Mrs. Susan Leddington Student No. 06029903 What are the key dimensions of the personal tutor role for nurse education today? A literature review. This dissertation is submitted in part fulfilment of the regulations for degree of Master of Science in Higher Professional Education. P49215 MSc Dissertation School of Health and Social Care Oxford Brookes University January 2008 Word Count: 21,725 2 ACKNOWLEDGEMENTS I would like to thank my family, Mark, Stephanie and Andrew for supporting me throughout writing this dissertation. Appreciative thanks also to my supervisor Sue Atkins, my colleague Carol Pook and my friend Claire Foster. 3 CONTENTS Page Abstract ????????????????????????. 4 Chapter 1 ? Introduction ????????????????.. 10 1.1 Aim ?????????????????????.. 10 1.2 Objectives ??????????????????.. 11 1.3 Rationale ???????????????????.. 11 1.4 The research question ?????????????. 12 1.5 Outline of the review??????????????? 12 1.6 Summary ???????????????????. 13 Chapter 2 ? Background ????????????????.. 14 2.1 Introduction ??????????????????. 14 2.2 Definitions of personal tutoring ?????????? 14 2.3 Pastoral care ?????????????????.. 15 2.4 Academic support ???????????????.. 16 2.5 Institutional perspectives ????????????.. 17 2.6 Government policy ???????????????. 18 2.7 Professional bodies ???????????????. 20 2.8 Student perspective ??????????????.. 22 2.9 Nurse education in higher education ???????.. 24 2.10 Summary ??????????????????.. 26 Chapter 3 ? Methodology ????????????????. 28 3.1 Introduction ??????????????????. 28 3.2 Literature review as a research method ??????. 28 4 3.3 Key features of a literature review ????????. 29 3.4 Validity and reliability ?????????????. 32 3.5 Critical review forms ?????????????.. 34 3.6 Rationale of a literature review for this study ???. 36 3.7 Summary ??????????????????. 36 Chapter 4 ? Method ??????????????????. 37 4.1 Introduction ??????????????????. 37 4.2 Data sources ?????????????????. 37 4.3 Search terms ?????????????????. 37 4.4 Supplementary literature ????????????. 40 4.5 Inclusion/exclusion criteria ???????????.. 40 4.6 Data synthesis ?????????????????. 41 4.7 Summary ???????????????????. 42 Chapter 5 ? Synthesis of Results ????????????.. 43 5.1 Introduction ??????????????????. 43 5.2 Epistemology ? The primary marker ???????.. 44 5.3 Adaptive and responsive research design ?????. 45 5.4 Purposeful sampling ??????????????. 48 5.5 Ethical approval ????????????????. 49 5.6 Adequate description ?????????????? 50 5.7 Data quality ? sources of knowledge ???????. 51 5.7.1 Interviews ???????????????. 51 5.7.2 Surveys ????????????????. 53 5.7.3 Focus group interviews ?????????. 54 5 5.7.4 Participant observation ?????????.. 55 5.7.5 Document analysis ???????????. 56 5.8 Analysis and interpretation of meaning ??????. 56 5.9 Generalisability ????????????????.. 57 5.10 Quantitative analysis ?????????????.. 58 5.11 Relevance to practice or educational policy ????. 59 5.12 Summary ??????????????????.. 59 Chapter 6 ? Analysis ??????????????????. 61 6.1 Introduction ??????????????????. 61 6.2 Emerging themes ???????????????.. 61 6.3 Summary ???????????????????.. 65 Chapter 7 ? Discussion ?????????????????. 67 7.1 Introduction ??????????????????. 67 7.2 Demonstration of a Relationship ?????????. 67 7.3 Maximising Learning ??????????????. 76 7.4 Recognition of a Professional Role ???????.? 81 7.5 Conclusions ??????????????????. 86 Chapter 8 ? Implications and Recommendations ?????. 88 8.1 Introduction ??????????????????. 88 8.2 Recommendations ??????????????.. 88 8.3 Limitations of the study ?????????????. 96 8.4 Summary ???????????????????. 98 6 Chapter 9 ? Conclusion ?????????????????. 99 9.1 Introduction ??????????????????. 99 9.2 Review of objectives ??????????????. 99 9.3 Summary ???????????????????. 102 Chapter 10 ? Personal Reflection ????????????. 104 References ??????????????????????. 105 Appendix 1 Summary of Papers included in review ???????.. 111 Appendix 2 Critical Review Form ???????????????.. 129 Appendix 3 Mind Map ?????????????????????. 132 7 Abstract Background. The accepted position of the personal tutor role from the background literature includes both pastoral care and academic support. Recent government led initiatives of widening access to higher education, the Dearing report (NCIHE, 1997) and the National Student Survey (HEFCE, 2006) have changed higher education and affected the personal tutor role. The implication of these initiatives for nurse education is unclear. Aim. The aim of this literature review is to explore the dimensions of the personal tutor role in higher education and how the expanding role of the personal tutor will impact on nurse education. Methodology. An analysis of literature review as a research method and its use in educational research is followed by discussion on the key features of a literature review and justification of why it is an effective tool to answer the research question. Method. A literature search was carried out from February ? April 2007 using the British Education Index, Education Resources Information Centre, Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, Psychological Information and Medical Literature Online (Medline) databases. Of the articles retrieved 17 met the inclusion criteria and corresponded to the aims of this review. Analysis of the data revealed a 8 comprehensive view of the personal tutor system as students and tutors in higher education presently experience it. Findings. The three meta-themes found are Demonstration of a Relationship, Maximising Learning and Recognition of a Professional Role. These each incorporate sub-themes including curriculum issues, personal supervision and staff development and training. The tutor-student relationship is crucial for the integration of students into the University. The process should begin in induction week, be maintained throughout the course and should be intact at the end of three years. For students learning in a different culture or in a different language the journey to independent learning could be more difficult and require more support. The benefits of supporting students? Personal Development Plans (PDP) by personal tutors are evidence of student self- management and skills acquisition for future employers. Staff development and training is required to undertake the role of personal tutor (Owen, 2002) and further training in these skills for lecturers, both within and outside postgraduate courses would enhance the personal tutor role. Codes of practice within the University need to be in place to direct and protect both student and personal tutor. Further research is needed utilising a wider variety of methods to explore the needs of all nursing students from a personal tutor. Conclusion. The role of the personal tutor is dynamic and complex. The findings of this review