Nursing Students’ Learning about an Empowering Discourse In Patient Education

The main purpose of this study was to describe and evaluate nursing students' learning about an empowering discourse in patient education. In Phase 1, the purpose was to describe an empowering discourse between a nurse and a patient. In Phase 2, the purpose was first to create a computer simulation program of an empowering discourse based on the description, and second, the purpose was to evaluate nursing students’ learning of how to conduct an empowering discourse using a computer simulation program. The ultimate goal was to strengthen the knowledge basis on empowering discourse and to develop nursing students’ knowledge about how to conduct an empowering discourse for the development of patient education. In Phase I, empowering discourse was described using a systematic literature review with a metasummary technique (n=15). Data were collected covering a period from January 1995 to October 2005. In Phase 2, the computer simulation program of empowering discourse was created based the description in 2006–2007. A descriptive comparative design was used to evaluate students’ (n=69) process of learning empowering discourse using the computer simulation program and a pretest–post-test design without a control group was used to evaluate students’ (n=43) outcomes of learning. Data were collected in 2007. Empowering discourse was a structured process and it was possible to simulate and learned with the computer simulation program. According to students’ knowledge, empowering discourse was an unstructured process. Process of learning empowering discourse using the computer simulation program was controlled by the students and it changed students’ knowledge. The outcomes of learning empowering discourse appeared as changes of students’ knowledge to more holistic and better-organized or only to more holistic or better-organized. The study strengthened knowledge base of empowering discourse and developed students to more knowledgeable in empowering discourse.

University students’ regulation of learning and text processing – examples from medical and teacher education

The general aim of the thesis was to study university students’ learning from the perspective of regulation of learning and text processing. The data were collected from the two academic disciplines of medical and teacher education, which share the features of highly scheduled study, a multidisciplinary character, a complex relationship between theory and practice and a professional nature. Contemporary information society poses new challenges for learning, as it is not possible to learn all the information needed in a profession during a study programme. Therefore, it is increasingly important to learn how to think and learn independently, how to recognise gaps in and update one’s knowledge and how to deal with the huge amount of constantly changing information. In other words, it is critical to regulate one’s learning and to process text effectively. The thesis comprises five sub-studies that employed cross-sectional, longitudinal and experimental designs and multiple methods, from surveys to eye tracking. Study I examined the connections between students’ study orientations and the ways they regulate their learning. In total, 410 second-, fourth- and sixth-year medical students from two Finnish medical schools participated in the study by completing a questionnaire measuring both general study orientations and regulation strategies. The students were generally deeply oriented towards their studies. However, they regulated their studying externally. Several interesting and theoretically reasonable connections between the variables were found. For instance, self-regulation was positively correlated with deep orientation and achievement orientation and was negatively correlated with non-commitment. However, external regulation was likewise positively correlated with deep orientation and achievement orientation but also with surface orientation and systematic orientation. It is argued that external regulation might function as an effective coping strategy in the cognitively loaded medical curriculum. Study II focused on medical students’ regulation of learning and their conceptions of the learning environment in an innovative medical course where traditional lectures were combined wth problem-based learning (PBL) group work. First-year medical and dental students (N = 153) completed a questionnaire assessing their regulation strategies of learning and views about the PBL group work. The results indicated that external regulation and self-regulation of the learning content were the most typical regulation strategies among the participants. In line with previous studies, self-regulation wasconnected with study success. Strictly organised PBL sessions were not considered as useful as lectures, although the students’ views of the teacher/tutor and the group were mainly positive. Therefore, developers of teaching methods are challenged to think of new solutions that facilitate reflection of one’s learning and that improve the development of self-regulation. In Study III, a person-centred approach to studying regulation strategies was employed, in contrast to the traditional variable-centred approach used in Study I and Study II. The aim of Study III was to identify different regulation strategy profiles among medical students (N = 162) across time and to examine to what extent these profiles predict study success in preclinical studies. Four regulation strategy profiles were identified, and connections with study success were found. Students with the lowest self-regulation and with an increasing lack of regulation performed worse than the other groups. As the person-centred approach enables us to individualise students with diverse regulation patterns, it could be used in supporting student learning and in facilitating the early diagnosis of learning difficulties. In Study IV, 91 student teachers participated in a pre-test/post-test design where they answered open-ended questions about a complex science concept both before and after reading either a traditional, expository science text or a refutational text that prompted the reader to change his/her beliefs according to scientific beliefs about the phenomenon. The student teachers completed a questionnaire concerning their regulation and processing strategies. The results showed that the students’ understanding improved after text reading intervention and that refutational text promoted understanding better than the traditional text. Additionally, regulation and processing strategies were found to be connected with understanding the science phenomenon. A weak trend showed that weaker learners would benefit more from the refutational text. It seems that learners with effective learning strategies are able to pick out the relevant content regardless of the text type, whereas weaker learners might benefit from refutational parts that contrast the most typical misconceptions with scientific views. The purpose of Study V was to use eye tracking to determine how third-year medical studets (n = 39) and internal medicine residents (n = 13) read and solve patient case texts. The results revealed differences between medical students and residents in processing patient case texts; compared to the students, the residents were more accurate in their diagnoses and processed the texts significantly faster and with a lower number of fixations. Different reading patterns were also found. The observed differences between medical students and residents in processing patient case texts could be used in medical education to model expert reasoning and to teach how a good medical text should be constructed. The main findings of the thesis indicate that even among very selected student populations, such as high-achieving medical students or student teachers, there seems to be a lot of variation in regulation strategies of learning and text processing. As these learning strategies are related to successful studying, students enter educational programmes with rather different chances of managing and achieving success. Further, the ways of engaging in learning seldom centre on a single strategy or approach; rather, students seem to combine several strategies to a certain degree. Sometimes, it can be a matter of perspective of which way of learning can be considered best; therefore, the reality of studying in higher education is often more complicated than the simplistic view of self-regulation as a good quality and external regulation as a harmful quality. The beginning of university studies may be stressful for many, as the gap between high school and university studies is huge and those strategies that were adequate during high school might not work as well in higher education. Therefore, it is important to map students’ learning strategies and to encourage them to engage in using high-quality learning strategies from the beginning. Instead of separate courses on learning skills, the integration of these skills into course contents should be considered. Furthermore, learning complex scientific phenomena could be facilitated by paying attention to high-quality learning materials and texts and other support from the learning environment also in the university. Eye tracking seems to have great potential in evaluating performance and growing diagnostic expertise in text processing, although more research using texts as stimulus is needed. Both medical and teacher education programmes and the professions themselves are challenging in terms of their multidisciplinary nature and increasing amounts of information and therefore require good lifelong learning skills during the study period and later in work life.

