key: cord-0743258-8pidoyyq
authors: Biles, Jessica; Murphy, Kylie; Moyo, Patience
title: Undergraduate nursing students’ course expectations, experiences, and satisfaction during COVID-19
date: 2021-11-24
journal: Teach Learn Nurs
DOI: 10.1016/j.teln.2021.10.005
sha: 509b49ea39cac59839ad73e1ab633f86cd2d904c
doc_id: 743258
cord_uid: 8pidoyyq

BACKGROUND: Student satisfaction is related to experiences and expectations. It is challenging for educational administrators to deliver quality experiences without student expectation insight. Without this insight, student satisfaction is at risk. AIM: This study aims to develop a better understanding of the gaps that exist between student expectations and student experiences in a nursing program to inform and potentially improve student satisfaction in undergraduate nursing programs. METHODS: This research was a mixed methods survey undertaken at an Australian regional university. A total of 82 nursing students completed the survey, which contained open and closed questions addressing various domains of course experience. The questions were mostly categorical (respondents selected from predetermined ordinal options), with opportunities to elaborate on some questions. FINDINGS: The survey responses showed that flexibility in subject requirements, the helpfulness of academic/teaching staff (lecturers and tutors), and clarity of teacher communications correlated strongly with satisfaction in those respective areas. Expectation-experience discrepancy correlated strongly with satisfaction in these areas: support to navigate university systems, the timing of subject availability, the helpfulness of academic staff, and timetable suitability. The strongest predictor of students’ overall satisfaction with their course was the extent to which they felt “supported to navigate university systems.” CONCLUSION: The findings indicate that a better understanding of student course expectations can lead to better student satisfaction and, as such, educational administrators should work to innovate methods to discover and address student expectations.

"Student satisfaction" is a major contributor to the development of policies in most universities in Australia (Smith et al., 2018) . This impetus of this approach lies with the national framework designed to collect students' feedback about their experiences as students (Quality Indicators for Learning and Teaching, 2018) . This framework aims to collect ongoing and consistent feedback from all higher education learners. The feedback is used to improve the outcomes of teaching and learning experiences for higher education students in Australia (Quality Indicators for Learning and Teaching, 2018) . The framework focuses mainly on the students' learning and environments, but it does not incorporate the students' expectations of their studies. Consequently, the support mechanisms developed in response to the feedback received are limited (Quality Indicators for Learning and Teaching, 2018; Smith et al., 2018) . Crisp et al. (2009) suggests that an appropriate alignment between the students' expectations and satisfaction with their learning experiences will only be possible by understanding their expectations. This aligns with Hassel and Ridout (2019) who have evidenced that it may be that students' expectations can be better managed (modified) and/or better met. Several factors have already been identified as influencing students' expectations of their university education, together with the capacity of students to complete their study requirements. These factors include inherent learner characteristics, attitude, communication skills, confidence, preferred learning exposure, learning capabilities, work, finance, and family commitments (Bourdeaux & Schoenack, 2016) . Several of these components have been identified as the social determinants of learning (Sanderson et al., 2021) .

Exploration of nursing student expectations before they begin and as they undertake their study will enable the development of strategies by nursing educational administrators to address any gaps. In addition, identifying and addressing students' expectations of study can increase the retention of students (Tower et al., 2015) . In contrast, a lack of contextualization or understanding of expectations may result in low student engagement in learning (Bourdeaux & Schoenack, 2016; Money et al., 2017) .

The expectations of students can limit their engagement in learning and negatively affect their study patterns and progression. Additionally, academic requirements may be an unexpected challenge, giving rise to transition and retention issues (Tower et al., 2015) . It has been cited that academic and institutional issues influence students' expectations and experiences (Hughes et al., 2020; Tower et al., 2015) . Some of the issues in navigating large institutions have led to perceived poor advice and difficulty in navigating through university systems (Tower et al., 2015) . This means there is a need to develop an understanding of the students' expectations to facilitate positive learning experiences (Money et al., 2017; Sch€ utze, 2020) .

