Table 1
Table 2 Inclusion and exclusion criteria
Discussion
O’Brien et al (2009) undertook a qualitative, exploratory study, in order to explore and articulate mature students experiences whilst undertaking a nursing undergraduate course. A secondary aim was to examine gender differences in the type of obstacles encountered. Twenty eight mature students participated in the study. Three discipline specific focus groups were utilised to extract the raw data which was then analysed using a thematic content analysis approach.
O’Brien et al (2009) report that access to courses for mature students has widened, and that mature students are actively sought due to the qualities of emotional maturity and intrinsic motivation they possess. However, they suggest that the support structures and resources available do not possess the flexibility required of this group of students, suggesting that these students have to adapt to practices that were developed with traditional age students in mind. In this study mature students found returning to education after a several year hiatus to be extremely demanding, particularly the first year of study. Essay writing was cited by all students as challenging, and particular references were made to the first essay and first exam. All participants expressed a desire for greater support from academic staff and the University generally, with regards to essay structure, exam techniques and the standard expected of them. Subjects also identified other mature students as an important network of support as invaluable to overcome these academic difficulties.
In terms of balancing college and home life the authors found that the students who encountered most difficulty were female students, particularly those with children. Subjects were repeatedly torn between these two facets of their lives. Household commitments and spousal friction were also frequently expressed as obstacles at least periodically, with exam periods frequently expressed as detrimental to their relationships. Male participants did not express as many problems in this category as females.
In order to understand an individuals’ experience, a qualitative approach utilising focus groups would seem perfectly appropriate. To ensure consistency the same researcher oversaw each focus group. On the conclusion to the focus groups the session was summarised and respondents were allowed further input or clarification. This is termed respondent validation or member checking, where participants review the collected data or the emergent themes with a view to being able to recognise themselves (Johnson & Waterfield 2004) and adds credibility to the collected data. (Johnson & Waterfield 2004)
The most significant flaw in the paper relates to a concept called reflexivity. This may be considered in terms of the background, experiences, and views that the researcher naturally brings with them when conducting research. This subjectivity if made explicit and transparent at the outset may enhance credibility, as the researcher may hold an instinctual awareness of an environment or situation and consequently the experienced and self-aware researcher becomes an incisive research tool (Mays & Pope 2000). Unfortunately we are not made aware of the researcher’s perspectives, backgrounds or even which of the researchers conducted the interviews. This leaves us without transparency in terms of researcher bias, and many authors would argue that this aspect of non disclosure does indeed detract from the validity of the papers’ conclusions, and could lead to biased results. (Malterud 2001, Greenhalgh 1997) This does not necessarily invalidate the papers’ conclusions, as the reader may make validity inferences and deduce meaning from the transcripts in the results section. Furthermore, it is the data analysis section where sense can be made of the data (Greenhalgh 1997).
O’Brien et al (2004) utilised a thematic, grounded theory approach to the analysis of the transcribed interviews. This again is perfectly congruous and appropriate with regard to the aims and objectives of the study, however, as we are not aware of the background or expertise in the field of researchers we are not able to relate this information to their interpretations or prejudices. Quality control was enhanced by the data being coded by two separate researchers to infer consistency and to minimise bias (Mays & Pope 2000). In terms of the sample, an appropriate reflection of mature students undertaking this course and an appropriate diversity of participants were included.
Kevern & Webb (2004) adopted an exploratory, qualitative study in an attempt to explore the experiences of mature women in pre-registration nurse education and to ascertain whether their needs could be more adequately addressed. The results suggested that many of the mature students were apprehensive with regards to the change in their identities when becoming a student and questioned their abilities to adapt to the course. These fears were often overcome by the support offered by other mature students on the course. Additionally, participants were apprehensive because they did not know what to expect. Competing demands and expectations of academic responsibilities and working full-time during placements, were often cited as major challenges due to competing claims on time and energy. Also, the course demands created conflicts with household responsibilities, parental duties and relationships. The course was all encompassing and all other pursuits suffered as a consequence. Financial pressures also figured highly for many participants, who found it difficult to maintain standards and sought paid employment to supplement their bursary. Additionally, many participants were underwhelmed with the relevant support from the university for mature students and overcame this with peer group support from other mature students.
