Journal of Nursing Education

Major Article 

Exploring Nursing Students' Experiences of Learning Using Phenomenography: A Literature Review

Sinead Barry, RN; Louise Ward, PhD, RN; Ruby Walter, PhD, RN

Abstract

Background:

The purpose of this extensive international and national literature review was to explore how phenomenography identifies nursing students' experiences of learning within preregistration (or prelicensure) nursing education.

Method:

Data were collected utilizing a comprehensive search of electronic databases. Full text, peer-reviewed, and scholarly articles published in English using the search terms phenomengraph*, nurs*, student, education, and learning were reviewed.

Results:

Two discreet themes emerged exploring students' experiences of learning within preregistration nursing education: (a) Phenomenography was a beneficial method to expose variation in students' understandings of a challenging concept or topic and (b) phenomenography was beneficial to evaluate teaching methods in attempt to improve student learning of challenging and complex concepts.

Conclusion:

On the basis of these findings, future research utilizing phenomenography within nursing education has potential to uncover variation in students' understandings of mental health, with future consideration of implications to nursing curriculum design and development. [J Nurs Educ. 2017;56(10):591–598.]

Abstract

Background:

The purpose of this extensive international and national literature review was to explore how phenomenography identifies nursing students' experiences of learning within preregistration (or prelicensure) nursing education.

Method:

Data were collected utilizing a comprehensive search of electronic databases. Full text, peer-reviewed, and scholarly articles published in English using the search terms phenomengraph*, nurs*, student, education, and learning were reviewed.

Results:

Two discreet themes emerged exploring students' experiences of learning within preregistration nursing education: (a) Phenomenography was a beneficial method to expose variation in students' understandings of a challenging concept or topic and (b) phenomenography was beneficial to evaluate teaching methods in attempt to improve student learning of challenging and complex concepts.

Conclusion:

On the basis of these findings, future research utilizing phenomenography within nursing education has potential to uncover variation in students' understandings of mental health, with future consideration of implications to nursing curriculum design and development. [J Nurs Educ. 2017;56(10):591–598.]

This literature review seeks to explore the application of a phenomenographic approach as a methodology to identify nursing students' experiences of learning within pre-registration or, what is called in some countries, prelicensure nursing education. From this point onward, the term preregistration will be used to describe nursing students undertaking formal education prior to completing the requirements to become an RN. Over the past 20 years, phenomenographic studies investigating students' experiences of teaching, learning, and related phenomena have informed curricula from a teaching and learning perspective across several disciplines within higher education. This research methodology is valuable in mapping the qualitatively different ways in which people “experience, conceptualize, perceive, and understand various aspects of, and phenomena, in the world around them” (Marton, 1986, p. 31).

Although originating in studies of learning, the phenomenographic approach has steadily gained ground as a research approach applied to a wide range of areas within and outside education (Bowden, 2000). During the past two decades, the phenomenographic approach continues to emerge as a relatively new approach to qualitative educational research, with the first publications appearing in the 1980s (Akerlind, 2012). As such, research in the field of nursing, including clinical nursing and nursing education, have identified phenomenography as a powerful tool to improve knowledge and understanding from the perspective of a patient (Berg, Arestedt, & Kjellgren, 2013; Fagerdahl, 2014; Schroder, Ahlstrom, & Larsson, 2006), a caregiver (Frank, Asp, & Dahlberg, 2009), a nurse (Brammer, 2006a; Flodén, Berg & Forsberg, 2011; Josse-Eklund, Jossebo, Sandin-Bojö, Wilde-Larsson, & Petzäll, 2014; Pham & Ziegert, 2016), a nursing student (Brammer, 2006b; Christiansen, 2011; Sjostrom & Dahgren, 2002), and a nurse educator (Forbes, 2010). The value of utilizing a phenomenographic approach above other research methodologies is its ability to uncover understandings and knowledge of a phenomenon central and unique to a cohort of participants in a specified field.

