RESEARCH

 

Nursing students' perceptions regarding feedback from their educators in a selected higher education institution in KwaZulu-Natal province, South Africa

 

 

L M Rathobei^I; M B Dube^II

^IHonours degree in Nursing student; Department of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
^IIPhD; Department of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Correspondence

 

 

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ABSTRACT

BACKGROUND: There is global awareness of investment in higher education to ensure quality learning. Provision of quality feedback is perceived as a key benchmark of effective learning and a vital requirement in meeting students' expectations. Nevertheless, increased students' demands and expectations regarding quality feedback compete with increased pressure on academic resources, which may result in student dissatisfaction. Despite the high priority that higher education institutions (HEIs) place on quality of feedback, insufficient research studies have been conducted of student nurses' perceptions of such feedback
OBJECTIVES: To describe nursing students' perceptions of feedback received from educators in a selected HEI
METHOD: A non-experimental, exploratory descriptive design was used to guide the research process. The non-probability convenience sampling method was used, with 75 nursing students as respondents. A descriptive statistics procedure was used to present the findings of the study
RESULTS: Most respondents (82.7%) reported that they received understandable, timely, personalised, criteria-referenced, positive clear feedback after assessment. Conversely, 17.3% of respondents indicated that they received delayed, non-understandable feedback, as well as unclear and negatively written feedback. The findings of the study suggest that quality feedback mechanisms in the selected HEI were used for effective learning and to meet nursing students' requirements and expectations
CONCLUSION: The findings of the research indicate that nursing students receive quality feedback after assessment. However, there is a need for the HEI to develop a clear organisational structure with an operational guideline to aid the feedback process and ensure that all students receive quality feedback, improving their performance and meeting their needs. The feedback process should be made transparent and communicated to educators and students

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There is global awareness of investment in education to ensure quality teaching.^[1] Therefore, higher education institutions (HEIs) have taken a proactive approach to improve quality teaching by designing principles of effective, transparent and easy-to-understand feedback related to assessment criteria.^[2] According to Taras,^[3] provision of quality feedback is widely perceived as a key benchmark of effective teaching, as it is vital in meeting students' expectations. This article describes nursing students' perceptions of feedback received from educators in selected HEIs in South Africa (SA).

Student feedback has been defined differently by various scholars. Brookhart^[4] defines feedback as a response in which information regarding previous performance is used to provide the facilitator's positive views, suggestions and guidance on students' work. Progressive philosophical views regard quality feedback as a collaborative problem-solving intervention or a strategy rather than a reward for complying with teachers' expectations or punitive consequences for failing, which is observed in behavioural theory.^'51 Therefore, nursing education encompasses the external curriculum programme for which assessment and feedback are mandatory in both classroom and clinical teaching.^[6]

According to Mulliner and Tucker,^[7] the purpose of feedback is to increase students' understanding of a learning goal and their own achievement status in relation to the goal, as well as enabling them to bridge the gap between

their status and the desired status. Hughes and Quinn^[8] assert that feedback provides scaffolding that may help to guide students through their potential maze of complex feedback by providing signs, clues and a partial learning solution. Moreover, Brookhart^'41 states that feedback involves motivating learners to deconstruct a task to make it more achievable, providing direction, identifying differences between achievements and expectations and reducing risks. Furthermore, Hughes and Quinn^[8] suggest that it is crucial that feedback feeds forward, encouraging further learning and helping students to identify gaps between their actual and desired performance. For students to benefit fully from the clinical experience, regular feedback is required, which provides student nurses with information on current practice and offers practical advice for improved performance.^[9] According to Clynes and Raftery,^[9] the benefits of feedback include an increased sense of personal satisfaction, student confidence, motivation, self-esteem and enhanced interpersonal skills. Even though principles of feedback may be employed in higher education, students' experiences might differ; hence their perceptions could be useful on how feedback can be improved.^[10]

