An exploratory study of the relationship between age and learning ...

Nurse Education Today 31 (2011) 18–23

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Nurse Education Today j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t

An exploratory study of the relationship between age and learning styles among students in different nursing programs in Taiwan Yuh-Shiow Li ⁎, Hsiu-Mei Chen, Bao-Huan Yang, Chin-Fang Liu Department of Nursing, Chang Gung Institute of Technology, Taiwan, ROC

a r t i c l e

i n f o

Article history: Accepted 4 March 2010 Keywords: Learning styles Age Associate degree of nursing Bachelor of science in nursing

s u m m a r y The purpose of this study was to identify the relationship between learning styles and age among nursing students in a two-year, a five-year associate degree of nursing (ADN) program, and a two-year bachelor of science in nursing (BSN) program in Taiwan. The Chinese version of the Myers–Briggs Type Indicator (MBTI) Form M was used to measure individual preferences in four dichotomous dimensions of Jungian theory: extraversion/introversion, sensing/intuition, thinking/feeling, and judging/perceiving. The study sample included 331 nursing students. The analysis of the data revealed that the most common learning styles were introversion, sensing, thinking, and judging (ISTJ) and introversion, sensing, feeling, and judging (ISFJ). The findings indicated that the SJs comprised 43.0% of the participating nursing students. SJs are highly preferred in the field of nursing. However, the ages of nursing students were not significantly related to their learning styles. The findings suggested that the participating nursing students were homogeneous. We recommend the use of a large sample for further studies. The awareness and understanding of individual differences is of great importance in tailoring each learning style to benefit educators and learners, thereby enhancing nursing education. © 2010 Elsevier Ltd. All rights reserved.

Introduction In nursing, the rapidly changing health care delivery and practices require sound critical thinking and decision-making skills. It is necessary to provide students with the skills to seek, analyze and utilize information effectively. Nursing educators are responsible to help their students acquire these skills (Lunyk-Child et al., 2001). The development of these skills requires different teaching and learning strategies. Learning is an interactive process and the product of student and teacher activity within a learning environment (Candela et al., 2006). Students' learning styles are a major consideration in planning for effective and efficient learning (Childress, 2001). Research suggests that successful teaching acknowledges the existence of individual differences in the teaching and learning process and, whenever possible, tailors the style of instruction to the learner's needs (Lau and Yuen, 2009; Rasmussen and Davidson-Shivers, 1998). If more attention is paid to the individual's different learning styles, students will learn more effectively. Therefore, it is important to identify and match the students' learning styles with the classroom delivery of subject matter (Doolan and Honigsfeld, 2000). According to Partridge's (1983) review, the learner's age is a factor for the educator to consider whether or not to use matching instructional strategies. Older learners may need more ⁎ Corresponding author. Address: No.261, Wen-Hua 1st Road, Kweishan, Taoyuan 333-03, Taiwan, ROC. Tel.: + 886 3 211 8999x3215. E-mail addresses: [email protected], [email protected] (Y.-S. Li). 0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.03.014

matching strategies, while younger students often adapt more easily to methods that differ from their style of preference. He suggests that “younger learners may be more responsive to mixtures and mismatching because they are generally more malleable than older learners” (Partridge, 1983, p.247). In the recent study, researchers indicate that students over 25 years of age are more independent as compared to younger students in the 246 female college students participating (Vaughn, et al., 2009). Educators need to be concerned with these differences so support services and educational strategies can be developed to satisfy their students' learning needs. In Taiwan, few studies have been conducted to explore this phenomenon, particularly in the field of nursing education (Cheng, 1994; Li, 1999, 2004). Therefore, the purpose of this study was to explore the factor of age and its relationship with the learning style in different nursing educational programs.