In addition to becoming increasingly prominent within nursing education, the utilization of a phenomenographic approach is gaining momentum within nursing research from a variety of unique perspectives, including an RN perspective (Brammer, 2006a; Jormfeldt, Svedberg, & Arvidsson, 2003; Jormfeldt, Svedberg, Fridlund, & Arvidsson, 2007), a newly graduated nurse perspective, as seen in the study by Ramritu & Barnard (2001), and an elderly Swedish women's perspective of mental health (Hedeline & Strandmark, 2001). The application of a phenomenographic approach within the nursing domain has highlighted the value in uncovering variation in understandings of key conceptions relating to the broader phenomenon of nursing and health care. Upon review of the most current literature, it is evident that over the past two decades, phenomenographic research has become increasingly recognized as a valuable methodology within nursing education.

Phenomenographic methodologies have been used to investigate students' experiences of learning as early as the mid-1970s. The approach was conceived in Sweden in the 1970s and developed by Ference Marton, Lennart Svensson, Lars Dahlgen, and Roger Saljo. Phenomenography was designed with a particular focus on how students approach their learning (Ireland, Tambyah, Neofa, & Harding, 2009) and sought to answer questions about the quality of learning. In particular, the approach was used to describe the variation in students' learning, rather than simply measuring how much was understood. In this way, the phenomenographic approach has revolutionized the way processes and outcomes of learning have been understood (Stenfors-Hayes, Hult, & Dahlgren, 2013). Furthermore, it has been a valuable methodology within higher education to contribute new insights into teaching and learning (Khan, 2014). Marton (1986) described phenomenography as a valued approach aiming to uncover qualitatively different ways people “experience, conceptualise, perceive and understand aspects of a phenomena” (p. 31). With this in mind, phenomenography sits within the interpretivism paradigm, recognizing many diverse interpretations of reality (Stenfors-Hayes et al., 2013). As such, a fundamental assumption underpinning the phenomenographic approach is that a finite number of interpretations of a phenomenon are held among individuals. Therefore, Marton (1986) identified that students hold a finite number of qualitatively different understandings of learning. The object of interest for phenomenography is discerning the various facets of a phenomenon as it appears to a number of individuals. Unique to the phenomenographic approach is its focus on variation in experiences and understandings of a phenomenon. Despite phenomenography and phenomenology sharing many similarities, including the aim to describe human experience (Stenfors-Hayes et al., 2013), Marton (1986) made clear that “phenomenography is not an offspring to phenomenology” (p. 40). Phenomenology's focus is on describing similarities in experience of phenomena, whereas, in contrast, phenomenography's focus is on describing the variation in understandings and experiences that define the phenomena under investigation (Marton & Booth, 1997). To uncover maximum variation in understandings and contribute new insights, a structured method is applied (Table).

Methods Involved With Phenomenography

Table:

Methods Involved With Phenomenography

The phenomenographic approach has been recognized for its value in contributing to the growing body of knowledge within clinical nursing and nursing education (Sjostrom & Dahgren, 2002). This includes exposing understandings of key phenomena from the perspectives of a nurse, a nursing student, and a patient (Sjostrom & Dahgren, 2002). From a nursing education perspective, exposing variation in understandings provides a powerful tool in the evaluation of the opportunity to deliver quality nursing education. Brammer (2006a) valued the phenomenographic approach from a nurse academic and nursing curriculum perspective to support nursing education to push forward into the 21st century.

Many studies have explored students' experience of learning within higher education. However, a literature search revealed few that use a phenomenographic approach to investigate undergraduate nursing students' experiences of learning (Brammer, 2006b; Christiansen, 2011; Jokelainen, Tossavainen Jamookeeah, & Turunen, 2013), and no phenomenographic nursing literature to date that investigates students' experiences of learning mental health nursing.

Two main questions were posed in this literature review:

  • What does phenomenographic research identify about undergraduate nursing students' experiences of learning?
  • What does phenomenographic research identify about undergraduate nursing students' experiences of learning that are relevant to future studies exploring students' understandings of mental health?

