An exploratory survey of undergraduate nursing students ’ experiences of group work within a Problem-Based Curriculum

Problem-based Learning is a learner-centered approach to education which encourages student participation and group work in the learning process. This method of self­ directed learning is facilitated by the use of small-group discussions. This being the case, it is important for groups to function effectively in order for this learning to occur. These small groups are guided by a facilitator and utilize real-life problems from the clinical settings. An exploratory survey using open-ended questionnaires was conducted amongst senior nursing students at the University of Natal, and this focussed on their experiences of group work. The students described their best and worst experiences as a member of a group, as well as what they found most irritating and most appreciated about the group work. The students also highlighted what they expected from the group and in turn what they were willing to do for the group Ab stra k Probleem gesentreede leer is ’n leerdergesentreerde benadering tot onderrig waar student deelnam e en groepwerk binne die leerproses aangemoedig word. H ierdie selfgerig te leerm etode word deur kleingroepbesprekings gefasiliteer. Dit is dus belangrik vir die groepe om effektief te funksioneer om sodoende te verseker dat die leer plaasvind. Hierdie kleingroepe word deur ‘n fasiliteerder begelei en benut werklike probleme vanuit die kliniese situasie. ’n Ondersoekende opname met ’n vraelys bestaande uit oopvrae wat op die ondervindinge van groepwerk gebaseer was, is met senior verpleegkundestudente aan die Universiteit van Natal uitgevoer. Die studente het hul beste en swakste ondervindinge as lid van ’n groep sowel as die aspekte wat hulle as die mees irriterende en mees gewaardeerde betreffende die groepwerk beskou het, beskryf. Die studente het ook daardie aspekte wat hulle van die groep verwag het en wat hulle bereid was om in ruil vir die groep te doen, beklemtoon.


Introduction
For students following a problem-based curriculum, group work is an essential component.Students may however expe rience difficulties in working in groups, as they are often not accustomed to this process.In many cases the transition from a secondary school education, which has largely been lec tured based and dependent on individual performance, can be difficult.Learners enter into educational programmes to take some thing away with them when they complete.They expect to pay for a programme of study and get information from an expert in that field.Imagine their surprise when they realize that they have to seek information for themselves and still share that with others in the group.What then are they pay ing for?This is a common reaction, which course instructors encounter when they present a cooperative learning pro gramme.Learners are selfish about what they learn and how they learn it.The idea of sharing and teaching each other has to be inculcated into the learners early in the programmes.This being the case, the researchers thought it important to test students understanding and appreciation of group activi ties.

Literature Review
The literature that was reviewed ranged from research done with students and faculty involved with group work, to the nursing team working toward quality patient care.The litera ture also drew information from non-nursing groups, for ex ample engineering classes in tertiary education.Information was divided into three simple categories which served the research objective of this study.These were the concept of group work, peoples' experiences within groups and group skills.
The concept " Group W ork" Education and training in general is predominantly teachercentered.This means that the students are taught by an ex pert in their field of study.Thereby making the students pas sive recipients of this unquestioned knowledge.In the last two decades education has moved to a more student-centred and shared active learning initiative.Problem-based learning, self-directed learning and coopera tive learning are all terms used to encompass this move, that is, getting the learner to realize that they need to work to gether, by sharing information in the learning environment.The students are the most important entity and therefore they have an active role to play in how and what the learning turns out to be.Curricula around the world are realizing the strengths of this type of teaching/learning strategy and ac cepting this process of active learning through groups.McDonald (1995:1-2) stated that students learn best when they interact with other group members and share their ideas.Since the instructor is no longer the focal point of the class, he/she becomes more involved in creating the group struc ture and ensuring that the groups are functioning as teams.The same researcher also found that cooperative learning was well receiv ed by students.K aufm an, Felder & F uller (2000:133) stated that "cooperative learning is an instruc tional paradigm in which teams of students work on struc tured tasks".The same authors cite five criteria for this learn ing to occur.These are: Experiences of people working in groups Sherman (1990:44) discusses the benefits of nurses working in teams.This author found that "team nursing is not possi ble without strong leadership and clear communication.The expected leadership style in this group is that of participa tory".Sherman (1990:44) goes on to say that mechanisms such as team conferences allow for team-building and resolu tion of interpersonal conflicts, and these are essential for co hesive team functioning.In addition, McDonald (1995:5) writes that students have reported that working together and discussing the material helped their understanding of the sub ject.This helped them learn to discuss group problems, share responsibility and be more conscientious about completing work on time as the other members were relying on their input.Long (1996:937) investigated team m em bers' views of a multidisciplinary team workshop.This author found that team members were very conscious of the roles they personally played within a team but felt that their extended roles, (ac tivities done outside the group) were not understood.It was also found that communication worked well only on an infor mal basis.This study found that there was poor communica tion between different disciplines and within similar disci plines.Conflict was concentrated on issues of communica tion and interpersonal issues.
According to Smith, (1995:5), the facilitator has five main tasks.These are to: Specify the objective for the lesson • Make a number of instructional decisions