point towards the importance for the student nurse of a relationship with a personal tutor within the HEI. Recommendations included in the review may maximize learning potential for students, improve the nature 9 of the role for lecturers and enhance the Universities commitment to student support. Further research into areas highlighted within the study may lead to greater understanding and fulfilment of this important role. 10 Chapter 1 ? Introduction In light of government policy and key political drivers to widen participation in higher education (Department for Education and Skills, 2003), there is a need to support the growing number of students who are in higher education. There is also a need to record student learning and achievement in the form of personal development plans (PDP) for all interested parties to see (QAA, 2001). The personal tutor system has been identified by Higher Education Institutions (HEI?s) as the delivery vehicle for this initiative and nurse education will be required to demonstrate how the system is developed across both academic and practice areas. PDP allows the student to articulate and write down their own aspirations, goals and achievements and to take these to future employers in the work place. 1.1 Aim The aim of this literature review is to explore the dimensions of the personal tutor role in higher education and how the expanding role of the personal tutor will impact on nurse education. Personal tutoring has a long historical basis within higher education but the nursing profession has only recently aligned itself with higher education and now needs to explore how this role can be fulfilled. 1.2 The research question What are the key dimensions of the personal tutor role for nurse education today? A literature review. 11 1.3 Objectives The objectives of this review are: ? To investigate the student expectations and experiences of personal tutoring and academic and non-academic support during their course in higher education. ? To analyse and explain how the personal tutor role can maximise learning potential within nurse education. ? To explore the key skills, training and development needs for nurse lecturers undertaking the personal tutor role. 1.4 Rationale As a lecturer in higher education with responsibility for undergraduate nurses it is necessary to engage with developments in the provision of higher education. The UK Government White Paper The Future of Higher Education (Department for Education and Skills, 2003) laid down the path for the future of higher education and built upon previous work of The National Committee of Enquiry into Higher Education (NCIHE, 1997). Prior to these initiatives the role of the personal tutor was seen to be in decline (Cotterill and Waterhouse, 1998) with academics perceiving a move away from responding to students holistically; meeting with them less and holding fewer tutorials and seminars. This has not been culturally acceptable for lecturers working in health and social care for whom a philosophy of caring has traditionally been held 12 (Benner, 1984). Nursing students readily explore nurse/patient relationships and nurse lecturers may utilise these skills of caring and nurturing with students. However with an increased numbers of students, this approach can quickly become burdensome and overloading. Nurse education has an additional dimension in terms of the student?s engagement with the practice setting for half of the course. There are a variety of emerging roles such as placement facilitators and link lecturers supporting students in the practice areas. The personal tutor role in nurse education may be concerned with supporting students in practice and differs from the traditional model of pastoral and academic support. Personal objectives for undertaking this literature review include exploration of the personal tutor role for professional practice as a nurse and senior lecturer in a University. As both students and lecturers cross from campus to clinical practice the student-lecturer relationship may be difficult to maintain. Further understanding of the role of the personal tutor from student, tutor and University perspectives may facilitate a growth and development of the role. 1.5 Outline of the review This thesis will begin with an exploration of the historical context of the personal tutor role and how it has been utilised in both older established Universities and post 1992 Universities. The background government policies and statutory bodies that oversee the quality and standards within higher 13 education will be analysed in terms of their impact on the future role of the personal tutor in higher education. The methodological section will critique the use of literature reviews as a tool for educational research and provide a rationale for the use of a literature review in this study. Validity and reliability are discussed in relation to literature reviews and analysis of papers within the review. The method section outlines the process of searching databases for research to answer the question: ?What are the key dimensions of the personal tutor role for nurse education today?? The results chapter critically analyses and synthesises the methodological quality of the research papers retrieved for the review together with an analysis of their contribution to the development of theory and practice for the personal tutor role. A thematic analysis is undertaken to explore emerging themes as they relate to the research question. Implications and recommendations for nurse education are then discussed in light of the knowledge gained from the extended literature review. 1.6 Summary To answer the research question this review is a systematic search and analysis of available literature. The robustness of the process allows for implications and recommendations to be drawn for personal tutoring within nurse education. 14 Chapter 2 ? Background 2.1 Introduction This chapter returns to earlier discourse on the personal tutor from a student, tutor and institutional perspective in order to answer the research question ?What are the key dimensions to the personal tutor role for nurse education today?? The competing definitions of the personal tutor and the facets associated with the role are explored along with the notion of pastoral care, academic support and supporting students in clinical practice. Recently there has been a revival of interest in the role of the personal tutor within HEI?s, despite being considered by some to be in decline (Cotterill and Waterhouse, 1998). Recommendations from government initiatives in widening participation in higher education and students? financial contributions to their education are examined (NCIHE, 1997). The work of relevant professional bodies contributing to these initiatives and student opinion of personal tutor support is also discussed (Jary and Parker, 1998). Implications of these initiatives for nurse education and the role of the personal tutor are summarised to take forward to the review of the literature. 