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Nurse Education in Practice 14 (2014) 188e194

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Nurse Education in Practice

journal homepage: www.elsevier .com/nepr

Nursing students’ experiences of involvement in clinical research:An exploratory study

Ingela Henoch a,*, Eva Jakobsson Ung a, Anneli Ozanne b, Hanna Falk b, Kristin Falk a,Elisabeth Kenne Sarenmalm a,c, Joakim Öhlén a,d, Isabell Fridh a,e

a The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Box 457, 405 30 Gothenburg, Swedenb The Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, SwedencResearch and Development Centre, Skaraborg Hospital, Swedend Ersta Sköndal University College, Department of Palliative Care Research, SwedeneUniversity of Borås, School of Health Sciences, Sweden

a r t i c l e i n f o

Article history:Accepted 19 July 2013

Keywords:Kolbs’s experiential learning theoryLearning stylesNursing educationNursing students

* Corresponding author. Tel.: þ46 317866092. Fax:E-mail addresses: Ingela.henoch@gu.se, ingela.hen

1471-5953/$ e see front matter � 2013 Elsevier Ltd.http://dx.doi.org/10.1016/j.nepr.2013.07.009

a b s t r a c t

Background: Nursing education can positively affect nurses’ attitudes toward nursing research, resultingin better patient outcomes. Experiential learning theory was the basis for this study.Objectives: To explore nursing students’ experiences of involvement in clinical research, their approachto learning and their interest in nursing research.Design: Cross-sectional.Methods: One hundred and twenty-six nursing students were invited to be involved as data collectors ina research project as part of their training in research methodology. The students completed an evalu-ation form and the Revised Study Process Questionnaire. The questionnaires were analyzed quantita-tively and one open-ended question was analyzed qualitatively.Results: On the whole, the students were happy to be involved in the data collection although a minorityfelt uncertain and exposed. Students with a deeper approach to learning felt that their involvement hadincreased their interest in nursing research and they stated that data collection should be a regularfeature of the course.Conclusions: Participation as data collectors in research has the potential to increase interest in nursingresearch among students with higher levels of deep learning. Further studies are needed to examineways to increase interest in research among students with lower levels of deep learning.

� 2013 Elsevier Ltd. All rights reserved.

Introduction

Nursing education has the potential to positively influence onnurses’ attitudes toward nursing research and evidence-basedpractice, which could result in better patient outcomes. Makinguse of the students’ experiences, observations and reflections intraining related to nursing research could facilitate the students’use of a deep learning approach and thus contribute to a betterunderstanding of nursing research and evidence-based practice. Anexperiential learning approach of this nature was applied whennursing students were invited to collaborate as data collectors in aresearch project.

þ46 317866050.och@gu.se (I. Henoch).

All rights reserved.

Background

The shift in nursing education toward an academic approachcould exert a positive influence on nurses’ attitudes, knowledgeand perceptions of nursing research (O’Brien and Heyman, 1989). Ahigher level of nursing education could promote better patientoutcome in health care and the application of evidence-basednursing methods (Kajermo et al., 2008).

The involvement of nursing students’ in clinical research has thepotential to increase the use of evidence-based nursing, but haveonly to minor extent been explored. However, there are studiesabout nurses’ attitudes toward evidence-based nursing and nursingresearch. Studies have shown, although nurses had a positive atti-tude to research, they report relatively low utilization of researchfindings (Bostrom et al., 2009; Wangensteen et al., 2011). On theother hand, nurses’ attitudes to research have been found to in-fluence the utilization of research positively (Estabrooks et al.,

I. Henoch et al. / Nurse Education in Practice 14 (2014) 188e194 189

2008), which could be inspired by university courses on nursingresearch (Bonner and Sando, 2008).

