. These factors were:
Student profile characteristics:
1. Family problems
2. Loving nursing
Students’ affective characteristics:
3. Having a goal
4. Working hard to achieve your goal
5. Having good health
Academic factors:
6. More practice in labs and hospitals
7. Difficulty of the courses
8. Time of the class
9. Freely choosing the major
10. Using all resources, including textbooks, PowerPoint presentation slides and
the handouts, for studying
11. Having more quizzes
12. Having a short break during class time
13. Reviewing previous years’ exams
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Coming to the class prepared, which included:
14. Having enough sleep and going to sleep early
15. Reading the materials
16. Having breakfast
17. Focusing on the class
18. Minimizing distractions (no cell phone in the class)
19. Coming to the class early
Environmental factors:
20. Having good friends
21. Having good staff
Social and academic integration:
22. Helpful teachers
Outside surrounding factors:
23. Saudi culture
24. Nursing reputation
25. Nursing future
Summary of the Students’ perception
The analysis of students’ perception about the factors that promote retention and success showed that students perceived 85 factors to be important—60 factors identified by the expert faculty panel and 25 additional factors emerged from the two open-ended questions.
Comparing and contrasting the perceptions
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During the first phase of data collection, expert faculty panelists rated 67 factors they believed to be important to student retention and success. Students agreed with the expert panelists on the importance of 60 factors, but disagreed with the remaining seven.
The factors that students believed to be less important are:
1. Factor #2: encouraging senior students in the college to mentor first-year
students
2. Factor #8: considering GAT score as one of the admission criteria
3. Factor #9: considering the Achievement Test score as one of the admission
criteria
4. Factor #41: the Preparatory Year program at KSU
5. Factor #42: academic advice during the Preparatory Year at KSU
6. Factor #46: facilitating study groups
7. Factor #78 “allowing students to be active learners through producing one or
more drafts of an assignment for faculty review and feedback before
completing the final project.”
In response to the two open-ended questions, students added 25 factors they believed to be important to student retention and success. To make the list of factors more meaningful and easier to discuss, the factors that were added by both the expert panelists and the students in response to the open-ended questions, were added to the appropriate categories that were proposed by Jefferys (2004). Under the new categorization, the distributions of factors were: student profile characteristics (9 factors), student affective factors (17), academic factors (31), environmental factors (10), social and academic integration factors (18), and outside surroundings factors /cultural factors
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(7). See table 10. More elaboration about the differences and similarities between the two groups are presented in Chapter 5.
Table10
Comparing Faculty Perceptions with Students Perceptions
Items Faculty Students M SD M SD Student Profile Characteristics
1. Special support for younger students 4.6 .51 3.5 1.3 2. Senior students in the college mentor first-year students 4.5 .54 3.44 1.18 3. Students’ attributes 4.5 .54 3.61 1.12 4. Loving nursing ______5. Family support 4.1 .4 3.7 1.1 6. Family problems ______Admission criteria include: 7. High school GPA 4.3 .81 3.5 1.2 8. General Aptitude Test (Qiyas/ General Test) 4.0 .89 3.28 1.3 9. Achievement Test scores (Qiyas/ Scientific Test) 4.0 .89 3.41 1.16 Student Affective Factors:
Workshops and presentations for first-year students to emphasize skills to care for themselves such as:
10. Stress management, 4.1 .75 3.62 1.08 11. Benefits of exercising, 4.3 .51 3.72 0.98 12. Caring for health, 4.5 .54 3.69 1.0 13. Having a goal ______14. Working hard to achieve your goal ______15. Having a good health ______16. Self esteem (trusting their decision to be nurses) 4.5 .83 3.71 1.0 17. Positive attitudes about academic commitment 4.6 .51 3.62 1.16 18. Self-motivation 4.0 1.09 3.68 1.1 19. Willingness to learn 4.6 .51 3.77 1.09
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Table10
Comparing Faculty Perceptions with Students Perceptions (continued)
Items Faculty Students M SD M SD 20. Self-initiative 4.3 .51 3.71 1.13 Coming to the class prepared, which includes: ______21. Having enough sleep and going to sleep early, ______22. Reading the materials, ______23. Having breakfast, ______24. Focusing on the class, ______25. Minimizing distractions (no cell phone in the class), ______26. Coming to the class early ______Academic Factors
27. Clear and concise course policies and guidelines 4.8 .4 3.61 1.05 28. Clear and ongoing expectations from the course 5.0 .0 3.69 1.05 materials 29. Clear, prompt feedback on questions, assignments, and 5.0 .0 3.82 1.04 grades 30. Relevant content 5.0 .0 3.5 1.3 31. Opportunities for independent student learning 4.5 .54 3.77 0.98 32. Interactive and updated courses/curriculum/program 4.8 .4 3.68 1.03 33. Using all resources, including textbooks, PowerPoint ______presentation slides and the handouts, for studying 34. Having more quizzes ______35. Having short break during the class time ______36. Reviewing previous years’ exams ______37. Difficulty of the courses ______38. Workshops for first-year students about effective 4.6 .51 3.59 1.05 preparation for class 39. Intensive English language courses 4.8 .4 3.68 1.07
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Table10
Comparing Faculty Perceptions with Students Perceptions (continued)
Items Faculty Students M SD M SD 40. Emphasizing college attendance policies and the 5 .0 3.6 1.05 importance of attending classes 41. The Preparatory Year program at KSU 4.1 .75 3.37 1.09 42. Academic advice during the Preparatory Year at KSU 4.8 .4 3.41 1.3 43. SCFHS’s Prometric exam preparation course for fourth 5.0 .0 3.58 1.18 year students 44. A medical terminology course in the first year 4.6 .51 3.52 1.23 curriculum 45. Online courses 4.3 .51 3.53 1.0 46. Facilitating study groups 4.6 .51 3.32 1.07 47. Greater accessibility to the King Saud University 4.8 .4 3.59 0.97 libraries 48. Ensuring the availability of and accessibility to 4.6 .51 3.53 1.15 computer laboratories 49. Adequate and accessible learning resources 4.5 .54 3.53 1.21 50. Objective and valid assessment, evaluation of student’s 4.8 .40 3.56 1.15 performance 51. Enjoyable learning experiences and materials 4.8 .4 3.62 1.11 52. Vary teaching methods to meet student needs 4.8 .51 3.52 1.1 53. Providing hands on training 4.8 .4 3.74 1.07 54. More practice in labs and hospitals ______55. Encourage students to ask questions 4.6 .51 3.79 1.13 56. Time of the class ______57. Freely choosing the major ______Environmental Factors
58. Greater student involvement in athletics activities 4.6 .51 3.56 1.13 59. Students clubs that facilitate social interaction 4.6 .51 3.59 1.10 60. Part-time employment on the campus for students 4.3 .51 3.5 1.3
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Table10
Comparing Faculty Perceptions with Students Perceptions (continued)
Items Faculty Students M SD M SD 61. Greater availability of campus residences 4.3 .81 3.59 1.07 62. Improved campus transportation services 4.6 .51 3.62 1.17
63. Healthy academic environment 4.6 .51 3.76 1.08 64. Health care work experience 4.1 .98 3.62 1.08 65. Peer support 3.8 .98 3.68 1.04 66. Having good friends ______67. Having a good staff ______Social and Academic Integration Factors 68. Student-faculty interaction 5.0 .0 3.57 1.08 69. When a faculty member is a good role model for 4.8 .4 3.61 1.15 students 70. Acknowledge when students have done well 4.8 .4 3.85 1.03 71. Helpful teachers ______72. Correct students’ mistakes and bad behavior without 4.5 .54 3.73 1.09 belittling them 73. The quality of academic advising 5.0 .0 3.56 1.09 74. Assessing students’ needs 4.5 .83 3.53 1.25 75. Smaller class size (less than 20 students in the class) 4.5 1.2 3.62 1.07 76. Being active learners in the classrooms 5.0 .0 3.71 1.08 Students can be active learners through: 77. Developing presentations to give to other students in 4.0 1.2 3.53 0.99 the class 78. Producing one or more drafts of an assignment for 4.30 .51 3.43 1.17 faculty review and feedback before completing the final project Providing workshops to help student to increase skills in: 79. Taking notes, 4.3 .51 3.67 1.13 80. Preparing for class, 4.3 .51 3.61 1.07
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Table10
Comparing Faculty Perceptions with Students Perceptions (continued)
Items Faculty Students M SD M SD 81. Exam taking skills, 4.5 .54 3.60 .13 82. Critical thinking, 4.8 .40 3.76 1.05 83. Engaging in extracurricular activities 4.6 .51 3.58 1.08 84. Engagement in community service 4.5 .54 3.61 1.07 85. Academic engagement 4.5 .54 3.61 1.14 Outside Surroundings Factors Cultural factors: 86. Students in the preparatory program who are interested 4.3 .81 3.52 1.3 in nursing spend a day at a University Hospital alongside a practicing RN 87. A day-long workshop for preparatory students at KSU 4.6 .51 3.68 1.17 about opportunities for nurses in the country (education requirements, employment opportunities, and payment incentives) 88. Full understanding and acceptance for the nursing as a 4.6 .51 3.68 1.2 profession 89. Students need to feel that they are parallel with their 4.6 .81 3.76 1.08 colleagues in other university programs. (Feeling of justice instead of inferiority!) 90. Saudi culture ______91. Nursing reputation ______92. Nursing future ______Note. indicates the factors that are not important from students’ perspective. ____ indicates that these factors were added by students in response to the open-ended questions.
Summary
There were similarities and differences between the perspectives of the expert panelists and students in regard to the factors that promote retention and success. It is
113 notable that students emphasized the importance of culture on retention and success, whereas the expert panelists focused on academic factors. In addition, faculty members believed in the importance of the working in groups, senior students mentoring freshmen, and students seeking feedback from their teachers. However, students disagreed with experts about the importance of these factors. Further discussion of these similarities and differences is presented in Chapter Five.
CHAPTER FIVE
DISCUSSION
This study has examined the factors that promote undergraduate student retention and success in a nursing program in Saudi Arabia. This study addressed the following research questions:
What are the factors influencing nursing student retention and success as
perceived by a panel of expert nursing faculty in Saudi Arabia?
What are the factors influencing nursing student retention and success as
perceived by undergraduate nursing students in Saudi Arabia?
What are the differences and/or similarities between the perspectives of a
panel of expert nursing faculty and the undergraduate nursing students in
regard to the factors influencing nursing student retention and success?