The student experience in higher education is multilayered and often moves beyond the experience of the tertiary learning setting (Crisp et al., 2009; Sch€ utze, 2021) . Nationally, in Australia, around 20% of undergraduate learners considered withdrawing from the university system in 2019 (Quality Indicators for Learning and Teaching, 2020). One reason for this was financial stress (Kift, 2015; Quality Indicators for Learning and Teaching, 2020). On the other hand, student success in the first year of study contributes to ongoing retention and success (Maymon et al., 2019; Sch€ utze, 2021) . It has been shown that success can be enhanced by supporting the transition of specific skills such as self-efficacy and self-regulation yet often not identified as prerequisites for course admission (Hailikari et al., 2019) . As described by Maymon et al. (2019) , the tertiary sector must create environments where all learners can succeed. From a review of relevant literature, it is evident that a gap likely exists between some students' expectations versus experiences; but the precise nature of this gap has not yet been investigated (Crisp et al., 2009; Maymon et al., 2019; Sch€ utze, 2021) .

Within a large and complex university setting, learner expectations can be challenging to ascertain. It seems that students' levels of satisfaction with their learning experiences influence course satisfaction, but satisfaction is also relative to expectation. Therefore, there is a need to explore students' expectations and associated experiences, to enable the creation of environments that contribute to positive learning experiences for students, including in Bachelor of Nursing programs.

This research study aimed to uncover the expectations and experiences of current students enrolled in a Bachelor of Nursing degree. It aimed to understand the relationship between student expectations, experiences, and satisfaction levels at a regional Australian university. By gaining insights into student expectations that appear to influence satisfaction levels, it was anticipated that academics (lecturers and tutors) would be able to better manage (modify) and/or satisfy the expectations of learners. This research addressed three main questions:

1. What are the experiences of current nursing students and their corresponding expectations? 2. To what extent do nursing experience-expectation mismatches correlate with satisfaction levels? 3. What areas of experience-expectation mismatch appear to be most damaging to overall satisfaction?

Students' expectations, experiences, and satisfaction were investigated in the following areas: peer-relational experiences, academicrelational experiences, subject-delivery experiences, content-learning experiences, flexibility and accommodation experiences, and general university-belongingness experiences.

This project was a mixed methods study using an online survey involving both quantitative and qualitative methods. The survey was purposefully designed to address the study's questions. Surveys are accessible to many participants while engaging a flexible and broad scope (Polit & Beck, 2021) . The survey design aligned with the scope of the research questions and involved primarily closed/categorical questions with the opportunity for elaboration in open textboxes (see a list of survey questions in Table 1 ). Ethical approval was obtained before data collection (H19327).

Homogenous purposive sampling was used to recruit students based at a regional Australian university. Representativeness was desired and as such, all nursing students were equally encouraged to complete the survey anonymously. Nursing students were the target population. All year levels of the Bachelor of Nursing were included in the recruitment correspondence with three reminders being sent to the cohort. At the time of initial recruitment, there were approximately 1197 eligible nursing participants. Of these participants, 82 responses were received. Given this study was descriptive and exploratory in nature, a minimum sample size calculation was deemed unnecessary.

Recruitment was via an email/announcement invitation via the BlackboardÓ communication portal. The survey was disseminated via Survey MonkeyÓ in 2020 between week 2 to week 6 of the first session. The survey was designed by the team. A survey was considered relevant as the team was seeking answers to broad and possibly interrelated aspects pertaining to nursing studies. During recruitment, all nursing students' face-to-face classes were transferred to online delivery in response to COVID-19 health restrictions.

The survey primarily consisted of categorical questions as detailed in Table 1 . For example, the response options were: Not at all, A little, A moderate amount, A lot, Flexibility in the subject requirements has always perfectly met my needs. In addition, each question invited participants to explain their categorical responses in further detail; for example, please feel free to briefly describe the experience behind your answer, without identifying anyone. These open questions generated the qualitative data that were analyzed in this study.

Quantitative analysis included a mixture of descriptive and inferential statistics. Descriptive analyses determined the extent to which students expected versus experienced versus were satisfied with various aspects of their course experience, and the discrepancy between students' expectations and experiences in those respective areas. Spearman's rho correlation analysis was conducted to identify significant correlations, including areas where expectation-experience discrepancy was associated with (a) the level of satisfaction within that same domain and (b) overall course satisfaction. 