2.2 Definitions of personal tutoring The role of the personal tutor has previously been examined with respect to the Oxbridge model (Earwalker, 1992). Prior to the 1970?s young people were not considered adult until the age of twenty-one and Universities were acting in loco parentis for their students. The system worked to incorporate moral guidance (interestingly this could now be viewed as personal development). Staff-student relationships were built up around one-to-one tutorials with 15 shared scholarship and peer support included within the tutorial relationship. The number of students allocated to a tutor was relatively small, often between fifteen to twenty students. This model has had a powerful influence on the development of personal tutoring in higher education. It may be seen as outdated due to the increasing numbers, wider social diversity and expanding age ranges of students now entering University education. Up until very recently, some HEI?s were still utilising this system to some degree and having difficulty in resourcing and implementing it. The role of the personal tutor has been defined as to facilitate the personal development of their tutees, monitor their progress and to provide a link between the student and the University (Wheeler and Birtle, 1993). The perspectives the personal tutor can adopt are outlined, which are similar to that often regarded as mentoring ? friend, advisor, parent, counsellor, disciplinarian, advocate and teacher and suggests that the personal tutor consciously or unconsciously adopts one or several of these modes within their meetings. What is not made clear is that there may be difficulties in adopting different perspectives for different students and in the equity of tutorial guidance received by all students. What one student may perceive as friendly another may deem intrusive. 2.3 Pastoral care The personal tutor role has been seen as having a dual remit for both pastoral and academic care (Jaques, 1990), but the notion of pastoral care as part of the support network of the higher education institution, needs to be carefully 16 defined. At times of crisis students will turn to someone who they know and trust, who they think will listen to them without being judgemental. Part of the personal tutor?s repertoire of skills must therefore be listening and perfunctory counselling skills. In the first instance the student may be relieved to just talk, but as Earwalker (1992) pointed out, many tutors feel an obligation to do what they can but are fearful of being drawn too deep into a students problems without the skills necessary to make a difference. The range of problems a student may present with are diverse and the personal tutor may not have the expertise that the student requires. Knowledge of finance, accommodation and medical conditions are not normally required of an academic (Jaques, 1990). Therefore the tutor must have some knowledge of how, when and where to refer the student for more expert help. Crisis intervention is also not the best way to support students and their learning. 2.4 Academic support The role of the personal tutor to develop academic good practice has also suffered from competing ideas of how academic guidance should be delivered. Students may feel unprepared for the academic work in higher education (Thomas, 2006), especially with the changes brought about by widening participation in higher education. Non-traditional students such as the more mature and those of differing ethnic backgrounds may have no knowledge of the reality of higher education and a personal tutor could lessen the impact by offering academic advice and dealing with potential and actual academic failure. Perceived failure may be just as big a problem as actual failure (Wheeler and Birtle, 1993). High expectations of students and the 17 family and friends who support them, may push students into anxiety over their performance, especially at examinations. Personal tutors can be realistic in their summary of the students expected work and grades. Study skills techniques, such as time management, prioritisation of work and self- monitoring are important skills to learn and reinforce. Recent developments in education link the academic part of the role with the students own personal development and learning (Jary and Parker, 1998). The Dearing Report (NCIHE, 1997) emphasised the importance of getting students to plan their own learning with personal tutor support and be able to review and plan their next steps. It is seen as developing students responsibility for their own learning (QAA, 2001). This allows the students to be at the heart of their own development and learning (Bullock and Wikeley, 2004). In the 1990?s a professional model of personal tutoring emerged consisting of an expanded student service run by professionals on a full time basis. This is a reactive system of student self-referral and not all students who could benefit, access the services (Thomas, 2006). Many students could pass through the University without accessing student services at all. This model does not allow for relationships between lecturers and students to develop but allowed for an expansion of student services beyond that of careers advice. 2.5 Institutional perspectives With both these models HEI?s have an interest in maintaining the personal tutor to act as a front line safety net. Cotterill and Waterhouse (1998) regret the demise of the personal part of the role into being the invisible part of a 18 lecturer?s work. The modern student has many concerns such as family responsibilities and hardship that increasingly affect their ability to study (Grant, 2006). The personal tutor role is of value to all students when it is seen to be accessible and available to all. These models are not diametrically opposed to each other (Earwalker, 1992), although neither is sustainable fifteen years later with the agenda of widening participation in higher education. A model of support provision via the curriculum, helping and supporting students as a normal part of the course encompasses the best of both the personal and academic processes. Universities are increasingly complex organisations where unscheduled events are difficult to organise and it is increasingly recognised that this cannot be left to ad hoc arrangements (Jary and Parker, 1998). By scheduling and integrating personal tutor time all students benefit throughout the course. This is not to say there is no requirement for professional student services. As mass higher education increases and widening participation allows access to higher education for ethnically and culturally diverse students the professional support mechanisms are invaluable. 