This chapter reviewed the findings from this study and answered these research questions within the context of existing literature. It is organized according to the six categories used to classify the factors. These categories, with the number of factors in parentheses, were: student profile characteristics (9), student affective factors (17), academic factors (31), environmental factors (10), social and academic integration factors
(18), and outside surroundings/cultural factors (8). In each category, the factors’ importance to retention and success are discussed in response to the perceptions of both
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115 expert panelists and students. The findings of this study are then linked to the existing literature.
Results and Existing Literature
Student profile characteristics
There are nine factors under student profile characteristics. Both students and expert panelists believed in the importance of four factors in promoting student retention and success. These were: special support for younger students, admission criteria that include high school GPA, students’ attributes, and family support. However, students disagreed with the expert panelists on the importance of three factors, which were: encouraging senior students to mentor first-year students; admission criteria that include
General Aptitude Test scores; and Achievement Test scores. In addition, students added two factors – family problems and loving nursing – as important in promoting or inhibiting retention and success.
Researchers argue that young student nurses (under 21 years of age) are more prone to encounter challenges in identity development, transition to university life, coping strategies and support (Shepherd, 2008; Wright & Wray, 2012). Thus, researchers outlined the importance of providing support in the first year to overcome the challenges of the transition to college. Similarly, this study found that the importance of special support for younger students in promoting retention and success was (M= 4.6 ± .51) for expert panelists vs. (M= 3.5 ± 1.3) for students. This highlights the importance of providing support for first-year nursing students in Saudi Arabia to overcome the challenges of the transition to college.
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Even though students in this study believed in the importance of providing special support for younger students, they did not believe that encouraging senior students to mentor first-year students would promote retention and success (M=3.44 ± 1.18). The expert panelists, in contrast, rated this factor as important for retention and success (M=
4.5 ± .54). The expert panelists’ perceptions were congruent with other studies where students highlighted support from their peers and senior students as important to their success (Cowin & Johnson, 2011; Wray et al., 2012). The discrepancy between the two views could be related to the fact that 83% of participating faculty members were non-
Saudi. Hence, this could limit what they know about the impact of the Saudi culture on retention and success. On the other hand, four experts (66%) had been on the curriculum committee more than five years, which could be enough for them to learn about the culture. Hence, further study is needed to clarify this topic. Nevertheless, students’ perceptions about this factor could be related to Saudi culture, in which students prefer to work as individuals as opposed to in groups (Razek & Coyner, 2011); alternatively, it could be due to the fact that the students surveyed were seniors, and may not have wished to have extra work mentoring junior students. This highlights the need for further study to examine this topic and suggest possible alternatives to promote retention and success.
Student attributes could contribute to retention and success (Jeffreys, 2004).
Student attributes refers to a student’s characteristics prior to beginning a nursing course, including age, gender, prior educational experience, employment status, family background, and enrollment status (Jeffreys, 2004). There was agreement between expert panelists and students in this study about the importance of student attributes in promoting retention and success (M=4.5 ± .54 for expert panelists vs. M=3.6 ± 1.2 for
117 students). Similarly, Wyatt (2011) noted that the growing number of nontraditional students returning to college campuses increased the need for educators to study those students’ attributes and create a supportive environment to enhance retention and success
(Wyatt, 2011). In the study setting, there were many students, especially in the female program, who were returning to the college for a bridging program to earn a BSN degree.
Without determining their special challenges and needs, the nursing educators in the college will be missing an important factor that promotes retention and success. It is recommended that the college’s administrative personnel create a supportive learning environment to help those students remain and succeed in the college.
In this study, students believed that enrolled students who love nursing are more likely to remain in college and succeed. As discussed earlier, admission to the nursing college is competitively based on the Preparatory Year GPA. Thus, students with higher
GPAs are directed toward other programs like medicine. Hence, we could have students who did not choose nursing as a major, but were assigned to nursing college based on their GPA. Those students should be given the chance to transfer to other colleges, since nursing was not their first choice.
Family support was an important factor promoting student retention and success
(M=4.1 ± .40 for expert panelists, vs. 3.7 ± 1.1 for students). These findings are congruent with Depremont’s (2011) study, which indicated that African American nursing students valued their family support and faculty encouragement as factors that enhanced success. Even though family support is an important factor in promoting retention and success, family problems on the other hand could have a negative impact.
Students in this study, especially females, cited family problems as one the factors
118 inhibiting their retention and success. There was no discussion about this factor, however, since students just listed it without further explanation. However, these findings are not surprising since, as noted in Chapter One, both family in Saudi culture and the public image of nursing in the country are important factors when considering career choice. Many women associated nursing with long working hours, working with males (a culturally challenging prospect), and the worry that they might not be able to get married since they would not have time for their family obligations (Al-Omar, 2004). On the other hand, in Saudi culture, there is great emphasis on the needs, attitudes, and objectives of the family, as opposed to in individualistic societies where personal goals are often more important than family ones (Long & Maisel, 2010). Considering these findings, it is recommended that nurse administrators involve family in workshops that discuss the future of nursing and to include success stories from Saudi nurses of both genders. Success stories have been widely used to change behaviors and attitudes, and have been shown to motivate and encourage participants to continue on a weight-loss program (Hwang et al., 2010) and with smoking cessation (Butler et al., 2014).
There is evidence that high school grade point average (GPA) and SAT scores predict students’ success (Ullmer, 2012). Similarly, in this study both expert panelists and students agreed about the importance of considering the high school GPA as one of the admission criteria (M= 4.3 ± .81 for expert panelists vs. M=3.5 ± 1.2 for students). It worth mentioning that even though both groups believed in the relevance of this factor to student retention and success, the standard deviations indicated low agreement between students and experts on its importance. However, there was disagreement between the student and expert panelists on the importance of GAT and Achievement Test scores in
119 predicting students’ retention and success. Expert panelists perceived these factors as important whereas students did not. The mean and the standard deviations of the importance of considering GAT scores as one of the admission criteria were 4.0 ± .89 for expert panelists vs. 3.28 ± 1.3 for students. The mean and the standard deviations of the importance of considering Achievement Test scores as one of the admission criteria were
4.0 ± .89 for expert panelists vs. 3.4 ± 1.16 for students.
These results represented contradictory findings about the importance of these three factors in predicting student retention and success in Saudi Arabia. Researchers have found that preadmission criteria (high school GPA, GAT scores and Achievement
Test scores) predicted college success in medical education in Saudi Arabia (Al Alwan et al., 2013; Albishri et al., 2012). Nonetheless, none of these studies was conducted in a nursing setting, so it hard to argue that embracing these preadmission criteria would predict student retention and success in that context. Currently, admission to nursing programs is competitive and based only on the preparatory year GPA, without considering high school GPA, GAT or Achievement Test scores (Preparatory Year,
2009). However, starting with the next academic year (2015/2016), admission to the nursing program will include consideration of the Preparatory Year GPA, high school
GPA, GAT and Achievement Test scores (Preparatory Year, 2009). Thus, it is recommended to track how these factors predict nursing students’ retention and success.
Student affective factors
There are 17 student affective factors. Both student and expert panelists believed in the importance of eight factors in promoting student retention and success. These included providing workshops and presentations for first-year students to emphasize
120 skills for stress management, the benefits of exercising, and caring for health; self esteem, positive attitudes about academic commitment, self motivation, willingness to learn, and self-initiative. However, students added nine factors that they believed promoted retention and success. These were: having a goal, working hard to achieve the goal, good health, and coming to the class prepared, which included: getting enough sleep, reading the materials, having breakfast, focusing on the class, minimizing distractions (no cell phones in class), and coming to the class early.
Providing workshops and presentations for first-year students to emphasize skills to care for themselves was perceived as an important factor to promote retention and success. The workshops would include: stress management (4.1 ± .75 for experts, 3.62 ±
1.08 for students), benefits of exercising (4.3 ± .51 for experts, 3.72 ± .98 for students), and caring for health (4.5 ± .54 for experts, 3.69 ± 1.0 for students). Students in this study claimed that good health/self-care was one of the factors promoting retention and success. McDonough (2013) suggested that there is a relationship between students’ self- care and their retention and success in college. Indeed, self-care is the second most important factor after study habits (Gardner et al., 2007). Self-care strategies reported by students included exercise, stress management, having enough rest, and proper health
(McDonough, 2013). Similar findings have been reported by De Ridder et al. (2012).
These findings are congruent with those of this study, in which students addressed the need to come to class prepared. Abdulghani et al. 2012 found that insufficient sleep duration and delayed sleep onset negatively impacted Saudi medical students’ success.
Considering the normal sleeping time, which is 7 to 10 hours per day, almost half of the sample slept from just 4 to 6 hours. In addition, the study indicated that female students
121 were affected by sleep disorder (sleep duration and delayed onset) more than male students. In fact, Eliasson, Lettieri, and Eliasson (2010) found that timing of sleep is more correlated with academic success than the total sleep hours. Hence, “early to bed” matters more than the “total sleep hours” in regard to academic success. Sleep deprivation could negatively impact students’ retention and success due to psychiatric disorders, psychosocial stress, and memory problems (Davies et al., 2014; Eliasson et al.,
2010, Frenda, Patihis, Loftus, Lewis, & Fenn, 2014).
Thus, based on the findings of this study, it is recommended that nursing educators in the college implement a program to enhance student retention and success by targeting self-care. Self-care could help students in managing their stress, caring for their health, engaging in physical exercise, and coming to the class prepared.
Willingness to learn and a positive attitude toward academic commitment were rated as important factors promoting retention and success. Both expert panelists and students believed in the importance of willingness to learn (4.6 ± .51 for expert panelists;
3.77 ± 1.09 for students). Similarly, a positive attitude about academic commitment was rated at 4.6 ± .51 by expert panelists and 3.62 ± 1.16 by students. When discussing academic commitment and willingness to learn, Astin (1999) used the term “academic involvement” to refer to the extent to which students work hard at their studies, the number of hours they spend studying, their degree of interest in their courses, and good study habits. In the same vein, Kuh et al. (2005) used the term “academic challenge” to refer to the amount of time a student spends preparing for class, reading assigned books and other materials, and writing reports and papers. Research findings have suggested that the most important factor helping undergraduate students to succeed in the nursing
122 program was personal study habits (Gardner et al., 2007). Examples of good study habits reported by students included spending more hours studying, avoiding distractions, managing their time, preparing for tests more thoroughly; making charts and note cards, completing assignments before the due date, attending class, and familiarizing themselves with the lecture material. Similar findings were reported by Hafford-Letchfield (2007) and O’Gara (2009). These findings suggested the importance of more thoroughly examining the best practices to enhance students’ willingness to learn and academic commitment in a Saudi setting.