Consumer’s purchase intention of ethical fashion. Examining beliefs about fashion industry and attitudes towards ethical fashion

Globalization and the developments of supply chain have made inexpensive labor and the low production costs of developing countries available to businesses worldwide. Unfortunately, these developments have also led to the exploitation of human and natural resources. The increasing supply of cheap and fashionable clothing has created a contradiction between consumers’ concerns for sustainability and their purchase behavior in the fashion industry. Since the uncovering of several sweatshop scandals in the 1980’s and 1990’s ethical fashion brands have started to emerge. Ethical fashion has sparked the interest of consumers and studies have shown promising positive attitudes towards it. However, these attitudes have failed to translate into action and purchase behavior of ethical fashion has not reached the expectations. In order to translate the positive attitudes into buying companies must understand consumer’s motivations and reasons behind the purchase decision. The objective of this study is to understand the antecedents behind young consumer’s purchase intention of ethical fashion. The study is based on the theory of planned behavior which has been widely used to study consumer behavior and purchase decisions. The theory has also been used in ethical decision-making and fashion context before. According to the theory, in order to understand purchase intentions consumer’s attitudes toward buying ethical fashion were studied. The theory also states that attitudes are formed from beliefs, thus, consumer’s beliefs about the fashion industry were studied. To contribute to existing research, the effect of sweatshop issues and environmental issues were compared. The data was collected from university students (n=617) with an online survey. The results were analyzed by statistical methods and they revealed that young Finnish consumers hold positive attitudes towards buying ethical fashion as well as positive purchase intentions of ethical fashion. A strong relationship was found between positive attitudes and positive purchase intentions. Also, the more negative consumers’ beliefs of the fashion industry were the more positive their attitudes toward buying ethical fashion were. In contradiction to previous research this study revealed that environmental issues had greater effect on attitudes than sweatshop issues. Interesting differences between consumers were found depending on their field of education. Students from humanities and social sciences held the most negative beliefs as well as most positive attitudes and purchase intentions of ethical fashion.