Students’ satisfaction with the nursing program studying at Tribhuvan university’s institute of medicine, Nepal

Abstract

Background

Satisfaction is a psychological state that results from the confirmation or disconfirmation of expectations with reality. Student satisfaction involves the student’s unique perception of the value of his/her educational experience during the degree program. Satisfaction is the key element and criterion used to evaluate and represent the level of customer pleasure, program quality, student achievement and program success.

Objectives

The objectives of this study were to assess the satisfaction of nursing students with a nursing program.

Materials and methods

A cross-sectional study was conducted on five constituent nursing campuses (TUs) from 8th Nov 2022 to 8th March 2023 to identify their level of satisfaction with the nursing program. Adopted and a modified version of the Nursing Student Satisfaction Scale (NSSS) were employed to assess students’ satisfaction with the nursing program. Data were collected from 147 nursing students in their third year through the census method via a self-administered semi-structured questionnaire. Data analysis was performed via descriptive and inferential statistics.

Results

The results of the study revealed that nearly three-fourths (74.1%) of the students’ overall satisfaction with the Bachelor of Science with the nursing program was fair (mean score = 219.86). The highest mean level of satisfaction with the program subdomain was the curriculum (mean score = 44.73), where more than half (63.9%) of the students had a good level of satisfaction, and the lowest mean level of satisfaction was with theoretical education by faculty (mean score = 24.98), where nearly three-fourths (72.1%) of the students had a poor level of satisfaction. In other subdomains of the study, such as professional social interaction, clinical practice by the clinical guide, and the educational environment, nearly two-thirds (65.3%, 64.6%, 58.5%, and 69.4%) of the students, respectively, had fair levels, and resources and support had poor levels of satisfaction. More than one-fourth (34.7%) of the students’ satisfaction with the evaluation system of the institute was fair.

Conclusion

The study indicated that students have a fair level of satisfaction with the nursing program, so continuous innovation and quality services on the nursing campus are necessary for students’ optimum satisfaction.

Background

Satisfaction is a feeling of happiness that comes from meeting one’s needs and desires. It occurs when a person’s performance or outcome aligns with their expectations [1]. Students’ satisfaction is a short-term attitude shaped by their evaluation of educational experiences [2]. Student satisfaction involves the student’s unique perception of the value of his/her educational experience during the degree program [3]. Academic satisfaction refers to a person’s subjective assessment of their overall educational experience [4].

In the 21st century, the quality of academic resources and student satisfaction in universities emerged as a high-profile agenda [5]. Student satisfaction can be viewed as an essential factor for motivating and involving students, thus increasing the benefits of learning and, consequently, the professional competence of future professionals [6]. Thus, student satisfaction has been viewed as an indicator of program success [7].

In the competitive world where organizations compete with each other to attract customers, their satisfaction is a key element of success, and an important objective of each organization is to achieve success because it leads to profitability and customer trust in the organization [8]. Furthermore, there is a relationship between academic satisfaction and academic achievement, as satisfied students become more motivated and achieve better academic achievement among them as much as possible [9]. Satisfied students may provide higher-quality care than unsatisfied students [10]. Thus, satisfied students are more likely to engage in positive word-of-mouth (WOM) communication than are less satisfied students [11].

Universities need resources to effectively fulfill their core mandate of teaching, learning, and research. This, in turn, contributes to a more fulfilling educational experience for student satisfaction.

The use of standardized questionnaires to measure student satisfaction with a nursing program as a whole has allowed the identification of program features and facilities that are necessary to enhance program success and where change is needed [3, 12].

Therefore, various factors can increase student satisfaction with the educational field, and the lack of one factor in this collection can decrease student satisfaction. However, in the case of dissatisfaction, this experience can be a symbol of negative propaganda against the organization [13]. Many studies have shown that only 44.71% of nursing students are satisfied with their nursing program, and some studies have reported that nursing students’ satisfaction with nursing programs is neutral [3, 13, 14]. Many studies have revealed that various factors affect nursing students’ satisfaction with their nursing program, but most determinants are the content and structure of the curriculum, faculty teaching strategies, social interaction among students and faculty, and the learning environment, such as a nursing skills laboratory, which directly affects students’ satisfaction level with their nursing program. A few studies have been conducted to assess nursing students’ level of satisfaction with their nursing programs. Therefore, the purpose of this study was to assess the satisfaction of nursing students with a nursing program at Tribhuvan University, Institute of Medicine.