Literature review Nursing education system in Taiwan In an elementary school, students' ages range from 7 to 12 years old. In a junior high school, students' ages range from 13–15 years old. Compulsory education includes elementary school, which lasts for 6 years, and junior high school which lasts for 3 years in Taiwan. In a three-year vocational school, senior high school or five-year associate degree of junior college, the student entry age is usually 16 years.

Y.-S. Li et al. / Nurse Education Today 31 (2011) 18–23

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Fig. 1. Nursing education system in Taiwan.

Student entry age is above 18 years old in a two-year associate degree of junior college since they have graduated from a vocational school. Generally speaking, there are three popular ways to become a nurse in Taiwan. Fig. 1 describes the major pathways for becoming a nurse in Taiwan (Taiwan Nurses Association, 2002). One path is to enter a university to receive a baccalaureate nursing degree after graduating. Another is to receive an associate degree after completing a five-year associate nursing program. The final way is to receive a baccalaureate nursing degree after completing a two-year BSN program, and these candidates would have had previous nursing education before entering the two-year BSN program. In Taiwan, students who have graduated from a three-year vocational nursing school can become registered nurses if they pass the national licensure examination. They receive a baccalaureate nursing degree after finishing a four-year post vocational school program. Curry's model of learning style Curry (1987) proposed a framework with three levels in a circle of meaning and approaches to study. They are (a) instructional preference

style, (b) information processing style and (c) cognitive processing style. At the outer level, the instructional preference focuses on an assessment of the way people prefer to learn. An example is the individual's choice for various aspects of the learning environment, such as light and temperature (Dunn and Dunn, 1999). Instructional preferences are the least stable of the style elements but can be used by educators who want information to design specific teaching–learning situations for learners. The next level addresses differences in the intellectual approach people take to assimilate information. An example is Kolb's four learner types (converger, diverger, assimilator, and accommodator), which are based on two primary dimensions of the learner styles or ways of interacting with experience: concrete experience versus abstract conceptualization, and reflective observation versus active experimentation. The information processing differences that arise between these dimensions are more stable (Kolb, 1985). At the inner core of Curry's framework, cognitive personality style approaches examine an individual's personality dimensions for adapting to information. The level interacts less directly with the environment and is more applicable to predicting behavior. The cognitive personality preferences are the most stable elements. An example of this stability is

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the use of the Myers–Briggs Type Indicator (MBTI) instrument to test personality (Myers et al., 1998). Curry proposed that it is necessary to choose a model for assessing learning style based on how the information will be used such as whether one is concerned with modifying the learning environment to respond to instructional preferences, or using teaching–learning strategies that influence how people assimilate information.

students, such as working employees and care givers, may have difficulties learning. Clearly, age is a possible factor that influences learning. No matter what kind of students they are, consideration for students' age differences is a suggestion for education planning and policies to enhance student learning so that they will excel academically.

Myers–Briggs Type Indicator

This study was descriptive and exploratory in design. The Myers– Briggs Type Indicator (MBTI) was used as the instrument to identify the nursing college students' learning styles in Taiwan. Nursing students completed the MBTI questionnaire (Form M) in 15–25 min. Subjects were asked to complete a one-page demographic survey. All participants were female nursing students. This study utilized measures with quantifiable coding to operationalize variables and statistical procedures to analyze the data collected.

