1. careers
2. nursing

FINNISH DOCTORAL DISSERTATIONS OF
NURSING EDUCATION RESEARCH
Jonna Vierula
MASTER`S THESIS
Nursing Science
University of Turku
Department of Nursing Science
September 2015
ABSTRACT
UNIVERSITY OF TURKU
Department of Nursing Science
VIERULA, JONNA: Finnish doctoral dissertations of nursing education research
Master’s Thesis, 55 pages
Nursing Science
September 2015
Nursing education research has confirmed its place in the discipline of nursing and caring
sciences being one of the most central research areas. However, extensive and systematic
analysis of nursing education research has been lacking both nationally and
internationally. The aim of this study was to describe the focus of nursing education
research in Finnish doctoral dissertations in the field of nursing and caring sciences
between the years 1990–2014. In addition, the characteristics (i.e. methods, study
informants and reporting of validity, reliability, and research ethics) of the dissertations
were described. Also, international reviews (N=39) focusing on nursing education
research were analysed for a background literature.
A literature review was carried out. Altogether 51 (=N) Finnish doctoral dissertations of
nursing and caring sciences in the field of nursing education research were included in
the final analysis. The data for this research was collected from the open publication lists
of each university offering education in nursing and caring sciences in Finland. The
dissertations were published in 1990–2014. The data were analysed by content analysis
both deductively and inductively. This study consists of a scientific article manuscript
and a background literature review.
Nursing education research has focused both nationally and internationally on four main
areas: structural factors in nursing education, nurse teacherhood, teaching activities, and
learning and learning outcomes in nursing education. In Finland, the most central focus
area was learning (84.3 %) whereas nurse teacherhood and structural factors in nursing
education were studied the least. Students were the predominant study informant group
while nurse staff including nurse mentors were next and nurse educators only the third.
Surveys and interviews were the most common data collection methods. In the findings
there were a lot of similarities with international reviews of nursing education research.
Finnish nursing education research has been very student-centred yet studies focusing on
the education of other nursing based professions or different levels of education are rare.
Future research about nurse teacherhood, curricula and structural factors in nursing
education is recommended. There is also a need for experimental designs. In addition,
nursing education research should focus on the central phenomena of nursing education
and working life. All in all, more nursing education research is needed. Nursing education
dissertations cover only 12.3 % of all the dissertations of nursing and caring sciences in
Finland.
Keywords
Doctoral dissertation, literature review, nursing education, nursing education research
TIIVISTELMÄ
TURUN YLIOPISTO
Hoitotieteen laitos
VIERULA, JONNA: Hoitotyön koulutustutkimuksen väitöskirjat Suomessa
Pro gradu –tutkielma, 55 sivua
Hoitotiede
Syyskuu 2015
Hoitotyön koulutustutkimus on vakiinnuttanut paikkansa hoitotieteellisen tutkimuksen
kentällä. Tästä huolimatta kattava analyysi hoitotyön koulutustutkimuksesta on
puuttunut. Tämän tutkimuksen tarkoituksena oli kuvata suomalaisia hoitotyön
koulutuksen alueelle kohdentuvia hoitotieteellisiä väitöskirjoja vuosina 1990–2014.
Tutkimustehtävänä oli selvittää, mitä suomalaisen hoitotyön koulutustutkimuksen
kentällä on tutkittu. Myös väitöskirjojen keskeiset tekijät kuten metodit, tiedonantajat
sekä luotettavuuden ja eettisyyden raportointi kuvattiin. Lisäksi 39 (=N) kansainvälistä
hoitotyön koulutustutkimuksen alueelle kohdentuvaa kirjallisuuskatsausta valittiin
taustakirjallisuudeksi kattavan kuvan saamiseksi aikaisemmasta tutkimuksesta.
Tutkimusmenetelmäksi valittiin kirjallisuuskatsaus. Hoitotieteelliset väitöskirjat
katsottiin sopivimmaksi aineistoksi kuvaamaan hoitotyön koulutustutkimusta Suomessa.
Aineisto kerättiin suomalaisten hoitotieteen laitosten avoimista julkaisulistoista.
Lopulliseen analyysiin valittiin 51 (=N) suomalaista hoitotyön koulutukseen kohdentuvaa
hoitotieteellistä väitöskirjaa vuosilta 1990–2014. Aineisto analysoitiin sisällönanalyysillä
sekä deduktiivisesti että induktiivisesti. Tämä tutkimus koostuu tieteellisen artikkelin
käsikirjoituksesta sekä kirjallisuuskatsauksesta.
Suomalaiset väitöskirjat ja kansainväliset katsaukset kohdentuivat neljään eri
pääkategoriaan, jotka olivat: rakenteelliset tekijät hoitotyön koulutuksessa, hoitotyön
opettajuus, opetustoiminta hoitotyön koulutuksessa sekä oppiminen hoitotyön
koulutuksessa. 84,3 % valituista väitöskirjoista kohdentui oppimisen osa-alueelle ja näin
ollen se oli kaikkein keskeisin hoitotyön koulutuksen tutkimuskohde. Vastaavasti
hoitotyön opettajuutta sekä rakenteellisia tekijöitä hoitotyön koulutuksessa oli tutkittu
vähiten. Opiskelijat olivat hoitotyön koulutustutkimuksen eniten tutkittu kohderyhmä.
Kysely ja haastattelu olivat yleisimmät aineistonkeruumenetelmät. Suomalaisen
hoitotyön koulutustutkimuksen tulokset olivat hyvin samankaltaisia tarkasteltujen
kansainvälisten katsausten kanssa.
Opiskelijakeskeisyydestä huolimatta lähihoitaja-, kätilö-, terveydenhoitaja- ja
ensihoitajakoulutuksen tutkiminen on ollut niukkaa. Tulevaisuudessa tarvitaan
tutkimusta myös opettajuudesta, opetussuunnitelmista ja rakenteellisesta tekijöistä. Myös
kokeellisia tutkimusasetelmia tarvitaan. Hoitotyön koulutustutkimuksen tulisi jatkossa
kohdentua entistä paremmin sekä koulutuksen että työelämän kannalta merkittäviin ja
ajankohtaisiin osa-alueisiin.
Avainsanat
Väitöskirja, kirjallisuuskatsaus, hoitotyön koulutus, hoitotyön koulutustutkimus
CONTENTS
1. INTRODUCTION ........................................................................................................ 5
2. NURSING EDUCATION RESEARCH FROM THE INTERNATIONAL
PERSPECTIVE ................................................................................................................. 6
2.1 Search of international nursing education research ................................................. 8
2.2 Analysis ................................................................................................................... 9
2.3 Results ..................................................................................................................... 9
2.4 Conclusions ........................................................................................................... 16
3. AIM AND RESEARCH TASKS ................................................................................ 17
4. METHODS AND MATERIALS ................................................................................ 18
4.1 Design .................................................................................................................... 18
4.2 Data collection ....................................................................................................... 18
4.3 Data Analysis ........................................................................................................ 19
5. RESULTS ................................................................................................................... 20
5.1 A general description of the data and characteristics of the dissertations ............. 20
5.2 Focus of the dissertations in the field of nursing education research .................... 28
6. DISCUSSION ............................................................................................................. 35
6.1 Discussion of results .............................................................................................. 35
6.1.1 A general description and the characteristics of the Finnish dissertations ..... 35
6.1.2 Focus of the Finnish dissertations in the field of nursing education research 37
6.2 Trustworthiness and limitations of the study ........................................................ 40
6.3 Ethicality of the literature review .......................................................................... 42
7. CONCLUSIONS ......................................................................................................... 43
TABLES
Table 1 Methods reported in reviews .............................................................................. 10
Table 2 Study informants reported in reviews ................................................................ 12
Table 3 Focus of the reviews in nursing education research .......................................... 14
Table 4 Data collection methods in Finnish nursing education dissertations ................. 22
Table 5 Data analysis methods in Finnish nursing education dissertations .................... 24
Table 6 Study informants in Finnish nursing education dissertations ............................ 27
Table 7 Reporting of validity and reliability in Finnish nursing education dissertations ...
......................................................................................................................................... 28
Table 8 Focus of the Finnish nursing education research ............................................... 29
Table 9 Differences between the popularity of the main categories ............................... 38
FIGURES
Figure 1 Search to Medline database ................................................................................ 8
Figure 2 Publication types of the Finnish dissertations in nursing education research .. 20
The originality of this thesis has been checked in accordance with the University of Turku
quality assurance system using the Turnitin OriginalityCheck service
1. INTRODUCTION
Nursing education research has confirmed its place in the discipline of nursing and caring
sciences being one of the most central research fields. It seems that today the number of
studies in nursing education is constantly increasing internationally. However, it is said
that more nursing education research is still needed (Salminen et al., 2010). In Finland,
since 1979, the beginning of Finnish academic education of nursing and caring sciences
(Academy of Finland, 2003), the amount of nursing education research has increased,
especially in the 1990`s (Salminen et al., 2006). Earlier, the focus areas of the nursing
education research have stayed rather similar as the research has focused on nursing
students and their learning, nurse educators and teaching, and structural factors of nursing
education (Salminen et al., 2006) yet there has been a lack of experimental and
intervention studies not only in Finland but also internationally (Johnson, 2004; Hegarty
et al., 2008).
Nursing education research is influenced by several factors such as educational reforms
and administrative matters of nursing education itself. The field of education is under
constant changes and therefore challenging nursing education research also. It is said, that
nursing education research should focus on research topics that are central to nursing
education and its development (Ministry of Social Affairs and Health, 2003). Due to all
this, it is important to analyse what has been studied (i.e. what is the focus) in the field of
nursing education research.
In this thesis, a literature review was made concerning focus of nursing education research
in Finnish doctoral dissertations of nursing and caring sciences. A manuscript of an article
was written and submitted for a review. In this report, the focus is both in the international
reviews that were chosen for a background literature of an earlier study and in the Finnish
doctoral dissertations of nursing and caring sciences. Now, the results of the chosen
reviews are being reported more specifically. In addition, the purpose, method, analysis,
results, validity and conclusions of the study itself are reported more precisely. All in all,
the study aim is to find the focus of nursing education research.
5
2.