Group skills
Antai -Otang (1997:49) found that for teams to be successful they need to have four essential qualities.These are: • Effective communication  Antai-Otang (1997:49) goes on to explain that this means that "active listening that is, using all senses to assess verbal as well as nonverbal messages toward a movement of conflict resolution" are crucial for effective communication within groups.A sense of commitment to the team, respect for each other and a desire to understand team dynamics are all posi tive evidence toward group involvement.Biley & Smith (1999:1208) investigated undergraduate stu dents' perceptions of problem-based learning.When asked about their group processes, students mentioned that group functioning depends on the input of each student and the di vision of labour.Group collaboration was an essential skill for success.Sherman (1990:46) stated that cooperation was essential for team effectiveness, and elaborated that a theo retical framework for organizational development of teams was: • Team communication • Goal achievement and accountability Felder & Brent (1996:5) found that students working on group assignments complained that some students did not pull their weight and relied on other students to start the discussions.The same students do not participate in the discussions.One

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Curationis November2002 recommendation that these authors suggest is that students learn to create a list of standards and expectations for them selves.The authors also suggest that group members sign the list and make a copy for all members.This would aid teams to stay in focus of their collaborative tasks.They also suggest that students work alone independently and complete tasks as homework before meeting for discussion.This would ensure that students all participate in the discussion by com ing prepared.
McDonald (1995:5) found that group assignments in coop erative learning improved student learning, developed essen tial teamwork, communication and leadership skills.Stu dents mentioned that the interaction of their views and the need to listen as well as express ideas gave them the opportu nity to see other ideas.
Dana & Gwele (1998:63) in a study on students' perceptions of their personal and academic development during commu nity placement mentioned that students saw their peers as a source of support during their learning.Windsor (1987) cited in Dana & Gwele (1998:63) stated that students provide emo tional support to each other in clinical settings and this in turn reduces the likelihood of anxiety related to learning.
The cited literature clearly illustrates that there are positive implications for group learning.The literature briefly cited the meaning of "group work", researched experiences of peo ple working within groups and the noted skills that groups need in order to function together effectively.With these in mind the researchers aim to investigate students' personal experiences with group work.

Problem Statem ent
Students working in a problem-based curriculum find diffi culty in working in groups since they are not accustomed to the process.Secondary school education in South Africa has, by and large been lecture-based and dependent on individual performance.Students find this transition difficult and often have their grades suffer due to the inability of understanding the functioning of a group discussion.This study aims to visit the perceptions of students regarding their own experi ences of group work.

Purpose of the study
The purpose of this study was to use an exploratory survey to establish the perceptions of the nursing students' experiences of group work at the University of Natal.

Research question
How do nursing students experience working in groups?
Objectives of the study The objectives of this study were to: • Describe the student's positive and negative experi ences as a member of a group.

•
Identify factors that influence an individual's experi ences as a member of a group.

Group work
Students working in groups of 10 to 15, for the purpose of sharing and discussing information and experiences related to an identified area of learning.

Students
For the purpose of this study this was taken to mean the sen ior nursing students registered at the University of Natal, and currently in their third or fourth year of study.