2.6 Government Policy The Government has had a strong political influence over the shape of Universities during the last ten years. The National Committee of Enquiry into Higher Education (NCIHE, 1997) made clear recommendations for Universities to abandon the old elite system of only enrolling 15 per cent of the eligible age group into higher education. The recommendation was to 19 widen participation in higher education in order to enrol between 15 to 40 percent of the available age group to a mass system of higher education (Scott 1998). Many population groups were recognised as being under- represented in higher education, especially those from socio-economic groups III-V, women, those with disabilities and people from certain ethnic groups. Dearing (NCIHE, 1997) recommended allocating funds to Universities that committed to such a robust expansion, with quality monitoring mechanisms in place. This fulfilled a political agenda to address social and educational inequalities across the class system. Participation in higher education has become an important element of life style and increases individual life chances, far more than socio-economic factors (Scott, 1998). As a consequence of the Dearing report (NCIHE, 1997) students have become consumers of higher education instead of being a product. Students (and their parents) are being asked to contribute via tuition fees to the funding of higher education and progression to employability. Students are required to demonstrate their skills to a profession through evidence of personal transferable skills. University education has been forced to take into consideration the ideology of mass education and must prove the outcomes of that educational policy (Jary and Parker, 1998). It is no longer linked with the social elite but concerned with the professional and personal achievements of a wide variety of students, in order to enter the employment market. It may be argued that utilising managerial discourse to link academia to government ideology and industry has changed the culture of Universities forever (Shore and Selwyn, 1998). 20 Of particular significance to this study are the recommendations from the Dearing Report (NCIHE, 1997) that HEI?s develop a means by which students can monitor, build and reflect upon their own personal development. At this stage it is unclear whether the personal tutor is to undertake this role and the skills needed to fulfil it. It is clearly more than preparing and lecturing to a group of students and may demand further education and training for the personal tutor (Clarke, 2003). 2.7 Professional Bodies The need for students to provide evidence of their own learning and development has also been advocated by The Quality Assurance Agency for Higher Education (QAA, 2004). The remit of the QAA is to work with higher education institutions to define academic standards and quality, carry out reviews of these standards and to safeguard the public interest. Work has been developed on the nature of this evidence as student progress files that include two elements: a policy on transcripts of student learning and achievements in higher education (carried out by the institution) and a policy on personal development planning (PDP) (carried out by the student). PDP is intended to be a structured process undertaken by an individual to reflect on his or her own learning and to plan for their own development in terms of educational and career paths (QAA, 2001). Development of a PDP is intended therefore to be something undertaken with support from a tutor and it is in this initial document that the role of the personal tutor in higher education is first mentioned to be the person to undertake this supportive role. PDP 21 development is seen as integral to higher-level learning and is linked with a holistic concern for the student, both academic and non-academic (QAA, 2001). It should be a process of self-reflection and creation of personal objectives, achievements and records, which is intended to improve students ability to articulate their achievements to academic staff and future employers. HEI?s are responsible for providing opportunities, guidance and support for the process of PDP based on institutional policies within a national guidance framework (QAA, 2001). There is a national lead-in-time of 5 years, with a 20005/6-start date for the inclusion of PDP in higher education awards across all HEI?s. It is from this document that HEI?s have revived the role of the personal tutor (Cotterill and Waterhouse, 1998) to undertake the work involved. Within the documents there is no discussion as to what this role should be, but clear accountability for the implementation of PDP is left to each HEI. Much of the responsibility for identifying and addressing student support lies with the personal tutor (National Audit Office, 2002). This survey found that there were significant differences between faculties and institutions as to how many students a personal tutor may support. Discrepancies were also noted as to if, how and when students sought support. For the personal tutor the number of students they are expected to support over an academic year is a crucial issue. There is little evidence in these documents to substantiate that student performance is improved with an increased number of visits to their personal tutor. A further government led initiative is the recommendations of the UK Government White Paper The Future of Higher Education (Department for 22 Education and Skills, 2003). This recommended increased participation in higher education for people aged 18-30 years old and strengthening teaching and learning support for students. The Measuring and Recording Student Achievement Scoping Group (SCOP) was established by Universities UK following the White Paper to explore the degree classification system, the credit transfer system and to acknowledge the work achieved in the implementation of PDP. Objectives outlined in this document, included exploration about what makes each student experience different and how the student experience could be acknowledged and built upon within HEI?s. The SCOP group was searching for the additional value each HEI could bring to the student experience by the type of support offered through personal tutoring. This may affect the number of students any one personal tutor can support and monitor at a time. The Higher Education Funding Council for England (HEFCE) funded the Personal and Academic Development for Students in Higher Education (PADSHE) project in which seven Universities collaborated to improve and streamline the personal tutor role (PADSHE, 2002). The projects aim was to implement a system for students to document their own personal and academic