Methodology

Study design and settings: A cross-sectional study design was used to assess students’ satisfaction with the five nursing programs at the Nursing campuses of Tribhuvan University.

Study population and sampling

All five BNS (Bachelor of Science in Nursing) students from Tribhuvan University, Institute of Medicine, composed the population of the study. A total of 147 students were included in the study. Census methods were used to collect the data asthe calculated sample size was 148 but the number of students studying in BNS 3rd year was 147. During the study period, only female students were enrolled in the five campuses of Tribhuvan University, Institute of Medicine.

Instrument

The data were collected via a self-administered structured questionnaire. A self-developed questionnaire based on the literature, including the Nursing Student Satisfaction Scale (NSSS), was used in this study to assess students’ satisfaction with the BNS program. The Nursing Student Satisfaction Scale (NSSS) was developed for quantitative studies to measure nursing students’ satisfaction with their programs. The scale is validated in the United States with 303 nursing students and includes questions on curriculum and teaching, professional social interaction, and the learning environment [15]. The questionnaire was developed in English language. The developed tool was validated by consultation with subject experts for content validity.

Tool Reliability: A pilot study was conducted in 10% of the population in a similar setting, and the required modification was performed. Internal consistency was measured via Cronbach’s alpha, which was 0.84.

The tools include two main parts.

Part One included (5) questions about sociodemographic data such as age, sex, marital status, ethnicity, academic year, residence, and campus.

Part Two: Guide, section: G items (9) regarding the evaluation system of the institute. This part is considered the vital issue of the study for measuring student satisfaction with the BNS program and includes seven sections: section A (12), which includes items related to the curriculum; section B (8), which includes items related to professional social interaction; section C (10), which includes items related to support and resources; section D (8), which includes items related to the educational environment; section E, which includes items (7) related to theoretical education by the teaching faculty; and section F (10), which includes items related to clinical practices. A questionnaire was rated on a 5-point Likert scale: Very satisfied = 5, satisfied = 4, Neither satisfied nor dissatisfied = 3, dissatisfied = 2, Totally dissatisfied = 1.

Ethical consideration

Before data collection, ethical clearance was obtained from the Institutional Review Board, Institute of Medicine, TU, reference no.239 (6–11) E [2]. Informed written consent was obtained from each participant after explaining the elements of informed consent, such as purpose, methods, expected duration of participation, and voluntary participation. Confidentiality of information was maintained throughout the study. The respondents’ dignity was maintained by giving them the right to reject or discontinue research at any time. The respondents’ privacy was maintained during data collection by maintaining anonymity, and then the obtained data were used for research purposes only.

Data collection

Data were collected from the five constituent campuses, TU, and IOM, via the census method from a total of 147 students during the period of 8th Nov 2022-8th March 2023. Before the data collection, ethical clearance was taken from the Institutional Review Committee, Institute of Medicine, TU. The approval letter was taken from the concerned campuses for conducting the study. Written informed consent was also obtained from each respondent after the purpose of the study was explained. The privacy and confidentiality of the information of all the respondents were maintained. The nature and purpose of the study were explained to the respondents after they were collected in class. After that, instructions for completing the questionnaire were specified before the distribution of the questionnaires. Informed consent was obtained before the questionnaire was administered. Approximately 25–30 min were taken from each individual. During the time of data collection, monitoring was done to prevent contamination of the data among the participants. The collected data were checked for its completeness. Only the researchers were involved in data collection.

Statistical analysis

Data entry and analysis were performed via SPSS 16. The data were coded, tabulated, and presented in a descriptive form. For descriptive statistical analysis, the frequency, distribution, percentage, and mean score were used. The mean score was calculated from the ordinal data according to the five-level scales as (5, 4, 3, 2, and 1), with the lowest score indicating the severity of the problem.