Ethical considerations
The students were given a verbal explanation of the objec tives of the research and a request for verbal consent was made before the researchers distributed the questionnaires.
The questionnaire also contained a covering letter explain ing the purpose of the research and the researchers' contact details.The students were informed of their right to with draw from the research at any time and were assured that all their responses would be confidential, as the questionnaires were anonymous.

The research design
An exploratory survey was conducted amongst the senior nursing students using a semi-structured questionnaire.This questionnaire focussed on the students' experiences of group work the most irritating aspects of group work, what the stu dents expected from their groups and what the students were willing to do for their own group.An evaluation form given to students in previous years provided a framework for the development of the questionnaire.

The setting
The nursing students in the baccalaureate Problem-Based Learning programme at the University of Natal: Durban (UND) spend their first two years in Fundamental Nursing and Community Health Nursing respectively.Their third year is spent in Medical-Surgical Nursing, and in their final year they are exposed to Midwifery and Mental Health Nursing.
Throughout their training, these students are expected to work in groups and they are thus well exposed to group work.For the above mentioned programme to be successful it is thus essential that their group work be made as beneficial as pos sible and it is for this reason that the researchers have elected to concentrate on this area.

The population and sample
The population comprised of all the students in the under graduate programme.In 1998 there was a total of 121 stu dents enrolled in the four year nursing degree at the Univer sity of Natal.This was broken down as follows; 31 students in the first year, 31 students in second year, 32 students in third year and fourth year had 27 students.The third and fourth year students constituted the sample (n = 71).The students were purposively chosen because they had experienced a minimum of two years of group work, which was considered to be an adequate period of time for them to be able to reflect upon.

The pilot study
The first questionnaire was administered to a group of 19 third year students in January of 1998 -this served as a pilot study.This resulted in the questionnaire being refined as the respondents displayed a problem in understanding parts of the tool.The researchers also added two open-ended qualita tive questions to complete the data being collected.

Data collection
This revised tool was then re-administered to the same re spondents ten months later.This comprised the first group of participants.
The questionnaire was then administered to another group of 3rd year students in January 1999 (at the beginning of their 3rd year) and then re-administered to this same group 6f students in October 2000 (at the end of their fourth year).This made up the second group of students.This survey was carried out over a period of 2 years and 10 months (from January 1998 to October 2000) and all the ques tionnaires during this period were analyzed.

Reliability and validity
The questionnaire was subjected to a pilot study and it was then decided to add two open-ended questions.These ques tions asked students to describe their best and their worst ex periences of working in a group.A self-administered ques tionnaire was chosen as the means of data collection in order to facilitate accuracy of responses.Time was given during the problem-based tutorial session for students to complete the questionnaire.

Data analysis
Data were analysed manually.Use was made of frequencies and percentages to present the findings.

Findings of the study
Worst and best experiences as a member of a group The students were asked to describe the best and worst expe riences they had had as a member of their group the previous year.

Factors related to work
Poor levels of co-operation within the group, lack of enthusi asm and group members not talking in the group discussions were noted as bad group experiences for some students.
The responses from the questionnaires showed that the stu dents valued working well as a group to achieve the tasks.One of the students said; "working as a group is like collect ing different pieces to make one good object.We put all our knowledge together and came up with something good".A number of the students described how their best experiences within a group revolved around the sharing of experiences, be they work or personal experiences, as this then added to their own knowledge.
The students also highlighted the importance of active par ticipation by all in order to make the most of the group work.A student noted that; "being in a small group was very nice, especially because everyone has a chance to get an opportu nity to contribute and also if you are not sure someone will always explain it to you Some of the students marked on the questionnaire that their best experiences as a member of a group was that it increased their confidence and maturity.It also enabled students to learn the importance of taking responsibility and cultivated skills such as able to facilitate a group on their own!

