AbstractThe importance of active learning has continued to increase in Japan. The authors conducted classes for first-year students who entered the nursing program using the problem-based learning method which is a kind of active learning. Students discussed social topics in classes. The purposes of this study were to analyze the post-class essay, describe logical and critical thinking after attended a Problem-Based Learning (PBL) course. The authors used Mayring’s methodology for qualitative content analysis and text mining. In the description about the skills required to resolve social issues, seven categories were extracted: (recognition of diverse social issues), (attitudes about resolving social issues), (discerning the root cause), (multi-lateral information processing skills), (making a path to resolve issues), (processivity in dealing with issues), and (reflecting). In the description about communication, five categories were extracted: (simple statement), (robust theories), (respecting the opponent), (communication skills), and (attractive presentations). As the result of text mining, the words extracted more than 100 times included “issue,” “society,” “resolve,” “myself,” “ability,” “opinion,” and “information.” Education using PBL could be an effective means of improving skills that students described, and communication in general. Some students felt difficulty of communication resulting from characteristics of Japanese. View Full-Text
Keywords: first-year education; problem-based learning; critical thinking; communication; nursing educationfirst-year education; problem-based learning; critical thinking; communication; nursing education►▼ Figures
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Itatani, T.; Nagata, K.; Yanagihara, K.; Tabuchi, N. Content Analysis of Student Essays after Attending a Problem-Based Learning Course: Facilitating the Development of Critical Thinking and Communication Skills in Japanese Nursing Students. Healthcare2017, 5, 47.
Itatani T, Nagata K, Yanagihara K, Tabuchi N. Content Analysis of Student Essays after Attending a Problem-Based Learning Course: Facilitating the Development of Critical Thinking and Communication Skills in Japanese Nursing Students. Healthcare. 2017; 5(3):47.Chicago/Turabian Style
Itatani, Tomoya; Nagata, Kyoko; Yanagihara, Kiyoko; Tabuchi, Noriko. 2017. "Content Analysis of Student Essays after Attending a Problem-Based Learning Course: Facilitating the Development of Critical Thinking and Communication Skills in Japanese Nursing Students." Healthcare 5, no. 3: 47.
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Active learning is defined as an educational activity that requires students to have first-hand experience and to think for themselves about their actions . Active learning was first introduced in Japan in the 1990s, and its importance in university education has continued to increase [2,3] because Japan had seen a diversification of values stemming from societal changes. For example, family composition has diversified as single households and nuclear families increase. Additionally, employment patterns have become more diverse, resulting from an increase in non-regular employment. As a whole, society has also become increasingly informed owing to the ubiquity of the internet.
In our complex society, we all need the ability to collect information, accept variable values, judge subjectively, and resolve issues with other people. From this point of view, it is important for each person to develop the skills to examine issues from various perspectives . According to “The Occupational Consciousness and Knowledge, Essential Abilities and Skills for College Students’ Survey” conducted by the Japanese Federation of Economic Organization, “subjectivity,” “communication,” “ability to execute,” and “teamwork and cooperativeness,” were ranked as the top skills that companies look for in new workers . Owing to the desirability and importance of such skills, the authors’ university has set the following educational goal: “By encouraging learning through direct experience, students acquire certain basic academic skills and comprehensive perspectives during their undergraduate courses.” In order to realize this goal, the “Kanazawa University Global Standard” (KUGS) was established. KUGS is an educational policy that concretely shows the human resources Kanazawa University will cultivate in undergraduate courses. To actively fulfill this mission in the international community, Kanazawa University aims to nurture human resources into becoming leaders of a knowledge-based society who have the ability to face associated difficulties. One of the five KUGS items is, “express ideas and values.” The aim of this is for students to acquire “the ability to clarify their thoughts and ideas using words and charts, and express their own sensibilities and emotions, behaviors, and perspectives underlying their thoughts or expressions” . We conducted a class on debate theory and presentation using the problem-based learning (sometimes known as project-based learning: PBL) method. This kind of active learning is part of a general introductory undergraduate course for first-year students majoring in education. PBL is said to be an effective way of linking practice and theory within the university learning environment . A previous study of medical students suggested that education using PBL was effective in improving self-ratings on general competencies and interpersonal skills . In nursing education, PBL began to be used as a decision-making beginning at the end of the 1980s .