NURSING
EDUCATION
RESEARCH
FROM
THE
INTERNATIONAL PERSPECTIVE
Nursing education has and will face several challenges in the future. Nursing education
has been under various reforms for the last decades in Europe but also worldwide (Davies,
2008; Hofler, 2008; Rich et al., 2010; Råholm et al., 2010; Salminen et al., 2010; Öhlén
et al., 2011; McDermid et al., 2012; Kajander-Unkuri et al., 2013; Collins and Hewer,
2014). There is also a lack of nurse workforce worldwide while the nursing schools are
not producing sufficient number of graduating students (World Health Organization,
2006; McDermid et al., 2012; McEwen et al., 2013). The overall nursing shortage has
repercussions for the next generation of nurses, and it holds implications for the
development of nursing education and continued nursing practice development
(McDermid et al., 2012; McEwen et al., 2013). Nursing education is facing other
challenges in future development as well. Nursing has already undergone a process of
professionalization based on academic competence (Arvidsson et al., 2008). Furthermore,
the competence areas in nursing education within EU has identified (Kajander-Unkuri et
al., 2013). However, nursing education should be based on both evidence-based nursing
and teaching. In addition, there is a need for increased level of nursing education research
together with the aim of lifelong learning (Salminen et al., 2010).
It is said that by reviewing nursing doctoral dissertations it could be possible to identify
changing trends in the nursing profession as an academic discipline (Zeng and Samantha,
2012). Some reviews bracketing for example methods and contents in the field of nursing
research (Suominen and Leino-Kilpi, 1998; Välimäki et al., 2000) and in nursing and
midwifery education research have been done earlier (Hentinen, 1989; Salminen et al.,
2006; Hegarty et al., 2008). In addition, some studies focusing on doctoral dissertations
or other scientific publications produced by doctoral prepared nurses have been
conducted in Nordic countries (Bjørn et al., 2008; Lundgren et al., 2009; Kjellström and
Frilaund 2010) and for example in Hong Kong (Zeng and Samantha, 2012). However,
extensive and systematic analysis of nursing education research has been lacking both
nationally and internationally (Salminen et al., 2006). Nursing education in different
European countries is noted to have many similarities (Lahtinen et al., 2014). However,
the educational structures vary considerably both in the European level and also
internationally (Spitzer and Perrenoud, 2006; Zabalequi et al., 2006; Råholm et al., 2010;
Lahtinen et al., 2014). The Bologna Declaration (1999) is considered as the single most
6
important reform in higher education level in Europe during the last thirty years (Davies,
2008). As the main goal of the Bologna Declaration is to harmonize higher education
systems, there are remarkable challenges in implementation as every country has its own
legislation, culture, economics and healthcare needs (EHEA, 2010; Salminen et al., 2010;
Millberg et al., 2011; Collins and Hewer, 2014).
In Finland the largest and likely the most remarkable reform in nursing education has
been a structural change in the 1990s as the nursing education moved from the postsecondary institutions into polytechnics (nowadays also called universities of applied
sciences). By the year 1999 polytechnics had replaced the post-secondary institutions
completely. (Laki ammattikorkeakouluopinnoista, 255/1995; Salminen, 2001.) This
educational reform challenged also nurse educators to retrain and qualify themselves in
the university level (Tiilikkala 2004; Salminen et al., 2006). Nowadays a Finnish nursing
education is organized as two-level education while polytechnics are educating nurses
(RN:s) and other nursing-based professions (public health nurse, midwife and emergency
nurse) while vocational schools educate practical nurses (Ministry of Education and
Culture, 2006; Finnish National Board of Education 2010). In addition, polytechnics have
been offering a master´s degree programmes since 2005 (Laki ammattikorkeakoululain
muuttamisesta, 411/2005) and five universities are offering bachelor`s, master`s and
doctoral education in nursing and caring sciences in Finland. Finnish nursing education
is
also
regulated
by
various
legislations
nationally
(Laki
ammatillisesta
peruskoulutuksesta, 1998/630; Ammattikorkeakoululaki, 2014; Yliopistolaki, 558/2009)
and in the European level (e.g. Directive 2013/55/EU of the European Parliament and of
the Council).
To understand the nursing education research a review of international reviews in the
field of nursing education research was carried out. Similar research about nursing
education research and its focus areas has not been done before. Therefore, to identify
the focus of nursing education research on the international level a literature review was
conducted (Grant and Booth, 2009). The research tasks were:
1. Describe the characteristics (i.e. methods, study informants, reporting of validity
and reliability) of the reviews.
2. Find the focus of the reviews in the field of nursing education research.
7
2.1 Search of international nursing education research
Previously published international reviews focusing on nursing education research were
chosen for background literature of the study because they bracket a wide area of research
fields of nursing education.
A computerized systematic search to Medline database (from earliest to 19th November
2014) was conducted using search terms “Nursing Education Research” [MESH] AND
teacher OR student OR patient OR environment (Figure 1). The search was limited to
English language, reviews and title/abstracts. Medline database was selected for its wide
and comprehensive coverage of health and nursing science research (Subirana et al.,
2005). Altogether 216 reviews were identified of which 39 articles were included in the
final analysis. Two researchers independently evaluated the titles and abstracts and
selected the articles on the basis of inclusion criteria, if needed the consensus was
discussed in the research group. Inclusion criteria were: 1) focus on nursing education, 2)
a scientific literature review (i.e. method and N reported). The article was excluded if it
focused solely on e.g. patient education, nursing staff training and continuing education
of the nursing faculty in nursing units or was a discussion paper. The time delimitation
was not set.
Figure 1 Search to Medline database.
8
The chosen reviews (N=39) included altogether 1129 studies, scientific papers or other
documents (e.g. policy papers) and they were published from 2001–2014 in nine different
countries that were: Australia (n=5), Canada (n=5), China (n=1), Finland (n=3), Ireland
(n=1), Italy (n=1), United Kingdom (n=7), USA (n=19) and Singapore (n=1). The
reported review types were systematic reviews (n=8), integrative or integrated
reviews/literature reviews (n=13), literature reviews (n=12), reviews (n=2), critical
reviews (n=2), qualitative literature reviews (n=1) and narrative reviews (n=1).
2.2 Analysis
The focus of the reviews were analysed by categorizing and using inductive content
analysis according to their reported purposes and subject matters (Grove et al., 2013). The
following general information of the articles were collected on separate data sheet: author,
year, country, aim of the review, review type, databases used, number of papers analysed,
analysis method, main results, conclusions and description of validity and reliability of
the review. The characteristics of the reviews (i.e. methods, study informants, reporting
of validity and reliability) were categorized according to reporting of the reviews. Focus
areas of the international reviews were analyzed with inductive content analysis. The
analysis units (Polit and Beck, 2004) were sentences or paragraphs reporting the purposes
and aims of the reviews that were considered as the study focus and therefore simplified
first as content areas and then classified for subcategories and after all for main categories
describing the focus of nursing education research. One review could be classified in
several categories.
2.3 Results
The characteristics of the reviews
Reporting of the research methods and study designs varied from scarce to detailed in the
chosen reviews (Table 1). Therefore not all applied methods were applicable. Both
qualitative and quantitative methods were utilized in the studies among the reviews. In
addition, mixed methods were applied. Also, there were nine reviews, that included
studies applying experimental design (e.g. experimental design with pretest and/or
posttest, quasi-experimental and RCT:s). Other reported methods applied were case study
(n=5), grounded theory (n=5) and phenomenology (n=3). Data collection methods were
9
survey (n=16), interview (n=10) and focus group interviews (n=10), observation (n=6)
and Delphi panel (n=1). Otherwise the applied methods were not applicable.
Table 1 Methods reported in reviews (N=39).*
19
Hofler 2008 USA
35
Megginson 2009 USA
5
Riner 2011 USA
Cassidy 2009 UK
63
Dante et al. 2013 Italy
5
*Not applicable
X
X
X
X
X
16
X
X
58
Blakely et al. 2009 UK/Australia
Observation
X
X
De Gagne et al. 2012 USA
Delphi
Focus group
Interview
Survey
Phenomenology
Grounded theory
Experimental design
17
Case study
Brunero et al. 2010 Australia
Mixed methods
N
Qualitative
Review, author(s), year, country
Quantitavue
Design/Methods
X
X
X
X
X
X
X
X
X
X
X
DiBartolo et al. 2005 USA
8
Dorsey & Baker 2004 USA
16
Edgecombe et al. 2013
36
X
X
X
X
X
X
X
Epstein & Carlin 2012 Canada
9
Evans & Harder 2013 Canada
36
Jinks 2007 UK
19
Lambert et al. 2005 Ireland
13
X
X
X
X
X
X
X
X
Leigh 2008 USA
X
X
62
X
X
X
Olson 2012 USA
25
X
X
X
Pitt et al. 2012 Australia
44
Sisk 2011 USA
17
X
X
X
Storr et al. 2011 UK
65
Sulosaari et al. 2012 Finland
19
Yuan et al. 2008 China/Canada
10
X
X
X
X
X
X
Blum & Parcells 2012 USA
18
Brewer 2011 USA
10
X
X
X
X
X
X
10
Clayton 2006 USA
7
X
X
Kaakinen & Arwood 2009 USA
16
X
X
X
X
X
X
X
X
X
X
X
Loke Jennifer 2007 UK
36
Mancuso-Murphy 2007 USA
14
X
X
X
X
X
Norman 2012 USA
17
Porter 2001 USA
7
Ridley 2008 USA
24
X
X
X
X
Ward 2011 UK
39
Crookes et al. 2013 Australia
55
X
X
X
X
X
Holopainen et al. 2007 Finland
207
Teoh et al. 2013 Singapore
12
Garrity et al. 2014 Canada/USA
Miller & Jensen 2014 USA
Murdoch et al. 2013 Canada
Tella et al. 2014 Finland/UK
15
X
X
X
X
X
X
X
18
17
20
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
*One review could be classified into several categories.
The study informants were mostly nursing students as 30 reviews reported them as their
informants (Table 2). Other study informants were other students (not nursing students)
(n=11), educators, lecturers or faculty (n=9), clinical mentors/preceptors/instructors
(n=6), nursing professionals (n=12) and patients/residents (n=5). In addition, 13 reviews
reported study informants being other than any of the mentioned above. Also, seven of
the reviews did not reported the study informants at all. In addition sample sizes varied
greatly.