People factors
The students stressed how unsettling it was for the group to have members who arrived late for class or were unprepared or appeared disinterested in the group by not doing their work.Irresponsible and lazy group members were a problem as they then relied on others to get the tasks done.This created fur ther problems as one student said that the worst experience of the group was "knowing that marks are not allocated on indi viduals but on a whole group".
The lack of cohesion in the group (for example, taking a long time to resolve a problem or the problem not being solved in the end) was a bad experience for a number of students.
One of the students also noted that for them their worst expe rience was "being looked down upon, that I don 't know as much as the other members do The importance of being comfortable with each other, of re specting and getting to know each other very well, even the facilitator, were also factors which were considered to con tribute to the experiences of group work.One of the students suggested that their best experience as a member of a group was; "getting to know the members (of the group) in more detail, their cultural background and experiences and re lating or understanding it in my life contents".
The students also mentioned encouraging and supporting each other, and listening attentively to what each other was saying.Partnership and relationship building were also noted as some of the best experiences within the group.One of the students summed it up by saying; "watching the students grow closer together.Being able to communicate about any thing.It is remarkable to know that the group members are close and overface (overcome) whatever obstacles that stand in our way".

M ost irritating aspects of group work
When listing the aspects that irritated them as a member of a group, the students had a number of common responses and these are shown in

Things most appreciated about the group
The students expressed a number of aspects which they ap preciated the most in a group and these are shown in Table 2.
A helpful facilitator was viewed by 12.6% (n = 9) of the stu dents as being what they appreciated most in a group.This was seen by the students as being helpful when you have a problem, understanding and guiding the group and motivat ing the students.Participation by group members was also appreciated by a number of students (n = 17 / 23.9%).The students also mentioned that teamwork was appreciated (n = 23 / 32.3%), and this included sharing ideas, knowledge and experiences, learning from each other, encouraging each other and understanding weaker students and all having equal tasks to do.Being well prepared was also expressed by a number of the students (n = 11 / 15.4%) although a surprisingly few appreciated their group members being resourceful (n = 1 / 1.4%).

W hat is expected from the group
The students were asked to highlight what they expected the group to do for them and these findings are illustrated in Ta ble 3.
A large majority of the students expected the group to work together, to help when there were problems and function well together (n = 40 / 56.3%).Respecting group members («=11 / 15.4%) and participation in the group (n =18/ 25.3%) were also seen as expectations of the group.Communication was seen by 15.4% (n = 11) of the students as an expectation and this included discussing as a group if something was wrong and understanding each other.Being responsible was also expressed by 15.4% (n = 11) of the students as being expected from the group.

Willing to do for the group next year
The students were asked what they were willing to do for their group in the following year and their responses are shown in Table 4.Only 18.3% (n = 13) of the students said that they were will ing to access and share information and 29.5% (n = 21) said they would do the work allocated to them.The aspect which most were willing to do (n = 28 / 39.4%) was to participate actively in the group.Various personal characteristics were cited by 19.7% (n -14) of the students as what they would be willing to do for their group.These included being motivated, working hard, volunteering to do the work, being responsi ble, approachable and being willing to make sacrifices for the group.

Discussion of the findings Domination
Whilst only 15.4% (n =11) of the students mentioned domi nation by some group members as the most irritating aspect of group work, it is interesting to note that this concept was not an issue in Biley andSmith's study (1999:1208).In their study students acknowledged that there were those who were passive and those who were more extrovert.It was noted that when the extrovert members were absent, the session was "fragmented and disinterested".

Participation
One of the students commented about group work saying that; "it became fun-filled the more I participated." Felder and Brent (1996:5) stated that staff have difficulty get ting students to work in teams.Students even protested to the department head of their dislike of team work.A staff mem ber was quoted in Felder and Brent (1996:5) to state that if he/she assigns homework, presentations or projects, some stu dents would "hitchhike", and not participate, thus getting credit for work in which they did not participate.These authors go on to advise that individual tests and tasks would assist in alleviating this problem and also that students who do this routinely would generally fail tests.Active participation (n = 28 / 39.4%) and doing work allo cated (n = 21 / 29,5%) were the two most commonly named activities that students were willing to do for the group.Only 18,3% {n = 13) stated that they were willing to access and share information with the group.This is consistent with Biley andSmith's finding (1999:1208) that some students with held their best information in order to have the edge over other students.