records (PARS) and provide a point of discussion between personal tutors and students. The significance of this paper for the personal tutor is in terms of workload. Transparency of what the role entailed and equity in terms of the number of students a personal tutor was expected to support was not elaborated on. 23 2.8 Student perspectives From the student perspective personal tutors can either be of great benefit or are not utilised at all. These government initiatives were completed in 2005 before the first National Student Survey (HEFCE, 2006), drawing together the opinions of thousands of students on a variety of HEI courses. Students as consumers could now directly feedback to HEI?s their expectations of courses and the role of the HEI in their career development and plans. Academic Support and Personal Development were specifically targeted for students to comment on their experiences in HEI?s. In general the differences between student groups were small, however for academic support the lowest mean scores were found to be among black and Asian ethnic groups, whilst the most positive results came from older learners. Female students were less positive about their academic support than males. Students with a declared disability such as dyslexia were also less satisfied with their academic support. The conclusions drawn are that there is a more individualised approach to academic support in higher education, both in terms of demand and provision, which leads to less commonality of experience within student groups (HEFCE, 2006). The same findings were represented in personal development. Ethnic background had the most impact on whether students felt they were supported through personal development. In this area however, the subject of study had a large effect on the scores for personal development, with Medicine and Dentistry being especially positive and Mathematical Science and Computer science being the least positive, which may have a bearing on the role of personal development for professional 24 working life. It is evident from this survey that equity and parity of personal tutor support is difficult. Awareness of the diversity of student groups and the demands this may place on individual personal tutors is essential. Intercultural sensitivity to diverse student groups may affect the personal tutor role and the type and consistency of communication may contribute to student?s personal and professional development. Analysis of a University Graduate Survey (Grant, 2006) found that personal support was more important to women than men and that women rated personal tutoring lower when the ratio of female to male staff was lower. Also different age groups and students of different ethnic backgrounds reported the experience of having a personal tutor very differently. All students were found to need academic support that offers guidance on academic performance (Grant, 2006). What students actually want from their personal tutor is under researched but academic support and personal development now have prominence in the national student survey and HEI?s are taking seriously the provision of student support (HEFCE, 2006). 2.9 Nurse education in higher education By 1995 nurse education was fully integrated within higher education (Burke 2006) and several consequences arose from the break from direct control by the health service. Nursing was expected to adapt as a discipline within the University and adhere to principles of academic rigour, often to the detriment of skills for practice. This had an effect on the curriculum until Making a Difference (Department of Health, 1999) linked nurses career progression to 25 responsibilities and competencies in undertaking nursing care. Further curriculum demands of Fitness for Practice and Fit for Purpose (UKCC, 1999) adjusted the balance to include clinical practice and patient care. A further consequence of integration into higher education for students of nursing was the so-called theory practice gap (Gardener, 2006), linking education to relevant clinical nursing practice and the need to encompass the development and learning of students whilst on clinical placement. For nurse education this is a third element to the personal tutor role (Gidman, 2001). When on campus personal tutors are available and may already teach the students within a module. This is much more difficult when students are in the practice areas but HEI?s must find way to avail student nurses of personal tutor support throughout the whole course. This may be an ideal way to maintain clinical competence for nurse lecturers (Humphreys et al., 2000) or to explore the role of personal tutors alongside practice educator roles. Nurses in the past have not been good at documenting their own reflexive learning (Benner 1984) from practice and academia, but now there is an increasing emphasis on the individual and the commitment to professional and personal self-improvement. The use of reflection to develop clinical practice (Benner, 1984) is arguable but reflective incidents do contribute to portfolios of evidence from clinical practice. Development of PDP and progress reviews may be utilised both in undergraduate and post qualifying nurse education. This is reflected in further government led changes to NHS career progression (Department of Health, 2001). 26 These issues have specific outcomes for the role of the personal tutor in nurse education, both on campus and in the clinical area and how the personal tutor manages to cross and link the education and practice arenas in their support of student nurses. This role may also coincide with other nursing roles such as the link teacher (Gardener, 2006). This literature review on the dimensions of the personal tutor role will contribute to its implementation into the support and retention of student nurses. 2.10 Summary The accepted position of the personal tutor role from this background literature includes both the pastoral care and academic development of students. The increase in student numbers and the diversity of the student population have made it necessary to re-examine the role of the personal tutor (NCIHE, 1997). Student expectations of the personal tutor are being explored through national surveys (HEFCE, 2006). Government led initiatives have changed both higher education and nurse education over the last decade. The challenge for nurse education has been to adopt the academic infrastructure of higher education whilst retaining the core values of nursing. The widened entry gate to nursing (Department of Health, 1999) and the expanded number and diversity of entrants into the nursing profession has increased the pressure for student support. The development of the personal tutor role may have led to ambiguity in its duties and responsibilities. The training needs necessary for lecturers to undertake the role are also unclear. An in-depth review of the literature is justified in 27 order to explore how the personal tutor role may contribute to nurse education and support the student nurse between the areas of University and professional life, campus and clinical practice. 