Involving students in research activities has the potential topromote students’ use of evidence-based nursing. In one project,baccalaureate nursing students collaborated with registered nursesin certain research areas relevant to the nurses’ patients (Gray,2010). This increased the students’ knowledge of evidence-basedpractice. Halcomb and Peters (2009) discuss how research teach-ing needs to be relevant to nursing students’ practical work, makinguse of real-life clinical problems in research education. Whennursing students were involved in a research project as data col-lectors, they acknowledged that their involvement had increasedtheir understanding of the research process (Davies et al., 2002;Niven et al., 2013). Involvement in the research project alsoincreased the students’ understanding of the ethics involved in aresearch project (Davies et al., 2002).

Higher education is shifting from a teaching perspective to alearning perspective. Experiential Learning Theory has beendefined as “The process whereby knowledge is created through thetransformation of experience. Knowledge results from the combi-nation of grasping and transforming experience” (Kolb and Kolb,2005 p. 194). Experiential Learning Theory proposes a construc-tivist theory of learning, i.e. social knowledge is created andrecreated in the personal knowledge of the learner. ExperientialLearning Theory includes two dialectically related modes ofgrasping experience e Concrete Experience (CE) and AbstractConceptualization (AC) e and two dialectically related modes oftransforming experience e Reflective Observation (RO) and ActiveExperimentation (AE). Experiential learning constructs knowledgewithin a learning cycle where the learner uses all these modes e

experiencing, reflecting, thinking, and acting e in a recursive pro-cess. Concrete experiences form the basis for observations and re-flections. The reflections are transformed into abstract conceptsfrom which new actions can be planned and tested, which thencreate new experience in the cycle (Kolb and Kolb, 2005). Theproposition that learning is a process of adaptation to the world hasbeen applied when attempts have beenmade to include students inresearch projects. It has been shown that active learning is effectivein the students’ learning process (Everly, 2013; Munro et al., 2012).

Students’ approaches to learning could be an obstacle tolearning in that some students adopt a surface learning approachand are only able to account superficially for the facts, while otherstudents adopt a deep learning approach and acquire a deeperunderstanding of the facts (Biggs and Tang, 2007). When engagingin learning, students also adopt a deep approach to learning. Biggs(1993, 2001) describes the process of learning in the Presage-Process-Product (3P) model. The presage factors exist prior thelearning situation and refer to Student factors, such as priorknowledge and preferred approaches to learning, as well asTeaching context, such as content, methods of teaching andassessment, institutional climate and procedures. The process in-volves the task, the learning-focused activities, and the ongoingapproaches to learning. The product relates to the learning out-comes, which could be described quantitatively or qualitatively(Biggs, 1993; Biggs et al., 2001). Ramsden (2003) argues that stu-dents’ learning outcomes are related to their approach to learning,in that a deep approach to learning is related to higher qualityoutcomes and better grades.

The aim of the present study was to explore nursing students’experiences of participation in clinical research, their approaches tolearning and their interest in nursing research. In the present study,we included the presage of learning by investigating the students’approaches to learning. The process, i.e. the learning-focused ac-tivity in the present study, was the experiential learning adoptedthrough involvement in the research project. The presage and the

process have the potential to promote the learning outcome, whichin the present study was an increase in interest in nursing researchand evidence-based practice.

Methods

The design of the present study was descriptive and cross-sectional, using both quantitative and qualitative methods.Nursing students in the third year of their nursing program andwho were taking a course in research methodology were invited tocollaborate as data collectors in a research project. The researchproject was a point prevalence study conducted on two occasionsein February 2011 at a university hospital and in September 2011 at acounty hospital, using the same procedure but with a differentgroup of students. In total 100 hospital wards were involvedcomprising departments of internal medicine, surgery, geriatricand oncology. The aim of the point prevalence study was toinvestigate symptoms and other important concerns among adultin-patients by structured interviews. Point prevalence studies havebeen conducted previously in order to collect data about theprevalence of distressing symptoms in hospitalized palliative carepatients (Sigurdardottir and Haugen, 2008) and to collect dataabout the prevalence of pain among patients at a university hos-pital (Wadensten et al., 2011). Students have been involved previ-ously in data collection in point prevalence studies (Westergrenet al., 2008, 2009). Ethical approval was obtained from theRegional Ethics Committee (Ref. No. 604-10) and the hospitalmanagements approved the concept. Prior to the data collection,the hospital wards involved received detailed information aboutthe study and the procedure.