Active learning, originally developed by McMaster University in Canada, was introduced into Japanese nursing education in the late 1990s . The purpose of introducing active learning was to improve self-development in education and to support nurses with self-reflection and problem-solving abilities in response to societal changes. PBL is said to be effective in the acquisition of critical thinking . Critical thinking is defined as “intentional self-control judgments including interpretation, analysis, evaluation, reasoning, and contextual consideration” . In the 2000s, the number of established four-year nursing baccalaureate programs was increased in Japan and the curricula design increasingly focused on critical thinking . Hashimoto et al. examined the relationship between PBL and communication for university students and revealed that it has an effect in communication skills training . In nursing education, the practice of having students work in small groups to foster critical thinking and communication skills has been actively adopted. However, in traditional nursing education methods, it is difficult to say that learner-led, self-development education has been provided. Subsequently, even after the introduction of tutorial education, PBL has not been established in these programs.
Numerous studies evaluating students’ critical thinking abilities have been conducted in various countries around the world. Carter et al. reviewed previous studies using the Critical Appraisal Skills Program Tool, and found inconsistent reliability and validity . Critical thinking has also been studied using qualitative methods: Bittencourt et al. conducted an exploratory descriptive study on the application of a clinical case to identify critical thinking skills with seven nursing students and capture their justifications for decisions in the nursing diagnosis process, and performed content analysis to evaluate these data .
Against this background, this study aimed to developed students’ critical thinking and communication skills by providing classes incorporating PBL, and incorporating a post-class student essay task about critical thinking and communication. The purposes of this study were to analyze the post-class essay, describe the status of students’ logical and critical thinking after attended a PBL course.
This study was conducted in several steps. First, the author designed and conducted the course of classes using the PBL method named “Kanazawa University debate skills and presentation”. The classes took place from June 15 to August 3, 2016. Next, the authors received post-course essays as an assignment from the students. Then, the authors explained the study to the students and recruited participants. Finally, the authors analyzed those of the submitted essays that were written by participants who agree to participate in the research. This analysis was conducted between 1 October and 30 November 2016.
2.2. Sample and Recruitment
The classes were mandatory for students who entered the nursing program in 2016. Eighty-one students aged 18 or 19 were enrolled in the course, which consisted of eight 90-minute classes. Almost all students participated in every class and no students dropped out. After completing all the courses, every student submitted the post-essay following the course as an assignment. After that, the authors explained the study to the students and seventy-one students agreed to participate in the research.
2.3. Data Collection
The essays were created in Microsoft Word and submitted to a website installed on the on-campus network. The authors downloaded the essays and deleted the participants’ names.
The authors distributed informed consent forms and information pertaining to the purpose and methodology of the study in advance of student participation. Participants were also verbally informed about the ethical considerations including deleting the participant’s name at the time of essay analysis for anonymity, voluntary participation, and participants’ right to withdraw without penalty. All participants provided written informed consent prior to participation. This study was approved by the University of Medical Ethics Review Committee of Kanazawa University (approval number 724-1).
2.5. Class Structure and Post-Course Essay Task Procedure
In this study, the course consisted of debate and PBL. The course grade was calculated based on degree of class participation, enthusiasm in discussions, preparation of a handout, creation of a PowerPoint presentation, and the post-course essay. The aim of the essay was to evaluate the formation of logical and critical thinking. The classes consisted of the following four stages. (1) During the first class, five or six students formed groups and each group chose one topic from eight pre-prepared societal topics that they were likely to have opinions on including “the risk of dating violence,” “the danger of religious solicitation,” “the voting behavior of 18-year-olds,” “the trap of social networking services,” “the dangers of binge drinking,” “opinions and arguments about whether the constitution should be reconciled,” and “are nuclear power plants necessary?” Each group addressed the same selected theme throughout the course. (2) Students discussed and shared their acquired information and knowledge in the small groups in the second to fourth classes (group work). (3) Students in each group integrated their knowledge with one another and created a PowerPoint slide that was presented to the other students in the fifth to seventh classes (group work). (4) During the final class, each group gave a PowerPoint presentation to the rest of the class and facilitated a question and answer session.