28 Chapter 3 ? Methodology 3.1 Introduction This chapter will outline the use of literature review as a research method and its use in educational research. This will be followed by discussion of the key features involved in a literature review and justification of why it is an effective approach to answer the research question ?What are the key dimensions of the personal tutor role for nurse education today?? 3.2 Literature review as a research method A research literature review is ?a systematic, explicit, and reproducible method for identifying, evaluating and synthesising the existing body of completed and recorded work produced by researchers, scholars and practitioners? (Fink, 2005;3). Focusing on high-quality original research, it allows for accurate analysis of findings rather than reliance on second hand interpretations of the work. Critical reading of the identified research is needed for analysis of the robustness of the evidence and the rigour of the research process on which it is based (Parahoo, 2006). This in turn will allow for more robust conclusions and recommendations for practice. With the increasing volume of literature available, a literature review is suggested as an important tool to summarise and synthesise the amount of research evidence (Hart, 2001). The role of the personal tutor has been under examination lately (McNeill and Fawkes, 2006) and appears from the background literature to address the need for students to effectively engage with their learning and development. From the perspective of the HEI this seems an efficient tool, for supporting all 29 students, which is both proactive and available to all, not just in times of crises or need. As seen earlier, HEI?s are now explicitly directed to implement this service (QAA, 2004) which links the student to future employment. This literature review will highlight the role perspectives for both the nursing students and the personal tutors and will identify key implications for nurse education. Current emphasis on evidence based practice has increased the importance of the literature review (Parahoo, 2006). There is a growth in the amount of evidence available to practitioners and the literature review is a good way of synthesising research in a particular area, describing and explaining current knowledge, in order to guide professional practice (Fink, 2005). The process should be rigorous and adhere to research principles and the methodology for conducting such reviews has been developed considerably (Hawker et al., 2002). Reasons for completing a literature review range from enhancing understanding of the structure of the subject, identifying methodologies and research techniques to establishing a historical context for the research. 30 3.3 Key features of a literature review Evans and Benefield (2001) suggest that there are several key features to a systematic review that must be met: KEY FEATURES 1 An explicit research question to be addressed 2 Transparency of methods used for searching for studies 3 Exhaustive searches which look for unpublished as well as published studies 4 Clear criteria for assessing the quality of studies (both qualitative and quantitative) 5 Clear criteria for including or excluding studies based on the scope of the review and quality assessment 6 Joint reviewing to reduce bias 7 A clear statement of the findings of the review Adapted from Evans and Benefield, (2001). Table 1: Key features of a literature review Whilst a systematic review is usually a term used to denote the synthesis or meta-analysis undertaken by a researcher working with quantitative data, it is a useful framework to adapt to this literature review. A key feature of the literature review is the formation of a legitimate area of enquiry into a research question. Past reviews can help to establish the necessity for a new inquiry by assessment of the validity of the work. Identification of the characteristics and background to the study are important details. For a literature review the retrieval of previous studies and the 31 transparency of the literature search are important areas for protecting validity (Cooper, 1998). The process of accessing electronic online databases and the results of the search are made explicit in order for the work to be evaluated. Further searches by Internet or by hand for material is clearly detailed with missing studies reported. Key words or descriptors are important to gain access to the relevant articles and the descriptors need to be clearly evident within the method of the review. An important step in the search for literature is to decide on criteria that allow for inclusion or exclusion of articles to the review (Fink, 2005). The primary screen will be a practical one for identifying a broad range of articles pertinent to the study. The criteria used should be made explicit within the methodology along with any secondary screening for methodological quality within each article (Fink, 2005). This will narrow the search in order to answer the problem posed and will ensure that only studies that have a rigorous methodology with attention to design will be included. Once the search is complete the best available evidence to answer the specific research question is identified. This is discussed in terms of the hierarchy of evidence (Parahoo, 2006), where evidence from well-designed meta-analysis is considered the gold standard of research. Underneath meta-analysis are randomised controlled trials (RCT), then observational and descriptive studies and lastly to the evidence of expert opinion. For the medical profession this in reality means a double blind RCT (Polit and Beck, 2008) with technical language and statistical evidence as being the main evidence worth credibility. The world of social science and education have questioned the framework of the hierarchy of evidence with 32 meta-analysis of randomized controlled trials being at the top of the hierarchy (Evans and Benefield, 2001), as not being particularly useful to practitioners. Qualitative data as evidence may be equally valid and the nature of the subject to be researched should determine the kind of research that is relevant (Pring, 2000). This has particular relevance when educational research is linked with a practice discipline such as nursing. The research must be relevant to practice in order for practitioners to incorporate the findings into the work. Thus the research question is answered by the best available evidence (Oakley, 2002). 