Student-Centered Learning Development and Implementation as

Potential Strategy to Improve Nursing Students’ Competencies and

Learning Outcomes

Vetty Priscilla

and Lili Fajria

Maternity and Child Nursing Departement, Universitas Andalas, Padang, Indonesia

Keywords: Student-Centered Learning, Competency, Soft Kills.

Abstract: Nursing education program requires a series of learning outcomes from students. Reproductive System is

noticed as one of the nursing course subjects that carry out some learning outcomes. Student-Centered

Learning (SCL) has been implemented and evaluated over the years, but learning outcome achievement has

not been obtained optimally. This study aims to upscale the implementation of SCL through learning methods

combination and to rate the system of student assessment development in improving students’ competencies.

This study used action research as its research design. It started by providing semester teaching planning and

arranging the competencies according to the Indonesian Quality Framework. Small Group Discussion,

Collaboration Learning, and Discovery Learning have been used for theoretical learning. Thus, Role Play,

Games and Simulation, and Self Directing Leaning were used in the practicum. Student assessment was made

broader by adding soft skills items. Students were observed during the learning process by using a student

assessment instrument and continued with lecturers and students' reflection as evaluation. The results show

that the developed and applied learning methods and assessments have an impact on increasing students’

scores. The study also shows that more than half (69%) of the students achieved A- score grade. It is suggested

that the developed SCL learning methods can be used optimally to improve students’ competencies.

1 INTRODUCTION

Student Centred Learning (SCL) is a student-centered

learning method that focuses on achieving learning

objectives. The SCL method aims to make students

more active in the learning process and develop

critical thinking and to bring out profound positive

learning environment (Chen et.al., 2015). Active

participation of the students may increase knowledge

that is thoroughly studied and professionally

practiced (Rezende-Filho et.al., 2014). SCL learning

method has been implemented in the Undergraduate

Program of the the Faculty of Nursing, Andalas

University, for several years. The use of this learning

method is a form of response to the demands of

society for the quality of services provided.

Therefore, Bachelor Degree graduates from Nursing

Program must possess the competencies as a

professional nurses in their field based on the

concepts and values of nursing, so that people can

accept the nursing services provided. According to

Kristy (2017), nursing graduates who can think

effectively are very important in dealing with

complex health services offered.

As the era progressively goes by, the demands of

the society for nursing services are very high.

Therefore, the Nursing Undergraduate Study

Program must prepare its graduates while paying

attention to the high demands of the people. This

could result in the graduates being more useful in

society, as the people are satisfied with the nursing

services provided.

One of the subject courses that apply this learning

method is Nursing Reproductive System. Nursing

Reproductive System courses at this time have been

conducted for the fourth time, since the

implementation of the 2012 bachelor nursing

curriculum based on the Indonesia Quality

Framework (IQF) in the Bachelor Degree Program,

Faculty of Nursing, Andalas University. During the

implementation, lectures were delivered by using

SCL method consisting of Small Group Discussion,

seminar, collaborative learning, and also expert

lectures.

118

Priscilla, V. and Fajria, L.

Student-Centered Learning Development and Implementation as Potential Strategy to Improve Nursing Students’ Competencies and Learning Outcomes.

DOI: 10.5220/0008681101180123

In Improving Educational Quality Toward International Standard (ICED-QA 2018), pages 118-123

ISBN: 978-989-758-392-6

The implementation of reproductive system in

nursing courses in 2012, 2013, and 2014 has

experienced several obstacles related to the use of the

SCL method, because there a plephora number of

students, some of whom were more accustomed to the

Teacher Centre Learning methods and students’

capability to adapt to a different method that resulted

in the feeling of burn out. Therefore, the Nursing

Reproductive System has undergone several changes

including in this semester. Changes are made based

on the results of evaluations conducted internally on

the material and the learning outcome achieved by

students at the end of learning in grades. The changes

made were learning methods and implemented

student assessments.

Previously, this course only used 2 SCL methods

which are Small Group Discussion (SGD) and

Collaborative Learning (CL). Role Play has been

used in theoretical learning, Games and Simulation

methods for practicum learning. In this current class,

the SCL method was added along with Discovery

Learning method as theoretical learning and Self-

Directed Learning in the practicum. The addition of

the SCL method aims to integrate nursing trends and

issues of the Nursing Reproductive System on the

material provided, and students are well prepared to

attend the lectures. It was made to achieve more

learning outcomes in the Bachelor Nursing Program

curriculum.