Procedure

A pilot study was conducted prior to the first data collection dayand involved ten voluntary students on three wards at a universityhospital: a medical ward, a surgical ward and an oncology ward.After the pilot study, some of the logistical aspects were adjustedand the following procedure was applied.

The students were given the opportunity to collaborate in theresearch project as part of the data collection methods course unit.Prior to the data collection day, the participating students attendedthreeworkshops, i.e. observation, interviews and questionnaires. Atthe questionnaire workshop, the students were given all the in-formation about the study as well as instructions about ethicalconsiderations in research. The data collection involved bothqualitative and quantitative data collected in a structured inter-view. At the workshop, the students trained in all the proceduresthat were due to take place on the data collection day, i.e. informingabout the study, obtaining informed consent, performing a struc-tured interview with a fellow student and being interviewedthemselves. At the end of the workshop, the students were giventhe opportunity to ask questions and reflect on the study and thedata collection situation.

On the data collection day, students were assigned to the hos-pital wards by the research team. The number of students wasdetermined by the number of beds on the ward, the aim being toachieve a ratio of about 10 patients per student. The students wereinstructed to contact the ward nurse when they arrived on theward. They were given information about the number of patientson the ward and the number of patients who should be excludedaccording to the exclusion criteria. When shown to the eligiblepatients’ rooms, the students provided verbal and written infor-mation about the study and the patients were then given the op-portunity to consider if they were willing to participate. Thepatients who were willing to participate gave their informed

Table 1Demographic characteristics of the students, n ¼ 126.

Mean (SD); median (range)

Age, years 27.46 (7.01); 25 (20e51)Working experience prior

to nursing education, years5.06 (6.1); 3 (0e35)

n (%)

GenderFemale 109 (86.5)Male 15 (11.9)Missing 2 (1)

Earlier academic educationYes 48 (38.1)No 70 (55.6)Missing 8 (6.3)

Median (range)

Number of higher educationcredits for those withan earlier academic education

60 (3e300)

Table 2Number and percentage of students for each response alternative in the students’evaluation of their participation in the data collection (n ¼ 126).

n (%)

Totallydisagree

Neither/nor

Totallyagree

1 I considered my knowledgeof research ethics to besufficient to be involved inthe data collection.

3(2.4)

6 (4.8) 22(17.5)

41(32.5)

54(42.9)

2 I considered my knowledgeof data collection to besufficient to be involvedin the data collection.

e 2 (1.6) 19(15.1)

47(37.3)

58(46)

3 My interest inpatient-reportedsymptoms of illnessincreased through myinvolvement in the datacollection (missing 1; .8%).

14(11.1)

11 (8.7) 42(33.3)

30(23.8)

28(22.2)

4 My interest in nursingresearch increased throughmy involvement inthe data collection.

29(23)

13 (10.3) 32(25.4)

34(27)

18(14.3)

5 My interest in working withassessment scales in symptomevaluation increased throughmy involvement inthe data collection.

33(26.2)

23 (18.3) 34(27)

28(22.2)

8(6.3)

6 My knowledge of howinterviews,conversations, observationsand assessment scales can beused clinically increasedthrough my involvementin the datacollection (missing 1; .8%).

7(5.6)

8 (6.3) 30(23.8)

48(38.1)

32(25.4)

7 Involvement in data collectionshould be integrated into thiscourse as a mandatorycomponent(missing 2; 1.6%).

1(.8)

3 (2.4) 16(12.7)

35(27.8)

69(54.8)

I. Henoch et al. / Nurse Education in Practice 14 (2014) 188e194190

consent and they then underwent a structured interview. Thisinvolved the student reading the questions to the patient andnoting the patient’s answers. The researchers were available at thehospital throughout the day and visited the students on the wardsto help them if necessary. At the end of the day, the researcherscollected the study data, informed consents and flow charts andlocked them away.