3.4 Validity and Reliability Research designs have an impact on the quality of the evidence (Polit and Beck, 2008). The research process should take into account how validity and reliability are assessed and taken into consideration. The reviewer must apply these terms to a literature review as a research method, just as they would be applied to primary data collection (Parahoo, 2006). The rationale and actions of the reviewer must be clear to readers in order to assess the reliability and validity of the data and to incorporate the findings into practice. The parameters set and the tools used to appraise the literature must be clearly evident. Evans and Benefield (2001) include the process of joint review to enhance rigour, however this is not an agreed standpoint within the literature. Allowing another researcher to confirm the results of the analysis tool within the review may confirm validity (Parahoo, 2006). 33 Reviewers making every effort to ensure that any prior conceptual and methodological judgement influences the decision to include or exclude studies protect validity of the review (Cooper, 1998). Thus the decision should not be influenced by the results of any study that is included in the review (Cooper, 1998). Reviewers should be as explicit as possible about their guiding assumptions and conveying their conclusions. Without this transparency it is arguable whether the reader can accurately evaluate the validity of the conclusions (Hawker et al., 2002). The need for differentiation between study-generated and synthesis-generated conclusions within the discussion is paramount. The final threat to validity within a literature review relies on a clear statement of the findings of the review. The reporting of these findings is as important as for primary research (Cooper, 1998) if the review is to be critically evaluated. Ethical values exist in the researchers actions and should be practised within the literature review (Davies and Dodd, 2002). For the reviewer this means representing the work of others fairly and honestly and reviewing that the data itself was collected in an ethical manner (Hart, 2001). Ethical implications also include ensuring copyright protection and the appropriate citation of evidence. A statement of the findings is not always sufficient and the recommendations for professional practice should be explicit in order to make use of the review. A debate exists in the literature as to the nature of validity and reliability when reviewing qualitative research papers (Porter, 2007). Researchers argue that socially constructed research relies more on credibility and trustworthiness of 34 the data (Crotty, 1998). Rolfe (2006) contends that different methodological approaches within qualitative research must contain different approaches to validity, making it impossible to develop a universally accepted approach. As a consequence he proposes that individual studies be assessed by aesthetic judgements of the reader as opposed to traditional concepts of validity and reliability (Rolfe, 2006). Controversially, other researchers take a different stand point (Morse et al., 2002). They maintain that the introduction of parallel terminology sets qualitative research aside from mainstream science and reduces the legitimacy of the research (Porter, 2007). This would actually undermine the rigour of the research not add to it and they call for the terms validity and reliability to be maintained within qualitative research. For this review the work of Popay et al., (1998) is utilised to structure the synthesis of the research articles and their approach to theoretical and conceptual adequacy. 3.5 Critical review forms There are a variety of published tools to assess the quality of the data retrieved. These may be regarded as tools to assess the quality of the research post-hoc (Morse et al., 2002). There is a variety of tools as well as variety within the tools (Oakley, 2002), to assess the credibility of qualitative research. Sorting out untrustworthy qualitative data can be more difficult than for quantitative data, due to the variety of methodological approaches (Greenhalgh, 2006). The protocol utilised within this study is one adapted from Guidelines for Critical Review of Qualitative Studies that has been developed by McMasters University (Law et al., 1998). Within this protocol the 35 epistemological perspective of the study design, such as ethnography, grounded theory or action research have been taken into account and these assist in reviewing each study. It is argued that detailing each design distinction and describing the outcomes of their analysis strengthens the validity of the review (Cooper, 1998). Comprehensive strategies or criteria that should be included when reviewing qualitative research are outlined (Popay et al., 1998) so that reviewers can see the trustworthiness or credibility of the research. The reflexivity and subjectivity of the research and the role of the researcher undertaking the work needs to be clearly documented and accounted for, leaving an audit trail. These criteria can clearly be seen in the adapted Critical Review Form (Appendix Two) and are utilised in the synthesis of results. Thus by rethinking rigour in terms of attentiveness to the process of the research, the issues arising around validity and reliability of the literature review can be seen from a new perspective. They begin to be less of a dilemma and more a responsibility of the researcher to undertake clear, well- documented, ethical research and to justify this within the writing and dissemination of their work. This review aims to represent the review papers in an ethical manner and report evidence of good practice in terms of the review process as well as explore competing tensions within each piece of literature. 36 3.6 Rationale of a literature review for this study As a consequence of the Dearing Report (NCIHE, 1997) the QAA directed HEI?s to provide opportunities, guidance and support for the process of PDP (QAA, 2001). The personal tutor role was directed to undertake the process of PDP and student support. A review of the research literature is important in order to understand the role of the personal tutor from an educational perspective. This allows for further developments of the role for both students and personal tutors working in health and social care education. Student expectations and experiences of their personal tutor whilst in higher education may also inform future nurse education practice. The benefit to HEI?s in terms of recruitment and retention of healthcare students may also be clearer. 