Furthermore, learning outcomes are also carried

out by using student assessment. The achievement of

the students’ final results that have been applied for

three years refers to the total assessment of both the

process and results. In the assessment of the process,

there were assigned weight, such as class attendance

(5%) and presentation (15%), while in the assessment

of the outcome results, the weights were: midterm

(40%), final examination (40%), but there has been

no assessment for soft skills. This distribution of

scores for the current class varied between students,

where 5.3% had A, 10.5% A-, 22.8% B +, 35.1% B,

21% B- grade, and 5.3% C +. Based on the

distribution of these values, it can be seen that the

grades were concentrated on the B grade and there

were still around 26.3% of the students who had

grades below B. It also means that the learning

achievement was not optimal.

The problems found above illustrate that the

learning achievement of students in the Nursing

Reproductive System course has not been optimal.

Specifically, with the Andalas University Rector

Decree No. 4896/XIII/R/KPT/2017 concerning the

procedures for the implementation of student re-

examination, students who get B and below can be

given the opportunity for reexamination and can not

be processed if the grades of all of the students who

take the course subject are above B grades. Therefore,

it is necessary to find a solution for better learning

improvements to overcome these problems.

Classroom action research with the implementation

of SCL is one of the best ways that can be done as an

effort to increase the achievement of students’

competencies both in the process and at the end of

learning.

2 METHODS

The methodology used in solving the problems above

is an action research by developing Student Centred

Learning (SCL) methods using Small Group

Discussion (SGD), Collaborative Learning (CL), and

Discovery Leaning (DL) methods in theoretical

learning, and Role Play, Games as well as Simulation

(RPGS), and Self Directing Learning (SDL) in the

practicum learning. Furthermore, in the development

of student assessments, soft skills student assessment

is included in the rubric. In addition, to students'

cognitive training, affective, and psychomotor during

written exams—such as midterm examination and

final examination—the item questions are prepared in

the form of multiple choice by using a vignette and a

practicum competency examination using OSCE.

3 RESULTS AND DISCUSSION

Classroom action research aims to improve the

quality of learning in the course subject of Nursing

Reproductive System. Classroom action research has

been conducted on 39 nursing bachelor degree

students of Andalas University who took the 6

semester courses. They were divided into 1 class of

theoretical learning and three classes of practicum

learning. This research was conducted for four

months starting from February to June 2018 or 16

weeks of the learning process. Classroom action

research was carried out in several stages, namely

preparation, implementation, and evaluation stages.

The preparation stage started with the

development of the Semester Learning Plan of the

Nursing Reproductive System course which includes:

study program learning outcomes, courses’ learning

achievements, a short description of the course,

subject learning material/expected competencies,

learning methods and time allocation, student

learning experience, assessment criteria/indicators

Student-Centered Learning Development and Implementation as Potential Strategy to Improve Nursing Students’ Competencies and

Learning Outcomes

119

and assessment stage of portion. The development of

this semester plan is a refinement of learning planning

as a guideline for both students and lecturers before

the lecture starts.

Weekly learning outcomes are guided by the

achievement of students’ competencies, so the

students and lecturers know about the competencies

that must be achieved in each week. In addition,

lecturers and students can also prepare themselves

before the lecture begins. The example of learning

achievement such as the first-week meeting is the

introduction of a learning plan where students know

the competencies, subject matter, learning methods,

references and assessments used in this subject.

Compared to the previous learning plan, the

development of learning methods was clearly

developed in the current learning plan. The

implemented development is SCL learning methods

and the assessments used in the course. SCL learning

methods require students to be active in achieving

learning outcomes. The activeness of students in the

achievement of their learning objectives will also

produce students’ creativity and emergence.

According to O’Neill and Moore (2005), SCL method

makes students more responsible in achieving their

learning goals. This is very important to foster

motivation in all the students including those at the

Faculty of Nursing since they are required to be able

to provide comprehensive and professional nursing

care to patients and families after completing their

education at the Faculty of Nursing.

The development of SCL learning methods has

been carried out both in theory and practice. The

method used during theoretical learning were Small

Group Discussion (SGD) learning methods,

Collaborative Learning (CL), and Discovery

Learning (DL). Meanwhile in the practicum learning,

Role Play, Games and, Simulation (RPGS) and Self-

Directed Learning were used.