Besides having a positive academic commitment, students need to be self- motivated to remain and succeed in college. Self-motivation was rated to be important in promoting retention and success by both expert panelists and students (4.0 ± 1.09 expert panelists; 3.68 ± 1.10 students). These findings were congruent with those of Bykerk-
Kauffman et al. (2009), Madonna and Philpot (2013), and Stegers-Jager, Cohen-
Schotanus and Themmen (2012), who found that self-motivation is positively correlated with student retention and success.
Another important factor for student retention and success was self-esteem, which was represented as trusting their decision to be nurses (4.5 ± .83 experts, 3.71 ± 1.0 students). These findings were congruent with those of Burdenski and Faulkner (2010), who found that the more students’ self-esteem increased, the more their academic success increased. Nurse educators may conduct workshops for students to discuss their nursing future and opportunities after graduation, which may increase their self esteem and thus increase retention and success.
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Students’ need to be self-initiating to promote retention and success was rated at
4.3 ± .51 by the expert panelists and 3.71 ± 1.13 by the students. These findings are congruent with those of Sato (2012), who found that when Japanese students were involved in self-initiating strategies they learned English. Self-initiative can be defined as “a behavior syndrome resulting in an individual’s taking an active and self-starting approach to work and going beyond what is formally required in a given job” (Frese, Fay,
Hilburger, Leng, & Tag, 1997, p.140). It is characterized by the following: 1) a long- term plan, 2) a directed goal, 3) self-starting and proactivity, and 4) persistence in overcoming obstacles and difficulties (Frese et al., 1997). Self-initiating students will be doing things they may never have been told to do, setting a clear goal, working hard to achieve that goal, and overcoming barriers and difficulties. This is congruent with the students’ perception in this study, in which they believed that having a goal and working hard to achieve it was an important factor in promoting retention and success. In other studies, goal-setting was found to be a crucial step to student retention and success
(Bressler, Bressler & Bressler, 2010; Robinson & Gahagan, 2010). Students who have set their goal at early stage in college are more likely to work to meet both personal and academic goals (Bressler et al., 2010; Robinson & Gahagan, 2010). There are steps students need to follow to set their goals and to become self-initiating. While it is beyond the remit of this study to discuss this topic in detail, nursing educators may wish to consider developing a plan to help students become self-initiating in order to promote retention and success.
Academic factors
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There are 31 academic factors. Both student and expert panelists believed in the importance of 20 factors in promoting student retention and success. However, students disagreed with the expert panelists on the importance of three factors: the Preparatory
Year program at KSU, academic advice during the Preparatory Year, and facilitating study groups. Nonetheless, in response to the two open-ended questions, students added eight factors to promote retention and success.
Both expert panelists and students rated the importance of having the following factors to promote student retention and success in nursing programs in Saudi Arabia:
1. Clear and concise course policies and guidelines (4.8 ± .4 for experts, 3.61
± 1.05 for students).
2. Clear and ongoing expectations from the course materials (5.0 ± .00 for
experts, 3.69 ± 1.05 for students).
3. Clear, prompt feedback on questions, assignments, and grades (5.0 ± .00
for experts, 3.82 ± 1.04 for students).
4. Relevant content (5.0 ± .00 for experts, 3.5 ± 1.3 for students).
5. Opportunities for independent learning (4.5 ± .54 for experts, 3.77 ± .98
for students).
These findings are congruent with those of Manning (2010), who recruited 16 faculty at a southeastern community college in the US as an expert panel to give their perceptions about factors that influence student retention and success. The findings outlined the importance of these best practices in promoting retention and success. Thus, there is a need to emphasize the course policies and guidelines, as well as the expectations from the course materials in the college syllabi. To engage students in the
125 learning process, faculty need to provide helpful feedback (Shoepe, 2014). However, there is limited input from the faculty members in deciding on the content of the courses due to the centralized education system in Saudi Arabia, as discussed in Chapter One
(Alamri, 2011; Hamdan, 2014). However, through the curriculum committee in the college, recommendations and suggestions need to be made to the curriculum committee at the university level to make changes to the content of courses to make them relevant to the students’ needs. This study has shown the importance of having interactive and updated courses/curriculum/programs in promoting student retention and success (4.8 ±
.4 for experts, 3.68 ± 1.30 for students). Without academic freedom, nurse educators might have limited options to meet these recommendations.
Findings from this study indicated that the participants valued the importance of the independent (self-directed) learning. As knowledge in health care continues to expand and new technology develops, it becomes increasingly crucial that graduates engage in life-long learning. Consequently, nurses will be able to provide the best nursing care based on the current evidence-based practice (Dowing et al., 2009; Hoges,
2011; Kaddoura, 2011; Klegeris & Hurren, 2011). The findings of this study are congruent with the educational practices in western countries, such as the United Sates, where higher education is based on educational models that prepare students to be self- learners who can meet the challenges in the future. For instance, in February 2010, a forum was held about the challenges and future of nursing education by the IOM and the
Robert Wood Johnson Foundation (IOM, 2010). This forum outlined many recommendations about the future of nursing education. For instance, Recommendation
6 spoke to ensuring that nurses engage in self-directed learning.
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In contrast to US educational practices, students in Saudi universities are educated through the traditional lecturing approach where students are trained to memorize information to be retrieved only to pass exams (Alnassar & Dow, 2013). Thus, students lack skills in research, inference, and independent learning. Hence, students will not be able to locate new sources of information in the future. In fact, the main criticism levied at the Saudi teaching approach is that teaching methods are generally adopted to maximize the theoretical information, while placing less emphasis on teaching critical and creative thinking (El-Gilany & Sayed, 2013). This applies to all professions in the country with the exception of medical education in which, educational practices are problem-based rather than information gathering (Al-Shehri et al., 2013).
Even though the findings of this study indicate that the participants valued independent learning, course content in the country is usually delivered through a lecture which inhibits such an approach (Hamdan, 2014). Investing heavily in one teaching approach (lecturing) contradicts the view of the study participants, who valued varying teaching methods to meet students’ needs (4.8 ± .51 experts; 3.52 ± 1.10 for students).
It is important for students to have handouts or PowerPoint slides prior to the class to decrease note-taking time and allow them to concentrate. For instance,
Wongkietkachorn, Prakoonsuksapan and Wangsaturaka (2014) studied the importance of handouts on medical students’ academic success. The results indicated that an absence of handouts decreased student concentration by 83.6%, note-taking decreased by 38%, and class-skipping increased. Similarly, handouts allowed students to write less, giving them more time to engage in the class (Marsh & Sink, 2010; Nelson-Wong, Eigsti,
Hammerich, & Ellison, 2013). However, these studies indicated that handouts are to be
127 used only as study guidance to help students during class, but not to replace textbooks or other sources when studying for exams. Full use of all resources, including textbooks,
PowerPoint presentation slides and handouts, promotes student retention and success.
Thus, the findings of this study are supported by the existing literature. Faculty members may encourage students to use these handouts and PowerPoint slides as guidance to study, but not neglect the textbooks and other assigned resources.
Taking quizzes provides feedback for students, offers learning strategies, and allows students to modify these strategies to enhance learning (Shafiq & Siddiquah,
2011). Other studies showed that pre-exam quizzes significantly increased the percentage of students answering exam questions correctly compared with prior quizzes
(Kulesza, Clawson, & Ridgway, 2014; Orr & Foster, 2013). Similarly, the students in this study added that quizzes promoted retention and success. Hence, nurse educators in the college are recommended to provide more quizzes to enhance retention and success.
Short physical activity breaks help students to become refreshed and motivated to learn. For example, Mahar (2010) found that students who had short physical activity breaks got significantly higher scores for attention to the class compared to those who did not. Thus, students should not sit for more than 60 minutes without taking a short (3–5 minute) break (Castelli &Ward, 2012). This is congruent with students’ belief that having a short break during class promoted retention and success. Faculty members are therefore encouraged to follow these recommendations.
The availability and accessibility of previous years’ exam papers can enhance student success (Pass, Mehta, & Mehta, 2012). Reviewing past years’ exams help students to recognize missing or incorrect knowledge and encourages them to go over
128 their knowledge deficit (Pass et al., 2012). This is congruent with students’ perceptions that reviewing previous years’ exams promoted retention and success. In fact, each course in the nursing program in the college has a file containing previous years’ midterm exams, final exams, and an anonymous sample of students’ answers as a requirement of the accreditation organization. The previous year’s exam is available to all faculty members, but it is up to the faculty to make it accessible to students. These findings suggest that faculty should make the previous year’s exam accessible to students to promote retention and success.
The difficulty of the courses could negatively impact student retention and success. Researchers reported that an appropriate course workload significantly increased medical students’ self-efficacy and academic success (Kassab, Al-Shafei,
Salem, & Otoom, 2015). In another study, course difficulty was perceived to be one of the important factors affecting student success (Mahrous & Kortam, 2012). Other researchers claimed a lack of relationship between perceived course difficulty and students’ approaches to learning (Kyndt, Dochy, Struyven, & Cascallar, 2011). A perceived lack of information correlated with poor academic success regardless of the perceived workload and task complexity. In other words, perceived course difficulty did not correlate with academic success but did correlate with a perceived lack of knowledge.
In this study, students believed that the difficulty of the courses could inhibit retention and success. However, nurse educators in Saudi Arabia are encouraged to incorporate the findings of all these studies through ensuring an appropriate workload, while providing students with the needed knowledge.
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There was agreement between expert panelists and students about the importance of providing workshops for first-year students about effective preparation for class. The mean and standard deviations of the importance of this factor were (4.6 ± .51) for experts and (3.59 ± 1.05) for students. I have discussed earlier the importance of providing support for first-year students, and we have outlined what students believed to be important for getting prepared for the class. Thus, in linking these findings together, we could argue the importance of providing workshops for first-year students that included the five suggestions students gave to prepare for class.