Data collection

After both the data collection days, the students completed aquestionnaire comprising a demographic form, an evaluation oftheir participation in the data collection, and the Revised StudyProcess Questionnaire.

The demographic form included age, gender, years of workexperience, other academic education, and the number of hoursspent working alongside education.

The evaluation form was constructed especially for this studyand consisted of seven statements about the students’ knowledgeprior the data collection day, whether their interest in datacollection, symptoms and nursing research increased and if theythought this approach should be integrated into the course on aregular basis. One item, “My interest in nursing research hasincreased while being involved in the data collection”, wasconsidered to be the main outcome. The response alternativesconsisted of a five-point Likert scale from “1” e “totally disagree” to“3” e “neither/nor” and “5” e “totally agree”. One additional, open-ended question about the students’ experiences of involvement inthe data collection was included in the questionnaire.

The Revised Study Process Questionnaire (R-SPQ-2F) is a 20-itemquestionnaire that investigates approaches to learning and mea-sures two factors: Deep approach to learning (10 questions) andSurface approach to learning (10 questions) (Biggs et al., 2001). TheR-SPQ-2F has been translated into Swedish (Watkins and Dahlin,1997). The response alternatives in the Swedish version were afive-point Likert scale, with “never” as 1 and “always” as 5. Inaccordance with Biggs et al. (2001), the responses to the deepapproach questions were collated to obtain the ’deep approach’factor and likewise for the surface approach factor. In the presentstudy, Cronbach’s alpha for a deep approach to learning was .75 andfor a surface approach .67.

Data analysis

Descriptive statistics were used to describe the sample and thestudents’ evaluation of participation in the data collection. Differ-ences in demographics, academic experience and evaluation itemsbetween students with deep approaches to learning above andbelow the medianwere explored further using the ManneWhitneyU-test and Student’s t-test when appropriate.

Data from the open-ended question, which consisted of shortcomments or a few sentences, was transcribed verbatim and theanalysis followed the steps described by Elo and Kyngäs (2008). Thetext was read several times and meaning units were extracted andcoded. Codes with similar content were grouped in themes. Theanalysis was conducted by twomembers of the research theme andwas validated by all authors.

Results

On each occasion (i.e. February 2011 and September 2011), 70students participated in the data collection (n ¼ 140). Sixty-threestudents completed the evaluation questionnaire after each datacollection day (n ¼ 126). Fifty-five students responded to the open-ended question. There were no significant differences between the

students’ characteristics on the different occasions. The de-mographic characteristics of the students are presented in Table 1.

The students’ evaluations of their involvement are presented inTable 2. The students were generally satisfied with their involve-ment in the data collection, demonstrated by the fact that morethan four out of five stated that data collection should be includedin the course on a regular basis.

Table 3Differences between students with high and low levels of deep learning, divided atthe median, 32. Independent samples, T-test and ManneWhitney U-test were used.

Deep approach tolearning �32 (n ¼ 61)

Deep approachto learning <32(n ¼ 57)

p

Mean (SD)

Age 29.03 (7.68) 25.38 (5.27) .003Working experience,

number of years5.6 (6.5) 4.1 (5.7) .198

Number of highereducation credits

92.3 (74.8),(n ¼ 25)

65.0 (40.3),(n ¼ 13)

.152

Deep approachto learning �32(n ¼ 61)

Deep approachto learning <32(n ¼ 57)

p

n (%)

GenderFemale 54 (88.5%)

49 (86%).839

Male 7 (11.5%)6 (10.5%)

Earlier academic educationYes 29 (47.5%)

15 (26.3%).043

No 31 (50.8%)36 (63.2%)

Table 4Differences between deep learning above and below the median, i.e. 32, and stu-dents’ evaluation items. ManneWhitney U-test was used.