The principles of thematic analysis (Polit & Beck, 2021) , along with Lincoln and Guba's quality framework (Lincoln & Guba, 1999) , framed the data analysis of the qualitative findings. NVIVOÓ was used as a data management tool. Thematic analysis guided the analysis of the raw data (Polit & Beck, 2021) . This involved reviewing and rereading the raw data in each text box. Common keywords and sentences were highlighted as preliminary nodes. Nodes were then clustered into categories, which became parent nodes and final themes (Polit & Beck, 2021) . Consistent with qualitative thematic analysis, the methodological rigor and credibility were strengthened by asking another researcher to code some of the raw data to confirm data accuracy. Team meetings were used as a mode to ensure that findings were representative of our interpretation of the participants' experiences in the context of an open-ended response to a survey (Lincoln & Guba, 1999) . Importantly, the open question data was discussed by the research team, considering the quantitative findings. Given this, and the context of participants, transferability of the data may not be possible (Lincoln & Guba, 1999) .

A total of 82 students responded to the survey; 75 (91.5%) were female, 7 (9.5%) were male and no participants identified as nonbinary. Just under one-third (30%) were aged 18À24 years, 33% were aged 25À34 years, and 22% were aged 35À44 years. Most (88%) were born in Australia. Over half (61%) were studying in an online mode, 34% were studying on-campus, and the remaining 5% were studying in a blended mode. One-third (33%) of the respondents reported being the first in their immediate family to attend university. Table 2 shows that although the students' expectations, experiences, and satisfaction levels varied across the various experiencedomains, overall course satisfaction was moderate-to-high (M = 3.20; SD = 1.16). Expectation-experience discrepancies tended to be small; however, experience tended to be rated substantially below expectation for clarity of teacher communications (mean difference = -.58), the helpfulness of academic staff (-.50 difference), the timing of subject availability (-.49 difference), and access to technical resources (-.44 difference). Experience rated above expectation only for the supportiveness of fellow students (mean difference = .24). Table 3 shows that the extent to which students were satisfied with the support they received "to navigate university systems" was by far the strongest predictor of their overall satisfaction as a learner in their course (rho = .74, p < .01). The extent to which students reported experiencing "support to navigate university systems" was also a strong predictor of students' overall satisfaction with their course (rho = .667, p < .01), as was their expectation-experience discrepancy in that area (rho = .668, p < .01).

Table 3 also shows that students' experience in all domains was very strongly correlated (rho > .6) with their satisfaction in those respective areas, with the following exceptions: (a) the extent of students' use of university services and technical facilities, respectively, had only moderate associations with their satisfaction levels in those areas (rho = .33 to .46, p < .01) and (b) their experienced study-time requirements had no association with their satisfaction in that area (rho = .14, p > .05). The three areas where experience correlated most strongly with satisfaction in those same areas were (a) flexibility of study requirements (rho = .90, p < .01), (b) helpfulness of academic staff (rho = .89, p < .01), and (c) clarity of teacher communications (rho = .88, p < .01).

Finally, Table 3 shows that, in most areas, expectation-experience discrepancies predicted students' satisfaction levels moderately-tostrongly (rho > .30); exceptions were observed for the availability of technical resources (rho = .01, p > .05) and the time commitment required for study (rho = -.27, p < .05). Expectation-experience discrepancy was very strongly correlated with satisfaction regarding the extent to which students experienced support to navigate university systems (rho = .78, p < .01), suitable timing of subject availability (rho = .75, p < .01), the helpfulness of academic staff (rho = .65, p < .01), and timetable flexibility (rho = .61, p < .01). That is, the more a students' experience approximated or exceeded their expectation in these areas, the higher their satisfaction was in those respective areas; the more their experiences were rated below expectation, the lower their satisfaction.

Two overarching themes emerged from the students' elaborations in the open-ended textboxes. From this text, 36 nodes were collated into two major themes: I want more flexibility and Communication is important to me. Each theme related to students' experiences and expectations.

In line with the quantitative findings, participants were seeking flexibility in their learning experiences. Many students cited carer responsibilities that affected their ability to engage with content in a way that they felt was expected by the university:

"I have been clearly told that even though I am the primary carer of two children, I will not receive any special consideration for requiring placements in my local area, so I can still care for my children of an evening. I have found this to be inflexible and unhelpful for a mother who is retraining to return to the workforce."