According to level, good level = ≥ 80%, fair level = 60–79%, and poor level = ≤ 59% (total marks = 315).

In the inferential analysis, a chi-square test was performed, which revealed no association between the level of student satisfaction with the nursing program and the sociodemographic variables.

Results Regarding sociodemographic variables, the findings of the study revealed that more than half (51. 5%) of the respondents were between 26 and 30 years old. All of them were female. In terms of ethnicity, more than half (59.2%) were Bahunchetri. More than half (55.8) were unmarried. More than half (51.7) were living in hostels. More than one-fourth (34%) of the respondents were participated from Maharajgun.

The findings of the study revealed that, in terms of satisfaction with the curriculum, three-fourths (75%) of the items had fair level mean scores, with fewer than one fourth (16. 66 and 8.33%) of the items had good and fair level scores, respectively; satisfaction with support and resources provided by the campus; the majority (90%) of the items had poor scores; satisfaction with professional social interaction; all the items mean scores indicate fair level, satisfaction with the educational environment three forth (75%) of items’ mean scores indicate fair level, whereas only one forth ( 25%) of items indicate poor level, likewise satisfaction with the theoretical education by the teaching faculty, where all the items indicate a fair level, similarly, satisfaction with the clinical practicum by clinical supervisors, where all the items’ mean score indicate fair level and finally, satisfaction with the evaluation system of the institute, where all the items’ mean score is fair level.

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Table 1 shows that more than half (51. 5%) of the respondents were between 26 and 30 years old. All of them were female. More than half (59.2%) of the respondents were from Bahun, Chetri (59.2%), unmarried (55.8%), and staying in hostels (51.7%).

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Table 2 shows satisfaction with the curriculum, three fourth (75%) of items’ mean scores shows fair level and less than one fourth (16. 66 and 8.33%) items mean score good level and fair level respectively.

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Table 3 represents satisfaction with professional social interaction; all the items mean scores indicate fair level.

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Table 4 demonstrates satisfaction with support and resources provided by campus, majority (90%) of items mean scores indicate poor level.

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Table 5 demonstrates satisfaction with educational environment, three forth-fourths (75%) of the items’ mean scores indicate fair levels, whereas only one-fourth (25%) of the items indicate poor levels.

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Table 6 shows satisfaction with theoretical education by teaching faculty, where all the items indicate a fair level.

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Table 7 shows that satisfactions with the clinical Practicum by clinical supervisors where all of items’ mean score indicate fair level.

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Table 8 demonstrates satisfaction with evaluation system of institute where all of items’ mean score is fair level.

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Table 9 shows that the mean score of overall satisfaction was 219.86 ± 29.30. Analytical approach was used in the study to identify associations between the level of student satisfaction with the nursing program and sociodemographic variables. However, the test results revealed no significant associations.

Discussion

Satisfaction with the curriculum

Overall satisfaction with the domain of the curriculum, the present study revealed that only one-fourth of the students had a good level of satisfaction with the curriculum, which contradicts the findings of Jaradeen N [14]who reported that a high percentage (85%) of students were satisfied with the curriculum and instructions, which are very important aspects of the nursing program; similar findings with a mean score of 5.01 were reported in a study done by Chen & Lo [12]. This may be due to the lower relevance of the program to current nursing practices in Nepal, as nearly half of the students were satisfied with the statement of “program was relevant to current nursing practices”. However, with the statement “courses in this program are beneficial and contribute to my overall professional development”, the present study showed that fewer than three-fourths of the students were satisfied, with a mean of 3.86, which was interpreted as a fair level. A similar study done by Mohammed AK [3] showed inconsistency with the results, as only a few students were satisfied with the mean score (2.37).