11
Table 2 Study informants reported in reviews (N=39).*
Patients/residents
Nursing professionals
Mentors/preceptors/clinical
instructors
17
X
De Gagne et al. 2012 USA
19
X
Hofler 2008 USA
35
X
Megginson 2009 USA
5
X
Riner 2011 USA
58
Blakely et al. 2009 UK/Australia
16
X
Cassidy 2009 UK
63
X
Dante et al. 2013 Italy
5
X
DiBartolo et al. 2005 USA
8
X
Dorsey & Baker 2004 USA
16
Edgecombe et al. 2013
36
X
Epstein & Carlin 2012 Canada
9
X
Evans & Harder 2013 Canada
36
Jinks 2007 UK
19
Lambert et al. 2005 Ireland
13
Leigh 2008 USA
62
X
Olson 2012 USA
25
X
Pitt et al. 2012 Australia
44
X
Sisk 2011 USA
17
X
Storr et al. 2011 UK
65
Sulosaari et al. 2012 Finland
19
X
Yuan et al. 2008 China/Canada
10
X
Blum & Parcells 2012 USA
18
X
Brewer 2011 USA
10
X
Clayton 2006 USA
7
X
Kaakinen & Arwood 2009 USA
16
X
X
Loke Jennifer 2007 UK
36
X
X
Mancuso-Murphy 2007 USA
14
X
X
Norman 2012 USA
17
X
Porter 2001 USA
7
X
Ridley 2008 USA
24
**Other
Brunero et al. 2010 Australia
Not applicable
N
Other students
Review, author(s), year, country
Nursing students
Educators/lecturers/faculty
Study informants
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
12
Ward 2011 UK
39
X
X
Crookes et al. 2013 Australia
55
X
X
Holopainen et al. 2007 Finland
207
X
X
Teoh et al. 2013 Singapore
12
Garrity et al. 2014 Canada/USA
15
X
X
Miller & Jensen 2014 USA
18
X
X
Murdoch et al. 2013 Canada
17
X
X
Tella et al. 2014 Finland/UK
20
X
X
X
X
X
X
X
X
X
X
X
X
*One review could be classified into several categories.
**Health care organizations, government reports, national reports, documents, practitioners, medical
doctors, healthcare professionals (other than nurses), infection control personnel, students with disabilities,
Former graduate students, graduate teaching fellows, graduate faculty, educational Testing Service summer
interns, NLOR-writers (Narrative letters of recommendation), SLOR:s (Standardized letters of
recommendation), Military officer candidates, reference forms, medicine fellow, key education
stakeholders, curricula, academic professional nurses, nursing student files, preceptors, nursing program
leaders.
In 21 of the reviews the validity and reliability or study quality evaluation of the data was
reported. In 17 reviews the evaluation of the data validity and reliability was not
applicable at all. One review categorized the level of evidence of the data (Garrity et al.
2014).
Focus of the reviews in the field of nursing education research
Focus of the international reviews in the field of nursing education research could be
classified in four different main categories that were Structural factors in nursing
education, Nurse teacherhood, Teaching activities in nursing education and Learning and
learning outcomes in nursing education (Table 3). In addition, the content areas of the
reviews could be classified into 13 subcategories (Table 3). Learning and learning
outcomes in nursing education was the most central focus in the nursing education
research as teaching activities was next. However, nurse teacherhood (n=2) and structural
factors (n=4) in nursing education was focused least.
13
Table 3 Focus of the reviews in nursing education research (N=39).*
MAIN CATEGORY
SUBCATEGORY
CONTENT AREA
STRUCTURAL
FACTORS IN
NURSING
EDUCATION
(n=4, 10.3 %)
Curricula reform
orientations
Health informatics
education connected to
baccalaureate nursing
program
Nurse education level
connected to patient
safety
Recommendations for
nursing education
Graduate admission
process
Characteristics of a
nurse educator`s work
Nurse educators` role
in supporting students
Avatars and virtual
worlds
Blogging
Computer mediated
conferencing
Concept mapping
Distance education
Future orientations
NURSE
TEACHERHOOD
(n=2, 5.1 %)
TEACHING
ACTIVITIES IN
NURSING
EDUCATION
(n=21, 53.8 %)
Multidisciplinary
orientations
Role of a nurse
educator
Teaching methods
Engaging and
meaningful teaching
techniques
Evaluation of teaching
strategies
Gaming
PBL
Simulation
Academic
performance
Team-based learning
Infection control
Patient safety
Empathy education
programs
Global experiential
education
Academic success and
failure
Assessment of
learning
Self-efficacy
Student attrition
Student remediation
Support of disabled
students
Competence
assessment
Teaching of clinical
skills
Teaching of generic
skills
LEARNING AND
LEARNING
OUTCOMES IN
NURSING
EDUCATION
(n=26, 66.7 %)
REFERENCE,
YEAR
De Gagne et al., 2012
Ridley, 2008
Hofler, 2008
Megginson, 2009
Holopainen, 2007
Teoh et al., 2013
Miller and Jensen,
2014
Garrity et al. 2014
Loke Jennifer, 2007
Clayton, 2006
Mancuso-Murphy,
2007
Crookes and Crookes,
2013
Porter, 2001
Blakely et al., 2009
Yuan et al., 2008
Leigh, 2008;
Kaakinen, 2009;
Brewer, 2011; Blum
and Parcells, 2012;
Norman, 2012; Evans
and Harder, 2013;
Murdoch et al., 2013
Sisk, 2011
Ward, 2011
Tella et al., 2014
Brunero et al., 2010
Riner, 2011
Dorsey and Baker,
2004; DiBartolo and
Seldomridge, 2005;
Olson, 2012; Dante et
al., 2013
Leigh, 2008
Pitt et al., 2012
Evans et al., 2013
Storr et al., 2011
Cassidy, 2009
14
Clinical learning and
clinical learning
environment
Learning in clinical
skills
Learning in generic
skills
Students` relationship
to nursing
Learning theory in
assessing simulation
learning
Simulation outcomes
Valid tools for
admission process
Clinical learning
environment
Clinical learning in
international context
Clinical performance
Mentoring in clinical
learning
Infection control
Medication
competence
Patient safety
Critical thinking
Global learning
Ethics
Inter-professional
learning
The use of technology
Transition to practice
journey
Kaakinen and
Arwood, 2009
Norman, 2012
Megginson, 2009
Storr et al., 2011;
Ward, 2011
Edgecombe et al.,
2013
Pitt et al., 2012
Lambert and Glacken,
2005; Jinks, 2007;
Cassidy, 2009;
Epstein and Carlin,
2012
Ward, 2011
Sulosaari et al., 2012
Blum and Parcells,
2012; Tella et al.,
2014
Yuan et al., 2008
Riner, 2011
Epstein and Carlin,
2012
Loke Jennifer, 2007;
Murdoch et al., 2013
Loke Jennifer, 2007
Hofler, 2008; Teoh et
al., 2013
* One review could be classified into several categories
Reviews focusing on structural factors in nursing education were oriented in planning,
evaluation and development of nursing education and especially its management,
practices and curriculum. The reviews could be classified in three subcategories (Table
3).
Nurse teacherhood has been studied actively during the past years and approached from
several perspectives (Holopainen et al., 2007). However, in our analysis nurse
teacherhood was the focus of only two reviews (Holopainen et al., 2007; Teoh et al.,
2013) and was studied least. Nurse teacherhood could be classified only in one
subcategory (Table 3) and was reviewed from the perspectives of nurse educator`s work
and role.
Teaching activities in nursing education was an interest of 21 reviews and three
subcategories were identified (Table 3). Most of the reviews (n=17) focused on teaching
methods from several perspectives. However, simulation was studied by far the most
15
(n=7). Besides teaching methods, teaching activities were categorized in teaching of
clinical skills and generic skills in nursing education.
Learning and learning outcomes in nursing education was the most studied research area
of the reviews (n=26). Six subcategories were identified (Table 3) and learning was
reviewed from several perspectives such as students` academic performance, learning
assessment and learning both in clinical and generic skills. In addition, learning was
reviewed as students` relationships to nursing and learning was occurring in various
learning environments both in clinical and classroom surroundings. Academic
performance (n=8) and clinical learning (n=8) were studied the most.
2.4 Conclusions
International reviews of nursing education research have been student-centered as
learning and learning outcomes in nursing education has been the most central study
focus. Also, the reviews in this field included mostly students as the study informants,
even though the exact amounts of the study informants in the original studies were not
applicable. Teaching activities has been studied quite much internationally and also with
experimental methods, though more research is still needed. However, nurse teacherhood
and structural factors in nursing education has not been a popular focus areas and there is
a gap in these research fields.
16
3. AIM AND RESEARCH TASKS
The aim of this literature review was to describe the focus of nursing education research
in Finnish doctoral dissertations in the field of nursing and caring sciences during the
years of academic nursing education between the years 1979–2014. The research tasks
were:
1. Describe the characteristics (i.e. data collection and data analysis methods, study
informants, reporting of validity, reliability and research ethics) of the
dissertations.
2. Find the focus of the dissertations in the field of nursing education research.
The ultimate goal was to find an information gap in the field of nursing education research
and not only develop nursing education but also make recommendations for future
nursing education research.
17
4. METHODS AND MATERIALS
4.1 Design
In this study a literature review design was used. Reviews are enabling a summarizing
and synthetizing of rigour evidence as long as search and methodological policies are
being followed critically and correctly. There are several review types that all have their
strengths and weaknesses as it is typical for research methodology in general. A literature
review is a generic term for reviewing recent or current published literature to gather a
comprehensive and complete overview. (Grant and Booth, 2009.)
In this study a literature review (Grant and Booth, 2009) was carried out including the
identification and the definition of the research questions, data collection, data analysis
and the reporting of both the results and the conclusions.
4.2 Data collection
The data of this study consists of Finnish doctoral dissertations of nursing and caring
sciences focusing on nursing education research. The data for this research was collected
from the open publication lists of each university offering education in nursing and caring
sciences in Finland. Doctoral dissertations were considered as the most adequate research
data when focusing on the core of Finnish nursing education research, because they
describe the research area widely as the dissertations are combinations of data, methods
and perspectives. Furthermore, a considerable amount of the dissertations were available
as scientific articles while the latest published monographs were available on-line.
The inclusion criteria were the following:
1. The dissertation is in the field of nursing and/or caring sciences.
2. The focus of the study is on nursing education (i.e. education of practical nurses or
registered nurses and other nursing-based professions, master’s and doctoral level
education in nursing sciences and master`s degree programs in universities of applied
sciences).