The authors played a supporting role as tutors during the classes by assisting with the development of students’ thinking processes and helping them to expand their knowledge; however, they did not provide information or present their own opinions. The aim of the group work was to enhance critical thinking abilities through exposure to different values, peer discussion, active listening, communicating opinions, and critical examination of not only themselves, but others.
After the course, the authors gave the students two tasks covering three themes. Task 1 asked students to prepare an essay on the topic, “What kind of skills and attitudes do you think are necessary to resolve any kind of social issue?” In Task 2, students responded to two questions: “What do you need to do in order to clearly convey your thoughts and opinions to others?” and “What is difficult when you tell others about an issue?”
2.6. Data Analysis
The authors analyzed the submitted essays using both Mayring’s methodology for qualitative content analysis  and text mining.
Qualitative content analysis is an approach involving empirical, methodical, controlled analysis of texts without quantification, intended to analyze all kinds of recorded communication . The methodology was developed in detail by Mayring . Mayring’s methodology was used to extract codes through explicative content analysis; then, content analysis was summarized to develop categories and subcategories. In this study, the authors extracted sentences describing students’ thoughts about PBL and communication while retaining the meaning, context, and original words where possible. Next, the authors confirmed the similarity of the meaning of the initial codes, assigned subcategory names, further integrated similar subcategories, and assigned category names. The credibility of the analysis was validated by three co-authors, who read the descriptions separately under supervision from qualitative research experts. The authors judged the credibility of the study based on previous research  according to how well the category covers the data, whether relevant data are inadvertently excluded, and whether irrelevant data are included.
Text mining analyzes large amounts of text data from various perspectives and with various goals . In recent years, studies using text mining have been common in clinical fields , including nursing . On the other hand, issues with the method have also been pointed out. Goodwin et al. conducted a study on building knowledge in nursing and concluded that use of data mining will make significant progress only if important data that incorporate expert nurses’ knowledge are made available in the clinical information systems text mining in health research draws on . This suggests that it is difficult to build knowledge with text mining alone. In our study, the authors tried to extract students’ knowledge using text mining and qualitative content analysis at the same time. In text mining, the authors first imported the essay content as text data into a computer, classified the same clauses used in essays when broken into words, and classified the words into parts of words (morphological analysis). Second, after analyzing the trends and features of the classified words, frequently occurring words and keywords were extracted, and their frequency and simultaneous occurrence relationships were analyzed. Finally, analysis of the characteristics of the words, connections between words, and essay content were analyzed in concert with the results of qualitative data analysis. KH Coder (ver. 2.00) was used for analysis. Analysis was initially performed in the Japanese language, then results were translated into English when preparing this research paper. English language translations were verified by bilingual research collaborators.
3.1. Qualitative Analysis
In the qualitative analysis of the essays written by 71 students, 15 categories, 32 subcategories, and 71 codes were extracted from the three themes: What kind of skills and attitudes do you think are necessary to resolve any kind of social issue? What do you need to do in order to clearly convey your thoughts and opinions to others? and What is difficult when you tell others about an issue? Categories, subcategories and codes are shown in Table 1, Table 2 and Table 3. The author described each category with respect to each theme included in the post-essays. Categories are indicated as ( ).
3.1.1. What kind of skills and attitudes do you think are necessary to resolve any kind of social issue?
In this theme, seven categories were extracted as below.
(Recognition of diverse social issues) Regarding the various identified social issues, students described various problems such as politics, economics, and medical treatment. They also expressed the opinion that issues change as society changes, and pointed out that social issues are not uniform.