Satisfaction with professional social interaction with faculty

With respect to overall satisfaction with professional social interaction with faculty, only a few students had a good level of satisfaction with the domain, with a mean score of 27.74. When it was relevant to feel comfortable asking questions of faculty, more than half were satisfied, with a fair level with a mean score of 3.47. The findings are inconsistent with the findings of the study, which revealed that 18.2% of the students were satisfied [3]. Similarly, when asked about the statement “faculty are fair and unbiased in their treatment of individual students”, more than one-third of the students were satisfied. Similar findings were reported in a study conducted in Iraq [3]. Similarly, with the statement “Teachers’ availability in attending students outside the classroom,” very few of the students were very satisfied, which is inconsistent with the study done by C Bordin [4]. The present showed that only a minimum of students had a poor level, and more than half of the students had a fair level of satisfaction with professional social interaction with faculty, which is consistent with the findings showing that they were not very satisfied with their tutors [16]. The findings suggest that social interaction between faculty and students is crucial in developing a positive learning environment, which can also lead to student satisfaction.

Satisfaction with the educational environment

The study revealed that only a few of the students had a good level of satisfaction with the educational environment, with a mean score of 26.44. Nearly one-third of the students were poorly satisfied. Similar findings have been reported by studies showing that the majority (83.3%) of the students have little satisfaction as to the situation of the educational environment [8]. Fewer than half (42.2%) of the students were satisfied with the statement “We are respected by the nursing staff in the clinical setting”, which is coherent with the study showing that more than one third (39.7%) of the students were satisfied [14]. The present study revealed that more than half (53.1%) of the students were satisfied with the statement “The team members are easy to approach”, which is inconsistent with the findings of Abouelfettoh A & Mumtin SA [17]where nearly three fourths (70.7%) of the students were satisfied. Satisfaction with the educational environment enhances learning and promotes creativity and innovation among nursing students. It is an important component of the satisfaction and overall development of students. The Institute should focus on creating a conducive educational environment.

Satisfaction with support and resources

In this study, very few students had a good level of satisfaction with support and resources, with a mean score of 26.8, and more than two-thirds had a poor level. These findings are similar to those of the study by Mohammed AK [3]Chen and Lo [12]where only a minimum number of students were satisfied, who reported a lower level of satisfaction with nursing skills labs, noting that equipment was not always up-to-date or sufficient for their use. Whereas another study conducted by Ejercito M. et al. [18] shown a moderate level of satisfaction with resources. Similarly, in the present study, one-third (33.3%) of the students who were dissatisfied with library resources were the latest and adequate for their learning needs, which is similar to the findings of a previous study in which nearly half (44%) of the respondents were dissatisfied with services such as computer laboratories, restrooms, classrooms, and cafeteria and lacked cupboards [14]. Similarly, more than one-third (41.5%) of the students were satisfied with the statement “library time suits me, which is in contrast with the study by Jalak K et al. [19]where more than half (58.2%) of the students were satisfied. Likewise with the statement “Articles in the skill labs are up to date and sufficient,” only a few of the students were satisfied, with a mean score of 2.61, which is similar to the present study. [18]The above findings indicate that physical facilities, resources, and support need improvement, as these factors can enhance student satisfaction as an outcome and can play key determinants of student satisfaction in higher education. This theme is also supported by a study done by Ejercito M. [18]

Satisfaction with theoretical education by faculty

In the area of theoretical education by faculty, the present study revealed that nearly three-fourths of the students were satisfied, indicating a fair level, and only 10.2% had a good level (mean score of 24.98) of satisfaction. This finding is inconsistent with those of studies by Mohammed AK [3] and Hakim A [8]where fewer than one quadrant of students was satisfied and more than one-third (41.7%) of students were unsatisfied with the domain.

Likewise, with the statement “Faculty were knowledgeable”, most (68%) of the students were satisfied with the mean (3.82). This finding is also similar to those of studies by Chen & Lo [12]C Bordin and Ramos AM [4]. The present study showed that more than half (57.1%) of students were satisfied with the statement “Teaching style adopted by faculty is effective,” which is consistent with the findings of a previous study [9] in which 67.3% of the students were satisfied.