The exclusion criteria were the following:
1. The study is a dissertation of some other discipline than nursing and/or caring sciences
(e.g. educational science).
18
2. The focus of the study is completely in another field of education than nursing (e.g.
other social and health-care education) or on patient education, nurse personnel training,
continuing education or the education of other health care professions that are not based
on nursing (e.g. radiographer-education).
First the abstracts of the chosen dissertations were read through against the inclusion
criteria. Second, the studies were selected according to the whole text. The data selection
was performed in cooperation with the researchers. Altogether 51 (=N) doctoral
dissertations were identified and included in the final analysis. The data covered the years
1990–2014.
4.3 Data Analysis
Data analysis was conducted in two phases being the analysis of the characteristics of the
dissertations and the analysis of the focus areas of the dissertations. Firstly, general
information of the dissertations was collected on a data matrix from the dissertation
abstracts or texts for structuring the data: year, author, title, language, aim, subject matter
and dissertation type (article or monograph). Secondly, the characteristics (i.e. study
informants, data collection methods, data analysis methods and reporting of validity and
research ethics) of the dissertations were classified.
Next, the focus of the dissertations was analyzed by content analysis (Grove et al., 2013)
both deductively and inductively. The main categories of the analyzed international
reviews created a deductive framework in which the dissertations were classified. The
dissertations and their subject matters were simplified as contents areas and still classified
into sub and main categories describing the focus of the nursing education research.
However, the subcategories were also formed inductively as we decided to create new
subcategories if it was needed. One dissertation could be classified into several categories.
All classifications were made by consensus.
19
5. RESULTS
5.1 A general description of the data and characteristics of the dissertations
During the academic years 1979-2014 altogether 415 doctoral dissertations were
published in the field of Finnish nursing and caring sciences (Figure 2). The first Finnish
doctoral dissertation of nursing and caring sciences was published in 1984. However, the
first dissertation in nursing education research was published not before than 1990
(Leino-Kilpi, 1990). Until the end of the year 2014 there were 51 (=N) dissertations
published in the field of nursing education research covering 12.3 % of all the
dissertations of Finnish nursing and caring sciences. 50 nursing education researches were
women and only one man. Most of the nursing education dissertations have been
published in the 2000`s (n=39), especially in the beginning of the millennium. The
languages were Finnish (n=30), Swedish (n=3) and English (n=18). Of the total amount
of 51 dissertations 34 were published as monographs and 17 as compilations of articles.
A notable amount of the dissertations published in English were compilation of articles
(n=14). On the other hand most of the monographs were written in Finnish (n=28).
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
1990-1994
1995-1999
2000-2004
Article
2005-2009
2010-2014
Monograph
Figure 2 Publication types of the Finnish dissertations in nursing education research
(N=51).
20
Data collection and data analysis methods of the dissertations
The applied research methods of the dissertations were classified into categories that
described data collection methods (Table 4) and data analysis (Table 5) methods. One
dissertation could be classified into several categories as it is typical for dissertations that
there are multiple data collection and data analysis methods applied. Type of a data
collection and analysis method was categorized into categorization matrix according to
reporting of the dissertation. Survey and interviews were the most widely used data
collection methods. Statistical methods and content analysis were the most frequent
analysis methods. However, not all researchers reported their specific approach and
therefore we categorized their analysis method in content analysis as general.
Survey was a data collection method in 30 dissertations thus being the most widely used
data collection method. Semi-structured questionnaire was used the most (n=19) in the
survey studies. Different kinds of interview types were used as a data collection method
in 25 dissertations. Thematic interview was the most popular interview type (n=14).
Focus group/group interviews were used in seven dissertations as individual interviews
in ten and pair interview only in one dissertation (Nikula, 2011). Telephone interviews
were applied in two dissertations (Heikkinen, 2003; Sandelin, 2007). Observation was
applied in six studies. Panel methods as in Delphi and expert panels were gathered in five
dissertations. In addition, different kinds of documents were used in a data collection
(n=20). These documents were written papers produced by the study informants. The data
was collected as utilizing cases (n=2), critical incident descriptions (n=3), essays (n=8),
learning document (n=1), narratives (n=2), travel report (n=1) and written texts (n=1).
Also, written care plans of nursing and concerning patient care were applied in two
dissertations (Hupli, 1996; Kuokkanen, 2000). In addition, three different kinds of tests
were used for testing informants` skills in various areas (Hupli, 1996; Stenfors, 1999;
Grandell-Niemi, 2005). In one dissertation a clinical examination for patients/informants
made by a physician was carried out (Pirilä, 2002).
21
Table 4 Data collection methods in Finnish nursing education dissertations (N=51).*
Data collection method
SURVEY
Open-ended
(n=30, 58.8 %)
questionnaire
Semi-structured
questionnaire
Structured
questionnaire
INTERVIEW
(n=25, 49 %)
Unstructured
interview
Semi-structured
interview
Thematic
interview
Qualitative
interview
Focus group/
Group interview
Individual
interview
Pair interview
Telephone
interview
OBSERVATION
(n=6, 11.8 %)
PANELS
(n=5, 9.8 %)
DOCUMENTS
(n=20, 39.2 %)
Delphi panel
Pelttari, 1997; Karttunen, 1999; Pihlainen, 2000; Sivonen,
2000; Vanhanen, 2000; Heikkinen, 2003; Paukkunen, 2003;
Holopainen, 2007; Luukka, 2007; Suikkala, 2007; Brunou,
2009; Vidgrén, 2009; Nikula, 2011; Jämsä, 2014
Sivonen, 2000; Ekebergh, 2001
Koskinen, 2003; Paukkunen, 2003; Brunou, 2009; Vidgrén,
2009; Nikula, 2011; Jokelainen, 2013; Jämsä, 2014
Pelttari, 1997; Vanhanen, 2000; Sarajärvi, 2002; Turunen,
2002; Koskinen, 2003; Silén-Lipponen, 2005; Sandelin, 2007;
Suikkala, 2007; Nikula, 2011; Jämsä, 2014
Nikula, 2011
Heikkinen, 2003; Sandelin, 2007
Leino-Kilpi, 1990; Janhonen, 1992; Halme, 1998; Kuokkanen,
2000; Koskinen, 2003; von Schantz, 2005
Saranto, 1997; Lakanmaa, 2012; Lankinen, 2013
Expert panel
Case
Critical incident
description
Vanhanen, 2000; Saarikoski, 2002
Aavarinne, 1993; Juvonen, 2001
Turunen, 2002; Silén-Lipponen, 2005; Romppanen, 2011
Development
task report
Jämsä, 2014
Essay
Karttunen, 1999; Kuokkanen, 2000; Pihlainen, 2000; Sivonen,
2000; Vanhanen, 2000; Sarajärvi, 2002; Brunou, 2009;
Lakanmaa, 2012
Koskinen, 2003
Learning
document
TESTS
(n=3, 5.9 %)
Reference
Aavarinne, 1993; Halme, 1998; Stenfors, 1999; Pihlainen,
2000; Heikkinen, 2003; Heikkilä, 2005; Vidgrén, 2009
Harri, 1997; Saranto, 1997; Salanterä, 1999; Jaroma, 2000;
Salminen, 2000; Vanhanen, 2000; Juvonen, 2001; Pirilä, 2002;
Räisänen, 2002; Elomaa, 2003; Koskinen, 2003; Paukkunen,
2003; Salmela, 2004; Heikkilä, 2005; von Schantz, 2005;
Suikkala, 2007; Brunou, 2009; Laine, 2010; Numminen, 2010
Saranto, 1997; Juvonen, 2001; Saarikoski, 2002; Heikkinen,
2003; Laine, 2010; Nikula, 2011; Lakanmaa, 2012; Lankinen,
2013; Talman, 2014
Janhonen, 1992; Hupli, 1996; Sarajärvi, 2002; Holopainen,
2007; Luukka, 2007; Sandelin, 2007
Vanhanen, 2000; Koskinen, 2003; von Schantz, 2005;
Suikkala, 2007; Luojus, 2011; Nikula, 2011; Jämsä, 2014
Narrative
Travel report
Written care
plan
Written text
Computer
simulation test
Medication
Calculation
Skills Test
(MCS)
Ekebergh, 2001; Sandelin 2007
Kokko, 2008
Hupli, 1996; Kuokkanen, 2000
Leino-Kilpi, 1990
Hupli, 1996
Grandell-Niemi, 2005
22
Test of critical
thinking
(Watson&Glaser)
CLINICAL EXAMINATION
(n=1, 2 %)
Stenfors, 1999
Pirilä, 2002
*One dissertation could be classified into several categories.
Statistical methods and content analysis were the most widely used analysis methods in
the dissertations. Statistical analysis methods were applied in 31 dissertations whereas
content analysis was applied in 32 of the dissertations. Content analysis methods were
classified into inductive, deductive and abductive categories. However, not all researchers
reported their specific approach of content analysis and therefore we categorized their
analysis method in content analysis in general. Inductive approach was applied in 13
dissertations and deductive in seven. Only two researchers (Hupli, 1996; Sarajärvi, 2002)
used deductive approach as their only method of content analysis. Usually deductive
approach were used together with inductive approach (n=5). Only one researcher
(Vidgrén, 2009) reported abductive approach. In three dissertations categorization was
mentioned as a data analysis method (Pihlainen, 2000; Salminen, 2000; Laine, 2010). In
addition, narrative method (Koskinen, 2003; Sandelin, 2007), phenomenography
(Karttunen, 1999; Pihlainen, 2000; Heikkinen, 2003; Jokelainen, 2013), phenomenology
(Pelttari, 1997; Sivonen, 2000; Ekebergh, 2001; Sarajärvi, 2002; Turunen, 2002;
Heikkinen, 2003; Silen-Lipponen, 2005: Luukka, 2007; Jokelainen, 2013) and grounded
theory (Leino-Kilpi, 1990; Janhonen, 1992; Vanhanen, 2000; Sarajärvi, 2002;
Holopainen, 2007) were applied as a data analysis method not only as a research method
in general. Rarely reported data analysis methods were paradigmatic and ethnographic
analysis (Koskinen, 2003), etymological and semantic analysis (Sivonen, 2000) and
historical analysis method (Tallberg, 1991). However, conceptual analysis was utilized in
four dissertations (Sivonen, 2000; Vanhanen, 2000; Heikkinen, 2003; Silén-Lipponen,
2005).