The principles of effective feedback need to be adhered to, as students' learning processes, progress and understanding will otherwise be diminished. ^[4] Moreover, recent studies of perceptions of feedback explain that students are dissatisfied and do not use feedback owing to timing, clarity, quality and the way in which written feedback is presented.^[3,7,10] A study in the School of Built Environment, John Moores University, Liverpool, UK, of undergraduate students (n=194), showed that the majority (95%) agreed that feedback received too late was useless.^[2] The same study revealed that regarding the ideal time frame to receive feedback, 42% of students agreed on 2 - 3 weeks.^[7] However, Khowaja et al.^[11] found that in Pakistan, ~40% (n=152) of students perceived delayed feedback, low grades and limited opportunity to clarify feedback as common obstacles related to learning. In Tanzania, lack of adequate supervision and feedback were regarded as hindering factors.^[12] In SA, a study that evaluated higher education management students' (n=601) perceptions of teacher feedback, found that 64% rated their perceptions as average, 17.5% as good and 13.2% as weak.^[13] However, information on feedback in HEIs, particularly in KwaZulu-Natal (KZN) province, remains limited. In this context, the current article seeks to explore nursing students' perceptions regarding feedback from their educators in a selected HEI.

 

Methods

A quantitative, non-experimental, exploratory descriptive design was used to conduct the research. An exploratory design investigates the full nature of the phenomenon, the way it manifests and other factors in relation to the underlying process.^[14] According to Grove et al.,^[15] a descriptive design may be used for development of theory, identification of problems in current practice, justifying current practice, making judgements or detecting what others in similar situations do. This design was appropriate to obtain information that describes 'what exists' with regard to nursing students' perceptions of feedback, the key question addressed in this study.

Setting

The study was conducted at a selected HEI in KZN. The specific school (within the HEI) where the research was conducted falls under the College of Health Sciences and offers various undergraduate programmes, such as the Diploma in Nursing, the Bachelor's Degree in Nursing and advanced practice.

Population and sampling

The study population comprised all 84 nursing students registered for the first year of the Bachelors' Degree in Nursing programme in 2017. The non-probability convenience sampling method was used to select respondents. According to Polit and Beck^[14] and Brink et al.,^[16] when using the non-probability convenience sampling technique, the researcher chooses elements of the study that are available and ready at the right place and the right time during the study period. In the current study, the researcher distributed questionnaires to nursing students who were available and accessible in their theory class for the two weeks that data were collected. Seventy-five of 84 nursing students registered for the first year of the Bachelor's Degree in Nursing Science programme in 2017, who completed the questionnaire and were included in the study.

Data analysis

Descriptive analysis was used to describe and summarise student nurses' perceptions of feedback. According to Polit and Beck,^[14] descriptive statistics are sometimes used to directly address research questions in studies that are primarily descriptive and help set the stage for understanding of quantitative research evidence.

The questionnaire was developed by a researcher with the assistance of a research supervisor and a statistician, using the literature to guide the development. The five responses on the Likert scale were: strongly agree, agree, not sure, disagree and strongly disagree. Face validity was established by consulting experts in the field of nursing education, the supervisor and the statistician to provide feedback regarding validity of the questionnaire. To maintain test-retest reliability of the questionnaire, it was pretested in 10 respondents. As no changes were made to the questionnaire, these data were included in the final sample. By means of Cronbach's alpha reliability statistics, validity of the instrument (questionnaire) was grounded at 0.81 (81.0%), i.e. findings from this study would be reliable. The completed questionnaires were counted and coded to facilitate capturing and auditing of data after collection. The scores of the negative questions in the questionnaire were reversed to accommodate negativity. Data were then entered into SPSS version 24 (IBM Corp., USA) for analysis. Descriptive statistics were used to describe and synthesise data, where frequencies, percentages, standard deviations (SDs) and means were reflected. Tables and graphs were used to enhance interpretation. The composite score was computed for questions with ranges.

Ethical considerations

Grove et al.^[15]asserted that researchers must comply with three ethical principles, i.e. beneficence, respect for human dignity and justice. Permission to conduct the study was obtained from the School of Nursing and Public Health, University of KZN, and ethical clearance was received from the Research Ethics Committee of the University of KwaZulu-Natal (ref. no. HSS/1409/017H), where the study was registered and conducted. To respect the rights of respondents, the researcher explained the purpose of the study, that participation was voluntary and that students may withdraw at any time without fear of negative consequences. The researcher also explained that respondents would experience no harm by participating in the study.

After providing the necessary information regarding the study, signed informed consent was obtained from those who voluntarily accepted to participate. The researcher explained to the respondents that the questionnaire would take ~15 minutes to complete and that their anonymity and confidentiality were respected by using codes. Their names and student numbers did not appear on the questionnaire. The respondents were treated equally and data were transcribed verbatim. The data were kept in a locked area that only the researcher and supervisor could access. The researcher explained that the findings of the study would be helpful to students, including those who did not participate, as it would aid their transition to higher education. The results of the study may be useful in informing and reviewing the policies of the institution.

