The Nursing Journal of India - Determinants of Academic Performance among BSc Nursing Students: A Mixed Method Research

Academic performance is a critical factor in the success of nursing students, as it directly impacts their ability to provide quality care to patients, families, and communities (Gripshi et al, 2022). Numerous studies have explored various factors that contribute to the academic performance of nursing students, shedding light on the complex interplay of personal, academic, and environmental factors. Research has shown that academic performance in nursing programmes is influenced by a range of factors, including time management skills, self-confidence, and demographic characteristics (Abu Bakar et al, 2023; Amir et al, 2021).

The Bachelor of Science in Nursing (BSc Nursing) programme in particular, plays a vital role in preparing future nurses to meet these dynamic demands. This necessitates periodic curriculum changes to ensure that nursing graduates are equipped with the most current knowledge, skills, and competencies required for effective practice. Once changes are implemented, educators are faced with determining whether the curricular innovations have indeed lived up to their promise; are student learning outcomes any different from those of the previous curricula? This paper describes an initial systematic evaluation of the academic performance of students based on selected parameters by comparing learning outcomes following a curricular renewal, and highlights their significance in fostering a competent, adaptable, and innovative nursing workforce.

Hypothesis
H1-There will be significant difference in the influence of selected determinants on academic performance among BSc nursing students.

Objectives
The study was set out with following objectives:
1. To (a) identify, and (b) explore the determinants of academic performance among BSc nursing students.
2. To determine the impact of selected determinants on academic performance of BSc nursing students.

Operational definitions
BSc Nursing students - It refers to individuals who are currently enrolled in BSc Nursing degree at a nursing college following the 2016 scheme and revised 2021 scheme of curriculum as per KUHS.
Determinants - It refers to a specific factor that affect the outcome of academic performance such as socio-demographic factors and others that include student-related factors, teacher-related factors, college-related factors and home-related factors.
Academic performance - It refers to the extent to which students have achieved their educational goals in terms of marks secured in selected nursing subjects.

Review of Literature
A cross-sectional study was conducted by Alshammari Farhan, Saguban Reynita et al using quantitative-correlational design on 201 student nurses from the College of Nursing at University of Hail selected using convenience sampling. A modified survey questionnaire was utilised to gather data. Four types of factors such as teacher-related (with a mean 4.16), student-related (3.85), school-related (3.85), and home-related factors (3.54) were observed to have varying extent of effect on the academic performance of student nurses. Likewise, age, gender, year level, marital status, socio-economic status and previous school attended by the student nurses showed varying extent of influence on their academic performance.

A descriptive cross-sectional study was conducted by Fajar Shaheen Hussain M et al on students of Lahore School of Nursing, University of Lahore. Convenient sampling technique was used for data collection. This study concluded that most of the common contributing factors that affect academic performance of nursing students were related to teacher factor, student factor, home factor, school factors, significantly affect the academic performance of the nursing students.

Methodology
The mixed research approach with Mixed Method Concurrent Embedded Research design was used in the study. The study was set in Amala College of Nursing, Thrissur. BSc Nursing students of this college constituted the study population. The sample consisted of students who voluntarily consenting to be part of this study. A singlepopulation proportion formula based on previous study was used to estimate the minimum sample size (N) required. A 95 percent confidence interval (Z χ /2 =1.96), a 5 percent margin of error (d), and a 10 percent non-response rate was assumed. Calculated sample size was estimated as 206. There were a total of 228 responses.

Table 1: Tools and technique
For quantitative data collection, convenience sampling technique, and for qualitative data collection, purposive sampling technique was used. Study period was, two weeks after IRC approval. Inclusion criteria: (a) Nursing students studying in nursing educational institution following 2016 scheme (annual system) and 2021 scheme (semester system) of curriculum, and (b) Students willing to participate in the study were included. Exclusion criteria: Students who were absent on the days of data collection were not included.