The Myers–Briggs Type Indicator (MBTI) is a forced-choice psychometric test, which is based on Jung's mental typology. The MBTI is used to identify preference through a 93-item, self-administered, paper-andpencil questionnaire. MBTI is frequently used as a measure of learning styles (Myers et al., 1998). Four preferences comprise a type. The four preferences direct the characteristic use of perception and judgment by individuals. The Myers–Briggs Type Indicator instrument includes four separate dichotomies: extraversion/introversion, sensing/intuition, thinking/feeling, and judging/perceiving. According to the MBTI manual (1998), the four dichotomies are described as follows. Extraversion and introversion are referred to as fundamental human attitudes or orientations of energy. In the extroverted attitude, energy mainly tends to flow out to the people and objects in the environment. In contrast, for introverted individuals they focus on the inner world of experience and ideas. The sensing/intuition dimension is designed to reflect an individual preference between two opposite ways of perception. Sensing is a preference for perceiving through observable and concrete facts, and immediate experience based on the use of one or more of the five senses. On the other hand, intuition is a preference for perceiving meaning, relationships, and possibilities. The thinking/feeling preference refers to the mode of judgment. Thinking is a preference for making judgments through impersonal and logical analysis with a focus on objectivity. In contrast, feeling is a preference for making judgments based on personal or social values with a focus on understanding and harmony. The judging–perceiving dichotomy is an attitude toward dealing with the outer world. The judging preference tends to have an orderly, planned and controlled life. On the other hand, the perceiving preference favors to live in a spontaneous way with constant adaptations and changes. Those who prefer judgment as opposed to perception are likely to be better at organizing the events of their lives than they are at experiencing and adapting to them.

Methods

Sample All information disclosed in the demographics and the questionnaire was kept anonymous. The study sample of nursing students was selected by random cluster sampling of a class section of approximately 50 students from each grade level in an institute located in the northern part of Taiwan. Approximately 600 students were in the two-year associate degree program, 5000 in the five-year associate degree program, and 50 in the two-year baccalaureate degree program. On initial enrollment in the first semester, the total entry population of the class was systematically assigned to class sections in such a way that each section represented a cross section of the full range of scores on the entrance examination. This meant that each class was representative of the other sections in terms of the range of entry scores. A total of 331 nursing students participated in the study: 94 students (46/280 first-year students and 48/280 second-year students) in the twoyear associate degree of nursing (ADN) program, 189 students (47/1,100 first-year students, 47/ 1,100 second-year students, 48 /1,113 third-year students, and 47/983 fourth-year students) in the five-year ADN program, and 48 students (all first-year students) in the two-year baccalaureate degree of nursing (BSN) program. There were no second-year students at that time because it was the year when the two-year BSN program was introduced. Nursing students in grade five were not included in this study because at the time of data collection they were away from the school in clinical practice and preparing for their licensure exams. The participation rate for completed questionnaires was 98%.

Learning Styles and non-western populations Instrumentation Research regarding learning styles has long been studied in western settings. Considering the differences between western and non-western cultures, it is necessary to understand individual differences among the different multicultural groups. For example, Chinese-Americans were more able to handle their assignments independently. In contrast, AfroAmericans preferred to work with peers rather than by themselves. Moreover, Chinese-Americans preferred to have a quiet learning environment and formal structure while learning whereas Afro-Americans tended to have sound, music and informal seating while learning (Dunn, 1993). In addition, Lam (1998) stated that the learning style inventory has been used to investigate the relationship of different learning styles and organizational performance in a non-western sample of 95 Chinese salespersons from eight diverse organizations in Hong Kong. Participant age ranged from 18 to 37 years (M=21.6 years). The findings showed that salespersons tend to have an accommodative learning style. The accommodative learners are intuitive trial-and-error problem solvers who display social and interpersonal skills that are essential for a salesperson. Older students have a tendency toward the sensing dimension. The sensing type of student relies on facts, while the intuitive students are characterized by their “grasp of possibilities” (Myers et al., 1998). Older

The MBTI is a questionnaire designed for group administration to determine students' learning styles. The MBTI instrument determines the individual status on the four dichotomies (extraversion/introversion, intuition/sensing, thinking/feeling, and perception/judgment) by using forced-choice items. Previous research has proved that the MBTI is a reliable and valid instrument (McCaulley, 1990). Although the MBTI was originally developed in America, it has been translated into other languages and used in many countries, such as China, Japan, Korea, Canada, Australia, and Britain (Myers et al., 1998). According to Myers (1998), “More than two million indicators are administered annually in the United States. The MBTI is also used internationally and had been translated into more than 30 languages” (p. 5). Validity and reliability According to Myers and McCaulley (1985), reliability ranged from .82 to .98 on the four subscales (extraversion/introversion scale, r = .83; sensing/intuition scale r = .82; thinking/feeling scale, r = .87; and judging/perceiving scale, r = .98). Researchers who evaluated the reliability of the MBTI using a test–retest design indicated a range of