Then, at the implementation stage, the

implementation of learning method development in

theory is illustrated. Naturally, activities were run

based on the plans that have been prepared in the

semester learning plan. This can be seen in the second

week of learning where the expected learning

achievement of students is that the students can

explain the anatomy and physiology of the

reproductive system throughout the life cycle with the

anatomy and physiology of the reproductive system

in male and female; and also the focus of anatomy and

physiology of the fetus, baby, child, teenager, adult,

and elderly.

The learning methods used were SGD, CL and

DL. In the SGD method, students are divided into

small groups consisting of 6-8 students. Each small

group has to discuss the topic given. All group

members must play an active role in group

discussions. Before the discussion, the group must

formulate the objectives of the discussion and then

summarize and report the discussion results in their

papers. In addition, each group determines one of its

members to present the results of the discussion in

front of the class, so that other groups can provide

input on the results of the group discussion

presentations. At the end of the meeting, the lecturer

provides input and feedback and strengthens the

material related to the topic.

According to Arpaichiraratana & Attharos (2012),

this SGD learning method is very important to create

critical thinking in students and familiarize them with

organizing themselves in achieving goals. These

results satisfy students in achieving their

competencies. Critical thinking and self-regulation

are highly important objectives to be planted in

students at an early stage, because the majority of

nursing graduates’ students will work directly with

patients. Critical thinking is very necessary for a

nurse who provides care to patients. Familiarizing

nursing graduate students with critical thinking and

self-regulating can indirectly improve their

competence.

Another SCL learning method used in theory

learning is Collaborative Learning with Simple

Jigsaw techniques whereby students are divided into

eight small groups, each of which consisting of 5

students, discusses different topics so that they

become "experts" in the topics discussed.

Furthermore, the "expert" group is broken down and

combined with other "experts" to convey their

expertise in the new group so that the new group

becomes "experts" with the set topics.

The Collaborative Learning (CL) method of

Simple Jigsaw technique is one of the learning

methods that have been carried out in this study.

According to Sandahi (2009) CL is very important in

getting used to working in a group, sharpening critical

thinking in finding solutions to problems, and

building cooperation with other professions. The

nursing graduates who will become nurses, have a

profession that cannot be separated from other

medical professions and they cannot also work by

themselves. Therefore, indirectly, this learning

method has helped nursing graduates to become

professional nurses who are accepted in society. In

addition, CL method with Jigsaw Puzzles has also

been proven to improve the academic abilities of

students, including nursing students (Renganathan,

2013).

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Discovery Learning (DL) is another SCL method

used in theoretical learning. In this method, students

are divided into small groups, each of which consists

of 4-5 members. Furthermore, small groups try to find

the latest scientific journals article or at least the last

five years related to the topics given. The group

makes a summary of the scientific journals that has

been obtained. The summary is presented in front of

the class. Lecturers provide feedback on the

summaries that have been presented. Furthermore,

DL learning methods also have an impact on the

development of students' abilities related to the use of

technology in finding literature and increasing

students' self-confidence by using the literature

obtained (LeDuc, 2015).

In practicum learning process, the learning

method developed was Role Play, Games and

Simulation (RPGS), and Self-Directed Learning

(SDL) method. The aim of learning in practicum is to

enable students to apply the topic of theoretical

learning. In this case, the lecturer acts as a facilitator

who assists students during the practicum learning

process. Students are divided into three groups where

each group consists of 13 students. Each group in the

implementation of the practicum learning process is

accompanied by a facilitator

Using Role Play, Games and Simulation (RPGS)

method in a practicum, as one of the achievements of

practicum learning, the students can perform a

physical examination on postpartum mothers with the

subject of postpartum maternal physical examination

and sub-subject in immediate, early, and late

postpartum maternal physical examination.

Furthermore, role-playing groups are based on sub

topics to get an understanding of the expected

situation in learning outcomes. Along with role-play,

simulations are also carried out.

In addition, according to (Noohi and Maddah,

2013), Games are also used as effective learning

strategies in achieving learning objectives. Games

can be used in nursing education because, through

games, active learning processes can be improved, as

they support critical thinking, and make the learning

process interesting. In addition, through games, the

true state of a health problem can be simulated.