Qualitative data collection included (a) students competent in conversation, leadership skills, club activities, and (b) students representing different academic performance level.
Table 2: Interpretation of tool 1- Section B

Pilot study: After the finalisation of research proposal, institutional approval was obtained. Pilot study was conducted among 20 BSc Nursing students to assess the feasibility of items.

Data collection started on 29 June 2024. Tools were administered to the samples through a google form; 228 responses were received within 2 days.

Data analysis and interpretation: The data was collected through google form, analysed and interpreted according to the objectives of the study using SPSS version 23 (Tables 1-9).

Results
Table 3: Distribution of Sociodemographic variables (n=228)
Table 3 shows that 61.4 percent of the participants were between 19-21 years; 90.8 percent of the participants were females. Majority of the parents had an education up to high school, 68.8 percent participants had a total screen time of 2-6 hours a day, 56.1 percent participants of the participants slept for less than 6 hours a day, 67.6 percent participants mentioned that the teaching methodologies used were simulation, OSCE, Discussion and Self learning, 48 percent of the participants spent less than 2 hours on studies per day.

Table 4: Association between socio-demographic factors and academic performance
Table 4 shows that there is a statistical significant association between socio demographic variables such as age (in years), total screen time per day, hours of studying per day, percentage of attendance and teaching learning methods used with the academic performance of the students.

Table 5: Association between marks secured in selected subjects and academic performance
Mean academic performance of students was higher for FON university examination (Table 5). Significant correlation was observed on average sessional marks scored in FON and determinants. Table 6 reveals that mean of the four-given factors were comparable with a higher mean observed for college-related factors, followed by teacher-related factors and student-related factors.

Qualitative data analysis: After analysing the in-depth interview and focus group discussion, the meaning units were identified and categorised under the following headings.

Curriculum related factors
Table 8 shows curriculum-related factors of both semester and annual system. Table 9 outlines opinion for and against semester system. Verbatim of students collected through data collection are given below.

Annual students:
For difficult subject I will provide more time and for easy subject my time will be reduced; and group study is a very essential part of my study schedule

Table 6: Comparison of weighted means of Factors affecting academic performance

Table 7: Determinants of academic performance

If teaching method includes more varieties of method like role-play, then it is simple to understand.
Good classroom, library facilities, whiteboard and wi fi facilities can help to improve academic performances of students.
I feel my sister is always comparing her grades with my own grades. So, for meeting that it may become over burden or it may add an extra stress to my studies.
We all are the nurses who loves to migrate, we have to go through the OSCE sessions. So, the OSCE is not provided enough in our curriculum, but the same advantage is given to them. Hence, they will be more competitive than us when compared in the global context.

Semester students When It comes to student-life balance, in semester system there is limited time and there are so much requirements and my student-life balance is mostly impaired.

Table 8 : Modalities of curriculum-related factors in two systems
If the teacher is just doing the lecture methods, it may bore some to an extent, but if the teacher doing some interactive sessions like role play, will be more interesting.
During this tight schedule of studying some extracurricular activities, such as arts and sports is so much helpful for us to relieve from the stressful situations that we face.
My family is providing me with support emotionally, economically and physically to improve my academic performance. When I m in a stressful situation, my family has provided me a great support and they are my backbones.
My curriculum is tightly packed. The time that is getting to cover all those portions are also very limited and also there was increased number of exams within a limited duration of time which caused an extremely stressful situation.
A coin has two sides, opinion of students is for and against semester system. Tool 1, containing instructions, factors affecting academic performance of nursing students (Table 10), qualitative tool used and in-depth interview guide are given here.