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Data analysis

Table 1 Frequency distribution of the types among the participating nursing students. Type

Frequency

Percent

Cumulative percent

ENFJ ENFP ENTJ ENTP ESFJ ESFP ESTJ ESTP INFJ INFP INTJ INTP ISFJ ISFP ISTJ ISTP Missing Total

11 25 18 18 22 13 27 11 10 12 16 15 42 17 48 18 8 331

3.3 7.6 5.4 5.4 6.6 3.9 8.2 3.3 3.0 3.6 4.8 4.5 12.7 5.1 14.5 5.4 2.4 100.0

3.3 10.9 16.3 21.8 28.4 32.3 40.5 43.8 46.8 50.5 55.3 59.8 72.5 77.6 92.1 97.6 100.0

After completing the MBTI, the questionnaires were scored by the researcher using the official answer key. Computer analysis of the data was performed by an IBM-PC using the Statistical Package for the Social Science (SPSS 11.0). Demographic data were presented to describe the sample, using frequencies, percentages, ranges, means, standard deviations and modes. General statistical techniques were used to analyze the data based on an alpha level of .05. To explore the relationship between age and leaning style in Taiwanese nursing students, descriptive statistics, one-way analysis of variance and chisquare statistical analysis were computed.

Results

Note: N = 331, missing means that subjects either did not finish the Myers–Briggs type indicator (MBTI) questionnaire or did not participate in the survey completely. Data in bold represents the highest percentage among the participating students.

.77–.89 (Carskadon and Cook, 1982). Quenk (2000) indicated that a meta-analysis of the MBTI, resulted in acceptable results. The major strength of the MBTI instrument is its conceptualization of the whole person and its theoretical base from which implications for practice can be derived (Provost and Anchors, 1987). Ware and Yokomoto (1985) reported that 62% of their subjects indicated the MBTI type was similar to the description stated in their study. Another study by Carskadon and Cook (1982) resulted in 50% of those tested with answers of the type of description that was “very true of me.” Ethical consideration The University's Institutional Review Board approved the study. Permission to conduct the study was obtained from the president of the institute. To all enrolled students, the researcher sent a letter that introduced the general nature of the study, the student's role in it, and included a request to participate. The researcher administered the MBTI instrument. All subjects participated in the present study voluntarily and anonymously and received an explanation of the MBTI instrument before completing the questionnaires. The researcher scored the MBTI questionnaires.

In the present study, the most common type is also ISTJ (14.5%) in the five-year ADN program, and two-year ADN and BSN programs (see Table 1). The SJs (43.0%) are predominant among the total sample (N = 331). Missing data included 8 subjects who either did not finish the MBTI questionnaire or did not participate in the survey completely. No significant relationship between age and learning style was found by using one-way analysis of variance. However, a significant difference (p = .014) between age and the MBTI's intuition–sensing dimension was found by using chi-square. The subject mean age was 18.32 years (SD = 2.12), the median and the mode were both 18 years. The age range of the 189 nursing students was 15 to 20 years. Students in the five-year ADN program were younger. In the two-year and five-year ADN programs as well as the two-year BSN programs, the age range was 15 to 25 years. Table 2 presents the educational level and ages of the 331 female subjects. No students in the two-year ADN and BSN programs were under 18 years while 63% in the five-year program were under 18 years old. In the two-year ADN program, subjects' ages ranged from 18 to 24 years old, because they had graduated from nursing vocational schools and a few students even had nursing work experience before enrollment (see Table 2). In the five-year ADN program, the age of students in each grade level was: 15 and 16 years old for the first-year students, 16 and 17 years old for the second-year students, 17 to 19 years old for the third-year students, and 18 to 20 years old for the fourth-year students (see Table 2). The nursing student's average age was 17 years in the five-year ADN program. In the two-year BSN program, the age of nursing students ranged from 20 to 25 years, because some students had nursing work experience before enrollment