(Attitudes about resolving social issues) Students stated that there was a need to have a strong will and mission. In addition, they stated that it was necessary to develop solutions based on various people’s standpoints.
(Discerning the root cause) Students stated the importance of continuing to wonder “Why?”and having a detailed interest in topics. Furthermore, they realized that it is important to not only accurately investigate and grasp the information but also to understand information by acting upon it.
(Multi-lateral information processing skills) The ability to collect information multi-laterally includes not only collecting information but also the ability to capture problems without prejudice. Students indicated that it is important to identify the essence of the problem in order to obtain accurate information. Additionally, they thought that it was necessary to look at issues from different perspectives.
(Making a path to resolve issues) Here, students stated that goal setting needed to be clear and feasible.
(Processivity in dealing with issues) In this case, students highlighted the importance of the ability to “receive” and “send.” They also recognized how they could share information with others by raising a problem. In the “problem-solving cycle,” they noted the necessity of repeating the process of questioning, understanding and execution. Additionally, they stated that it was necessary to examine the problem, think, disseminate opinions, and establish a group.
(Reflecting on things) Students realized that taking steps for reflection was a way to review their thought process as well as have doubts and think about better solutions. They stated that they had the advantage of being able to organize their own thoughts by knowing themselves.
3.1.2. What do you need to do in order to clearly convey your thoughts and opinions to others?
In this theme, five categories were extracted.
(Simple statement) To narrow down the statement, students were aware of the need to talk to an appropriate extent with their opponents. In order to clarify their conclusion, they stated that it is necessary to first express their thoughts and arrive at a concise conclusion.
(Robust theories) Students were aware of the need to infer the causal relationship between the problem and cause and to clarify the basis of the problem by accurately grasping the information.
(Respecting the opponent) Students realized that it was important to state their opinions without denying those of others, consider others’ feelings, and accept others’ opinion.
(Communication skills) Students stated that it is necessary to communicate in a way that encourages dialogue speak so as not to become unilateral and to confirm whether it is transmitted using approaches such as eye contact.
(Attractive presentations) Students stated that to attract others’ interest it is necessary to use words and images that are familiar to their opponents, create expressions tailored to the story, and to speak with confidence. In addition, they thought that it was important to create meaningful PowerPoint presentations and to utilize appropriate pauses to prevent others from getting bored.
3.1.3. What is difficult when you tell others about an issue?
In this theme, three categories were extracted.
(Difficulty identifying others) Students stated that there was difficulty determining if opponents grasped comprehension based on their reactions. They felt there was the possibility of misunderstanding between speakers and listeners because each person understands the story in a different way. Additionally, because the opponent may be indifferent, they stated the importance and difficulty of keeping the listener’s interest.
(Difficulty of presentations) This category signified students’ difficulty talking while confirming the opponent's reaction with eye contact to ensure that the information was conveyed to others. They also stated the importance and difficulty of sorting and choosing the information they wanted to convey, and developing an ingenious way to communicate.
(Difficulty from lack of confidence and communication gaps) Students felt it was difficult to convey information because they were not confident in their thoughts and opinions. They also felt it was difficult to convey knowledge because there were differences in the generation, environment, and the amount of knowledge between themselves and the opponent.
3.2. Text Mining
Words extracted by text mining and their frequency of use are described blow. The results of the co-occurrence networks are shown in Figure 1 and Figure 2.
The total number of sentences from Task 1 (“What kind of skills and attitudes do you think are necessary to resolve any kind of social issue?”) was 866, and the total number of paragraphs was 124. The frequency of appearance of four words, “issue,” “society,” “necessary,” and “resolve” were ranked most highly. This result seems to have occurred because these words were used in the essay task theme and were cited in the essay text. Other extracted words that appeared more than 100 times were, “myself,” “solution,” “ability,” “able,” “people,” “opinion,” and “information.” The results of text mining of frequently extracted words suggests that students recognized the necessity of information literacy. These results support those of our qualitative data analysis.
The “co-occurrence network” figure expresses the frequency of words and co-occurrence of two or more words. Figure 1