Administrative influences seemed to be the biggest hurdle for learning. There was an expectation upon enrolment by participants that learning experiences would be balanced with their life commitments. However, as indicated in the quantitative findings, navigating the administrative aspects of their learning did not align with their expectations and influenced their overall experiences:

"The timetable is set and students have to adjust their lives around it ... if the timetable doesn't work due to employment commitments etc., then you have to unenrol from 'on campus' mode and enrol to study via distance education."

Participants were acutely aware of the impact of university studies on their varied commitments outside of university. In line with national data, university students are no longer typically school leavers. It is estimated that university students who experience extreme hardship while studying will consider withdrawing from higher education, with 46% being due to health or stress-related factors, and 23% being due to financial reasons (Quality Indicators for Learning and Teaching, 2020) .

This research aligned with these findings and demonstrated that learners appreciate flexibility and learning in both online and distance education modes that they can bridge to accommodate other commitments in their lives:

"My work hours vary every week, so as a distance learner I am able to learn whenever I can by listening to recordings retrospectively."

"As a mother, I find it hard when the classes are outside the hours of 9À5. 8 am classes or classes that go until 6 pm are just not necessary. When I had (an) 8 am class, I had to enrol my children in before school care and drop them off at 7:30 am. At times it would often just mean I would not attend many of these classes." Table 3 Spearman rho correlations between satisfaction and experience, and between satisfaction and experience-expectation discrepancy "I don't think anyone could easily work a part-time job and still make all the lectures. In fact, I know they couldn't; many students skipped lectures." "Online study should be able to be studied as wanted to work around family and employment."

Students expected that university could be balanced with other commitments and when it did not meet their expectations, they were not satisfied with their overall experience.

Importantly, student-lecturer relationships influenced participants' experiences. Interestingly, students' responses to communication were polarized. For example, some participants cited student relationships with staff as being excellent and others as not positive. Regardless, communication influenced learning experiences:

"A lot of us are quite new like myself. I've found our lecturers are open to hearing about our experiences and understandings, and often encourage us to express our views and knowledge." "[Communication occurs] but not individually as much as I'd like. If I knew there would be 300 students in my cohort, I wouldn't be doing it online!"

Interestingly, there was a discrepancy in communication experiences between on-campus versus distance education students. Online learners found the communication sporadic, lengthy and often not meeting their needs. This influenced their relationship with lecturers and their satisfaction levels. Consistent with other research, this study evidences the expectation students have in developing a relationship with their lecturer regardless of being enrolled on-campus or online. Evidence has linked attrition and learner engagement with lecturer relationships (Mottet et al, 2006) .

Online learning was referred to by many participants in the study. It was seen as a way for participants to accommodate life commitments but was also cited as a challenging mode of study for many learners. Many students cited online learning as not being as flexible as they expected. Communication for online learners was a determining factor as to whether participants were satisfied or dissatisfied with their overall online experiences:

"Many times, I have missed important information in emails because we receive emails for the whole discipline and every campus, which equals a lot of emails."

Navigating the balance between too little and too frequent communication has been explored and aligns with Hughes et al's (2020) understanding of communication during transition years of nursing studies.

The purpose of this study was to understand the relationship between undergraduate nursing students' expectations, experiences, and satisfaction levels. Several key findings emerged. There were clear relationships between participants' expectations, experiences, and satisfaction levels, but notable discrepancies were observed between expectations and experience for clarity of teacher communications, the helpfulness of academic staff, the timing of subject availability, and access to technical resources. That is, the experience was below expectations. Generally, students' experiences predicted their satisfaction, and expectation-experience discrepancies correlated less strongly with satisfaction levels. However, satisfaction appeared to be impacted by expectation-experience discrepancies for levels of support to navigate university systems, the timing of subject availability, the helpfulness of academic staff, and timetable suitability. The strongest predictors of students' overall satisfaction with their course were the extent to which they experienced support to navigate university systems, and expectation-experience discrepancy in that same area.

Two overarching short answer findings I want more flexibility and Communication is important to me contextualize the quantitative results and highlight the importance of flexible systems that support learner engagement with universities and communication that translates the required information in a way that is supportive to participants' experience.