Students whose first language is not the same as that used in school will have special academic needs (Jeffreys, 2004). In this study, both students and expert panelists believed in the importance of providing intensive English language courses to promote student retention and success (4.8 ± .4 for experts, 3.68 ± 1.07 for students). These findings are congruent with what I discussed in Chapter Two. Nursing colleges in Saudi
Arabia use the English language as a medium of instruction since the required textbooks are in written in English (Alhussain, 2009; Suliman & Tadros, 2011). In addition, the
English language is needed to prepare future nurses for the workplace, as many hospitals’ policies require that all written and verbal communication among staff be in English
(Alhussain, 2009; Suliman & Tadros, 2011). Despite the importance of the English language, 67.6% of undergraduate nursing students at different levels of the nursing program at King Saud Bin Abdulaziz University reported a fear of communicating in
English (Suliman & Tadros, 2011). Thus, providing intensive English language courses is imperative to promote student retention and success.
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Research findings proposed a positive correlation between class attendance and student retention and success as opposed to absenteeism, which is positively correlated with attrition (Currie et al., 2014; Gardner et al., 2007; McCarey et al., 2007). Similarly, in this study, all expert panelists rated the importance of emphasizing the college attendance policies and the importance of attending classes as 5 out of 5; however, students rated this factor at 3.6 ± 1.05. Thus, there is a need to educate freshmen students about college attendance policies and how important it is to minimize absenteeism.
In Chapter Two, the researcher discussed the aim of the Preparatory Year at KSU.
However, this is the first study to examine both students’ and faculty perceptions of its importance with regard to retention and success. The perceptions of faculty and students were contrary. While faculty believed in the importance of this program in promoting retention and success, the students disagreed. The mean and standard deviation of the importance of the Preparatory Year program at KSU were 4.1 ± .75 for experts, and 3.37
± 1.09 for students. Similarly, the mean and standard deviation of the importance of the academic advice during the Preparatory Year were 4.8 ± .40 for experts, and 3.41 ± 1.3 for students. The expert panelists believed in the importance of the academic advice given during the Preparatory Year in promoting student retention and success, while the students did not.
Further study is therefore needed to examine how important this program in promoting retention and success and whether or not modifications are needed to make it achieve its aims. However, faculty perceptions about the importance of academic advice during this program were congruent with other studies that showed that the advice provided to pre-college students on the Preparatory Program has helped Saudi students to
131 meet their academic, psychological and social needs (Al-Daghri et al., 2014; Tashtoush,
2012). However, students in this study did not value the advice provided for them in this program. Students’ responses to this item might reflect their lack of valuing the
Preparatory Year, and the advice provided to them in this program, altogether.
Fear of not being able to pass the license exam could decrease nursing student retention rates (McDonough, 2013). On the other hand, student success in this study is defined as the completion of BSN program graduation requirements and passing the license exam (Jefferys, 2007). Thus, it is important to prepare students to pass the license exam. In this study, both students and expert panelists believed in the importance of providing SCFHS’s Prometric exam preparation course for fourth-year students to help them prepare to pass the license exam after graduation. The means and standard deviation of the importance of the license exam preparation course were 5.0 ± .00 for experts, 3.58 ± 1.18 for students. These findings are congruent with other research that claimed the importance of the preparation course for the licensure exam in promoting student retention and success (Higgins, 2005; McDonough, 2013; Sutherland et al.,
2007). Hence, it is recommended that the curriculum committee in the nursing college should consider implementing such program to promote retention and success since such a program is not available now.
Even in the English-speaking countries, undergraduate nursing students have a hard time reading and comprehending nursing texts because of the high reading level and medical terminology (McDonough, 2013). The findings of this study indicated the importance of providing a medical terminology course in the first-year curriculum to promote student retention and success. The mean and standard deviations of the
132 importance of providing a medical terminology course in the first year curriculum were
4.6 ± .51 for experts, 3.52 ± 1.23 for students. These findings are congruent with another study that reported that Saudi medical students spent considerable time translating medical terminology from Latin to English and then to Arabic (Abdulghani et al., 2014).
Hence, it is recommended that the curriculum committee consider curriculum reform to incorporate a medical terminology course into the nursing program to promote retention and success.
Both students and expert panelists believed in the importance of providing online courses to promote retention and success. The mean and standard deviations of the importance of providing online courses were 4.3 ± .51 for experts, 3.53 ± 1.00 for students. These findings are congruent with Hamdan (2014), who reported that online courses helped students to get involved in the learning process and, as Astin (1999) suggests, involved students are more likely to remain and succeed in college. Similarly,
Willekens (2010) found that online student-faculty interaction increased the likelihood of student success through the greater use of technology. Considering the fact that some of the students in the college are working part time and studying in the bridging program, online courses could make it easier for them to attend class while they are at home. Thus, the nursing administration in the college is advised to consider implementing online courses to help promote retention and success.
Group learning helped students to accomplish complicated tasks more effectively than individual learning (Dohaney & Kennedy, 2009; Kirschner et al., 2009b). However, this study represented contradictory findings about the importance of group learning in promoting retention and success. The expert panelists believed in the importance of
133 facilitating study groups to promote student retention and success, but the students did not consider this factor to be important. The mean and standard deviations of the importance of group study were 4.6 ± .51 for experts and 3.32 ± 1.07 for students. The researcher discussed working in groups in Saudi education in Chapter One. Here, the researcher briefly summarizes those findings with some elaborations. There are contradictory findings about studying in groups in Saudi education. Some researchers have argued that students’ views of education are generally influenced by the collectivist norm of the culture (Hamdan, 2014), which may negatively impact their collaborative learning experience (Alkhalaf et al., 2013; Razek & Coyner, 2011). However, others claim that there is no relationship between the Saudi collective cultural norm and group collaboration, and suggest that Saudi students found that collaborative learning helped them to learn better than individual learning. For instance, Abdulghani et al. (2014) found that Saudi medical students work collaboratively in small groups to help each other overcome their English-language barriers and learn the course content better than through individual learning. In addition, many studies conducted in Saudi medical schools found that students learned better in small groups in subjects delivered through a Problem
Based Learning approach than through individual learning in a Lecture Based Learning approach (Albarrak et al., 2013; Meo, 2013; Suleman et al., 2010).
However, all these studies claiming that there is no relationship between Saudi culture and learning in groups were conducted in medical education, where Problem
Based Learning (PBL) is common. Thus, students were trained to work in groups as one of the PBL characteristics. Consequently, medical students had experience working in groups, which may have impacted their perception about group work. In nursing
134 education, however, the main teaching method is a lecturing approach. If we were to implement other teaching methods, such as PBL, that required students to work in groups, this might change their perceptions about group work. However, one may ask, if students did not value group learning, why did faculty believe otherwise? Referring to the experts’ demographics, 83% of participating faculty members were non-Saudi. This could limit their knowledge about the culture and its impact on the way students learn.
However, since our students are not trained to work in groups, faculty who wish to facilitate group work need to consider the challenges they will encounter in the first group get-together. Barrows (1988) has suggested ground rules for the first group session in order to make group work more beneficial. Faculty members in the college are encouraged to follow these steps to make group work more effective.
Learning resources are very important for enhancing academic achievement. In this study, both expert panelists and students believed that the availability and accessibility of resources promote student retention and success. These resources include greater accessibility to the King Saud University libraries (4.8 ± .4 for experts, 3.59 ± .97 for students), ensuring the availability and accessibility of computer laboratories (4.6 ±
.51 for experts, 3.53 ± 1.15 for students), and adequate and accessible learning resources
(4.5 ± .54 for experts, 3.53 ± 1.21 for students). These findings are congruent with other studies that suggested that students who use academic library services and other library resources on at least one occasion during the academic year are more likely to have higher GPA and retention than their peers who did not (Soria et al., 2014). Similar findings were reported by Grallo et al. (2012) and Needham et al. (2013). Thus, general academic services such as university libraries, learning resources, and computer
135 laboratories in KSU are needed to be more available and accessible to promote retention and success.
Learning experience that captures the attention of students is crucial to meaningful learning (Ziyaeemehr & Kumar, 2014). This study suggested that enjoyable learning experiences and materials promote student retention and success (4.8 ± .4 for experts, 3.62 ± 1.1 for students). In discussing the importance of making nursing education more enjoyable, Baid and Lambert (2010) argued that “rather than standing at the front of a group of learners simply speaking about a topic, teachers have the opportunity of livening up their teaching with humor, games, and other fun activities”
(p.1). Educators are encouraged to teach in a manner that catches the interest of students and keeps them motivated to learn (Baid & Lambert, 2010; Stankić, 2011; Ziyaeemehr &
Kumar, 2014). Unfortunately, the current teaching method in the college may prevent students from enjoying their learning experience, since content is usually delivered through a lecturing approach. Thus, nursing educators in the college are required to reflect on these findings and to make efforts to ensure that courses are more enjoyable.
Varying the teaching methods may help faculty to make courses more enjoyable and meaningful and thus promote retention and success.
The importance of clinical settings in nursing rests on the fact that they are the places where students apply what they have learned in the classroom (Ironside, McNelis,
& Ebright, 2014). Both groups in this study believed in the importance of providing hands-on training in the labs and the hospitals to promote student retention and success
(4.8 ± .40 for experts, 3.74 ± 1.07 for students). These findings were congruent with
Gubrud-Howe and Schoessler (2008), who outlined that hands-on training improved
136 student achievement and promoted success. Thus, a recommendation would be made to the curriculum committee to consider increasing the practice hours to promote student success.
There is evidence that the first step students take to fill their knowledge gaps is to pose questions (Chin & Osborne, 2008). Thus, a student’s question indicates their engagement in the learning process (Sung-Hee & Soobong, 2012). Similarly, in this study both students and faculty members believed in the importance of encouraging students to ask questions (4.6 ± .51 for experts, 3.79 ± 1.13 for students). These findings are congruent with the idea that students’ questions play an important role in meaningful learning and scientific inquiry (Chin & Osborne, 2008; Eshach, Dor-Ziderman, &
Yefroimsky, 2014; Niemczyk & Savenye, 2010). In order to promote retention and success, therefore, students should be encouraged to ask questions.
To promote retention and success, institutions need to ensure that classes are held at times that are convenient in terms of the students’ needs (Wyatt, 2011). In this study, students addressed the importance of times of classes to retention and success. These findings reinforce the need for institutional leaders to consider the time factor in order to make classes more convenient for part-time students.
The researcher has argued that its important that students are able to freely select their major if they are to remain in college (Ferratt, 2010; Germeijs, Luyckx, Notelaers,
Goossens, & Verschueren, 2012). This was confirmed by the findings reported in this study, in which students believed in the importance to retention and success of being allowed to choose their major freely. However, as discussed in Chapter Two, admission to medical tracks such as medicine, dentistry, pharmacy and nursing are competitive and
137 based on Preparatory Year GPA. Hence, there may be students who did not select nursing, but because of their GPA were assigned to nursing college. To promote retention and success, therefore, it is important for the institution to ensure that all freshmen are studying nursing voluntarily.