23
Table 5 Data analysis methods in Finnish nursing education dissertations (N=51).*
Data analysis method
Reference
Aavarinne, 1993; Hupli, 1996; Harri, 1997; Saranto, 1997;
Halme, 1998; Salanterä, 1999; Stenfors, 1999; Jaroma,
2000; Kuokkanen, 2000; Salminen, 2000; Vanhanen,
2000; Juvonen, 2001; Pirilä, 2002; Räisänen, 2002;
Saarikoski, 2002; Elomaa, 2003; Heikkinen, 2003;
Paukkunen, 2003; Salmela, 2004; Grandell-Niemi, 2005;
Heikkilä, 2005; von Schantz, 2005; Suikkala, 2007;
Brunou, 2009; Laine, 2010; Numminen, 2010; Luojus,
2011; Nikula, 2011; Lakanmaa, 2012; Lankinen, 2013;
Talman, 2014
Harri, 1997; Saranto, 1997; Salanterä, 1999; Stenfors,
1999; Kuokkanen, 2000; Juvonen, 2001; Räisänen, 2002;
Elomaa, 2003; Heikkilä, 2005; Silén-Lipponen, 2005; von
Scahntz, 2005; Kokko, 2008; Brunou, 2009; Luojus, 2011;
Romppanen, 2011; Lankinen, 2013
STATISTICAL ANALYSIS
METHODS
(n=31, 60.8 %)
CONTENT ANALYSIS
(n=32, 62.7 %)
Inductive
Deductive
Abductive
Aavarinne, 1993; Halme, 1998; Vanhanen, 2000; Pirilä,
2002; Koskinen, 2003; Paukkunen, 2003; Salmela, 2004;
Luukka, 2007; Suikkala, 2007; Numminen, 2010; Nikula,
2011; Lakanmaa, 2012;
Jämsä, 2014
Aavarinne, 1993; Hupli, 1996; Halme, 1998; Vanhanen,
2000; Sarajärvi, 2002; Lakanmaa, 2012; Jämsä, 2014
Vidgrén, 2009
CATEGORIZATION
(n=3, 5.9 %)
Pihlainen, 2000; Salminen, 2000; Laine, 2010
NARRATIVE ANALYSIS
(n=2, 3.9 %)
Koskinen, 2003; Sandelin, 2007
PHENOMENOGRAPHY
(n=4, 7.8 %)
Karttunen, 1999; Pihlainen, 2000; Heikkinen, 2003;
Jokelainen, 2013
PHENOMENOLOGY
(n=9, 17.6 %)
Pelttari, 1997; Sivonen, 2000; Ekebergh, 2001; Sarajärvi,
2002; Turunen, 2002; Heikkinen, 2003; Silen-Lipponen,
2005; Luukka, 2007; Jokelainen, 2013
GROUNDED THEORY
(n=5, 9.8 %)
Leino-Kilpi, 1990; Janhonen, 1992; Vanhanen, 2000;
Sarajärvi, 2002; Holopainen, 2007
PARADIGMATIC AND
ETNOGRAPHIC
ANALYSIS (n=1, 2 %)
Koskinen, 2003
ETYMOLOGICAL AND
SEMANTIC ANALYSIS
(n=1, 2 %)
Sivonen, 2000
HISTORICAL ANALYSIS
METHOD (n=1, 2 %)
Tallberg, 1991
CONSEPTUAL ANALYSIS
(n=4, 7.8 %)
Sivonen, 2000; Vanhanen, 2000; Heikkinen, 2003; SilénLipponen, 2005
*One dissertation could be classified into several categories.
24
Study informants of the dissertations
Study informants of the dissertations were collected in a matrix according to the reported
amounts in the dissertations (Table 6). However, in four dissertations the exact amount
of the study informants was not applicable because they were reported only in a total
amount, not separately (Sivonen, 2000; Vanhanen, 2000; Sandelin, 2007; Nikula, 2011).
Therefore we were unable to count the total precise amount of the study informants of all
the dissertations. Still, the predominant study informant group was students consisting
mostly of bachelor level nursing students (e.g. nurse students, public health nurse
students, midwifery students). In 43 (84.3 %) dissertations the study informants were
students either as target- or sub target group. Also, some of the dissertations studied
nursing students from post-secondary institutions as the chosen dissertations covered the
years before the establishment of polytechnics in Finland (e.g. Räisänen, 2002; von
Schantz, 2005). Only one dissertation included practical nurse-students (Pirilä, 2002), one
dissertation students and teachers in a master´s degree programme in polytechnics (Jämsä,
2014) and two dissertations master level students of nursing and caring sciences
(Ekebergh, 2001; Turunen, 2002). None of the dissertations included doctoral level
students or students of paramedic nursing. Some dissertations studied also other socialand health care students than nursing students (e.g. Heikkinen 2003; Paukkunen 2003)
and one dissertation included a bachelor student of Business administration (Vidgren,
2009).
Nurse staff was a study informant group of 18 dissertation while mentors only in three.
Rarely studied informants were managers in nursing (n=2) and education (n=1), nursing
researchers (n=1), Delphi-panel-members (n=3), vaccination professionals (e.g. public
health nurses, physicians, nurse educators) (n=1) and other representatives of nursing
education or working life (i.e. other than nurse educators or managers in education) (n=3).
Patients or clients were a sub target population in five dissertations (9.8 %). Nurse
educators were studied in 25 dissertations (49.0 %) but only two of the dissertations
included nurse educators as their only sources of information (Janhonen, 1992;
Holopainen, 2007). One dissertation focusing on nurse educators studied also their
spouses (Harri, 1997).
Learning situations and different kinds of documents (e.g. historical documents, curricula,
thesis, literature and other learning or research documents) were a source of information
all in all in nine dissertations (17.6 %). Documents were considered as study informants
25
according to the reporting of the researchers or if the document could be regarded as a
study informant itself not as a data collection method. Six dissertations had their
informants from other countries than Finland as well, such as the Nordic countries or
Britain (Salminen, 2000; Saarikoski, 2002; Turunen, 2002; Koskinen, 2003; Kokko,
2008; Jokelainen, 2013). The amounts of the study informants vary considerably between
the dissertations as the sample sizes and methods were different.
26
Table 6 Study informants in Finnish nursing education dissertations (N=51).*
Informant
STUDENT
Range,
median, N,
total
3–859, 160, 43,
9996
NURSE EDUCATOR
4–542, 96.5,
24, 2710
NURSE STAFF
6–876, 115, 18,
4252
MENTOR
39–768, 268, 3,
1075
6–272, 13, 5,
379
N=1, total 15
PATIENT/CLIENT
MANAGER IN
EDUCATION
MANAGER IN
NURSING/HEALTH
CARE
SPOUSE OF THE
NURSE EDUCATOR
NURSING
RESEARCHER
DELPHI-PANEL
MEMBERS
VACCINATION
PROFESSIONALS
OTHER
REPRESENTATIVES
OF NURSING
EDUCATION OR
WORKING LIFE
DOCUMENTS AND
LEARNING
SITUATIONS
Reference
Leino-Kilpi, 1990; Aavarinne, 1993; Hupli, 1996;
Saranto, 1997; Halme, 1998; Karttunen, 1999; Salanterä,
1999; Stenfors, 1999; Jaroma, 2000; Kuokkanen, 2000;
Pihlainen, 2000; Salminen, 2000; Sivonen, 2000;
Vanhanen, 2000; Ekebergh, 2001; Juvonen, 2001; Pirilä,
2002; Räisänen, 2002; Saarikoski, 2002; Sarajärvi, 2002;
Turunen, 2002; Elomaa, 2003; Heikkinen, 2003;
Koskinen, 2003; Paukkunen, 2003; Salmela, 2004;
Grandell-Niemi, 2005; Heikkilä, 2005; Silén-Lipponen,
2005; von Schantz, 2005; Sandelin, 2007**; Suikkala,
2007; Kokko, 2008; Brunou, 2009; Vidgrén, 2009; Laine,
2010; Numminen, 2010, Nikula, 2011; Romppanen,
2011; Lakanmaa, 2012; Lankinen, 2013; Jämsä, 2014;
Talman, 2014
Leino-Kilpi, 1990; Janhonen, 1992; Aavarinne, 1993;
Harri, 1997; Pelttari, 1997; Saranto, 1997; Halme, 1998;
Salminen, 2000; Sivonen, 2000; Juvonen, 2001;
Räisänen, 2002; Saarikoski, 2002; Elomaa, 2003;
Heikkinen, 2003; Koskinen, 2003; Salmela, 2004;
Heikkilä, 2005; von Schantz, 2005; Holopainen, 2007;
Sandelin, 2007**; Vidgrén, 2009; Laine, 2010;
Numminen, 2010; Nikula 2011
Leino-Kilpi, 1990; Hupli, 1996; Pelttari, 1997; Salanterä,
1999; Sivonen, 2000; Pirilä, 2002; Elomaa, 2003;
Heikkinen, 2003; Koskinen, 2003; Grandell-Niemi, 2005;
Silén-Lipponen, 2005; Luukka, 2007; Sandelin 2007**;
Brunou, 2009; Nikula, 2011; Lakanmaa, 2012; Lankinen,
2013; Jämsä, 2014
Salmela, 2004; Luojus, 2011; Jokelainen, 2013
Pelttari, 1997; Pihlainen, 2000; von Schantz, 2005;
Suikkala, 2007; Nikula, 2011
Vidgrén, 2009
Range 4–6,
N=2, total 10
Pelttari, 1997; Jämsä, 2014
N=1, total 409
Harri, 1997
N=1, total 6
Pelttari, 1997
15–79, 34, 3,
128
N=1, total 22
Saranto, 1997; Lakanmaa, 2012; Lankinen, 2013
2–14, 2, 3, 18
Pelttari, 1997; Vidgrén, 2009; Jämsä, 2014
6–81, 43, 9,
246
Tallberg, 1991; Halme, 1998; Salanterä, 1999; Stenfors,
1999; Sivonen, 2000**; Vanhanen, 2000**; Heikkinen,
2003**; Silén-Lipponen, 2005; Kokko, 2008
Nikula, 2011
*One dissertation could be classified into several categories. **N not applicable.