 

Results

Questionnaires were handed out to the total population of 84 nursing students, of whom 75 completed and returned their questionnaire. Students had varied perceptions regarding quality of feedback (Table 1).

When exploring quality of feedback after assessment, 20.0% (n=15) of 75 respondents strongly agreed and 37.3% (n=28) agreed with the statement that 'feedback mainly tells me how well I am doing in relation to others', while 5.3% (n=4) strongly disagreed and 29.3% (n=22) disagreed. However, 8.0% (n=6) were not sure about the statement.

Regarding 'feedback shows how to do better next time', 40.0% (n=30) of respondents strongly agreed and 42.7% (n=32) agreed with the statement, 4.0% (n=3) strongly disagreed and 10.7% (n=8) disagreed, whereas 2.7% (n=2) indicated that they were not sure.

As to 'feedback helps respondents to understand things better next time', 41.3% (n=31) strongly agreed and 41.3% (n=31) agreed, 2.7% (n=2) strongly disagreed and 6.7% (n=5) disagreed, while 8.0% (n=6) were not sure about the statement.

Based on the statement that 'I can hardly see from the feedback what I need to do to improve my performance', 22.7% (n=17) of respondents strongly agreed and 10.7% (n=8) agreed, 8.0% (n=6) strongly disagreed and 42.7% agreed, whereas 16.0% (n=12) stated that they were not sure, with the highest mean score (SD) 3.03 (1.33).

Regarding 'once I read the feedback, I understand why I got the marks I received', 34.7% (n=26) strongly agreed and 41.3% (n=31) agreed, 5.3% (n=4) strongly disagreed and 10.7% (n=8) disagreed, whereas 8.0% (n=6) stated that they were not sure.

With reference to 'I do not understand some of the feedback that I receive', 12.0% (n=9) strongly agreed and 24.0% (n=18) agreed with the statement, 4.0% (n=3) strongly disagreed, 38.7% (n=29) disagreed and 21.3% (n=16) stated that they were not sure.

As regards 'feedback encourages me to improve my performance', 44.0% (n=3) strongly agreed and 40.0% (n=30) agreed, 2.7% (n=2) strongly disagreed and 8.0% (n=6) disagreed, while 5.3% (n=4) stated that they were not sure, with the lowest mean score 1.85 (1.02).

Regarding 'I can easily read the feedback I receive on my assignment', 26.7% (n=20) strongly agreed with the statement, 41.3% (n=31) agreed, 1.3% (n=1) strongly disagreed and 12.0% (n=9) disagreed, whereas 18.7% (n=14) stated that they were not sure.

Based on the statement that 'feedback received on assignment was too brief to be helpful', 25.3% (n=19) strongly agreed, 48.0% (n=36) agreed, 1.3% (n=1) strongly disagreed and 10.7% (n=8) disagreed, whereas 14.7% (n=11) stated that they were not sure.

With respect to 'feedback on an assignment can be useful in a subsequent assignment', 26.7% (n=20) strongly agreed and 45.3% (n=34) agreed, 2.7% (n=2) strongly disagreed and 5.3% (n=4) disagreed, while 20.0% (n=15) stated that they were not sure.

 

Discussion

The study indicates that the majority of respondents perceived that feedback mainly shows them how well they are doing in relation to others, compared with a minority of 34.6% of respondents, who opposed the statement. This may be owing to the previous content-based curriculum, which emphasised students' comparison of marks rather than their competency. The study results are in line with those of the University of Western Cape, where the majority of respondents reported that the purpose of feedback was to show them how well they were doing in relation to others.^[13]

The majority of respondents agreed that feedback shows them how to do better next time, while the minority opposed the statement. This may be owing to educators' use of principles of effective feedback, such as transparent feedback, easy-to-understand feedback and feedback related to assessment criteria that are imposed by HEIs. This is in line with Hughes and Quinn,^[8] who asserted that it is crucial that feedback feeds forward, encouraging further learning and progress. Moreover, Seker and Dincer^[17] echoed this sentiment in a study at the Foreign Language School in Turkey, to identify students' perceptions on feedback. The results revealed that students felt that they had been assessed, they were satisfied and had improved.