Environmental factors
There are 10 environmental factors under consideration. Both the students and expert panelists believed in the importance of eight factors in promoting retention and success. Nevertheless, in response to the two open-ended questions, students added two factors (having good friends and having good staff) as relevant to retention and success.
Students’ involvement in campus activities increases the likelihood of retention and success. In this study, students and faculty members believed in the importance of ensuring greater student involvement in athletic activities (4.6 ± .51 for experts, 3.56 ±
1.13 for students), and the availability of student clubs that facilitate social interaction
(4.6 ± .51 for experts, 3.59 ± 1.10 for students) to promote retention and success. These findings were congruent with other research findings that claimed that students who were involved in athletic activities were more likely to remain and succeed in college (Eckert et al., 2010; Mazerolle & Dodge, 2014). To engage students in campus life, KSU’s
Deanship of Student Affairs established a group of student organizations/clubs focused on community outreach programs, academics, sports, and professional interests
(Deanship of Student Affairs, 2015). Thus, recommendations will be made to KSU’s
Deanship of Student Affairs to consider greater student involvement in athletic activities to promote retention and success.
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Creating a student-friendly campus environment promotes retention and success.
For instance, in this study, both groups believed in the importance of a healthy academic environment to promote student retention and success (4.6 ± .51 for experts, 3.7 ± 1.08 for students). In addition, students addressed the importance of having good friends and good staff to promote retention and success. These findings are congruent with those of
Rausch and Hamilton (2006), who investigated the factors that influenced 20 university freshmen to withdraw prior to the end of their first year at two US Midwestern universities. The reasons included stressful environment, lack of socialization, and adjustment difficulties such as the absence of friends and separation from family. Thus, efforts are needed by the KSU leadership to make a student-friendly campus environment to promote retention and success.
Researchers have claimed that lack of financial support inhibits academic performance in nursing school (McDonough, 2013; Shelton, 2003). In this study, both groups believed in the importance of part-time employment for students on campus to promote retention and success (4.3 ± .51 for experts, 3.5 ± 1.3 for students). Our students who are in the bridging program (part-time students) have part-time jobs and are therefore less prone to financial problems. However, full-time students need to be screened for any financial challenges, and part-time jobs are needed to promote retention and success.
Campus residence increases the time available for students to study, attend campus events, and interact with peers, all of which increase the likelihood of retention and success (Astin, 1999). Both expert panelists and students believed in the importance of greater availability of campus residences (4.3 ± .81 for experts, 3.5 ± 1.07 for
139 students), and improving campus transportation services (4.6 ± .51 for experts, 3.6 ± 1.17 for students) in promoting retention and success. These findings are congruent with other studies that indicate that living on campus substantially increases a student’s chances of retention and college success (McDonald & Preston, 2010; Schudde, 2011). KSU’s
Deanship of Student Affairs should consider these findings to promote retention and success.
Both groups believed in the importance of peer support in promoting student retention and success (3.8 ± .98 for experts, 3.68 ± 1.04 for students). These findings are congruent with Abdulghani et al. (2014), who reported that students who got help from peers were more successful in their academic courses than those who did not, as measured by test scores. These findings may appear confusing, since students in this study did not value group study and student mentoring in promoting retention and success. However, Dennis (2003) conducted a concept analysis about peer support within a health-care context. One of the attributes of peer support is the peer relationships. Learners in peer support avoid professionalization, which negatively impacts peer support work (Dennis, 2003). Thus, in peer support students work with their friends, in contrast to group study where students work with people with whom they may not get along (Barrows, 1988). However, no study has examined how Saudi students define peer support and how this concept impacts retention and success.
There is evidence that nursing students encounter violence by patients, nurses, or other healthcare providers in the health-care setting, which could inhibit their retention and success (Escallier & Fullerton, 2009; Thomas, 2010). This study indicated the importance of health-care work experience in promoting retention and success. Both
140 expert panelists and students believed in the importance of health-care work experience to student retention and success (4.1 ± .98 for experts, 3.6 ± 1.08 for students). Thomas
(2010) therefore, advised nurse educators to educate students about how to deal with violence in clinical settings. Clinical instructors in the college should educate nursing students in dealing with and managing any potential violence they may face in clinical settings.
Social and academic integration factors
There are 18 academic factors. Both students and expert panelists believed in the importance of 16 factors in promoting student retention and success. However, students disagreed with the expert panelists about the importance of producing one or more drafts of an assignment for faculty review and feedback before completing the final project.
Nonetheless, in response to the two open-ended questions, students added that having helpful teachers promoted retention and success.
University students place student-faculty interaction at the top of the list of factors that contributed to their engagement in the learning process (Shoepe, 2014). Similarly, in this study, student-faculty interaction was rated as important to student success (5.0 ± .00 for experts, 3.57 ± 1.08 for students). The standard deviation indicated the all the expert panelists rated the importance of this factor at 5 out of 5; however, there was a low agreement among the students about the importance of student-faculty interaction. If students are satisfied with their faculty, they will see them as role models, something both experts and students believed promoted retention and success (4.8 ± .40 for experts, 3.61
± 1.15 for students). According to both students and expert panelists, students needed acknowledgement that they had done well (4.8 ± .40 for experts, 3.85 ± 1.03 for
141 students), to have their mistakes and bad behavior corrected without belittling them (4.5
± .54 for experts, 3.79 ± 1.13 for students), and to find their teachers helpful when they were in need for help (4.6 ± .51 for experts, 3.73 ± 1.09 for students). These findings are congruent with those of other research that claimed that students who are retained in a nursing program had significantly greater perceived faculty support, both psychological and functional, than those who withdrew either voluntarily or because of academic failure
(Shelton, 2003). Functional support includes monitoring academic progress, helping with course content and study skills, and referring students for appropriate learning support and counseling services (Shelton, 2003). Psychological support included faculty being approachable, correcting students without criticizing them, being respectful to students, listening, acknowledging students’ efforts, and being patient (Shelton, 2003).
Nevertheless, McDonough (2013) reported some barriers to effective student-faculty interaction, which included students’ fear and anxiety about approaching faculty, lack of time for faculty to meet students, and large class sizes that impact negatively on the time available for student-faculty interaction in and out of the classroom. This is supported by this study, which found that both expert panelists and students rated smaller class size
(less than 20 students in the class) as one of the important factors promoting retention and success. Thus, faculty members in the college should consider improving the student- faculty interaction and ensuring the appropriate class size to enhance retention and success.
Freshmen students are usually overwhelmed by the academic demands, particularly when it comes to knowing how to produce assignments (Cameron et al.,
2011). However, academic advice may help them to overcome these demands and
142 enhance success and retention rates (Cameron et al., 2011). During academic advice, both the student and the faculty adviser develop a plan of study that is congruent with the student’s needs and abilities (Kuh et al., 2005; McKendry et al., 2014). Thus, researchers propose that academic advice can influence undergraduate nursing students’ retention and success (Braxton et al., 2014; Habley et al., 2012). Similarly, in this study, both groups believed in the importance of the quality of academic advising in promoting student success (5.0 ± .00 for experts, 3.57 ± 1.08 for students). During academic advice, faculty may assess a student’s needs, a factor participants rated as important to retention and success (4.8 ± .83 for experts, 3.53 ± 1.25 for students). To promote retention and success, therefore, faculty members in the college need to reflect on the quality of academic advice given to students.
Educators argue that active learning strategies that engage students in critical thinking about the subject matter improve success and retention rates (Kuh et al., 2005).
Researchers proposed different strategies for active learning, including developing a presentation to give to other students in the class and producing one or more drafts of an assignment before completing the final version (Popkess, 2010; Shoepe, 2014).
Similarly, in this study, both expert panelists and students believed in the importance of academic engagement to retention and success (4.5 ± .54 for experts, 3.61 ± 1.14 for students), and students being active learners in the classroom (5.00 ± .00 for experts, 3.71
± 1.08 for students). Both groups agreed that students can be active learners through developing presentations to give to other students in class (4.5 ± 1.2 for experts, 3.62 ±
1.07 for students). While the expert panelists believed that producing one or more drafts of an assignment for faculty review and feedback before completing the final project
143 could promote student success, the students did not agree with this suggestion (4.3 ± .51 for experts, 3.43 ± 1.17 for students). The poor attitudes of Saudi students regarding seeking feedback from their teachers were congruent with the existing literature. For instance, Al-Haqwi, Al-Wahbi, Abdulghani, and van der Molen, (2012) found that Saudi medical students refrained from seeking feedback from their faculty due to the absence of a clear system for doing this, inadequate skills of teachers for the provision of effective feedback, and students’ fear of insult. Another study reported that around 85% of Saudi medical students had poor feedback-seeking attitudes (Al-Mously, Nabil, Al-Babtain, &
Fouad, 2014). Thus, students in the college need to be engaged in the learning process and encouraged to be active learners to promote retention and success. However, all these studies were conducted in medical education. Thus, further study is needed in the nursing setting to examine students’ attitudes regarding seeking feedback from teachers to improve students’ feedback experience.
Studies have shown that note-taking skills, exam-preparation skills, exam-taking skills, and critical thinking promote student retention and success (McDonough, 2013;
Popkess, 2010; Romeo, 2013; Wurdinger & Rudolph, 2009). Similarly, in this study, participants agreed that providing workshops to increase students skills in taking notes
(4.3 ± .51 for experts, 3.67 ± 1.13 for students), preparing for class (4.3 ± .51 for experts,
3.61 ± 1.07 for students), exam taking (4.5 ± .54 for experts, 3.60 ± 1.13 for students), and critical thinking (4.8 ± .40 for experts, 3.76 ± 1.05 for students) would promote retention and success. Thus, it is imperative to provide these skills for our students.
Engagement of students goes beyond the classroom. For instance, researchers have claimed that when students are engaged in extracurricular activities and community
144 service, they are more likely to remain and succeed in college (Astin, 1999; Wawrzynski,
Heck, & Remley, 2012; Wyatt, 2011). Similarly, this study suggests that engaging students in extracurricular activities (4.6 ± .51 for experts, 3.58 ± 1.08 for students), and community service (4.5 ± .54 for experts, 3.61 ± 1.07 for students) promotes retention and success. KSU’s Deanship of Student Affairs needs to consider these findings to promote retention and success.
