This mixed methods quantitative-dominant, explanatory sequential design study investigated meaningful learning outcomes of first semester associate degree nursing students at a private nursing college in the Midwestern United States. The quantitative strand compared meaningful learning of two groups: students who received concept-based teaching (CBT) and students who received traditional nursing pedagogy. Meaningful learning was measured by higher order thinking (HOT) gain (i.e., the difference between standardized pre- and post-test scores). The instruments used to measure HOT gain were the Assessment Technologies Institute (ATI) Critical Thinking Assessment (pre-test) and the ATI Nursing Fundamentals Assessment (post-test).
The quantitative data were extracted from 346 archived student records from six consecutive cohorts. The cohorts consisted of students enrolled in the first semester nursing course between spring, 2009 and fall, 2011. Three cohorts had received CBT and three had received traditional teaching.
Multiple regression was used to analyze relationships between HOT gain and the potential influencing variables of teaching method, pre-test score, age, previous science coursework, and the time interval between the pre- and post-test. The findings included: (1) no significant between group differences, and, (2) a significant inverse relationship between pre-test score and HOT gain that was not influenced by teaching method. The quantitative results were used to purposefully select the qualitative sample.
The qualitative sample consisted of 11 students whose HOT post-test scores were from the uppermost quartile, and 11 students whose scores were from the lowermost quartile. This maximal variation sampling technique was used to increase understanding of the mechanisms underlying the meaningful learning process. A patient case study discussion was conducted with each of the 22 CBT students during the spring semester of 2012. Transcripts of the discussions were analyzed using flow mapping.
Flow mapping is a qualitative data analysis method in which the researcher creates a graphic representation of students’ knowledge connections. The completed flow maps fell into two distinct groups distinguished by number and type of knowledge connections. Integrative analysis found that students who verbalized a greater number of knowledge connections during the interview had higher HOT scores and a deeper understanding of principles underlying nursing interventions than did students who verbalized fewer connections. Knowledge connections and HOT appear to be associated, as predicted by meaningful learning theory. Additional research is needed to investigate CBT’s effect on this relationship.