The findings of this paper align with our current understanding that tertiary education operates under a business model and this impacts how academics teach and how students approach their learning (Broome et al., 2018; Ciancio, 2018) . With universities operating as an international business, the focus on positive service delivery is important (Asif, 2014) . From this study, it is clear that there is a relationship between expectations, experiences and levels of satisfaction. The findings that students' satisfaction was heavily influenced by the extent to which they felt supported to navigate university systems is particularly significant and demonstrates the relationship between service delivery and customer satisfaction. Therefore, it is important for academics and administrative staff to work in partnerships to ensure that positive experiences can be achieved for learners. Learning satisfaction has moved beyond content and delivery, and is now reliant on all services within a university. This creates a praxis for educators working within universities where strong satisfaction is related to systems beyond their control.

Consistent with other literature (Donald, 2019; Maymon et al., 2019) , it is evident that students come to tertiary level study with preconceived ideas and expectations of their experiences. Managing these expectations is increasingly challenging (Maymon et al., 2019) . Our findings that academic flexibility, helpfulness, and communication were major factors in students' sense of satisfaction are also important for university leaders to consider. For students facing academics, there is some evidence that flexibility in delivery modes and creating the time for nursing students to maintain their wellbeing and morale can be helpful and flexibly accommodate student needs (Field et al., 2019) .

Literature has cited higher education institutions as being ineffectual service providers within a business sector that values personalized, accessible and simple service delivery (Balzer, 2010; Massy, 2016) . The increasing marketization of higher education underscores the importance of our findings; it is more important than ever to understand and meet the expectations of students as consumers. Many studies about course satisfaction and attrition are related to university leaders and discipline leaders (Li & Carroll, 2019) ; however, few focus on how universities operate as a business, for example, navigating systems. If universities are truly embracing the marketization business model of higher education, then they need to deeply engage with the views, thoughts, and experiences of consumers and from this, facilitate pathways that enable expectations to align with experiences (Brooker et al., 2017) .

Despite the clear and statistically significant findings uncovered in this study, there are limitations to acknowledge. One limitation of the study is that the sample was primarily female. The sample of male participants was too small to enable robust sub-group analysis. In addition, the response rate was 10%, which may impact the generalizability of the findings. It is important to also note that the survey was developed by the research team and, while its face validity was supported in the current study, the survey was not psychometrically evaluated. Further research in this area should psychometrically assess the survey tool and explore perspectives of students in international and metropolitan settings, and in other disciplines inclusive of postgraduate students, to help identify nuances in students' expectations, experiences, and satisfaction levels. It may be found that students in other (non-nursing) courses, where male students are more represented, have different expectations and satisfaction levels. Finally, while this study uncovered that experiences and expectation-experience discrepancies in certain areas most strongly influence student satisfaction levels, intervention studies focused on those areas will be required to understand how to improve students' experiences and how to better manage their expectations (i.e., moderate the expectations to make them more realistic).

Overall, this study makes a valuable contribution to the existing literature by demonstrating that a pattern of relationships exists between expectations, experiences, and satisfaction levels among undergraduate nursing students. The level of flexibility in subject requirements, the helpfulness of teaching staff, and the clarity of teacher communications are important to these students. However, student satisfaction is also negatively impacted when their expectations go unmet regarding support to navigate university systems, the timing of subject availability, and timetable suitability. In addition to trying to optimize these aspects of student experience, university administrators should aim to ensure that student expectations are realistic from the outset. The extent to which they felt "supported to navigate university systems" had the largest impact on the students' overall satisfaction with their course. Therefore, this should be considered a particularly important focus for administrators and educators seeking to maximize student satisfaction.

1. The article has not received prior publication and is not under consideration for publication elsewhere 2. All authors have seen and approved the manuscript being submitted 3. We (the authors) abide by the copyright terms and conditions of Elsevier and the Australian College of Nursing

The authors of this paper do not have competing priorities or interests.

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Our research was conducted living and working on the lands of the Wiradjuri peoples. As authors we acknowledge First Nations peoples as the traditional owners of all Australian lands, and we acknowledge Elders past, present, and emerging.