Method

A review of the literature to explore the effectiveness of a methodological approach to uncover students' experiences of learning within nursing education is fundamental to identifying and understanding the preexisting knowledge of a field of interest (Garrard, 2014). A thorough review of literature within the determined restrictions of the research area becomes the foundation for identifying a gap in the field of interest. Given the increasing number of phenomenographic research studies published during the past decade within the context of nursing education, it was decided to review the most current conversations specific to the identified research question. The inclusion strategies illustrated in the Figure were utilized to identify the final seven eligible studies for this review that included phenomenographic studies by Brammer (2006b), Osterlind et al., (2016), Skar and Soderberg (2016), Christiansen (2011), Heyman, Webster, and Tee (2015), Tagher and Robinson (2016), and Venkatasalu, Kelleher, and Shao (2015).

Identification of studies selected for the literature review.

Figure.

Identification of studies selected for the literature review.

Search Strategy

An international literature review exploring nursing students' experiences of learning using a phenomenographic approach was undertaken using a structured approach. Data were collected using a comprehensive search of electronic databases, including Proquest® Education Journals Linguistics and Language Behavior Abstracts, ProQuest® Central, ERIC, ProQuest®, and SCOPUS® from 2006 to 2016. Due to the phenomenographic approach being a qualitative research method, only qualitative studies were included within the review including full text, peer-reviewed, and scholarly journal articles published in English. The relatively narrow date range was selected to review the most current conversations within the topic field. The search terms of phenomengraph*, nurs*, student, education, and learning were reviewed. Findings from this literature review are discussed within two distinct themes. Findings indicate that a phenomenographic approach has the potential to be a valuable research methodology to uncover students' understandings of mental health within nursing education.

Inclusion Criteria

  • International and national phenomenographic studies exploring nursing students' experiences of learning within preregistration nursing curriculum.
  • Preregistration nurse education studies using a phenomenographic approach.

Exclusion Criteria and Limitations of the Literature Review

  • Studies prior to 2006.
  • Editorial and literature review articles.
  • Studies involving RNs as participants.
  • Studies involving postgraduate nursing students as participants.
  • Studies involving groups of participants other than pre-registration nursing students.
  • The search was limited to the key search terms, which excluded prelicensure.

Findings from the Literature Review

Seven studies met the search criteria, and two themes emerged. First, the phenomenographic approach was a beneficial method to expose variation in students' understandings of a challenging concept or topic within preregistration nursing education. Second, the phenomenographic approach was beneficial to evaluate teaching methods in an attempt to improve student learning of challenging and complex concepts. Findings drawn from this literature review identified that students' understandings of mental health are yet to be explored. The literature sourced for this review provides supportive evidence suggesting that a phenomenographic approach would be valuable at uncovering variations in nursing students' understandings of mental health. Gaining such insight into how nursing students understand mental health will assist to improve student learning process and outcomes.

Understandings of a Nursing Concept and Role

A small number of researchers within the field of nursing have used a phenomenographic approach to explore preregistration students' understandings of key concepts and roles. The use of a phenomenographic approach enabled identification of variation within students' understandings and its subsequent effect on learning key concepts. Brammer's (2006b) phenomenographic study explored 24 bachelor of nursing students' understandings of the role of a buddy nurse while undertaking clinical learning. Sampling students undertaking the first, second, and third years of a preregistration nursing degree in Australia achieved variation in participant profile. Brammer's (2006b) study aimed to identify students' understanding of the role of a buddy nurse and the implications this had on student learning within the clinical learning environment. According to Walker, Cooke, and McAllister (2008), the definition of an RN buddy “is a registered nurse, often previously unknown to students, assigned by nurse managers or shift coordinators to work with a student for a shift at a time” (p. 761). The use of a phenomenographic approach for this study uncovered that within the nursing student participant profile, notable variations existed in the understanding of the role of the RN buddy. Findings from this research highlighted the understanding and expectations of the RN buddy role varied dependent on the year level of the nursing student. The variation in students' expectations influenced by their year level was evident within the findings from first- and second-year nursing students. Initially, first-year nursing students held positive expectations that the RN buddy would seek to involve them in all clinical matters and were responsible to provide a positive learning environment. However, in contrast, the second year nursing students identified that they needed to be responsible for their learning.