Satisfaction with clinical education by clinical guide

As clinical practice is the most essential part of nursing, the present study revealed that fewer than one-fourth of the students had a good level of satisfaction with clinical education by clinical guide with a mean score of 36.16, and that two-thirds of the students had a fair level of satisfaction. This finding is inconsistent with the study of Hakim A [8]where more than one-third (41.7%) of the students reported little satisfaction, and few reported very little satisfaction. When it was relevant to the statement “clinical guide views my mistakes as part of my learning,” more than half (59.2%) of the students were satisfied; these findings are inconsistent with those of a study done by Mohammed AK [3]where approximately 22.4% of the students were satisfied. With respect to the statement that the clinical guide encouraged me to link theory with practice, only two-thirds (68%) of the students were satisfied, which contradicts the findings of the present study, which showed that 24.1% were satisfied. This discrepancy might be due to the setting and sample size. The link between theory and practice is crucial in nursing to develop competency in skills and evidence-based practice. Similarly, an earlier study done by Hakim A [8] revealed that nearly half of the students had little satisfaction with the clinical education by a clinical trainer. If clinical practice is well structured in the curriculum, the gap between theoretical courses and practice could be minimized [12].

Satisfaction with the evaluation system of the Institute

In the case of the satisfaction of the students with the evaluation system findings, more than half of the students had a good level of satisfaction, with a mean of 32.89, indicating that the students were satisfied with the evaluation system. This finding is inconsistent with the findings of Hakim A [8]who reported that nearly half of the students have little satisfaction. In the study, more than half (60.5%) of the students were satisfied with the statement “I received useful feedback on my assessment”, which is supported by the study showing that they received detailed feedback from faculty members on their work and written assignments. Likewise near two third (61.2%) of students were satisfied with assessment methods which is inconsistent with the findings of [9]who reported that nearly three forth (74.3%) of the students were satisfied. With the statement that “Students have clearly defined method of assessment to assess knowledge, skills and attitude components by examiner prior to assessment”, two-thirds (66%) of the students were satisfied, which contrasts with the findings of a study by Jalak K et al. [19]where only nearly half (48.5%) of the students were satisfied. To guide decision-making and enhance the efficacy of the educational program, nursing educators are compelled to carry out a thorough and consistent assessment of their students’ expectations and satisfaction with the evaluation system [10].

The overall satisfaction of the students with the quality of the nursing program showed that more than half of the students were satisfied, which is in contrast to the findings of the present study, which showed that most [20]of the students were satisfied with their field of study; more than half of the study participants were barely satisfied with the college program [3]and 46.2% of the students had moderate-level satisfaction with their academics [7]. The findings suggest that evidence-based practices and technological innovations and their applications should be incorporated into institutions to increase the satisfaction of the students; similarly, faculty members should update their knowledge and practices through training and education and apply them in their day-to-day lives.

Conclusion

This study provides a detailed evaluation of the curriculum, social interaction, educational environment, faculty, support and resources, and evaluation system offered by the Institute for the BNS program. With respect to domain, satisfaction with the curriculum and educational environment, three-fourths of the items’ mean scores indicate fair level where as satisfaction with professional social interaction, theoretical education, the clinical practicum by the clinical guide and the evaluation system of the institute. All the items’ mean scores are fair level, with only satisfaction with support and resources provided by the campus, where the majority of the items indicate poor levels.

Overall satisfaction with the nursing programme, the present study indicates that students have a fair level of satisfaction with the nursing programme, so continuous innovation and quality services on the nursing campus are necessary for optimal student satisfaction. For quality services, a motivational environment, training facilities for employees, and the availability of resources are needed. There was no association between the level of satisfaction and the selected demographic variables.

Limitation

The study was conducted on only five campuses and only female students of Tribhuvan University, Institute of Medicine. This limits the generalizability of the results. The data collection was challenging, as the data were collected from all (five) constitute the campuses of Tribhuvan University, TU, and IOM, which are located in diverse geographical locations. Response bias and social desirability bias were concern in the study, as the data were collected through a self-administered questionnaire. However, students are requested to complete the questionnaire in a timely manner and provide factual information regarding their level of satisfaction with the nursing program.

Data availability

Data is provided within the manuscript.

Abbreviations

BNS:

Bachelor of Nursing Science

IOM:

Institute of Medicine

Nov:

November

NSSS:

Nursing Students Satisfaction Scale

SPSS:

Statistical Package of Social Sciences

TU:

Tribhuvan University

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