Outside surroundings/cultural factors
There are seven outside surroundings/cultural factors. Both students and expert panelists believed in the importance of four factors in promoting retention and success.
Nonetheless, in response to the two open-ended questions, students added another three cultural factors they believed to be significant. These factors were Saudi culture, the reputation of nursing in general, and the future of nursing. These results were congruent with the perception of nursing in Saudi society discussed in Chapter One. For instance, in Saudi culture many women did not choose nursing because they did not want to work with males (a culturally challenging prospect), and were worried that they might not be able to get married since they would not have time for their family obligations (Al-Omar,
2004). As far as the reputation of nursing is concerned, the dominant view in the country is that it attracts poor, under-educated foreign women (Mebrouk, 2008; Miller-Rosser et al., 2009). Imagining one’s future is one of the important factors promoting student retention in college (ACT, 2010). Thus, nursing educators could conduct workshops to discuss the future of nursing in the country, which may help retention and success.
However, participants suggested that students in the Preparatory program who are interested in nursing spend a day at a university hospital alongside a practicing RN (4.3 ±
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.81 for experts, 3.52 ± 1.3 for students). Furthermore, day-long workshop should be facilitated for preparatory students at KSU about opportunities for nurses in the country
(education requirements, employment opportunities, and payment incentives) (4.6± .51 for experts, 3.68 ± 1.17 for students). Enrolled students would thus have full understanding and acceptance of nursing as a profession (4.6 ± .51 for experts, 3.68 ± 1.2 for students). Finally, nursing students need to feel that they are parallel with their colleagues in other university programs (feeling of justice instead of inferiority) (4.6 ±
.81by experts, 3.76 ± 1.08 for students). Nursing leaders in the college should consider these suggestions to promote retention and success.
The results from this research indicated many similarities and differences between
Western (US and Europe) attitudes and Saudi attitudes about factors that promote retention and success. All the factors that Saudi faculty believed to be important to retention and success were congruent with those found in studies conducted in Western countries. Moreover, Saudi students had many similarities with findings from both Saudi faculty and Western study. For instance, Saudi students believed in the importance of providing help for freshmen students to overcome the challenges of their first year in the colleges. In addition, Saudi students believed in the importance of student-faculty interaction, academic engagement, providing an optimal learning environment, and providing workshops for students to emphasize self-care skills. However, students had many differences with findings from both Saudi faculty and Western studies. For instance, Saudi students did not value the group work, the Preparatory Year program, and the importance of considering the standardized tests such as GAT, and Achievement Test as pre-admission criteria. While Saudi students agree with Saudi faculty on the
146 importance of academic factors, they emphasized the importance of outside factors more, particularly Saudi culture, nursing reputation, and the future of nursing in the country.
Some findings were surprising and had never been discussed before. Among these were having enough sleep and going to sleep early. Although much evidence suggests the importance of getting enough sleep during the night, I was surprised that students indicated this. Saudi faculty missed these two factors and did not include them, and I personally had never thought that sleep duration (how many hours) and timing (during the night) could affect academic achievement. This is because, in Saudi culture, people stay awake until late at night and they get used to it, and little considerations has been given to the impact of these behaviors on retention and success. However, students were able to recognize the impact of the timing and duration of sleep on retention and success.
The study findings suggested that students who were assigned to the nursing college based on their results in their GPA in the Preparatory Year, and for whom nursing was not their first choice, should be given the chance to transfer to other colleges to increase the retention and success rate in the college. It is important to involve the family of pre-college students in workshops about the future of nursing in the country and the importance of the profession for positive health outcomes for Saudis. There is a need for workshops to increase students’ skills in self-care, note taking, preparing for class, and exam taking. It is imperative to implement interactive and updated courses/curricula/programs to promote retention and success. Providing SCFHS’s
Prometric exam preparation course, online courses, English intensive courses, and medical terminology course are very important for retention and success. Many other recommendations have been outlined throughout this section.
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Reliability and Validity of the Delphi
To ensure the accuracy of the Delphi results in this study, the survey was pre- tested before starting round one. The survey was emailed to six faculty members in the
Nursing College, King Saud University, who were not part of the study panel for review.
The aim was to determine the time needed to complete the survey and ensure the clarity/readability of questions. The time estimated to finish the survey was 10–15 minutes and there was no issue about the clarity/readability of questions. In addition, the rating codes were available at the top of each page of the survey to avoid any mistakes in rating the factors. Follow-up emails would be sent to faculty members who did not respond to the invitation email to remind them about the deadline for responding.
However, the six participants who agreed to take part in the study all responded on time.
Thus, no follow-up email was needed. Furthermore, instructions on completing and retuning the survey were included in each round.
To minimize threats to validity in this study, panel members were asked to rate the importance of the factors with regard to student retention and success considering the group response, but were encouraged not to change their opinions based on the responses of other panelists. In addition, communication between the researcher and the panelists was conducted by email so that no expert could exert an undue influence on the opinions of others (Nieswiadomy, 2008). Participants knew that the curriculum committee members were included, but they did not know which ratings were associated with which individual (Dalkey, 1969; Hasson et al., 2000). Thus, participants were not placed under undue pressure from strongly opinionated individuals.
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Researchers who are experts in the Delphi technique indicated that if panelists are very knowledgeable about the subject, content validity is more likely to be obtained
(Hasson et al., 2000; Watson et al., 2008). Similarly, Cantrill et al. (1996) argued that in
Delphi studies, the term expert refers to individuals who have knowledge and experience of the topic. Following this suggestion, the selection of the panel members in this study was based on their knowledge and experience of this topic. In fact, the experts were both male and female, served on the curriculum committee in the college, and represented the four departments of the college. Moreover, the panelists were thanked for their contributions and assured that their input was valued. This could be one of the reasons why panelists remained throughout the three rounds, with a 100% response rate.
Additionally, it is assumed that the successive rounds increase concurrent validity
(Hasson et al., 2000; Watson et al., 2008).
With regard to the number of Delphi rounds needed, Mullen (2003) suggested two to three; this decision is based on achieving the method’s goal, which is consensus or agreement (Skulmoski, Hartman, & Krahn, 2007). In this study, consensus was achieved in the third round and researcher stopped at this stage.
Limitations of the Study
Generalizing these results may be difficult because of the limitations of the study.
Several limitations should be outlined for the reader. First, the study employed the
Delphi technique, which means that consensus did not necessarily represent the “correct” answer, only that consensus had been achieved among a panel of experts. An additional limitation was that the panel size was small, even though it was within the recommended range for Delphi studies. Second, the data presented the perspectives of the curriculum
149 committee members in the college who chose to participate in the study as expert panelists. This may be a limitation, because the sample was based on convenience and not random. A third limitation is that the majority of the expert panelists were non-
Saudis, which may limit what they know about the Saudi culture and its impact on student retention and success in the country. In fact, one of the curriculum committee explained that she would not participate in the study because she was new to the country and not sufficiently familiar with Saudi culture.
In addition, for students’ perceptions, this study was restricted to undergraduate nursing students in Saudi Arabia. Furthermore, this was a convenience sample of students who volunteered to participate at one university, which affects the generalizability of the findings. In addition, it was a descriptive study. However, the state of research into the factors promoting student retention and success among undergraduate Saudi nursing students made this study worth doing. It was the first such study in this setting and population, and will be a building block for addressing student retention and success in the country.
Conclusions
This study examined Saudi faculty and student perceptions of the factors that promote nursing student retention and success in Saudi Arabia. There were many similarities and some differences between the perceptions of faculty and students. Both faculty members and students agreed on the importance of 60 factors in promoting retention and success. However, students did not value seven factors that faculty members believed to be important to retention and success. These seven factors were: 1) encouraging senior students to mentor first-year students; 2 & 3) the importance of GAT
150 and Achievement Test scores in predicting retention and success; 4 & 5) the value of the
Preparatory Year program in KSU and the quality of advice students were receiving in this program; 6) the importance of facilitating study groups; and 7) the importance of producing one or more drafts of an assignment for faculty review and feedback before completing the final project.
In addition, students added 25 factors they believed to be important. These included: loving nursing; family problems; having a goal and working hard to achieve it; good health; coming to the class prepared; using all resources including textbooks,
PowerPoint presentation slides and handouts; reviewing previous years’ exams; difficulty of courses; class times; freely choosing the major; good friends and helpful teachers;
Saudi culture; the reputation of nursing; and their future as nurses. Coming to the class prepared included having enough sleep and going to sleep early, reading the materials, having breakfast, focusing on the class, minimizing distractions (no cell phone in class), and coming to the class early.
While some of these factors promote retention and success, others are inhibitors.
For instance, family problems and Saudi culture could inhibit retention and success, where freely choosing the major and having a good health could promote them. It notable that students stressed the importance of outside factors, particularly Saudi culture, and their impact on retention in the program. It was clear that female students considered family problems an important factor affecting retention and success. This research suggests that it is time to involve family in workshops that discuss the present and future of graduate nurses, and the opportunities open to them.
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Of course, the complexity of the factors influencing retention and success posed overwhelming challenges to the researcher in understanding the interrelations among variables. It would be challenging to study all of the interrelations between factors in this study. However, nursing educators should consider the importance of all these factors to enhance retention and success until further research examines the interrelations among factors.
Directions for Future Research
The results from this research may serve as a building block for a more complex study to validate the list of factors promoting retention and success in Saudi Arabia.
Future studies may examine the importance of these factors with larger number of faculty members in the college. They may also study the interrelations among these factors and how each factor promotes retention and success. Once researchers have examined the relationships between these factors and student retention has been examined, an intervention study would examine the causal relationship between these factors and retention and success.
In addition, more research may examine the lack of agreement between experts and students to confirm or revoke these findings. Thus, further research is recommended to examine the relationship between these factors and retention and success: 1) Factor #2, which indicated the importance of encouraging senior students in the college mentor first- year students; 2) Factor #8, which indicated the importance of considering GAT score as one of the admission criteria; 3) Factor #9 (mean = 3.44), which indicated the importance of considering the Achievement Test score as one of the admission criteria; 4) Factor
#41, which indicated the importance of the Preparatory Year program at KSU in
152 promoting student retention and success; 5) Factor #42, which indicated the importance of academic advice during the Preparatory Year at KSU in promoting student retention and success; 6) Factor #46, which indicated the importance of facilitating study groups in promoting students’ retention and success; and 7) Factor #78, which indicated the importance of allowing students to be active learners through producing one or more drafts of an assignment for faculty review and feedback before completing the final project. Similarly, family problems were listed as a factor by students without discussion. Thus, more research is needed to examine what students mean by family problems, and how this factor inhibits retention and success. Once the relationship between these factors and retention and success is examined in a longitudinal study, a
Likert survey could be developed to predict retention and success in the Saudi setting.