27
Reporting of validity, reliability and research ethics of the dissertations
Reporting of validity and reliability in the dissertations was classified into nine categories
(Table 7). Internal consistency was reported most (60.8 %). On the contrary face validity
and dependability was reported only in 3.9 % of the dissertations. Reporting of the applied
methods varied between the dissertations and therefore the categorization of the methods
was not unambiguous. Reporting of research ethics was classified into two categories:
reporting of ethical approval and reporting of informed consent. Obtaining of ethical
approval was reported in 11.8 % of the dissertations and the use of informed consent in
39.2 % of the dissertations.
Table 7 Reporting of validity and reliability in Finnish nursing education dissertations
(N=51).*
Validity and reliability
Face validity
Content validity
Criterion validity
Construct validity
Internal consistency
Credibility
Transferability
Confirmability
Dependability
n
2
29
20
17
31
14
21
10
2
%
3,9
56,9
39,2
33,3
60,8
27,5
41,2
19,6
3,9
*One dissertation could be classified into several categories.
5.2 Focus of the dissertations in the field of nursing education research
As a result of the analysis four main categories were found representing the focus of
nursing education research: Structural factors in nursing education, Nurse teacherhood,
Teaching activities in nursing education and Learning and learning outcomes in nursing
education (Table 8).
28
Table 8 Focus of the Finnish nursing education research (N=51).*
MAIN
CATEGORY
SUBCATEGORY
CONTENT AREA
REFERENCE
STRUCTURAL
FACTORS IN
NURSING
EDUCATION
(n=9, 17.6 %)
Curricula reform
orientations
Curriculum connected to
patient education
Curriculum connected to
professional education
Evaluation of polytechnics
and post-secondary
institutions
Future functions in nursing
Good nursing care
Qualification requirements
History of nursing
education
Development and
evaluation of collaboration
Development and
management of educational
innovations
Student selection
Aavarinne, 1993
Nurse educators` views of
nursing
Janhonen, 1992; Sivonen,
2000; Sandelin, 2007
Becoming a nurse educator
Turunen, 2002
Characteristics of a nurse
educator`s work
Harri, 1997; Holopainen,
2007
Requirements for a nurse
educator
Well-being at work
Mental violence in a
workplace
Critical incidents as a
teaching method
Measurement of blood
pressure
Nursing functions
Physical and psychoemotional nursing skills
Critical thinking
Decision making
Ethics
Salminen, 2000
Future
orientations
Historical
orientations
Multidisciplinary
orientations
NURSE
TEACHERHOOD
(n=7, 13.7 %)
Nurse educator`s
relationship to
nursing
Role of a nurse
educator
Well-being of a
nurse educator
TEACHING
ACTIVITIES IN
NURSING
EDUCATION
(n=10, 19.6 %)
Teaching methods
Teaching of
clinical skills
Teaching of
generic skills
LEARNING AND
LEARNING
OUTCOMES IN
NURSING
EDUCATION
(n=43, 84.3 %)
Academic
performance
Assessment of
learning
Clinical learning
and clinical
Information technology
Research knowledge
utilization
Student success
Competence assessment
Evaluation methods
Student success and
motivation
Clinical learning
environment
Jaroma, 2000
Räisänen, 2002
Jaroma, 2000
Leino-Kilpi, 1990
Pelttari, 1997
Tallberg, 1991
Paukkunen, 2003
Vidgrén, 2009
Talman, 2014
Harri, 1997
Sandelin, 2007
Turunen, 2002
Laine, 2010
Räisänen, 2002
Salmela, 2004
Halme, 1998
Juvonen, 2001
Brunou, 2009; Numminen,
2010
Saranto, 1997
Heikkilä, 2005
Talman. 2014
Räisänen, 2002; Salmela,
2004; Grandell-Niemi, 2005;
Heikkilä, 2005; Laine, 2010;
Nikula, 2011; Lakanmaa,
2012
Numminen, 2010
Talman, 2014
Saarikoski, 2002; Brunou,
2009; Romppanen, 2011
29
learning
environment
Mentoring in clinical
learning
Saarikoski, 2002; Luojus,
2011; Jokelainen, 2013
Learning of
clinical skills
Aseptics and infection
control
Emergency nursing
competence
Intensive care nursing
competence
Nursing functions
Measurement of blood
pressure
Medical calculation skills
Nursing care of children in
pain
Nursing of the elderly
Operating room nursing
Oral and dental care
Physical and psychoemotional nursing skills
Vaccination competence
Cultural skills
von Shantz, 2005
Learning of
generic skills
Räisänen, 2002
Laine, 2010
Grandell-Niemi, 2005
Salanterä, 1999
Pirilä, 2002; Luukka, 2007
Silén-Lipponen, 2005
Pirilä, 2002
Salmela, 2004
IT-skills
Nursing science
Patient education
Reflection skills
Research knowledge
utilization
Scientific thinking
Student-patient relationship
Teamwork and
collaboration
Stenfors, 1999
Suikkala, 2007
Paukkunen, 2003; SilénLipponen, 2005
Work-based learning
Critical learning incidents
Jämsä, 2014
Turunen, 2002; SilénLipponen, 2005; Luukka,
2007; Romppanen 2011
Ekebergh, 2001; Kokko,
2008
Heikkinen, 2003; Sandelin,
2007
Vanhanen, 2000
Ethics
Students`
relationship to
nursing
Lakanmaa, 2012
Nikula, 2011
Koskinen, 2003; Kokko,
2008
Halme, 1998; Stenfors, 1999
Hupli, 1996; Kuokkanen,
2000; Juvonen, 2001
Pihlainen, 2000; Sivonen,
2000; Brunou, 2009;
Numminen, 2010
Saranto, 1997
Ekebergh, 2001
Aavarinne, 1993
Ekebergh, 2001
Ekebergh, 2001; Elomaa,
2003; Heikkilä, 2005
Critical thinking
Decision making
Meaningful
learning
experiences
Lankinen, 2013
Experiences enhancing
learning
Experiences of envy and
mental violence
Students` orientations to
nursing
Students` views of nursing
Karttunen, 1999; Jaroma,
2000; Sivonen, 2000;
Sarajärvi, 2002; Heikkinen,
2003; Sandelin, 2007
*One dissertation could be classified into several categories.
30
Structural factors in nursing education
All in all nine dissertations focused on structural factors in nursing education (Table 8).
Further, we identified four subcategories describing the research areas more specifically:
Curricula reform orientations, Future orientations, Historical orientations and
Multidisciplinary orientations. Therefore, these dissertations were interested in
developing nursing education, its management, curricula, evaluation, innovative
approaches and student selection to meet the needs and demands of working life of
nursing. Amount of the dissertations focusing on research of the nursing curricula were
little (n=3). Structural changes in nursing education can be seen as research of postsecondary institutions and polytechnics as it was studied as an evaluation of these two
educational institutions (Räisänen, 2002) and curricula connected to professional
education (Jaroma, 2000). In addition patient education connected to curricula was an
interest of one dissertation (Aavarinne, 1993). Future-perspective was a focus of three
dissertations (Jaroma, 2000, Pelttari, 1997, Leino-Kilpi, 1990) as the future functions of
a nurse professional (Jaroma, 2000), future requirements for nursing education (Pelttari,
1997) and good nursing care (Leino-Kilpi, 1990) was identified. Historical research of
nursing education was considerably scarce while only one dissertation focused on the
history of nursing and nursing education (Tallberg, 1991). The subcategory of
multidisciplinary orientations covered the dissertations focusing on several developmentareas of nursing education structures that were development and management of
educational innovations in universities of applied sciences (Vidgrén, 2009) , collaboration
in social- and healthcare education (Paukkunen, 2003) and student selection (Talman,
2014).
Nurse teacherhood
Nurse teacherhood was a focus of seven dissertations thus being the least studied research
field (Table 8). The category of nurse teacherhood covered studies interested in being and
becoming a nurse educator, the working-life and characteristics of a nurse educators` role
as well as nurse educators` views of the world of nursing and its actions. The phenomenon
of nurse teacherhood was classified into three subcategories: Nurse educators`
relationship to nursing, Role of a nurse educator and Well-being of a nurse educator.
Subcategory of Nurse educators` relationship to nursing covered the dissertations
focusing on nurse educators` views of nursing as the studies described nursing and its
actions defined by the nurse educators themselves. These dissertations focused on nurse
31
educators` views of the core of nursing (Janhonen, 1992), the meaning of “spiritual” in
nursing and nursing science (Sivonen, 2000) and mental violence in workplaces in the
healthcare (Sandelin, 2007). Role of a nurse educator was studied as nurse teacher
students` process of becoming a nurse educator (Turunen, 2002), characteristics of a nurse
educators` working life (Harri, 1997) and nurse teacherhood in polytechnics and how the
nurse educators are experiencing it (Holopainen, 2007). In addition, requirements
focusing on nurse educators was evaluated (Salminen, 2000). Well-being of a nurse
educator was studied as well-being at work defined by the nurse educators` themselves
but also by their spouses (Harri, 1997). Mental-violence in a workplace covered also the
point of views of a nurse educator and nursing education not only the clinical healthcare
area (Sandelin, 2007).
Teaching activities in nursing education
Teaching activities in nursing education was a focus of ten dissertations (Table 8). The
focus of teaching and learning in nursing education were overlapping and therefore nine
dissertations were categorized in both categories covering not only the perspective of
teaching but also learning. Furthermore, teaching activities were classified into categories
of teaching of clinical skills (n=3) and teaching of generic skills (n=6). Two of the
dissertations focused on the teaching of ethics in the nursing education (Brunou, 2009;
Numminen, 2010). Research focusing on teaching methods was considerably scarce as
only one study was interested in a certain teaching/learning method (Turunen, 2002).
Learning and learning outcomes in nursing education
Learning and learning outcomes in nursing education was the most common category and
therefore the most central focus in nursing education research (Table 8). The category of
learning overlapped with the category of teaching and covered learning occurring on
many levels of nursing education both in class-room and in practical training. The main
category could be divided further into seven subcategories that were Academic
performance, Assessment of learning, Clinical learning and clinical learning
environment, Learning of clinical skills, Learning of generic skills, Meaningful learning
experiences and Students` relationship to nursing. Assessment of learning was studied
from the perspectives of competence and evaluation of skills. Evaluation study of level
of know-how between the students from post-secondary institutions and polytechnics was
carried out (Räisänen, 2002). Furthermore, skills and the level of competence was
evaluated in the areas of intensive and critical care nursing (Lakanmaa, 2012), vaccination
32
competence (Nikula, 2011), measurement of blood-pressure (Laine, 2010), research
knowledge utilization (Heikkilä, 2005), medication calculation skills (Grandell-Niemi,
2005) and nursing skills in general (Salmela, 2004). In addition, the use of evaluation
methods in teaching of code of ethics was regarded (Numminen, 2010) and three
researches developed assessment scales for skills and competence evaluation (Lakanmaa,
2012; Laine, 2010; Grandell-Niemi, 2005). Also, the phenomenon of assessment
appeared in students` success and motivation in student selection (Talman, 2014).