ANNEXURE
Tool-1: Socio demographic Variables Instructions

  • Read questions carefully. Put tick mark in respective columns.
  • The data given by you will be confidential.
  • Fill up the blanks wherever needed.
  1. Age in years . . .
  2. Gender
    Male
    Female
  3. Socio economic status
    Upper class family
    Middle class family
    Lower class family
  4. Educational status of father
    Illiterate
    High school
    Diploma
    Graduate
  5. Educational status of mother
    Illiterate
    High school
    Diploma
    Graduate
  6. Habits of substance abuse (alcoholism, smoking, tobacco use)
    Yes
    No
  7. Total screen time in a day as per setting in your phone in hours _______
  8. How many hours of sleep do you get per day ______
  9. Do you struggle with any health issues that affect your academics
    Yes
    No
    If yes, specify ___________________
  10. University Register Number of the participant
  11. Curriculum followed in the present BSc Nursing programme 2016 scheme (Annual System) 2021 scheme (Semester System)
  12. Percentage of attendance in previous year
    80%
    80-85%
    85-90%
    90%
  13. Average score secured in sessional exam of Foundation of Nursing _____________
  14. Score secured in university examination of Foundation of Nursing ________________
  15. Average score secured in sessional exam of Adult Health Nursing ________________
  16. Score secured in university examination of Adult Health Nursing ___________
  17. Teaching Learning Methods used
    Self-learning
    Lecture cum discussion
    Simulation
    OSCE
  18. Hours spend on studying per day _______

Table 10: Factors that affect the academic performance of student-nurses

Tool 2: Qualitative tool
Focus group Discussion (FGD) Guide is aimed at identifying the determinants of academic performance among BSc Nursing students:

  1. In your view point what are the factors affecting academic performance?
    Student-related
    College-related
    Curriculum-related
    Teacher-related
    Home-related
  2. How do these factors influence your daily study habits and overall academic success?
  3. What are the main challenges or obstacles you face that impact your academic performance? How do you overcome these challenges, and what support systems do you find most helpful?
  4. How does the college environment, including classroom settings, teaching methods, and clinical placements, affect your academic performance? Can you provide specific examples of positive and negative experiences?
  5. In what ways do personal and social factors, such as family support, peer relationships, and work-life balance, influence your academic performance. How do these factors interplay with your academic responsibilities.

In-depth Interview Guide
In-depth interview guide aimed at identifying the determinants of academic performance among BSc Nursing students.

  1. In your view, point what are the factors affecting academic performance.
    Student-related
    College-related
    Curriculum-related
    Teacher-related
    Home-related
  2. How do these factors influence your daily study habits and overall academic success?
  3. What are the main challenges or obstacles you face that impact your academic performance? How do you overcome these challenges, and what support systems do you find most helpful?
  4. How does the college environment, including classroom settings, teaching methods, and clinical placements, affect your academic performance? Can you provide specific examples of positive and negative experiences?
  5. In what ways do personal and social factors, such as family support, peer relationships, and work-life balance, influence your academic performance? How do these factors interplay with your academic responsibilities?

Discussion
This study shows that the determinants such as college-related factors followed by teachers-related and student-related factors have an extensive impact on academic performance.

Similar study conducted by Alshammari Farhan, Saguban Reynita, et al also showed that four types of factors viz teacher-related, studentrelated, college-related, and home-related factors were observed to have varying extent of effect on the academic performance of student nurses.

A mixed method study by Reem Al Alawi identified factors influencing nursing students's academic success such as pre-nursing academic experiences, educational environment, teaching approaches. This study opens a new avenue for future studies on identifying the determinants affecting academic performance of nursing students of various curriculum.

Limitations
Data was collected from only one selected college of nursing

Recommendations

  • Similar studies can be conducted by increasing the sample size so that findings can be generalised.
  • Curriculum related factors can be quantified using a standardised tool.

Conclusion
Our study highlights the significant impact of college-related factors on the academic performance of BSc nursing students. By fostering a supportive learning environment, colleges can play a vital role in shaping the future of nursing professionals and ultimately, the quality of healthcare. Therefore, it is essential to recognise the importance of college-related factors in influencing academic performance and take proactive steps to create an environment that nurtures academic excellence and prepares students for success in their nursing careers.


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