Implications of the Study
This study has implications for students’ retention and success, student’s personal skills, nursing education, and curriculum reform. It proposes a list of factors that are believed to promote retention and success in Saudi Arabia. For nursing practice, these findings suggest that nurse educators should create a student-friendly environment in which students enjoy learning and enhancing their skills. As recommended above, nurse educators should teach nursing students how to manage violence in clinical settings. In addition, these findings suggest that before they learn to take care of patients, student nurses should take care of their own health, for instance, through stress management and attention to sleeping habits.
The results also suggest that students should receive workshops in critical thinking skills, be encouraged to work in groups to build their communications skills, and
153 gain skills in conflict management while working and interacting with peers. In addition, students should learn how to set up a goal and work hard to achieve it.
Based on the findings of this study, the Minister of higher education and the chair of the nursing council could increase the number of professionally prepared nurses in the country. These steps may include:
1. Education reform to prepare graduates with the required skills such critical
thinking, self-directed learning, group collaboration, and problem solving.
This may be achieved through shifting from the current teacher-centered
learning approach to a student-centered approach.
2. Providing workshops to improve students’ skills in self-care, such as time
management, health care, sleep time and duration, and stress management.
Graduates needed to take care of themselves before they can provide care for
their patients.
3. Saudi students need intensive courses in English language and medical
terminology.
4. Careful assessment of the Preparatory Year at King Saud University to make it
more beneficial for students.
5. Encouraging students’ engagement in the community service. For instance,
students could participate in workshops to measure blood pressure and blood
glucose level for shoppers in the big malls in the city. This might increase
students’ self-confidence and improve students’ satisfaction about the
profession. In addition, this could help in changing the public image of
nursing.
154
Finally, the findings suggest that a comprehensive curriculum reform is needed to promote student retention and practice. This would include establishing online courses to make it more convenient for part-time students to attend class while at home or at work, and varying teaching methods to meet students’ needs.
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APPENDIXES
APPENDIX A
LIST OF FACTORS PROMOTE STUDENT RETENTION AND SUCCESS
Appendix A
List of Factors Promote Student Retention and Success
Student Profile Characteristics
1. Special support for younger students, such as mentoring programs.
Admission criteria include:
2. High school GPA
3. General Aptitude Test (Qiyas/ General Test)
4. Achievement Test scores (Qiyas/ Scientific Test)
Cultural factors:
5. Students in the preparatory program who are interested in nursing spend a day
at a University Hospital alongside a practicing RN.
6. A day-long workshop for preparatory students at KSU about opportunities for
nurses in the country (education requirements, employment opportunities, and
payment incentives).
Student Affective Factors:
7. Senior students in the college mentor first-year students.
Workshops and presentations for first-year students to emphasize skills to care for
themselves such as:
8. Stress management.
9. Benefits of exercising.
10. Caring for health.
Academic Factors
11. Clear and concise course policies and guidelines.
177 178
12. Clear and ongoing expectations from the course materials
13. Clear, prompt feedback on questions, assignments, and grades.
14. Relevant content and resources.
15. Opportunities for independent student learning.
16. Workshops for first-year students about effective preparation for class
17. Intensive English language courses.
18. Emphasizing college attendance policies and the importance of attending
classes.
19. The Preparatory Year program at KSU.
20. Academic advice during the Preparatory Year at KSU.
21. SCFHS’s Prometric exam preparation course for fourth year students.
22. A medical terminology course in the first year curriculum.
23. Online courses.
24. Facilitating study groups.
25. Greater accessibility to the King Saud University libraries.
26. Ensuring the availability of and accessibility to computer laboratories.
Environmental Factors
27. Greater student involvement in athletic activities.
28. Students clubs that facilitate social interaction.
29. Part-time employment on the campus for students.
30. Greater availability of campus residences.
31. Improved campus transportation services.
Social and Academic Integration Factors
179
32. Student-faculty interaction
33. The quality of academic advising.
34. Smaller class size.
35. Being active learners in the classrooms.
Students can be active learners through:
36. Developing presentations to give to other students in the class.
37. Producing one or more drafts of an assignment for faculty review and
feedback before completing the final project.
Providing workshops to help student to increase skills in:
38. Taking notes.
39. Preparing for class.
40. Exam taking skills.
41. Critical Thinking.
APPENDIX B
FACULTY RECRUITMENT E-MAIL TEXT
Appendix B
Faculty Recruitment E-mail Text
Dear Curriculum Committee Members/ Dr….
I am a lecturer in the nursing program at King Saud University. I am on scholarship to complete my PhD in nursing at Kent State University, Ohio, USA Dr. Barbara Drew is my research advisor. I am now in the process of collecting my dissertation research data. The purpose of my research is to learn more about the factors that promote nursing student retention and success in Saudi Arabia. I am personally inviting you to participate in this project. I have selected you as a possible participant because you are a member of the curriculum committee in the nursing program, and I believe you have expert knowledge about the factors that promote student retention and success. A letter that fully describes the study and a survey are attached. Please let me know by email if you have questions.
Your help is greatly appreciated.
Homood Alharbi
181
APPENDIX C
FACTORS PROMOTING STUDENT RETENTION AND SUCCESS SURVEY/ 1ST DELPHI ROUND
Appendix C
Factors Promoting Student Retention and Success Survey/ 1st Delphi Round
Directions: First, please indentify from your experience, factors that promote student retention and success. For the purpose of this study student retention is defined as the continuous enrollment in the nursing program until the completion of the degree (Jefferys, 2007). Student success is defined as is the completion of the BSN program graduation requirements and passing the nursing license exam (Jefferys, 2007).
Section A: 1. What are the top five factors that promote student retention? 1.
2.
3.
4.
5.
2. What are the top five factors that promote student success? 1.
2.
3.
4.
5.
183
184
Section B: Now, please rate the following factors that promote student retention and success in a nursing program in Saudi Arabia. The followings factors were identified from a review of the literature. Please rate each item’s importance by typing “x” on the appropriate number from 1-5, where 1= strongly unimportant (St Un), 2 = unimportant
(Un), 3 = neutral (Neut), 4 = important (Imp), and 5 = strongly important (St Imp)
Items Ratings (importance)
1 2 3 4 5
St Un St Un Neut Imp Im St Student Profile Characteristics
93. Special support for younger students, such as 1 2 3 4 5 mentoring programs.
Admission criteria include:
94. High school GPA 1 2 3 4 5 95. General Aptitude Test (Qiyas/ General Test) 1 2 3 4 5
96. Achievement Test scores (Qiyas/ Scientific Test) 1 2 3 4 5
Cultural factors:
97. Students in the preparatory program who are interested 1 2 3 4 5 in nursing spend a day at a University Hospital alongside a practicing RN.
98. A day-long workshop for preparatory students at KSU 1 2 3 4 5 about opportunities for nurses in the country (education requirements, employment opportunities, and payment incentives).
185
Items Ratings (importance)
1 2 3 4 5
St Un St Un Neut Imp Im St Student Affective Factors:
99. Senior students in the college mentor first-year 1 2 3 4 5 students.
Workshops and presentations for first-year students to emphasize skills to care for themselves such as:
100. Stress management. 1 2 3 4 5
101. Benefits of exercising. 1 2 3 4 5
102. Caring for health. 1 2 3 4 5
Academic Factors
103. Clear and concise course policies and guidelines. 1 2 3 4 5
104. Clear and ongoing expectations from the course 1 2 3 4 5 materials
105. Clear, prompt feedback on questions, assignments, 1 2 3 4 5 and grades.
106. Relevant content and resources. 1 2 3 4 5
107. Opportunities for independent student learning. 1 2 3 4 5
108. Workshops for first-year students about effective 1 2 3 4 5 preparation for class
109. Intensive English language courses. 1 2 3 4 5
110. Emphasizing college attendance policies and the 1 2 3 4 5 importance of attending classes.
186
Items Ratings (importance)
1 2 3 4 5
St Un St Un Neut Imp Im St 111. The Preparatory Year program at KSU. 1 2 3 4 5
112. Academic advice during the Preparatory Year at 1 2 3 4 5 KSU.
113. SCFHS’s Prometric exam preparation course for 1 2 3 4 5 fourth year students.
114. A medical terminology course in the first year 1 2 3 4 5 curriculum.
115. Online courses. 1 2 3 4 5
116. Facilitating study groups. 1 2 3 4 5
117. Greater accessibility to the King Saud University 1 2 3 4 5 libraries.
118. Ensuring the availability of and accessibility to 1 2 3 4 5 computer laboratories.
Environmental Factors
119. Greater student involvement in athletic activities. 1 2 3 4 5
120. Students clubs that facilitate social interaction. 1 2 3 4 5
121. Part-time employment on the campus for students. 1 2 3 4 5
122. Greater availability of campus residences. 1 2 3 4 5
123. Improved campus transportation services. 1 2 3 4 5
Social and Academic Integration Factors
124. Student-faculty interaction. 1 2 3 4 5
187
Items Ratings (importance)
1 2 3 4 5
St Un St Un Neut Imp Im St 125. The quality of academic advising. 1 2 3 4 5
126. Smaller class size. 1 2 3 4 5
127. Being active learners in the classrooms. 1 2 3 4 5
Students can be active learners through:
128. Developing presentations to give to other students 1 2 3 4 5 in the class.
129. Producing one or more drafts of an assignment for 1 2 3 4 5 faculty review and feedback before completing the final project.
Providing workshops to help student to increase skills in:
130. Taking notes. 1 2 3 4 5
131. Preparing for class. 1 2 3 4 5
132. Exam taking skills. 1 2 3 4 5
133. Critical Thinking 1 2 3 4 5
THANK YOU! This completes the first round of the study.
Your help is greatly appreciated!
APPENDIX D
INFORMED CONSENT TO PARTICIPATE IN A RESEARCH STUDY/STUDENTS
Appendix D
Informed Consent to Participate in a Research Study/Students
Study Title: A Delphi Study: Exploring Saudi Faculty and Student Perceptions of the Factors Influencing Nursing Student Retention and Success
Principal Investigator: Dr. Barbara L. Drew and Co-Investigator: Homood A. Alharbi
You are being invited to participate in a research study. This consent form will provide you with information on the research project, what you will need to do, and the associated risks and benefits of the research. Your participation is voluntary. Please read this form carefully. It is important that you ask questions and fully understand the research in order to make an informed decision. You will receive a copy of this document to take with you.