The role of RN as gatekeeper emerged as one of the most significant findings from this study. Students' opportunity to undertake successful learning while on clinical practice was directly influenced by their experience with a buddy nurse. The variety of experiences ranged from having a buddy nurse wishing to promote, limit, or even block student access to positive clinical learning experiences (Brammer, 2006b). It was identified that students' experiences of learning in the clinical learning environment was greatly influenced by the buddy nurses' approach to facilitating their learning. In addition, findings highlighted that the buddy nurses' style of communication and relationship with the student influenced the accessibility of positive student learning experiences. The value in exploring students' understandings of the role of buddy nurses has uncovered a significant degree of complexity within the clinical learning environment.

Building further on phenomenographic research within the field of nursing education, Osterlind et al. (2016) explored Swedish nursing students' perceptions of caring for a dying patient after 1 year of education. Seventeen first-year nursing students across three universities participated in individual interviews exploring how they perceived death and caring for a dying person. Osterlind et al. (2016) used a phenomenographic approach that highlighted that students' perceptions of caring for a dying person was complex and varied between individuals. Among the participant profile, students expressed varied levels of comfort and confidence, with some feeling they lacked preparedness. Each of these experiences subsequently defined the students' future experience of death and dying in a negative way. These findings further reinforce the value of uncovering variation in students' experiences of learning death and dying, and how this can influence their future perception of the phenomena.

Skar's and Soderberg's (2016) phenomenographic study comprising 233 nursing students undertaking their first, third, and sixth semester of study in northern Sweden uncovered student complexities when identifying and distinguishing the difference between the concept of health and illness. Using the data collection method of written responses to complete the sentence “I perceive that health is…” enabled the researchers to increase their participant sample above the usual confines of a phenomenographic approach. Findings from that research have uncovered significant variation in students' understandings of the concept of health. Furthermore, the implication of this on students' perceptions of their professional role as a nurse was uncovered. Historically, it was identified that a medically orientated perspective had been the focus of health care education, whereby health was viewed as the absence of illness (Skar & Soderberg, 2016). The study results largely mirrored a medical perspective of health that valued the absence of illness (Skar & Soderberg, 2016). Recommendations of the research suggest that nurse educators shift their approach from a medical focus to a holistic perspective of health. Skar and Soderberg (2016) concluded that providing a holistic perspective of health will help educate students' of the complexity surrounding the concept of health while considering a wider perspective of individuals' needs and experiences of health. Those findings have been instrumental in highlighting the relationship between the institutions selected model of nursing education and the subsequent effect on students' greater perceptions of their professional role. These results demonstrate the significant variation between students' understandings of key concepts, such as health, and the greater implications on their professional identity.

Evaluating Teaching Methods to Improve Student Learning

The vast majority of nursing education literature using a phenomenographic approach has evaluated teaching methods in attempt to improve student learning of challenging and complex concepts critical to nursing education. Christiansen (2011) used a phenomenographic approach to explore how 20 preregistration third-year nursing students were influenced by patient digital stories as a method to promote professional learning. Findings from that study conclude that within the participant profile, four key themes emerged that highlighted variation in students' approach and interpretation of patient digital stories as a teaching method. The four key themes included digital stories being a learning resource, an emotional experience, a reflective experience, or a transformative experience. Implications from that research identify that patient digital stories can be a catalyst for promotion of transformative learning. Students' approach to digital stories varied from superficial, where the teaching resource was perceived solely as a learning resource, to advanced and deep identification of digital stories, promoting a transformative experience where insights of self-identity and practice were established. The research further highlights the variation in nursing student experiences of engaging with a teaching method and its subsequent effects on individual learning outcomes. Through the use of a phenomenographic approach, these findings provide insight into the consideration of teaching methods to promote transformational learning within nursing education.

Building further on the evaluation of nursing education teaching methods using a phenomenographic approach was a study undertaken by Heyman, Webster, and Tee (2015). This study explores second-year nursing students' experiences of learning suicide intervention strategies. Exploring students' experience of engaging with suicide intervention strategies within the nursing curriculum highlighted the complexity surrounding the topic of suicide. This research implemented an applied suicide intervention skills training program to engage second-year students with suicide intervention strategies. The implementation of this specialized teaching and learning approach found that despite students' emotional challenge with the concept of suicide, it was significant that students found the group approach to learning a positive experience that promoted group bonding, peer learning, and class cohesion (Heyman et al., 2015). Findings from that study highlighted that students often reported feeling ethically challenged and ill equipped to engage with suicide intervention strategies. The utilization of a phenomenographic approach highlighted variation in the way students experience suicide intervention education and the subsequent influence this had on their learning of this subject matter.