The current study suggests that the majority of respondents agreed that feedback helped them to understand things better subsequently, while the minority disagreed with the statement. This may be owing to the selected HEI-qualified nurse educators, who were able to deliver clear, understandable feedback based on the needs of students. This is in keeping with the report by Mulliner and Tucker,^[7] who asserted that the prime aim of feedback was assisting students to understand more regarding their learning purpose. The results of the current study also correspond to those of a study conducted in the School of Built Environment, Liverpool, where the majority of students (72%) agreed with the concept.^[7] However, in the National Student Survey (NSS) study in 2009, <55% of respondents in the UK agreed that feedback was helpful in clarifying understanding.^[3] Moreover, Taras^[3] added that the results of the NSS were in marked contrast to the overall course dissatisfaction (>80%).

Based on whether respondents hardly have an understanding of the feedback of what is needed to improve their performance, the minority of respondents were positive, while the majority opposed the statement. This may be owing to educators providing clear and understandable criteria and guidelines before assessment and when marking and giving feedback. These results concur with those of a study conducted among first-year business-unit students at an Australian university, where results revealed that 80 - 81% of students agreed that feedback helped them to achieve the unit outcomes and satisfaction was between 70% and 79%.^[18]

The results indicated that once the respondents had read the feedback, they understood their results, because the majority responded positively to the statement. This could be because of educators' use of clear marking criteria, which are provided to students in advance. Nixon et al.^[19]echoed this sentiment in the study conducted at John Moores University, Liverpool, UK, with second-year students, where the major theme was around marking criteria, with issues such as vagueness, lack of detailed guidance, lack of clarity and unhelpful comments.

The results indicated that the respondents understood only some of the feedback that they received, because the majority answered negatively. This is in contrast to the study by Pitt and Norton,^[20] who asserted that some of their students reported that they did not understand all the feedback they received from their lecturers, as they did not understand the language that their lecturers used.

For the purpose of whether feedback encouraged respondents to improve their performance, the results suggested that feedback encouraged respondents to improve their performance, because most responded positively. This may be observed in students' continuous assessment reports and portfolios, which show that respondents improved on their performance. The study results are in keeping with those of the Foreign Language School in Turkey. The results revealed that the majority of students felt that they had been assessed, they were satisfied and had improved.^[17]

The current study results also correspond to those of a study of first-year students in business and the humanities, UK, where the majority of students (97%) believed that they kept feedback in mind for later use.^[21] However, this is in contrast to results of a study conducted by Crisp,^[22] on effects of students' response to feedback, where findings revealed that there was little evidence of improvement in scores or regarding the reduction of problems.

Based on whether feedback received on an assignment was too brief to be helpful, most respondents answered positively. This may be because the educators, when giving feedback to students, observed the quality - not the quantity - of feedback, which may also be influenced by the types of feedback, such as verbal, written and email feedback. However, the results are in contrast with those of the NSS study, where <55% of respondents agreed that feedback had been detailed and helpful in clarifying understanding.^[3]

Based on whether feedback can be useful in a subsequent assignment, the majority answered positively. This may be assessed in students' portfolios on a summative report. It is also in line with the study by Pitt and Norton,^[22] who stated that the majority of the students indicated that the feedback they received regarding an assignment helped them in writing the next assignment, as it made them realise their weaknesses.

Recommendations for improving feedback

The provision of quality feedback is widely perceived as a key benchmark of effective teaching and as an important requirement for meeting students' expectations.^[3] However, there is need for HEIs to develop a clear organisational structure with a policy and an operational guideline, which will aid the process to ensure that all students receive quality feedback to improve their performance and meet their needs. The feedback process should be transparent and communicated to educators and students.

 

Conclusion

Students acknowledged that quality of feedback received after an assessment positively aided the process. However, there is a need to provide feedback that improves performance of students and that meets their needs.

Recommendation for further research and policies

Further research is recommended, including four levels of the Bachelor's Degree in Nursing Science, using both qualitative and quantitative research approaches. It is also recommended that feedback policy be developed in HEIs.

Declaration. None.

Acknowledgements. None.

Author contributions. MB Dube supervised LM Rathobei's research.

Funding. None.

Conflicts of interest. None.

 

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Correspondence:
M B Dube
202507610@stu.ukzn.ac.za

Accepted 18 August 2020