Deep approachto learning �32(n ¼ 61)

Deep approachto learning <32(n ¼ 57)

p

Mean (SD);median(range)

1 My knowledge of researchethics was sufficient to beinvolved in the data collection.

4.08 (1.05);4 (1e5)

4.04 (.98);4 (1e5)

.629

2 My knowledge of datacollection was sufficientto be involved in

4.30 (.78);4 (2e5)

4.19 (.77);4 (2e5)

.413

I. Henoch et al. / Nurse Education in Practice 14 (2014) 188e194 191

The students’ deep approach to learning was a mean of 31.4 (SD5.35) and a median of 32 (ranging from 14 to 45). Their surfaceapproach to learning was a mean of 24.28 (SD 5.02) and amedian of24 (ranging from 14 to 38). The students were then divided into twogroups according to their scoring of deep approaches to learning.The first group scored � median, i.e. 32, on deep approaches tolearning, the second group scored below 32. The students whoadopted a higher level of deep learning were significantly olderthan the students who adopted a lower level of deep learning andto a greater extent had a previous academic education (Table 3). Therelationships between a deep approach to learning and a surfaceapproach to learning are shown in Fig. 1.

Differences in deep approaches to learning were explored in theevaluation items of the students above and below the median, i.e.32 (Table 4). Significant differences were found. Students withhigher levels of deep approach to learning felt that the data

y = -0.356x + 35.387

R² = 0.1471

0

10

20

30

40

0 10 20 30 40 50

Su

rfa

ce

a

pp

ro

ac

he

s t

o le

arn

in

g

Deep approaches to learning

Relationship between deep and surface

approaches to learning

Fig. 1. Relationship between the students’ deep and surface approaches to learning.

collection had increased their interest in symptoms, their interestin nursing research (see also Fig. 2) and their interest in andknowledge of assessment scales in symptom evaluation. They alsofelt that data collection should be included in the course on aregular basis.

In total, 55 of the students who completed the evaluationquestionnaire answered the open-ended question. The analysisresulted in four themes: Opportunity to learn about researchthrough practice; Useful to practice the upcoming role of nurse;The questionnaire and the organization were not optimal; Experi-ences of uncertainty and exposure (Table 5).

The vast majority stated that it was an interesting and instruc-tive experience to be involved. It was an opportunity to practiceresearch in reality and several commented that it was excellentpreparation for their upcoming role as a nurse. Others expressedopinions about the questionnaire and stated that they had expe-rienced problems due to the organization of the data collection day.Some students expressed negative experiences. They reportedfeelings of uncertainty and exposure and they were not preparedwhen patients told them about their suffering beyond what wasasked for in the questionnaire.

Discussion

The results showed that generally the students were positive tothe idea of being involved in data collection. Students with higherlevels of deep learning felt to a greater extent that their

the data collection.3 My interest in symptoms

increased through myinvolvement inthe data collection.

3.92 (.89);4 (2e5)

2.77 (1.27);3 (1e5)

<.001

4 My interest in nursingresearch increased throughmy involvement inthe data collection.

3.57 (1.13);4 (1e5)

2.28 (1.33);2 (1e5)

<.001

5 My interest in workingwith assessment scalesin symptom evaluationincreased through myinvolvement inthe data collection.

3.02 (1.15);3 (1e5)

2.16 (1.24);2 (1e5)

<.001

6 My knowledge of howinterviews, conversations,observations and assessmentscales could be used incare work increased throughmy involvement inthe data collection.

4.08 (.94);4 (1e5)

3.27 (1.10);3 (1e5)

<.001

7 Participation in datacollection shouldbe integratedinto this course ona regular basis.

4.48 (.85);5 (1e5)

4.20 (.86);4 (2e5)

.030

Table 5Themes and examples of students’ comments on the open-ended question.