Tagher and Robinson (2016) aimed to capture bachelor of nursing students' experiences of stress when exposed to high-stakes testing. Individual interviews from five participants highlighted that each participant, despite age, gender, and grade point average, experienced stress when high-stakes testing was used. Findings from this research are valuable in highlighting that despite all students experiencing stress, stress was perceived in countless ways. Responses ranged from fear of not progressing to graduation, physical and psychological manifestations, balancing academic and personal responsibilities, and promoting isolation and withdrawal, to name just a few. The data analysis process of this study was unique in identifying categories of description as interrelational in nature, rather than hierarchical. One drawback of the study is the small number of participants. However, despite the limited participant number, the research provides evidence of the value of a phenomenographic approach to identify how students experience learning within nursing curriculum. As such, high-stakes testing has been aligned directly with students' experience of stress. These findings encourage future development within nursing education to provide supportive environments to students if high-stakes testing is deemed an appropriate method to assess student learning.

The study by Venkatasalu, Kelleher, and Shao (2015) builds on existing research supporting the use of a phenomenographic approach to explore the effect of teaching methods on student learning. Their research used a comparative approach, whereby students were randomly allocated to undertake either classroom-based or high-fidelity simulation–based teaching related to the topic of end-of-life care. The comparative data analysis exposed findings suggesting that high-fidelity simulation–based teaching provided greater value in promoting enhanced skills and improved emotional experience. The utilization of a comparative approach to data analysis adds further value in using simulation as an innovative and effective teaching method for complex topics, such as end-of-life-care. Consequently, teaching end-of-life-care was identified as a complex but critical component of first-year nursing education that is best taught using simulated teaching–learning strategies to develop student competencies. This research has added further support to the value of using a phenomenographic approach to evaluate the effects of teaching methods on student learning of challenging and complex concepts. Overall, the methodology has been valuable to evaluate teaching methods of complex concepts within nursing education. Future research exploring students' experiences of learning within mental health may help uncover variation in understandings of mental health.

Discussion

The literature review revealed two key themes. First, the phenomenographic approach was a beneficial method exposing variation in students' understandings of a challenging concept or topic within preregistration nursing education. Second, the phenomenographic approach was valuable to evaluate teaching methods in attempt to improve student learning of challenging and complex concepts. The literature review is significant because it identified the importance of applying a phenomenographic approach to provide insight into students' experiences of learning within nursing education. More specifically, it has been viewed as a powerful tool to obtain an understanding of key phenomena from a student's perspective in attempt to enhance the quality of education (Sjostrom & Dahgren, 2002).

A consistent finding from within the phenomenographic studies was the identification of considerable variation in nursing students' understandings of key concepts. Of particular interest, Skar and Soderberg (2016) uncovered challenges students face when identifying and distinguishing the difference between health and illness. Findings from that study highlighted the relationship between the focus of nursing education and the subsequent perceptions of health and illness that students adopt. This was evident by Skar's and Soderberg's (2016) recognition of a strong influence from a medical perspective of health within their findings. Recommendations from their study support nursing education to develop inclusive measures that encompass health (i.e., how patients experience and maintain their health [Piper, 2008; Skar & Soderberg, 2016]) and integrate nursing students experiences and understandings of health with nursing theory as one way to promote further development of knowledge (Skar & Soderberg, 2016).