Appropriately, purposive sampling was employed (Johnson and Waterfield 2004). 28 of the 32 participants had at least two dependent children rendering the sample limited in terms of the diversity of participants. However, it must be noted that although flaws within the sample, this does not detract from the validity of the papers conclusions within this setting, only the transferability of the concepts/findings to differing settings (Mays & Pope 2000). No respondent validation strategies were implemented, which would have enhanced credibility (Greenhalgh 1997). The data was analysed using thematic analysis, via coding major topics. We are not made aware of who coded the information or whether or not it was checked by more than one researcher, also, the researcher’s backgrounds and experiences are
not disclosed in the investigation, rendering it less than transparent in terms of bias, and detracting from
the papers validity (Greenhalgh 1997). However, it is possible, to a certain extent, to infer a tenuous
decision trail from the transcripts presented in the paper, this helps the reader to infer validity by looking
at the raw data (Mays & Pope 2000), and there is data on show to support the main themes.
Young (1990) attempted to explore and outline differences in problems and needs between mature students and traditional age school leavers and found that the most common problem for mature students was one of finance and increased financial support was a recommendation to attract further mature students in to physiotherapy. Academic anxieties, such as essay and exam structure, were also a consistent finding. Data was collected via an open ended, self administered questionnaire with mainly pre-coded response structures. The questions were designed with the help of previous mature students from the course. This was administered to all third year students who were over twenty one at the start of the course, and to random samples from traditional age students as control groups. Subjects were from two schools of physiotherapy, one in the north of England and one in the south. Appropriately, the sample reflected the diversity, within one year at least of mature students undertaking the course. (Johnston & Waterfield 2004). The strength of this type of questionnaire allows for unambiguous and easily collated responses. (Bowling 2009) , and with the benefit of no face to face interaction with the researcher, can help to minimise interviewer bias helping to facilitate the expression of intimate details due to its anonymity (Bowling 2009). The drawback is that without moderation, themes cannot be explored or clarified and it also lacks social and cultural context (Bowling 2009). The collected data was then treated descriptively and summarised quantitatively in terms of frequency of response. For the purposes of this study the sample and data collection methods are adequate to answer the research question. Full background and experience of the researcher is made explicit enhancing credibility (Mays & pope 2000).
Cuthbertson at el (2004) undertook a comparative study of the course-related family and financial problems of mature nursing students in Scotland and Australia. The research objectives included exploring the prevalence of financial difficulties and the range of course related problems encountered by this group. For the purpose of this study mature students were defined as over 26 years old. Findings for both groups were very similar. Social problems figured prominently, including a lack of time for socializing, hobbies, exercising, child care and household duties. A significant proportion of respondents affirmed that financial pressures conflicted with course progression. Over 87 % of respondents found the course emotionally demanding. In addition a large number of respondents often, or very often, felt like leaving the course.
Postal survey methods were adopted via a self completion structured questionnaire. The closed question nature of this study only allows respondents to suggest that they encountered problems in any given category by answering yes or no, it does not allow them to go into specific details and thus gives us no clues as to why they felt this way. In addition this method may not represent the complexities of student problems and categories may not be present that offer a more truthful response. However in terms of rating the incidence of a particular problem this strategy is adequate. The raw data was analysed using statistical methods via SPSS, and presented via descriptive statistics: counts, percentages and standard deviations, which are appropriate in clarifying the research aims.
Lauder & Cuthbertson (1998), attempted to ascertain the prevalence of any financial difficulties, explore course related problems and to uncover any gender differences within the mature student fraternity. A survey design incorporating a self completion postal questionnaire, containing structured and unstructured questions was employed to capture the raw data. The subjects were all mature students taken from the 1995 and 1996 intake from a single college. Mature students were defined as over 26 from course initiation, taken from the bursary definition. A majority of subjects expressed problems in terms of childcare, relationships with partners, household duties and hobbies, although more females than male mature students reported these problems. Travelling to attend placements compounded these factors further. 71% of subjects expressed that financial difficulties made the course increasingly difficult. This was true for male and female students. Specifically, funding placements and childcare costs elicited the greatest challenges. The authors also outlined the importance of family support networks in negating these problems. 81% of all respondents suggested the course was emotionally demanding, particularly placements away from home initiating feelings of remoteness and isolation in which family responsibilities have to take a back seat. In addition a large number of respondents expressed a lack of support from teaching staff, expressing concerns that staff did not take into account mature student responsibilities when postulating that the course should take priority and of being inflexible when situations clashed. Additionally most of the students contacted had at some point in the course thought about leaving.
Quantitative and qualitative data analysis methods were employed. The quantitative using descriptive statistics: counts, percentages and standard deviations. The qualitative utilizing a modification of the descriptive method, which syntheses data via the construction of re-current themes. For the proposed aims of the study the samples and data collection methods are appropriate.