Themes Students’ comments

Opportunityto learn researchthrough practice

- To make a true study out there inthe real world was really good

- Good to participate yourself; itprovides a better picture of howresearch works in reality

- Good to practice the theory.It makes for a lot of learningand creates a special interest.Raises questions, thoughts anda desire for research

- Data collection was a good breakin the theoretical studies.Good insight into howyou go about one of the variousdata collection methods

- Incredibly rewarding momentsin the course. It’s fun being partof something bigger

Useful to practicethe upcomingnurse role

- I think it was useful and instructiveto participate in the study andpractice the futurerole of a nurse by training indata collection

- In-depth knowledge of researchin general but also as part ofmy developmentin my role as a nurse

- Useful both for research purposesand in my future role as a nurse

- This practical experience coversboth the research perspectiveand treatmentissues in my role as a nurse

- You learn different ways toapproach patients

Experiences ofuncertaintyand exposure

- Prepare the students betterfor how to respond tothe patient’s story (taking the timeto listen although not havingthe opportunity to document and follow up)

- More information on how to deal withunexpected responses/queries without affectingthe collected data

- Must be more prepared. What questionscan appear and how shouldI handle situations

- The data collection was laborious;an unpleasant situation

- We need more knowledge of whatsituations we would be facing andhow we shouldprocess all the information we receivedfrom the patients. They perhaps told us aboutvery difficult and personal aspects of theirife, but the only thing we wanted was tomake an estimate on a scale

- Do not think it was good that some hado go onto the ward alone; insecure

The questionnaireandthe organizationwere not optimal

- The questionnaire needs to be improved- Many patients did not understandthe difference between intensity and distress

- Don’t let staff determine the drop-out- High drop-out e could affect the study- The day needs to be organized better- Information to the ward should be improved.No one knew exactlywhat it was all about when we arrived

Fig. 2. The students’ opinion about the extent to which the data collection hadincreased their interest in nursing research, related to above and below median deepapproaches to learning.

I. Henoch et al. / Nurse Education in Practice 14 (2014) 188e194192

involvement had increased their interest in symptoms, their in-terest in nursing research, their interest in assessment scales andtheir knowledge of how interviews could be used in care work.They also felt that data collection should be part of the course.

When applying the present study to the Presage-Process-Product model, the student factors, were the students’ preferredapproach to learning and the learning-focused activity was the datacollection experience. These together were assumed to influencethe product, in the present study the interest in nursing research.All the students in the study were involved in the data collection,but it was the students who adopted a deep approach to learningwho increased their interest in nursing research to a greater extent.Another factor that influenced the increase in interest could be age.Since students with higher levels of deep learning were older thanstudents with lower levels, it could be argued that age was animportant factor behind an increase in interest in nursing research.

Students with higher levels of deep learning were more positiveto being involved in data collection and they stated that their in-terest in nursing research increased. Mansouri et al. (2006) alsofound that interest in the subject among nursing and midwiferystudents was related to deep learning. According to Ramsden(2003), a higher degree of deep learning relates theoreticalknowledge to everyday experience, which is important in under-standing the link between practical care reality and a theoreticalunderstanding of reality. We assumed that concrete experiencecould be a way to increase all the students’ interest in nursingresearch, but this mostly involved the students with higher levels ofdeep learning.

In our study, there was a weak yet significant negative correla-tion between surface learning and deep learning. One might haveexpected that the students who applied a higher degree of deeplearning would apply a lower degree of surface learning and viceversa. This was partly the case and we found a difference betweenthose with higher levels of deep learning and those with lowerlevels of deep learning in relation to certain parts of the evaluation,but not between those with different degrees of surface learning.Are surface learning and deep learning two sides of the same coin?In our study, Cronbach’s alpha was lower for surface learning thanfor deep learning, which may mean that the surface learningdimension is not completely reliable. Onemain issue is whether the

key is to increase deep learning itself, or whether students applydeep learning more in order to learn the subject better. Accordingto Ramsden (2003), the students’ application of surface learning ordeep learning depends on the task and the students’ application ofsurface learning or deep learning is not related to this learning

I. Henoch et al. / Nurse Education in Practice 14 (2014) 188e194 193

opportunity. We do not know if the students’ response to the deepand surface items was related to their involvement in the datacollection or whether it was simply a response to learning ingeneral.