Although the current literature review has focused on phenomenographic studies using preregistration nursing students as participants, findings such as Skar's and Soderberg's (2016) support those that were found by an earlier study conducted by Jormfeldt, Svedberg, Fridlund, and Arvidsson (2007). In particular, this phenomenographic study investigated RNs' conceptions of health in mental health settings. Jormfeldt et al. (2007) conducted a phenomenographic study exploring perceptions of the concept of health among nurses working in mental health services in Sweden. Findings from their study concluded that nurses, similar to the nursing student participants in Skar's and Soderberg's (2016) study, often held conceptions of health of which they were unaware. Of significance, their judgments and actions in their relationship with clients under their care were directly influenced by these conceptions. Of particular interest, qualified nurses struggled with defining the concept of health. The participants acknowledged that it is not merely the absence of disease (Jormfeldt et al., 2007) and that the concept needs to be defined with greater clarity. A multidimensional and more holistic understanding of the concept was recommended, with suggestions being made to higher education nursing curriculum to integrate a more holistic view to ensure graduates have a deeper understanding of what it is prior to working in the health profession. Despite health being recognized as one of the central goals in providing health care (Skar & Soderberg, 2016; World Health Organization, 2007), these studies have highlighted the difficulties and confusion associated with defining the concept and its meaning in health care delivery. Findings from these studies are encouraging, as they begin the discussion and highlight the difficulty not only nursing students, but also qualified health professionals, have with understanding the concept of health. Skar's and Soderberg's (2016) research has been valuable in highlighting the need for future research, using a phenomenographic approach to explore students' understandings of mental health. Uncovering how students define such critical components of health care is required to ensure that nursing education effectively prepares students for the realities of modern-day health care.

Brammer's (2006b) investigations into students' understandings of the RN buddy role and the subsequent effects on student learning have provided insightful findings. In particular, findings from that research have brought to the forefront the challenges nursing students experience at different stages specific to their expectation of the RN buddy within clinical education. The phenomenographic approach within that study was instrumental in capturing the variation in student expectations of the RN and the effect this had on student's access to learning opportunities. A significant recommendation drawn from these findings is the importance of having appropriately educated and supported (through clear roles and responsibilities) RNs who provide positive student-centered learning opportunities. Taken collectively, Brammer's (2006b) study has been critical in exposing the variation in quality learning opportunities provided by buddy nurses and its subsequent effects on students' understanding of the clinical education role.

Exploration of nursing students' experiences of learning through a phenomenographic lens exposes the complexity student's encounter when engaging in learning. When considering the concept of death and dying, research into students' experiences of learning to manage the process becomes critical. A phenomenographic approach within the study by Osterlind et al. (2016) exposes complexities encountered by first-year nursing students when handling the concept of death and dying. Such complexities included emotional demands, personal difficulties, a sense of fear, and struggling with a sense of regret and remorse. In particular, the variation within the first-year student profile highlighted the differing levels of comfort and confidence with the concept. As such, this research has been valuable in highlighting the need to review nursing education to uncover how best to teach the concept of death and dying. Recommendations made by Skar and Soderberg (2016) suggest that one way to better prepare nursing students to provide care for dying patients is by using simulation, supervision, and supervised reflection. A central perception among the participants from this study exposed a sense of unpreparedness. Students reported struggling with addressing care issues around death and dying. One student stated that when they were in a situation in which they did not know what to say to the client or relatives. A key finding from this research noted the significance of students' sense of lack of preparedness to deal with death and dying and how this was perpetuated by a sense of fear and being afraid.

From the research conducted within nursing education alone, it is clear that nursing students approach their engagement with learning in a variety of ways. Of particular interest, it is confirmed there are many challenging and complex concepts nursing students experience when undertaking their degree. How students discern these concepts has the potential to directly affect understandings of their professional identity. One aspect requiring further exploration is nursing students' experiences of learning within mental health care; in particular, uncovering students' understandings of mental health. It is important to recognize that simply gaining insight into students' understandings does not of itself drive nursing education to address the variation. Rather, there is an important step intermediary to drive changes to curriculum and teaching methods in response to these insights. Identifying critical aspects of a concept, such as mental health, that students discern or not discern will encourage the development and design of teaching that promotes students' holistic understanding of a concept (Akerlind, 2008). The aforementioned research suggests that using a phenomenographic approach helps to encourage nursing education to push forward into the 21st century and improve the quality of student learning. Tight (2016) made suggestions on how to improve student learning, which include encouraging a deep rather than surface approach to learning and employment of variations in teaching approaches. Data obtained through using a phenomenographic approach provide valuable insight into the variation in understandings, which educators can then consider interventions that could be used in effort to improve student learning (Bowden, 2000).

