Distributions of Nursing Student ’ s Problems with Student Centered Learning Method

Purpose: Student centered learning (SCL) method is a new approach in Indonesia in which students have to more proactive in achieving competencies. A nursing school in Semarang, Indonesia has applied this method since 2006. Many students’ achievements were obtained from local, national, and regional level. However, several concerns also came up with this method. This study aims to identify students’ problems with SCL methods from 1 to 4 year grades. Methods: Research design was a descriptive quantitative by conducting survey based on the domains and categories from a qualitative study. The questionnaire has been tested the validity and reliability. The researcher kept the items do not valid since they are significant to explore those crucial problems. Univariate analysis was done to measure the problem percentage in each grade. The investigator described each category in quantitative analysis tables. Results: The results showed that the problem percentages found in the early year almost similar with others. Conclusion: This recommends that it needs learning system improvement from life skill competence arrangements, learning scenario design, and tutor’s capacity enhancement.


Introduction
The adoption of Problem Based Learning (PBL) in medicine, nursing, and health alliance professionals in US and Europe has been reached Asia Pacific, particularly in last ten years (Biley & Smith, 1998;Baker, 2000;Khoo, 2003 as cited in Hesson & Shad, 2007).PBL, Active Learning (AL) dan Student Centered Learning (SCL) were applied to indicate the change of emphazing on teachers to students as the core of learning process.Greenwood Dictionary of Education mentions that AL is a process to keep students active in learning psychologically a process to keep students active in learning psychologically and frequently physically in their learning process which engage them in collecting information, assuming, problem solving (Hrycaj, 2005;Collins & O'Brien, 2003 as cited in Hesson & Shad, 2007).This activeness results in positive consequences during learning process both in academic and clinic.Constructivism supports nursing education in enhancing critical thinking skill and rapid adaptation to change in evidence-based practice.The skill development in gaining knowledge, analyzing the information critically, evaluating according to experience, and then creating a novel framework are the best strategies to graduate nurses with critical thinking skill (Candela et al., 2006).An active method in learning result in clinical grade means greater than lecturing one (Hoke & Robbin, 2009).This strategy is also employed in a nursing school in Semarang, Indonesia since 2006.
With this method, students are able to gain a plenty achievements in academic and competitions.However, this also has consequences in several problems.Many students expressed a lot of assignment complaints.Furthermore, there were reports that several students were absence because of health problems that might be caused by exhausted of a full learning schedule.Some of them communicated irregular eating pattern so the gastritis incidence also increase.Adaptation problem is the most frequent concern of first year students.
Another complaint is lack of togetherness intensity with their families.It requires a further study to explore these so it can be solved by nursing education institutions in Indonesia.This study aimed to identify the nursing students' problems during learning with SCL method particularly in each grade.

Methods
The investigator accomplished a survey to measure each problem frequency in students.The population in this study is nursing students in a nursing school in Semarang (450 students).The sampling technique is total sampling including all nursing students from 1 st to 4 th year students in the academic phase with active status in academic.The sample size in survey was 425 students.
The researcher fulfilled the subject's right including self determination, privacy and dignity, anonymity and confidentiality, justice, and protection from discomfort or harm (ANA, 1985 as cited in Macnee, 2004).These were required since the students can be involved with forced.The investigator guaranteed that those subject's right with informed consents and kept the subject's identity in this study.
The questionnaire was developed from a qualitative study that produced categories in the tool which was tested for validity in a nursing school in Kendal with consideration that this institution also applies the similar SCL method in the nursing school in Semarang.This tested in the 1 st until 3 rd year students.The validity test showed that several items were not valid (r<0.3).The researcher revised the invalid components and re-test in data collections.
The validity retest showed that there were 31.90%statements with r<0.3.Because based on FGD result the item contents were important, so the investigator still kept all of them with a consideration that they will be useful in the future.The reliability test used Alpha Cronbach illustrated that questionnaire were reliable (α= 0.92).The researcher measured percentage of each category in every grade.

Results
The investigator described nursing student's problems during learning with SCL method in several domains including learning achievement, family, group, facilitator, learning process, material, presentation, financial, timing, technology and information, evaluation, psychological, physical, daily life, and social concerns.Each category will be described in tables as below:

Discussion
Problem percentage in 4 th year students was not less than the 1 st year students.This reflects that student still found stressor until 4 th level.It can be related to student competency achievement in all of life skill competencies as below: Figure 1 Targeting life skill model  Many problems occurred in students because of the competencies above were not accomplished.For example, concerns in group that were not finished until the end of learning period.This reflected team work, conflict resolution and leadership competencies that were not achieved.Several psychological and physical concerns happened as the result of high stressed can be associated with stress management competency which could not be well performed.
The study result show that most students conveyed unsatisfied in learning achievements.
Moreover, students felt that they only focus on assignment submissions without understanding the competency achieved.Nursing competency learning should keep instruction that focus on students.Learning goals in instructional modules describe significance knowledge and skills as the indicator in which competencies assessed (Fay, 2005).Students will be difficult in achieving and understanding learning targets if tutors only focus on the process without providing feedback toward their learning result.
Competency achievements cannot be separated from group process in learning.The investigator found several concerns regarding this.Tipping, Freeman, and Rachlis (as cited in Hesson & Shad, 2007) purposed that learning process in students depends on group effectiveness.Although tutors are significant in the initial phase of study, however learning will depends on the effectiveness of small group process.This study showed that a small number or health professionals and students who are skilled in working in a group effectively.This is caused by traditional learning process from elementary school until higher education.
As the consequence, students have to be independent by trial and error in working in a team.
Student's habits in a group are various such as a student's dominancy result in passiveness of others and some of them are ramble while others seem to be shame for expressing their arguments (Hitchock & Anderson, 1997;Riderout, 1999as cited in Hesson & Shad, 2007).Stinson andMilter (1996, as cited in Hesson &Shad, 2007) said that observer frequently found that students were work ineffectively, wasting time, repeating previous information or confrontation.Tutor's role is crucial in facilitation students in their team work or overall learning process.
Facilitator involvement in learning process becomes an attention in SCL method.
Several of them are not more engaged in learning due to opinion that in this strategy, the students should more pro active (Turana, Elcina, Odabasi, Warda, & Sayek, 2009).This situation must be an importance aspect since learning process is facilitator's responsibility.
For instance, effective tutors in PBL are able to enhance discussion and be part of group (Goldie, Schwartz & Morrison, 2000).Some studies articulated a good tutor's characteristics including able to support critical thinking of student with problems (Das, Mpofu, Hasan & Stewart, 2002), facilitating discussion (Felder, 1996), eliminating conflicts (Hitchcock & Helen-Zoi, 2000), focusing on student's learning instruction (De Grave, Dolmans & van der Vleuten, 1999), enhancing learning process (Pinto, Rendas & Gamboa, 2001;Reznich & Werner, 2004), and acknowledging when and how intervening students (Maudsley, 2002;Haith-Cooper, 2000).Tutor's roles are significant according to Fay, Selz, and Johnson (2005) expressing that SCL strategy will be successful only if students in this approach adopt a new way and more vocal, organized, and confident.
Survey in this study used reliable questionnaire however several items are not valid (r<0.3).Setiaji (2004) suggested that an instrument item is valid if r value more than 0.3.However, the investigator kept these since this represent students' problems in detail so if it was not used those concerns will not be explored quantitatively.Fay, Selz, and Johnson (2005) purposed a model in which one of the domains is oriented in nursing competencies.The skill built as learning result should be sustainable.Educator requires creating a learning strategy to fulfill a particular need as a professional reflection so students can comprehend theory and practice in learning process., 4, 2, 2014, 785-798 796 working), heart (relating and caring), and health (living and being)".All components in this framework can represent student competencies to learn successfully so the problems can be solved with student's life skill achievement.Hardie (2007) expressed there is a need to ensure that student can learn with appropriate and funny ways and learning experience becomes meaningful, attractive, and challenging and enhancing student's skills, competencies, and confidence.Moreover, the educator must guarantee that learning is relevant according to science context and the students are engage in theory and practice so they can integrate in their work successfully.
Those needs can be facilitated by tutors who should maintain cognitive activities such as create a relationship, providing suggestion, and helping students to control their own study.This reflects that tutorial requires particular skills besides teaching.Tutor's performance might be not like a teacher, but specific according to situation found (Dolmans, Gijselaers, Moust, De Grave, Wolfhagen & Vleuten, 2002).

Conclusions
This study resulted in 16 themes of nursing student's problems during learning with SCL method including learning achievement, family, group, facilitator, learning process, material, presentation, financial, timing, technology and information, evaluation, psychological, physical, daily life, and social concerns.Descriptions of each category in table expressed many specific problems in students with SCL method.These conditions can be solved with designing learning process in detail in scenarios describing student's competency achievement process.This should include group forming and timing among courses so there is no time conflict for students to work in the similar team and method.For instance, in one week, a student should not engage in PBL in two subjects.This will be a burden for them in manage time and concentrate in competence achievement so they will not only focus on process without concentrate on learning target.
Nursing education institution should develop curriculum that involve for life skill competencies including heart, hand, head, and health.These are significant so learning designers need to make them in operational descriptions.For example, in a problem solving competency, tutors should have skill to find problem solving strategy and apply this to evaluate for its effectiveness so the students can use this as a coping in the future.
Facilitator roles are very important in SCL method so it requires tutors who can support students in enjoying learning process and not to be additional stressor for students.
Tutors should have skills in facilitating students to solve their problems such as counseling skill in identifying their concerns and finding out an effective solution.
The study limitation is not used a 100% valid questionnaire.It needs a next study to develop standard instruments to evaluate students' problem with SCL method.This tool will be helpful to assess problem developments in time series so this can be evaluation material towards learning process in each semester.Those concerns should be decrease in the next semester.
Nursing education institutions can develop competency based curriculum referring targeting life skill in which many life skill competency requirement are summarized in 4-H framework.The model purposed by 4-H Cooperative Curriculum System can support students in meeting basic need and developing importance capabilities in here and now and future life.
4-H focuses on skill development of health and productive life for students and their communities.The main dimensions are "head (managing and thinking), hand (giving and Nursing Student's Problems with Student Centered Learning Method Nurse Media Journal of Nursing Nursing Student's Problems with Student Centered Learning Method Nurse Media Journal ofNursing, 4, 2, 2014, 785-798 787