Clinical learning consisted of several single content areas and was an interest of five
dissertations. Nursing students learning and learning experiences in clinical learning
environment (Saarikoski, 2002; Romppanen, 2011) was studied. Also, ethical problems
occurring in clinical learning environment and their detecting and resolving by nursing
students (Brunou, 2009) was focused. Mentoring including student-mentor relationship
was studied from the perspectives of both the students` (Saarikoski, 2002) and mentors
(Luojus, 2011; Jokelainen 2013) experiences.
Like the category of teaching so the category of learning could be divided into learning
in clinical and generic skills (Table 8). There were altogether 13 content areas in which
the learning in clinical skills was described. Nursing students` know-how as in
knowledge, skills and competence was the focus of nine dissertations (Salanterä, 1999;
Räisänen, 2002; Salmela, 2004; Grandell-Niemi, 2005; von Shantz, 2005; Laine, 2010;
Nikula, 2011; Lakanmaa, 2012; Lankinen 2013). In addition, learning of clinical skills in
nursing education was described occurring in different kinds of nursing contexts that were
nursing of the elderly (Pirilä, 2002; (Luukka, 2007), operating room nursing (SilenLipponen, 2005) and oral and dental care (Pirilä, 2002). Learning in generic skills
consisted of 13 content areas. Learning in ethics was the biggest group as it was studied
as nursing students` personal values (Pihlainen, 2000), the concept of “spiritual” in
nursing described by the nursing students (Sivonen, 2000), the use of code of ethics
(Numminen, 2010) and the ethical problems and their recognizing (Brunou, 2009) in
nursing education. Cultural skills was studied from the perspectives of learning
intercultural competence (Koskinen, 2003) and transcultural nursing (Kokko, 2008)
utilizing the contexts of exchange programs and studying abroad. The development of
critical thinking (Halme, 1998; Stenfors, 1999) and scientific thinking (Stenfors, 1999)
during the nursing education was a focus of two dissertations while the decision making
of the nursing students` was the focus on three dissertations (Hupli, 1996; Kuokkanen,
2000; Juvonen, 2001). Research knowledge utilization was the focus of three dissertations
33
(Ekebergh, 2001; Elomaa, 2003; Heikkilä, 2005) and teamwork and collaboration of two
as collaboration was studied within experimental education of collaboration in social- and
healthcare education (Paukkunen, 2003) whereas teamwork in operation theatre (SilénLipponen, 2005). Learning outcomes of information technology (Saranto, 1997) and
learning of nursing science and reflection skills (Ekebergh, 2001), patient education
(Aavarinne, 1993), student-patient relationship (Suikkala, 2007) and work-based learning
(Jämsä, 2014) were single content areas in the category of learning in generic skills.
Meaningful learning experiences could be regarded as students` positive and negative
experiences connected to their learning and students` relationship to nursing consisted of
students` orientation and views of the working-life and characteristics of nursing. Four
dissertations aimed at describing students` critical learning incidents not only from
nursing students` perspective (Silén-Lipponen, 2005; Luukka, 2007; Romppanen, 2011)
but also from nurse teacher students` perspective (Turunen, 2002). In addition, nursing
students` experiences enhancing their learning was studied as experiences in exchange
(Kokko, 2008) and in nursing situations (Ekebergh, 2001). Also, the nursing students`
experiences of envy in nursing (Heikkinen, 2003) and mental violence in healthcare and
in nursing education (Sandelin, 2007) was focused. Students` relationship to nursing
consisted of students` orientations to nursing (Vanhanen, 2000) and students` views of
nursing (Karttunen, 1999; Sivonen, 2000; Jaroma, 2000; Sarajärvi, 2002; Heikkinen,
2003; Sandelin, 2007) as the studies described nursing and its actions defined by the
nursing students. Nursing students views of nursing were studied as nursing students
views and concepts of knowledge relating to actions in nursing (Karttunen, 1999), future
functions in nursing (Jaroma, 2000), the meaning of “spiritual” in nursing and nursing
science (Sivonen, 2000), mental violence (Sandelin, 2007) and envy (Heikkinen, 2003)
in nursing and formation of conceptions of nursing during nursing education (Sarajärvi,
2002).
34
6. DISCUSSION
6.1 Discussion of results
6.1.1 A general description and the characteristics of the Finnish dissertations
As said, nursing education research is a central study field of nursing and caring sciences
nationally and internationally. Also, it seems that more and more studies in the field of
nursing education have been made all the time. By reviewing 39 papers we included 1129
scientific papers this being only one example of a great amount of nursing education
studies. However, Finnish dissertations focusing on nursing education research cover
only 12.3 % of the total amount (N=415) of all the academic dissertations of nursing and
caring sciences in Finland. It is said that more nursing education research is still needed
(Salminen et al., 2010). The Finnish dissertations describe the zeitgeist. During the 1990`s
the studies were interested in for example good nursing care and general educational
reforms like the establishment of polytechnics in Finland. By the 2000`s it seems that
studies focusing on students` competence and its assessment were increased by the
Bologna Process and the European Qualification Framework. As said, educational
reforms are challenging not only nursing education but also nursing education research.
Therefore, the impact of the reforms might appear even more to affect the focus of nursing
education research. Internationally, the reviews covered years 2001–2014. Therefore, the
chosen reviews can`t represent a complete historical timeline in the field of education of
nursing and caring sciences. However, some studies included in the reviews are published
earlier than 2001. The educational reforms like the Bologna Process appeared in the
reviews as well.
Data collection methods have been mainly conventional in Finnish doctoral dissertations.
Surveys and interviews have been the most popular methods both in the Finnish
dissertations and in the international reviews. Experimental and intervention studies both
in Finland and internationally have been scarce (Johnson, 2004; Hegarty et al., 2008). In
the international reviews, the included studies utilized experimental designs whereas the
applied methods in the Finnish nursing education dissertations have been quite traditional.
Triangulation, though, has been utilized as it is typical for academic dissertations. Finnish
nursing education research has increased since its early days yet experimental and
intervention studies have not followed the same trend. Although the dissertations are
empirical it might not be enough considering the development of education. In addition,
35
there might be a need for the development of ontological, philosophical and theoretical
bases for nursing education research.
Nursing students were the biggest study informant group both in Finnish dissertations and
in the international reviews. Only eight dissertations excluded students as their study
informants. The data of the dissertations have been collected during several decades and
therefore the students are both from post-secondary institutions and polytechnics.
Practical nurse students have been studied considerably little, even though vocational
schools play a significant role in nursing education, and also when it comes to the work
of the nurse educators. Still, there are dissertations that have been interested in practical
nurse education, even though their study informants were not students (e.g. Luukka,
2007).
Research concerning the education of other nursing based-professions (midwifery,
emergency nursing and public health nursing) and master’s or doctoral students in the
discipline of nursing and caring sciences has either not been done or it has been scarce
both nationally and internationally. Public health nurse education has been a focus of only
one dissertation (Nikula, 2011) while dissertations focusing fully to midwife or paramedic
nurse education and its development have not been made. However, in the Finnish
dissertations the study informants have been also other students of nursing-based
professions, but in the international reviews the students were mainly nursing students
(RN) or students completely from another field. Master students have been an informant
group in two dissertations (Ekebergh, 2001; Turunen, 2002), but doctoral students were
none. Also, not only the managers of nursing but also the managers of education have
been a minor group as study informants in Finland and almost forgotten study informant
group internationally. In Finland, nurse educators were studied much less than students
or nurse staff which is slightly surprising since nurse educators have an essential role in
nursing education and its development and we have our own teacher education in health
sciences. On the other hand, the result goes hand in hand with the scarce research of nurse
teacherhood both nationally and internationally. Even though clinical learning and
clinical learning environment has been a focus of quite a few dissertations, mentors have
been study informants only in three dissertations. Precise amounts of study informants of
the international reviews were not applicable and therefore it is not possible to compare
their popularity.
36
Validity, reliability and research ethics have been considered from several perspectives
in nursing education dissertations. Still, the percentages of our classification in research
ethics seem to be particularly small. On one hand, participation in survey studies itself is
typically regarded as informed consent and a separate consent is not requested. On the
other hand, it might be possible that ethical approval has not been considered if the
research focus is on education and not necessarily on a sensitive informant group.
However, patients for example were studied in several dissertations. Only one of the
dissertations included only documents as research data while all the other dissertations
focused on human research. All in all, this phenomenon might occur due to the course of
time. In the international reviews the reporting of the research ethics was not reviewed,
because it was not usually reviewed in the reviews themselves. Only approximately half
of the chosen reviews (n=21) reported the validity and reliability or study quality
evaluation of the data.
6.1.2 Focus of the Finnish dissertations in the field of nursing education research
According to the analysis, nursing education research has focused both nationally and
internationally on four main categories and learning and its outcomes has been the most
central focus area. The popularity of the main categories in Finnish dissertations were
similar to international reviews. However, the percentages of the popularity vary between
the Finnish dissertations and international reviews (Table 9). Also, the subcategories
describing the focus areas were mostly similar between the dissertations and reviews as
the international reviews formed a deductive frame for classification of the dissertations.
However, new subcategories were created if it was needed and therefore in the
international level the subcategories of Historical orientations, Nurse educators`
relationship to nursing, Well-being of a nurse educator and Meaningful learning
experiences do not exist.
37
Table 9 Differences between the popularity of the main categories.
FINNISH DISSERTATIONS
INTERNATIONAL REVIEWS
1.
LEARNING AND LEARNING
OUTCOMES IN NURSING
EDUCATION: 84.3 %
1.
2.
TEACHING ACTIVITIES IN
NURSING EDUCATION:
19.6 %
2.
3.
STRUCTURAL FACTORS IN
NURSING EDUCATION:
17.6 %
NURSE TEACHERHOOD:
13.7 %
3.