Purpose: The purpose of this study is to determine Saudi faculty and student perceptions of factors that influence nursing student retention and success in Saudi Arabia. Student retention is defined as continuous enrollment in the nursing program until the completion of the degree and student success is defined as the completion of the BSN program graduation requirements and passing the nursing license exam. Findings from this study will help Saudi nursing faculty identify strategies, within the context of Saudi Arabia that will support students as they progress through their nursing program.
Procedures
You have been selected as a participant because of your experience in the nursing program. You will be asked to complete two short surveys. In the first we will ask you to provide information about yourself; the second will ask you to rate factors that may or may not have helped you during your years of college.
Benefits
This research will not benefit you directly. However, your participation in this study will help us to better understand the factors influencing student retention and success which may help future students.
Risks and Discomforts
There are no anticipated risks beyond those encountered in everyday life.
Privacy and Confidentiality
189
190
Your study-related information will be kept confidential within the limits of the law. Any identifying information will be kept in a secure location and only the researchers will have access to the data. Research participants will not be identified in any publication or presentation of research results; only aggregate data will be used. Your research information may, in certain circumstances, be disclosed to the Institutional Review Board (IRB), which oversees research at Kent State University, or to certain federal agencies. Confidentiality may not be maintained if you indicate that you may do harm to yourself or others.
Compensation
A basket of chocolate will be passed out to everyone in the classroom after participants complete the survey.
Voluntary Participation
Taking part in this research study is entirely up to you. You may choose to not participate, returning the envelope with the blank survey, or you may discontinue your participation at any time without penalty or loss of benefits to which you are otherwise entitled.
Contact Information
If you have any questions or concerns about this research, you may contact Dr. Barbara L. Dre) at +1330-672- 8821, [email protected] or Homood A. Alharbi at +1440-532-2690, [email protected]. This project has been approved by the Kent State University Institutional Review Board (IRB) and by the Dean of the College of Nursing at King Saud University. If you have any questions about your rights as a research participant or complaints about the research, you may contact the IRB at +1330.672.2704, [email protected]
Consent Statement and Signature
I have read this consent form and have had the opportunity to have my questions answered to my satisfaction. I voluntarily agree to participate in this study. I understand that a copy of this consent will be provided to me for future reference.
______
Participant Signature Date
______
Research Assistant Signature Date
Appendix E
Factors Promoting Student Retention and Success /Student Survey
Appendix E
Factors Promoting Student Retention and Success /Student survey
Directions: First, please indentify from your experience, factors that promote your retention and success as a student. For the purpose of this study student retention is defined as the continuous enrollment in the nursing program until the completion of the degree (Jefferys, 2007). Student success is defined as is the completion of the BSN program graduation requirements and passing the nursing license exam (Jefferys, 2007).
Section A:
1. What are the top five factors that promote student retention?
1.
2.
3.
4.
5.
2. What are the top five factors that promote student success?
1.
2.
3.
4.
5.
192
193
Section B: Now, please rate the following factors that promote student retention and success in a nursing program in Saudi Arabia. Please rate each item’s importance by typing “x” on the appropriate number from 1-5, where 1= strongly unimportant (St Un), 2
= unimportant (Uni), 3 = neutral (Neut), 4 = important (Imp), and 5 = strongly important
(St Imp).
Items Ratings
(importance)
1 2 3 4 5
St Un St Un Neut Imp Im St Student Profile Characteristics
1. Special support for younger students, such as 1 2 3 4 5 mentoring programs. Admission criteria include:
2. High school GPA 1 2 3 4 5 3. General Aptitude Test (Qiyas/ General Test) 1 2 3 4 5
4. Achievement Test scores (Qiyas/ Scientific Test) 1 2 3 4 5
Cultural factors:
5. Students in the preparatory program who are interested 1 2 3 4 5 in nursing spend a day at a University Hospital alongside a practicing RN. 6. A day-long workshop for preparatory students at KSU 1 2 3 4 5 about opportunities for nurses in the country (education requirements, employment opportunities,
194
Items Ratings
(importance)
1 2 3 4 5
St Un St Un Neut Imp Im St and payment incentives).
Student Affective Factors:
7. Senior students in the college mentor first-year 1 2 3 4 5 students.
Workshops and presentations for first-year students to emphasize skills to care for themselves such as:
8. Stress management. 1 2 3 4 5
9. Benefits of exercising. 1 2 3 4 5 10. Caring for health. 1 2 3 4 5
Academic Factors
11. Clear and concise course policies and guidelines. 1 2 3 4 5
12. Clear and ongoing expectations from the course 1 2 3 4 5 materials.
13. Clear, prompt feedback on questions, assignments, and 1 2 3 4 5 grades.
14. Relevant content and resources. 1 2 3 4 5
15. Opportunities for independent student learning. 1 2 3 4 5
16. Workshops for first-year students about effective 1 2 3 4 5 preparation for class. 17. Intensive English language courses. 1 2 3 4 5
195
Items Ratings
(importance)
1 2 3 4 5
St Un St Un Neut Imp Im St 18. Emphasizing college attendance policies and the 1 2 3 4 5 importance of attending classes. 19. The Preparatory Year program at KSU. 1 2 3 4 5 20. Academic advice during the Preparatory Year at KSU. 1 2 3 4 5 21. SCFHS’s Prometric exam preparation course for fourth 1 2 3 4 5 year students.
22. A medical terminology course in the first year 1 2 3 4 5 curriculum.
23. Online courses. 1 2 3 4 5
24. Facilitating study groups. 1 2 3 4 5
25. Greater accessibility to the King Saud University 1 2 3 4 5 libraries.
26. Ensuring the availability of and accessibility to 1 2 3 4 5 computer laboratories.
Environmental Factors
27. Greater student involvement in athletic activities. 1 2 3 4 5
28. Students clubs that facilitate social interaction. 1 2 3 4 5
29. Part-time employment on the campus for students. 1 2 3 4 5
30. Greater availability of campus residences. 1 2 3 4 5
31. Improved campus transportation services. 1 2 3 4 5
196
Items Ratings
(importance)
1 2 3 4 5
St Un St Un Neut Imp Im St Social and Academic Integration Factors
32. Student-faculty interaction. 1 2 3 4 5
33. The quality of academic advising. 1 2 3 4 5
34. Smaller class size (Less than 20 students in the class). 1 2 3 4 5
35. Being active learners in the classrooms. 1 2 3 4 5
Students can be active learners through:
36. Developing presentations to give to other students in 1 2 3 4 5 the class.
37. Producing one or more drafts of an assignment for 1 2 3 4 5 faculty review and feedback before completing the final project.
Providing workshops to help student to increase skills in:
38. Taking notes. 1 2 3 4 5
39. Preparing for class. 1 2 3 4 5
40. Exam taking skills. 1 2 3 4 5
41. Critical Thinking. 1 2 3 4 5
42. Full understanding and acceptance for the nursing as a 1 2 3 4 5 profession. 43. Healthy Academic environment. 1 2 3 4 5
44. Students need to feel that they are parallel with their 1 2 3 4 5
197
Items Ratings
(importance)
1 2 3 4 5
St Un St Un Neut Imp Im St colleagues in other university programs. (Feeling of justice instead of inferiority!) 45. Interactive and updated courses/curriculum/program. 1 2 3 4 5
46. Objective and valid assessment, evaluation of student’s 1 2 3 4 5 performance. 47. Enjoyable learning experiences and materials. 1 2 3 4 5
48. Assessing Students’ needs 1 2 3 4 5
49. Self esteem (trusting their decision to be nurses). 1 2 3 4 5
50. Vary teaching methods to meet student needs. 1 2 3 4 5
51. Providing hands on training. 1 2 3 4 5
52. Engaging in extracurricular activities. 1 2 3 4 5
53. Engagement in community service 1 2 3 4 5 54. Adequate and accessible learning resources. 1 2 3 4 5
55. Academic engagement. 1 2 3 4 5
56. Students attributes. 1 2 3 4 5
57. Positive attitudes about academic commitment. 1 2 3 4 5
58. Health care work experience. 1 2 3 4 5
59. Self motivation. 1 2 3 4 5
60. Willingness to learn. 1 2 3 4 5
61. Family support. 1 2 3 4 5
62. Peer support. 1 2 3 4 5
198
Items Ratings
(importance)
1 2 3 4 5
St Un St Un Neut Imp Im St 63. Self-initiative. 1 2 3 4 5
64. When faculty member is a good role models for 1 2 3 4 5 students. 65. Acknowledge when students have done well. 1 2 3 4 5
66. Correct students’ mistakes and bad behavior without 1 2 3 4 5 belittling them. 67. Encourage students to ask questions 1 2 3 4 5
THANK YOU! This completes the study.
Your help is greatly appreciated!
APPENDIX F
DEMOGRAPHIC DATA FORM/ FACULTY SURVEY
Appendix F
Demographic Data Form/ Faculty Survey
Directions: Please check the appropriate answer and/or write in your response as indicated.
1. Nationality ___ Saudi ___ Others (Please specify) ___
2. Gender ___ Male ___ Female
3. Age ___ Years
4. Education ___ Masters ___ PhD ___ Post- Doctoral
5. Years of teaching experience ___ < 1 year ___ 1-5 ___ 6-10 ___11-15 ___ > 15
6. Years of Curriculum Committee experience ___ < 1 year ___ 1-5 ___ 6-10 ___11-15 ___ > 15
200
APPENDIX G
DEMOGRAPHIC DATA FORM/ STUDENT SURVEY
Appendix G
Demographic Data Form: Student survey
Directions: Please check the appropriate answer and/or write in your response as indicated.
1. Academic level ___ 5th college year
___ 6th college year
___ 7th college year
___ 8th college year
2. Gender ___ Male
___ Female
3. Age ___ Years
4. GAT score ___ %
___ I don’t remember
5. Achievement Test score ___ %
___ I don’t remember
6. High School GPA ___ %
___ I don’t remember
7. Current GPA ___ /5
202
203
8. Previously earned degree(s) ___ High School
___ Diploma
9. Are you employed? ___ Yes
___ No
10. If employed, how many hours per week? ___ 1-5
___ 6-10
___11-15
___ 16-20
___ > 20