In the open-ended question, most students expressed satisfac-tion at being involved in data collection but for some students itwas an unpleasant experience. These students felt unprepared toface the suffering patients expressed beyond the structured ques-tions in the questionnaire. These findings show the importance ofpreparing students before involving them in interview studies. Animportant ethical issue to discuss is how to endure and handle thepatients’ suffering in conjunction with interviews. These studentshad one year left before graduating. The findings perhaps alsoindicate that in the training of nurses, there must be a greater focuson training the students to talk with patients about symptoms anddistress.

To be involved in a research project has the potential to increasestudents’ interest in nursing research, but we found that it wasprimarily students with higher levels of deep learning who wouldbenefit. Borredon et al. (2011) defined deep learning as learningthat fully integrates the four parts of experiential learning, i.e.experience, reflecting, thinking and acting (Kolb, 1984; Kolb andKolb, 2005). According to Kolb (1984), the concrete experience istransformed into knowledge by reflecting on experience and/oractive experimentation. In the data collection situation, the stu-dents were not given the opportunity to reflect or actively experi-ment. There should be meaningful interaction between experienceand reflection to facilitate learning (Fowler, 2008). An opportunityfor reflection could have also provided an opportunity for abstractconceptualization. Reflection within experiential learning wasdescribed by Moon (2001), who argues that Kolb’s ExperientialLearning Theory does not define the relationship between reflec-tion and learning. On the other hand, Fowler (2008) proposed thatexperiential learning is a product of reflection on learning. Theexperience is dependent on the degree to which the student isinvolved, whether the subject is relevant to the experience andwhether the experience is task-centered or patient-centered.Furthermore, reflection is dependent on the tools used to aidreflection, the student’s level of activity and whether it is plannedor ad hoc reflection (Fowler, 2008). It could be argued that the lackof opportunity to reflect was a limitation to the present study.

Another potential limitation is the questionwhether the R-SPQ-2F is the best way to measure surface learning and deep learning.Cuthbert (2005) analyzed the literature on surface learning anddeep learning and argues that there is support for the concepts ofsurface learning and deep learning but that the criticism concernsthe validity and reliability of instruments that measure surfacelearning and deep learning. Research into surface learning anddeep learning indicates that students’ learning approaches are noteasy to change. Research into deep learning and surface learninghas had greatest impact on teachers rather than students. Thebetter the teachers’ understanding of the factors that influencestudent attitudes and the learning process, the better is theteachers’ learning practice (Cuthbert, 2005).

Conclusions

Students evaluated their involvement in the data collectionpositively although a minority expressed feelings of uncertaintyand exposure. Participation increased interest in nursing researchamong students with higher levels of deep learning. This study alsohighlights the importance of preparing students before involvingthem in interview studies and indicates that in the training ofnurses there must be a greater focus on training students to talkwith patients about their distress. To determine whether

experiential learning improves deep learning, more studies areneeded in which all elements of experiential learning are included,i.e. concrete experiencing, reflective observation, abstract concep-tualization and active experimentation. Further studies are alsoneeded to examine ways to increase interest in nursing researchamong students with lower levels of deep learning.

Conflict of interest

There are no conflicts of interest.

Acknowledgments

The Health and Medical Care Committee of the Regional Exec-utive Board, Västra Götaland Region, Sweden. Ulla-Carin LindquistFoundation, Sweden. Foundations of the Sahlgrenska UniversityHospital, Gothenburg, Sweden.

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