4.
4.
LEARNING AND LEARNING
OUTCOMES IN NURSING
EDUCATION: 66.7 %
TEACHING ACTIVITIES IN
NURSING EDUCATION:
53.8 %
STRUCTURAL FACTORS IN
NURSING EDUCATION:
10.3 %
NURSE TEACHERHOOD:
5.1 %
Focus of the nursing education research not only in Finland but also internationally
according to our analysis has stayed rather traditional as it was noticed already earlier
(Salminen et al., 2006). However, the focus areas of the studies are representing widely
not only interesting but also important and central perspectives of nursing education. For
example, a student-centred research is not a negative matter as students must be placed to
the core of planning and performing of education. However, the structural factors in
nursing education have been a minor interest of research both in Finland and in the
international reviews, though it is a central focus of educational planning. There has been
a need for evaluative research of curriculum because nursing education is undergoing
remarkable changes (Hentinen, 1989). Despite this, research focusing exactly on nursing
education curricula has been forgotten during the last ten years. However, the curricula
can be considered closely even though the dissertations’ interest is for example on
students` learning or teaching activities. In addition, the changes in nursing curricula are
rapid posing challenges for long-term research. Historical orientations in nursing
education have been focused on Finland only in one dissertation. On the other hand, little
research of history in nursing science has been made in general (Lukana et al., 2012).
Studies focusing on student selection and motivation have been made in the 1980`s in
Finland (Salminen et al., 2006), but on the doctoral level the only study in this field was
not published before than 2014 (Talman, 2014). In the international reviews, student
selection has not been studied much either and it is said that little consensus exits in
criterion and tools for valid admission process (Megginson, 2009). However,
international nursing shortage (Mcdermid et al., 2012) and the concern of nurses leaving
their profession (Flinkman, 2014) underlines the importance of this study field. Still, it is
obvious that in nursing education research also the studies focusing on different areas are
38
nevertheless aiming for developing the nursing education including its contents,
structures and most important management. Therefore, it is possible that some of the
chosen dissertations and reviews are setting several goals for nursing education
development and proposing topics for further studies in nursing education research within
their conclusions and discussion.
All in all, teacherhood, teaching methods and teaching activities are considered but not
significantly focused on in Finnish nursing education research. Compared to Finland,
teaching activities and especially teaching methods, particularly simulation, has been a
greater matter of interest in the international reviews. Therefore, evidence based teaching
is possible being central goals of nursing education. Also, it is not necessarily surprising
that reviews are focusing on teaching methods, because the purpose of a review is to
gather a synthesis of a current evidence. In the dissertations, teaching activities are usually
described in a wider perspective and not as a single method. On the other hand, research
of nurse teacherhood has been scarce both in Finnish dissertations and international
reviews. However, the role of nurse educators has changed (Gillespie and McFetridge,
2006) and it might be important to study the new roles of teachers.
Learning in nursing education has been a major focus of nursing education research
connected to many factors of nursing both nationally and internationally. Also, three
developed scales for students` competence assessment have been developed after the
2000`s in Finland. However, none of the dissertations set their central focus on the
methods, solutions or ethics of assessment in nursing education and only one dissertation
(Numminen, 2010) notices the use of assessment methods. Therefore, there is a lack of
knowledge of assessment as a key phenomenon of nursing education including nurse
educators` performance in student assessment. In addition, there is not a single study
concerning external evaluation of the quality of nursing education neither in Finland nor
internationally. Both nurse educators and nursing students have been studied concerning
their views and perceptions of nursing being an interesting matter. In the international
level, similar research has not been done. On the other hand, students` academic
performance and success have been quite a considerable interest internationally, but not
in Finland. For instance, the international reviews include studies focusing on students
and their possible challenges during the education (e.g. language skills, disabilities etc.).
At least in United Kingdom and in United States a phenomenon of an increasing number
of disabled applicants in nursing programmes, due to the changes in legislation, has
noticed. On the other hand, Finnish dissertations have focused on students` meaningful
39
learning experiences being unique study field comparing to international reviews and
their focus areas. Also, clinical learning has a remarkable role in nursing education, but
studies focusing on this area are not very common. In clinical learning, mentoring, has
been the biggest interest both nationally and internationally.
According to the analysis, both the Finnish dissertations and international reviews have
focused mainly on students and their learning and there was remarkable variation between
the popularity of the main categories. Also, nursing education research is quite scattered
as the analysis shows a large number of single content areas, which could not be classified
into entities. Despite this the studies cover many not only interesting but also important
perspectives of the wide research field of nursing education including the development
of nursing education and its management. However, there are several challenges and
needs for future nursing education research.
6.2 Trustworthiness and limitations of the study
This review presents the wide focus area of nursing education research, though the main
information source was not all pedagogical research but only the Finnish nursing
education dissertations of nursing and caring sciences. However, by reviewing also
international reviews focusing on nursing education research, it was possible to expand
the perspective. The search of both international reviews and Finnish dissertations and
their inclusions was utilized in cooperation of the researchers to increase the validity of
the research process. Analysis of the dissertations was performed in cooperation with the
research group increasing the validity of our analysis. Throughout the analysis process
both the reviews and the dissertations were classified into several categories. This was
considered as the most reliable decision as the data included several different purposes
and data. Hence, the main categories of the international reviews guided the analysis
process deductively. This can be regarded to increase the validity of the content analysis
as both data have been viewed from similar perspectives. However, the inductive
approach strengthens the data-based analysis. The results of the analysis process
including any occurring problems were discussed in the research group and consensus
was achieved.
However, the classification is not watertight. First, there were challenges in setting
inclusion criteria and identify nursing education research from a wider field of health care
education research. There were a number of studies that did not set their main focus on
nursing education. Still, these studies were included into the data, because their secondary
40
focus is in development and research of nursing education (e.g. Sivonen, 2000; Pirilä
2002). In addition, the educational system and structures of nursing in Finland vary and
therefore many levels of education were included into the analysis. Also, the educational
structures and concepts of nursing education research varies internationally setting
challenges for inclusion and analysis of the core of nursing education research. The
concept of nursing education research itself is abstract and difficult to determine.
According to the analysis, international nursing education research focuses on nursing
students (RN) and their education. In Finnish dissertations a proper concept could be
health care education research in the future, because the studies cover many forms of
education. For instance, master programmes in nursing science and in polytechnics are
educating health care professionals in general, not only nurses (RN) and nursing based
professions. The same applies to nurse educators. However, the inclusion criteria must
always set.
Second, there were several challenges in the analysis process and in identification of the
focus of nursing education research. The categorization of the characteristics of the data
were applied according to reporting of the studies. For example, type of a data collection
and analysis method was categorized into categorization matrix according to reporting of
the dissertation yet type of a survey and interview were first identified and specified.
However, not all researchers described their questionnaires or interviews precisely.
Therefore there was a need for defining different kinds of questionnaire-types from the
literature into the categorization matrix. During the data-analysis, open-ended
questionnaires were questionnaires analyzed with qualitative methods, structured with
quantitative and still semi-structured with both statistical and qualitative methods.
Reporting of the applied methods varied between the dissertations occurring possibly due
to change of time.
Both the reviews and the dissertations were approached similarly. Same research tasks
were determined. However, the reviews and dissertations were not alike as data. For
instance, ethical aspects of the reviews were mostly not applicable and therefore not
categorized. Also, the characteristics of the studies were not usually reported as accurate
and in detail in the reviews as in the dissertations. Also, a comparison between
international reviews and Finnish dissertations was not possible to do in detail due to the
difference of the data. However, by choosing the international reviews as data a wider
perspective was possible.
41
There are also strengths and weaknesses in the chosen method. A scoping review could
have been possible as well. Scoping reviews provides a preliminary assessment of the
potential size and scope of available research literature (Grant and Booth, 2009).
However, a literature review was chosen for a method for its generality. Still, literature
reviews may lack an explicit intent to maximize scope or analyze data yet being open to
bias (Grant and Booth, 2009). In this study, the research group had several conversations
and applied double-check to increase the validity of the literature review.
6.3 Ethicality of the literature review
Ethical aspects of a literature review are connected to honest reporting of the results
(Grove et al., 2013). In this review the research group has aimed for honesty in the
reporting of the analysis and results. In addition, decisions concerning the research and
especially the analysis were made in consensus with the research group. Also, author
contribution was reported in the article manuscript. The data of this review consisted of
reviews and academic dissertations of nursing and caring sciences and therefore they were
publicly available and no permission was needed. (The Finnish Advisory Board on
Research Integrity, 2012.)
42
7. CONCLUSIONS
Nursing education research has focused internationally and nationally on four main
categories: Structural factors in nursing education, Nurse teacherhood, Teaching
activities in nursing education and Learning and learning outcomes in nursing education.
The focus of nursing education research is partly scattered yet overlapping while covering
multiple research areas. Nursing education research has focused mostly on students and
their learning whereas the research of other areas of nursing education has been studied
less not only nationally but also internationally. Hence, more studies in nursing education
are needed and there are several recommendations for future research.
Future nursing education research, especially in Finland, is challenged by experimental
designs and follow-up studies as the applied methods have mainly been conventional.
Besides, the consideration of research ethics must be taken into account even more
specifically as nursing education research stands out as human research. In addition, as
nursing education research already covers multiple professional areas, the different
nursing based professions (i.e. education of midwives, public health nurses and
emergency nurses) and their development should stand out more in the future research.
Also, the different levels of education like practical nurse education and master and
doctoral programs should take into account as the research so far is scarce.
In addition, the research should focus on phenomena that are central to nursing education
and its development, not to mention the working life. The educational reforms are
challenging both the nursing education and nursing education research, but the impact of
the reforms is not necessarily appearing in the focus of nursing education research yet.
Therefore the structural factors and elements in nursing education should guide the
research for developing evidence based nursing education and teaching being challenging
as the changes of education, policy and working life of nurse teacherhood are rapid yet
constant. In addition, both the concepts of nursing education research and the structures
of education differ internationally posing challenges for common language of research in
the future. The amount of nursing education studies seem to be increasing constantly
enabling evidence based nursing education. Still, Finnish dissertations focusing on
nursing education research cover only 12.3 % of the total amount of all the academic
dissertations of nursing and caring sciences in Finland. All in all, more nursing education
research is needed while nursing education research is interested in developing not only
the world of education itself, but also the world of nursing and health-care.
43
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