Shanahan (2000) utilised a phenomenological approach to explore the experience of five female mature students studying various healthcare courses at one university, with the aim of explaining why mature students lacked confidence in their abilities. Raw data was accrued via a triangulated two phase data collection strategy. One student was interviewed one on one, one student’s data was collected via a diary and a questionnaire and group discussion was utilized for the other three participants. Post data synthesis, five main themes emerged. Of the problems encountered, all participants struggled with the variety of roles they were expected to negotiate, for example, partner, mother, daughter, homemaker, friend and student. The greatest source of consternation and stress came from guilt from the familial sacrifices that had to be made for students to progress satisfactorily. Four of the five respondents were mothers and all previous research would suggest this is a major obstacle to overcome, particularly for mothers. (Kevern & Webb 2003, Obrien et al 2009). Additionally, the respondents were saddened by the loss of previous friendships and hobbies and the support networks that these provided. However, this was compensated somewhat by the participants developing new social networks with other mature cohorts and with support from partners. Academic insecurities were a common feature of this study, even though all had attained the entry qualifications, they still felt inadequate and did not know what to expect. First exams and essays were particularly problematic. Interestingly, the study highlighted that as the students progressed on the course these fragmented feelings of being pulled in many directions intensified, suggesting that instead of students finding a balance as the course progressed they were gradually worn down, and in essence faced a war of attrition (Fleming & Murphy 1997). This was echoed by Deary et al (2003) who found that psychological health deteriorated as the course progressed.
At the time of data collection the researcher was actively teaching at the university and it could be argued that this could have an inhibiting effect on students releasing intimate details (Bowling 2009). This is offset somewhat by the strategies employed for the data collection, as the least well known to the researcher was interviewed one on one and the diary was utilized by a participant who had previously been a close colleague. This was also highlighted in the paper adding to validty as the reader is allowed to infer bias from this information. (Johnston & Waterfield 2004). A further flaw involves the lack of detail with regards to how the data was analysed. We may only infer that some type of content analysis was utilized, as emergent themes are discussed and listed, and evidence from the raw data is presented to validate themes (Mays & Pope 2000).
All, but one of the research papers took place in one institute of higher education, which limits the transferability to a wider populace, however, all findings were congruent with previous research, which helps with its wider applicability (Bowling 2009) and conclusion validity (Greenhalgh 1997). Furthermore, Greenhalgh, (1997) also suggests that when assessing validity, the data interpretation should concur with common sense and the themes uncovered by the included research papers in this review would certainly slot into that pattern. Additionally, the review findings are congruent with previous research done in this area lending credibility and validity to the findings (Mays & pope 2000).
It would appear that students attempting to juggle different roles and responsibilities face significant challenges, often torn between college and home life and the additional responsibilities many mature students faced, such as household activities, parenting and relationships. Several studies suggest that this is compounded for females and especially females in relationships or with children (Kevern & Webb 2003, O’Brien et al 2009). This may be explained by exploring conventional gender roles in society, where women are often expected to be the main care-giver (Cuthbertson et al 2004). McGivney (1993) suggested that conflict can arise when women attempt to pursue activities outside of their home life and that this can serve to illuminate the un-equal power structures within the family. This is supported by Leonard (1999) who postulates that women in education received support from their partners if they still conformed to conventional gender expectations and if their partner still received personal attention. This is further highlighted by O’Brien (2009) who found male students did not suffer to the same extent, suggesting that partners provided support by completing household duties and child-care responsibilities allowing them the time to study. Furthermore, to overcome this role overload Scott et al (1996) recommend the possibility of leaving and re-entering the course without punitive and restrictive penalties. Or that part-time or distance learning should be considered (Kevern & Webb 2004). Additionally, these barriers were often compounded by the workload demanded when on placements and several authors recommend more flexibility in opportunities to acquire clinical skills (Kevern & Webb 2003). This was further compounded for many with the resulting change in identity which had the potential to alter family dynamics and relationships. This may de-stabilise established gender roles with family and friends and manifest in changing feelings of individual characteristics or self-identity (Baxter & Britton 2001). This echoes the findings of Steele et al (2005) who suggests that changing identities creates tensions between already established roles. For many this was a major area of consternation and stress and often impinged negatively on course progression (Baxter & Britton 2001).