Therefore, this RPGS method is very suitable to apply

in nursing education because with RPGS, a

simulation/role play can be performed with

conditions that resemble real action. It is very

important to apply such method to nursing profession

education.

Self-Directed Learning (SDL) method is another

method used in practicum learning. Before the

practicum begins, students are required to summarize

the topic to be studied. The preparation efforts of

students taking practical learning will be seen from

the summaries they make. The summaries made

describes the mastery of the practicum topic before

the practice begins. This can be seen from the topic of

the introduction of the reproductive system. Before

the practice starts, each student is required to make a

summary. During the practicum, the majority of

students understand the topic being studied. Getting

students to learn to use SDL is very useful when they

work in challenging health services (Fatemah et.al.,

2017).

Student assessment development was followed by

the development of learning methods for both theory

and practice. Theoretical learning was achieved by

providing SGD, CL, and DL instruments and soft

skills. meanwhile, in the practicum learning, RPGS

and SDL instruments as well as soft skills were also

carried out.

Student assessments were developed based on the

rubric assessment which was made for each learning

method for both the theoretical and practicum

learning methods. A rubric assessment is made with

the aim of transparency in providing an assessment to

students. In addition, the assessments were given to

all students with equal standards. This is important to

do in order for students to feel equal in obtaining the

grades. During the exam, the form of the question

being tested is a multiple-choice question by using a

vignette to trigger cognitive, affective, and

psychomotor of students. This form of questions was

chosen and used to accustom students to vignette

form used in national competency examination.

Meanwhile, in the practicum learning process, the

assessment using OSCE aims to assess the

components of clinical competence such as physical

examination and communication skills.

Soft skills assessments are also included in the

assessment. Soft skills are important to assess in order

to indicate how students’ talents, abilities, and skills

are. One of the soft skills that can be seen is

communication (Jackson and Back, 2011).

Communication is an important part of the nursing

profession. Every day, nurses communicate with

patients. According to Khodadali, et.al., (2013) good

communication carried out by a nurse can shorten the

patient's day of care. Therefore, it is essential to

include soft skills as one of the assessments of nursing

students to familiarize students with the wise

management of their behaviour related to their

talents, abilities, and skills.

The final stage of this research process is the

evaluation stage, where evaluation and reflection on

the implementation of the learning process have been

Student-Centered Learning Development and Implementation as Potential Strategy to Improve Nursing Students’ Competencies and

Learning Outcomes

121

carried out. Reflections and evaluations are carried

out by lecturers and students. Based on the experience

of lecturers and students, reflection is applied as an

effort to see the opinions of students and lecturers

after generally taking the learning process in this

course. Reflections from students has a noticeable

effect on the activities that students had to do when

attending the course since it is related to students’

feeling as though they are guided by the precise

semester learning plan, and the applied learning

methods, to make them always active in each learning

achievement. As a result, all students play an active

and enthusiastic role during the learning process.

Students who, at the beginning of the learning

process, seem passive now become active.

During the self-reflection, the lecturer/facilitator

said that, within every meeting with students in both

theory and practice, the students prepared themselves

well. At the SGD, the students brought references

related to the topic, they brought scientific journals

during the DL, and in RPGS the prepared the

necessary instruments, such as phantom and a set of

postpartum maternal physical examinations before

the activity was carried out. Students brought their

summaries at the SDL. The shortcomings that can be

seen during this learning process are the lack of

students' ability to make scientific papers and to use

references when writing their papers.

The final result which can be seen as an indicator

of action research is the students’ final examination

grades. The results show that there has been an

increase in the distribution of grades compared to the

previous academic year. In the current academic year,

15% of the students got A, 69% got A-, 13% got B +,

and 0.03% got B.

4 CONCLUSIONS

The development of learning methods and student

assessment is a significant effort to make in the

improvement of the competence of graduate students.

This is evident by the increase of the grades achieved

by current students compared to the previous ones. In

addition, the development of learning methods and

assumptions also have a major influence when

students are already working. By getting used to

working in groups, collaborating with other people,

and fostering good communication, this will increase

the confidence and add more values to the

Undergraduates of Nursing Program Andalas

University.

ACKNOWLEDGMENT

We extend our gratitude to LPPM Andalas University

that has provided funding for this research, to all the

members of the Nursing Reproductive System subject

teaching team who have carried out the optimal

learning process, and to all the students of the 2015

class who participated actively in the learning

process.

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