Facilitators
It was disturbing to note that a few students identified facili tator behaviour as irritating.However, this finding is consist ent with that of Biley andSmith (1999:1208) who found that confusion arose in the group when the facilitator displayed what was perceived as "inconsistent behaviour".Moust has proposed a theory of tutor performance and how it relates to student performance.Cognitive congruence is a key concept in his theory.It includes the ability of the facilitator to be able to adapt to the student's level of understanding of the subject matter, sensitivity to the problems that students may have in dealing with the subject matter related to the problem.This The findings of this study indicate that students were learn ing skills in addition to the knowledge component of the pro gramme.Amongst these skills were the importance of team work and group participation, communication skills and re spect for differing opinions.It was disappointing to find that only one student stated that she/he appreciated someone who is resourceful.It appears that students are not aware of or had not learnt to value their own or others' contributions to the group.Interestingly this finding is consistent with that of Biley andSmith (1999:1210).Muller (1996:215) stated that teams need creativity and flex ibility amongst its members.Experimentation with new ideas should be encouraged within the group to address problems in the best way possible.

Com m unication
In this study laughter was identified by students as an in stance which created their worst experiences in group work.Laughing whilst others áre speaking and being laughed at are belittling and intimidating experiences.Barnes writes that valuing students' contributions is the first requirement for successful group work and furthermore, it may form the basis for genuine communication (Prawat, 1989:323).Biley & Smith (1999:1208) quoted students to state that a "percentage of the group let us down by not turning up or not pulling their weight".These authors state that participants in their study understood that the PBL process depends on group collaboration for its success.McDonald (1995:1) stated further that group assignments forced students to be account able to each other and thus promote communication and team work skills that would help students.The importance of good communication skills was alluded to by a number of the students.Only 15.4% (n = 11) of the students mentioned that they expected the group to commu nicate well and the students valued getting to know each other, sharing experiences and ideas -all of this is not possible with out good communication skills.One of the student's described how their communication skills developed saying; "my worst learning experience was trying to reiterate that everything (was) to (be) done properly and sometimes making people angry because o f this, however as I developed within the group I was able to put my point across without angering anyone".

Lim itations of the study
The researchers were the facilitators of some of these groups and this possibly coloured the student's responses as they might have felt inclined to give the responses they knew their facilitators would like.A further limitation to the study was the fact that the first group of students completed the ques tionnaire twice in one year, albeit that the second was a re vised questionnaire.Another limitation of this study is that the findings of the study cannot be generalised due to the size of the sample.

Recommendations
The researchers identified the need for further in-depth re search on how the students perceive working in a group.There is also a need to conduct a similar study with a larger sample size that would facilitate comparison of findings between groups.
The importance of establishing group norms and rules within the group at the beginning of each year has been highlighted by the findings of the research and is recommended in prac tice.

Conclusion
From the results the researchers are of the opinion that the students appear to have grasped the importance of group work and co operative learning.They appear to be aware of what is needed to get the most out of their groups and how the groups can in turn help them.In concluding the students summed up the experience of group work by saying; "I understand it and enjoy it.I hope that I can manage a group o f my own now " and "It definitely works!"

Table 2 :
Things most appreciated ( n ^7 1 ) group scored as the most irritating aspect amongst the par ticipants (n = 14 / 19.7%).Not participating in the group discussions (n = 10 / 14%) and disruptive behaviour by the group members (n = 11 / 15.4%) was also highlighted.Some of the participants cited problems with the facilitator as being their most irritating aspect of group work (n = 3 / 4.2%).This included the facilitator not being specific about the objectives and structure of the class, rephrasing information incorrectly and sidetracking the group.

Table 3 :
Expected from the group ( n ^7 1 )

Table 4 :
Things willing to do for the group ( n ^7 1 ) requires that the facilitator know when to intervene and what to offer -either in the way of clarification or a brief explana tion.Moust states that a facilitator is only able to do this if he / she has knowledge of the relevant subject matter.In addi tion to subject matter knowledge the facilitator must have a genuine and personal interest in the students and their learn ing(Schmidt and Moust 1995:709).