Academic anxiety was also a common theme, particularly from mature students who had not formally studied for a number of years (Kevern & Webb 2004). In addition many mature students cited a lack of support from tutors and the institution in general and a lack of organizational and structural flexibility. This was particularly apparent during the first year with the first essay and exam cited as the most difficult obstacle (O’Brien et al 2009, Kevern & Webb 2003). Many mature students expressed a need for better guidance on essay writing and exam technique, including references and what was expected to pass and yearned for opportunities to show their work to academic staff before submission for feed back as to where they are going wrong (O’Brien et al 2009). Support, guidance and feed-back varied greatly between lecturers (O’Brien et al 2009) and often family commitments were encouraged to come second to academic pursuits (Kevern & Webb 2003). Some students were aware of varying degrees of support that the university offered but cited that time-table commitments and placements away from home impinged on being able to take advantage of these (Chur Hansen 2003). West (1996) purported that academic support was pivotal to mature students survival and progression and suggested that personal attention and recognition from lecturers served to increase the self-efficacy and confidence of mature students. Thus, coping strategies based upon improving self-esteem and self-efficacy could contribute to success and progression and even positive health benefits (Siegrist & Marmot 2004). Thus it would appear that without some type of social support network these anxieties and challenges were compounded (Steele et al 2005).
Interestingly many of these obstacles and challenges were more easily overcome when students received strong peer group or familial or tutor support, these were often cited as pivotal to students successfully completing the course (steel et al 2005). Students professed that peer support aided in them comprehending the academic demands expected, helped them to overcome writers block and to generally vent frustrations (O’Brien et al 2009). This often helped with individual motivation and course progression (Fleming & Murphy 1997). Interestingly, Chur Hansen (2003) clarified further, suggesting that social support figured highly as an obstacle. The respondents expressed difficulties in forming friendships with younger cohorts due to lack of commonality. Social isolation was further compounded by the time demands of the course. Chur-Hansen (2003) clarified further the peer isolation that some mature students face by suggesting that her research found that this lack of peer group support was not through lack of association or invitation but rather that the inter-relationship dynamics were one of confidant or mentor rather than a more intimate mutual friendship. The students also found forming associations with other mature students difficult due to their scarcity and distribution through different years of the course. These findings would suggest the importance of course planners and deliverers to encourage mature students to foster relationships and form study groups from an early stage (O’Brien et al 2009) as this has been found to help overcome obstacles and to develop effective coping strategies (Steele et al 2005).
Financial difficulties also figured repeatedly, with mature students facing differing financial roles than their younger counterparts, with many having to work part-time to progress, which further encroached on available time to study, increasing academic anxiety (Shanahan 2000, Young 1990). Gilah et al (2004) concluded that a characteristic feature of mature students was one of financial hardship, with 75 % of the sample having to work to progress financially. This resulted in a continuous struggle to balance the demands of work and study. This is not a surprising finding, and financial sacrafices are often coped with by imagining future success and improved lifestyle upon completion (Sloman & Norris 2002). To offset this hardship Kevern & Webb (2003) suggest that flexible modes of study should be offered, such as part-time, distance learning and flexible models of developing clinical experience.
Thus, it would appear that mature students face a war of attrition juggling familial relationships, financial constraints and coping with exams and essay writing which can result in a constant temptation to quit (Fleming and Murphy 1997). It may be argued that the pressure to succeed for mature students is greater than for younger cohorts. Feelings that this is their last chance to succeed may weigh heavily and compound challenges (Macdonald & Strata 1998). Additionally these problems would appear to be compounded further with mature students studying healthcare courses with their increased contact hours and placements away from home (Lauder & Cuthbertson 1998) facilitating feelings of loneliness and isolation (Harth et al 1990). With cross reference to the literature, these findings do not appear to be groundbreaking, these problems have been highlighted during the last two decades, yet the problems still remain and institutions do not appear to be moving towards a new paradigm (O’Brien et al 2009). Although many institutions of higher education have some structures in place, the high number of contact hours and differing responsibilities place these resources out of reach for many mature students (Kevern & Webb 2003).
It has also been postulated that students studying in different fields of healthcare confront different challenges and barriers, suggesting more research is required within specific fields of healthcare (Wear & Castellani 2000; Bloch 2003).
Conclusion
In conclusion the research would suggest that if mature students are to minimise obstacles and challenges and fully integrate juggling multiple social roles with academic pursuits and benefit from university in the same way that younger students do, then fundamental curriculum revision, in terms of philosophy, flexibility and organization needs to take place. (O’Brien et al 2009, Rautopuro & Vaisanen 2001, Lauder and Cuthbertson 1998).
Limitations
The majority of the students respondents in all of the studies were older than the definition utilized in this review and whether their experiences were much different for say a 21 year old than a 41 year old were not addressed.
Due to the search being limited to Keele University library, text books that could have been useful to extending the selection of literature available were not able to be included. Additionally journals that had the potential to be informative were unable to be utilized due to membership fees required for their perusal.
The researcher would like to thank Carole Watkins as research supervisor.
Word count: 5000
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Appendix I Analysis of reviewed literature evidence