There are some limits to how far the use of a phenomenographic approach within nursing education has been used. A review of the literature captured no previous preregistration mental health nursing education studies using this approach. The research identified within this review provides supportive evidence valuing the need to use considered methodological approaches to help uncover variation in students' approaches to learning. Based on these findings, the phenomenographic approach has value in uncovering students' understandings of key concepts, making possible enhancements to teaching methods. Future studies utilizing a phenomenographic approach to identify variation in students' understandings of mental health has the potential to pave the way for development of enhanced approaches to nursing curriculum to improve student learning. Stenfors-Hayes et al. (2013) claimed that phenomenography has revolutionized the way educators think about learning in higher education, with particular attention to the processes and outcomes. The adoption of that approach provides valuable insight into the variation of understandings held by students and how this can be considered in designing education to facilitate improved understanding and learning (Akerlind, 2005; Marton & Pang, 2009). Strategies to improve student learning, such as exposing variation in student understanding, helps create greater awareness. Dahlin (2007) claimed that if a learner is supported to see a phenomenon in a new way (through exposing variation of other people's understandings), the learner's consciousness has changed in relation to how that phenomena is thereafter seen.

Conclusion

This literature review revealed a presence for phenomenographic studies within preregistration nursing, highlighting the substantial learning complexities students encounter when engaging with nursing education. A consistent finding is that the phenomenographic approach has dual value to both teaching and learning. This methodology complements nursing education research by exposing variation in students understanding of key concepts, in addition to evaluating teaching strategies to improve student learning of complex concepts. However, the aim of this article was to review the literature on students' experiences of learning within preregistration nursing education. The findings from this review identify that despite there being a growing number of phenomenographic nursing education studies exploring students' experiences of learning, there is a current gap in research exploring nursing students' understanding of mental health using such an approach.

Indeed, the research sourced for this review suggests that nursing students' experiences of learning remains challenging and complex. In addition, students are reflecting significant variation in understandings of concepts central to their professional role. The insight provided within the studies from this review reveal the value phenomenography brings to improving quality learning experiences for preregistration nursing students. Gaining further insight into nursing students' experiences of learning enables nursing education to continue to push forward into the 21st century and prepare graduates for the realities of contemporary health care.

Currently, there is a paucity of phenomenographic nursing literature exploring students' experiences of learning within mental health. However, the nursing studies sourced for this review support the proposition that a phenomenographic approach would be a suitable methodology to explore variation in students' understandings of mental health. Future research using this approach will be a valuable contributor to developing teaching and learning strategies aimed at improving graduate nurses confidence and ability to work within a rapidly diversifying health care system.

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Methods Involved With Phenomenography

MethodDescription
Purposive sampling of participantsTo achieve this, the methodology requires as much variation as possible from its participant sample (Akerlind, 2004; Khan, 2014).
In-depth interviewsThe most commonly used method of data collection using phenomenography is open-ended, in-depth interviews (Bowden, 2005). The interviews are structured encouraging participants to provide personal experiences and examples relating to their understandings of the phenomena under investigation (Larsson & Holmstrom, 2007).
Data analysisData analysis aims to discern the qualitatively different understandings of the phenomena under investigation guided by the research question (Akerlind, 2005). During data analysis, the identification of qualitatively separate categories describing the ways in which participants experience a phenomenon are established (Ornek, 2008). These categories are arranged to look for themes of expanding awareness. Akerlind (2008) described the expansion of awareness between the categories as demonstrating an increase in sophistication in the experience of the phenomenon.
FindingsFindings from phenomenographic research are described as categories of description. Differences in how participants experience the phenomena are described within the limited qualitatively different categories of description (Ramritu & Barnard, 2001).
Authors

Ms. Barry is a PhD candidate and RN, Lecturer in Nursing, and Dr. Ward is Associate Professor Clinical Nursing, La Trobe University, School of Nursing and Midwifery; Dr. Walter is Lecturer in Nursing, Victoria University, Melbourne, Victoria, Australia.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Author correspondence to Sinead Barry, RN, Lecturer in Nursing, La Trobe University, School of Nursing and Midwifery, Melbourne, Victoria 3086, Australia; e-mail: s.barry@latrobe.edu.au.

Received: December 06, 2016
Accepted: April 25, 2017

10.3928/01484834-20170918-03

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