Table 2 Number of nursing students with different educational level and age distribution. Type of program

5-year ADN

Education level

1st year (% of 1st year)

15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years 25 years Missing Total number of the same year level (% of the same program) Mean of age SD Total (% of the total N = 331)

24 (51.1) 23 (48.9)

47 (24.87) 15.49 .51 189 (57.10)

2-year ADN 2nd year (% of 2nd year) 29 (61.7) 18 (38.3)

3rd year (% of 3rd year)

25 (52.1) 20 (41.7) 2 (4.2)

4th year (% of 4th year)


30 (63.8) 15 (31.9) 1 (2.1)

16 (34.8) 22 (47.8) 4 (8.7) 1 (2.2) 1 (2.2) 0 (.0) 1 (2.2)

47 (24.87)

48 (25.40)

47 (24.87)

16.38 .49

17.51 .59

18.37 .53

2-year BSN 2nd year (% of 2nd year)

19 (39.6) 23 (47.9) 3 (6.3) 3 (6.3)

1 (2.2) 46 (48.94)

0 (.0) 48 (51.06)

18.96 1.15 94 (28.40)

19.79 .82


7 (14.6) 13 (27.1) 20 (41.7) 3 (6.3) 1 (2.1) 3 (6.3) 1 (2.1) 48 (100) 21.72 1.25 48 (14.50)

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(see Table 2). No students were in the second-year of the two-year BSN program because the school was in its first-year of enrollment. Discussion In Taiwan's nursing institutes, the majority of students are females, and all study subjects were females. The most common learning styles were ISTJ and ISFJ in this study. Also “nurses are often classified as combined sensing and judging type” (Jain and Lall, 1996, p. 938). Research supports the idea that college freshmen who are nursing majors are more ESFJ than non-nursing majors. However, the extroverted type was not prevalent among Taiwanese nursing students. The findings demonstrated that the extroverted type constituted only 44.9% of the Taiwanese subjects, this is in contrast to the 58% of the United States counterpart reported by McCaulley (1981). No significant difference between learning styles and age was detected. A possible explanation is that the participating nursing students are homogeneous due to their age range of 15–25 years. However, age is significantly related to the function of intuition–sensing at the .05 level of significance. Older students have a tendency toward the sensing dimension. Consequently, determining the learning style of the student may be more helpful to the educator than knowing the student's age. Educators need to deal with students' differences to develop support services and educational strategies in order to satisfy students' learning needs. Older students may have difficulties in learning, such as working employees and care givers. However, Zhang and Lambert (2008) stated that “the students involved in clinical practice would be older and in the highest academic level of their program of study (p.180)”. Clearly, age is a possible factor in influencing learning. For example, there are differences between traditional nursing students and non-traditional nursing students Therefore, nursing faculty need to apply multiple strategies to match the individual differences of nursing students. While the majority of nursing students were the sensing type of learners (n = 198, 61.3%), a significant proportion preferred the intuitive dimension (n = 125, 38.7%). Nursing faculty need to be aware that both preferences operate within classrooms. The intuitive learner prefers exploring ideas, patterns and theory, and learns best by creative brainstorming and reflection. Thus, nursing educators need to design a variety of teaching strategies that provide intuitive students with plenty of opportunities to invent, create and work independently (Mamchur, 1996). The current findings revealed that most students were the judging type (60.1%). Nursing educators need to provide clear structure, such as syllabi and grading criteria. For the perceiving type of students, learning options can be developed to match their learning style, such as using an individual study plan. McCaulley (1981) indicated that the health field attracts judging and feeling types. They were more equally divided in terms of extraversion/introversion and intuition/sensing dimensions. However, each type of individual could have an opportunity to enter the nursing profession. In this study, a preference for the sensing function indicates that nursing students perceive information through immediate experience and favor facts, observing, and practical learning. The sensing type of student tends to use the five senses and prefers practical applications and a pragmatic style. Therefore, nursing faculty need to be aware of students' needs for direct experience and “hands-on” learning. Teaching step-by-step is a useful method to assist learning. Also, students who prefer the sensing type are more persistent in nursing academics (Fladeland, 1995; Provost and Anchors, 1987). Instructors need to design the program by breaking down the materials into small components to give students plenty of time for observation and practice (Mamchur, 1996). The way of processing information needs to be relevant and have a practical purpose to persist in academics. In designing nursing curriculum, faculty should understand that the thinking type of students tend to follow logical rules. The thinking

learners need a sense of mastery to know things deeply in order to learn orderly. On the other hand, the feeling preference of learners primarily relies on personal or social values while making a decision. Nursing faculty need to offer support and approval while assisting their learning. In fact, because nursing is a discipline in which clinical experience is as important as the grasp of theoretical concepts, it is possible to diversify the types of classroom activities that better match the learning style of the practical learner. Although every student has a preferred style of learning, learners should be encouraged to practice new ways of learning. The most successful learner processes information lie in many alternative ways (Thompson and Crutchlow, 1993). As a result, a variety of teaching strategies will create a match with most students and is needed to increase learning outcomes. Implications for nursing education Educators can apply the MBTI to develop different teaching methods to meet the needs of different types of students. Educators can appreciate the needs and strengths of the various types while understanding the type differences. In classroom and clinical learning, nursing faculty can use the MBTI to create a climate where differing types and attitudes toward learning are seen as interesting and valuable in order to avoid irritating or problematic learning situations. Consequently, learners and educators can benefit themselves by recognizing the different types to reach the highest level of learning. Conclusion Research indicates that a better understanding of learning styles can be beneficial to both teachers and students (Rassool and Rawaf, 2007; Zhang and Lambert, 2008). The teacher should be aware of the learning styles present in the classroom and adjust the presentations accordingly. The students can benefit by managing their learning more efficiently (Li et al., 2008; Young and Diekelmann, 2002). A limitation of this study is the cultural difference that relates to translating the meaning of word nuances in the MBTI instrument, while a cultural factor exists which influences the cross-cultural translation of a language-based test. While the worldwide nursing shortage involves more variables than learning style, we are likely to lose fewer potential nurses if instruction can be improved. Paterson (2010) also reported that educators need to be aware of generational differences when working with nursing staff, they need to appreciate individual preferences in communication, when examining the learning factors in an aging workforce. Moreover, researchers found that using a learning style approach can empower staff development to create an optimal environment for successful staff learning to assist in providing quality care with increasing retention (Brunt and Kopp, 2007). Gillespie (2002) indicated that teachers seek to know students as whole persons. The results of this study support increasing faculty understanding of learning styles, as this understanding will be useful to both the students and the teachers who will encounter each other in learning settings. Acknowledgements We would like to thank the Chang-Gung Institute of Technology, Taiwan for sponsoring this study. We would also like to thank our colleagues and students of Chang-Gun Institute of Technology in Taiwan, who gave their participation and assistance. References Brunt, B.A., Kopp, D.J., 2007. Impact of preceptor and orientee learning styles on satisfaction: a pilot study. Journal for Nurses in Staff Development 23 (1), 36–44. Candela, L., Dalley, K., Benzel-Lindley, J., 2006. A case for learning-centered curricula. Journal of Nursing Education 45 (2), 59–66. Carskadon, T.G., Cook, D.D., 1982. Validity of MBTI type descriptions as perceived by recipients unfamiliar with type. Research in Psychological Type 5, 89–94.

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