3.7 Summary Literature reviews are a valuable method for synthesising the primary data collection of others in order to inform practice (Parahoo, 2006). In education and the social sciences this type of research is also being utilised to inform educational policy (Pring, 2000). A literature review may also add to the understanding of human experiences (Pope and Mays, 2006). In answering the research question ?What are the key dimensions of the personal tutor role for nurse education today?? this review adds to the body of knowledge of support for student nurses by the personal tutor, across University and practice settings in a time of widening access to higher education. 37 Chapter 4 - Method 4.1 Introduction The aim of this chapter is to demonstrate the systematic process used in the synthesis of the data retrieved to answer the research question ?What are the key dimensions of the personal tutor role in nurse education today?? Tabulation of each summary (Appendix One) assisted the identification of themes and discussion of their findings. The methodological quality within the data is also explored by use of a critique tool adapted from the Guidelines for Critical Review of Qualitative Studies developed by McMasters University U.S.A. (Law et al., 1998). The success of the analysis of the data retrieved allows for the findings to be generalised to other nurse education settings. 4.2 Data sources Manual searching using non-electronic library sources provided an initial baseline of material and assisted in defining further sources. The University library was a source of key texts on the subject of personal tutoring which informed the preliminary literature review. It also helped to clarify the nature of the enquiry and its relevance to nurse education within higher education. Following this initial search for published books a mind map was made of the terms and concepts concerned with the role of the personal tutor. In this way it was possible to establish the terms linked with the existing role of the personal tutor and identify how pertinent the retrieved literature would be to the research question. 38 The next stage of the literature search was to access computerized databases. The search was carried out over a period of time from February ? April 2007 and consisted of applying key search terms to a variety of databases. These databases were selected as they have relevance either to education (Education Resources Information Centre) or relevance for nurse education (British Nursing Index). Each database has appreciable differences in the way they could be searched and the search help facilities were utilised with unfamiliar databases such as Psychological Information. Database Number of articles British Education Index 113 Education Resources Information Centre (ERIC) 81 Cumulative Index to Nursing and Allied Health Literature (CINHAL) 48 British Nursing Index (BNI) 34 Psychological Information (PsychInfo) 8 Medical Literature On-Line (Medline) through PubMed 64 Total 348 Table 2: Databases accessed The title and abstracts of papers were screened to assess their suitability for the review before being downloaded from library electronic journals catalogue or online databases. Access to educational databases produced a wealth of literature around education in primary and secondary schools, further 39 education and higher education. Within each database individual searches were recorded on search histories to allow for consistency of searching different databases. 4.3 Search terms Within each of these databases keywords or descriptors were utilised as well as the Boolean operators OR and AND but use of NOT was disregarded with these search terms. Not all databases allowed for the utilisation of Boolean operators and this may be a weakness to the search strategy. Truncation was also utilised with * to encompass singular, plurals and other end derivative endings to keywords. Key Terms Personal tutor* Or Pastoral care Or Student health and welfare Or Tutors* AND Personal tutor* Or Pastoral care Or Student health and welfare Or Tutors* OR Higher Education OR Academic support Table 3: Key Search Terms 40 4.4. Supplementary Literature Following the search of online databases further educational databases were searched. The Higher Education Academy database was accessed on-line for current research. This yielded one article for inclusion in the review undertaken in Further Education and two further research articles. Three articles from the Conference proceedings from the Higher Education Academy Conference on Personal Tutoring 2006 were retrieved as grey literature to be included in the discussion. The British Educational Research Association (BERA) database was also searched. This proved to be disappointing in terms of the search keywords and no further articles were retrieved. Following this the database for unpublished research and conference papers at Leeds University was accessed online at www.leeds.ac.uk/educol/documents. A conference paper delivered in December 2005 at the Research into Higher Education Conference in Edinburgh discussing students perceptions of learning support at Kingston University was retrieved. The search was concluded when saturation point had been found and the searches were yielding repeated articles but no new material. 4.5 Inclusion/Exclusion Criteria The inclusion criteria were expanded from the initial search to include the education of other professionals in health and social care. This allowed for inclusion in the sample of key texts from medical education. Also a manual 41 search of research in education literature was undertaken, which yielded a key study from a Masters in Pharmacy course to be included in the review. The search was limited to articles after 1996. This did exclude one key review undertaken in 1994 from a nurse teacher perspective on the move of nursing into Higher Education. Inclusion Exclusion Primary research Tutorials for Enquiry Based learning Professional education in health and social care Tutoring in schools Further education Peer tutoring Articles in English Distance learning/online learning Research articles after 1996 Spiritual care of patients by the Priesthood or Ministry Research articles prior to 1996 Table 4: Inclusion and Exclusion Criteria 4.6 Data synthesis A total of 348 articles and books were identified through the literature search. On screening the literature, some of the articles were excluded as they did not apply directly to the research question but have been retained as grey literature to support further discussion. By applying the inclusion and exclusion criteria identified above the number was reduced to the seventeen articles included in this review. This is a collection of the best available evidence to answer the review question. 42 The studies were also critiqued for methodological quality by adapting a critical review proforma from the Guidelines for Critical Reviews developed by McMasters University U.S.A. (Law et al., 1998). The proforma for qualitative review was adapted to explicitly include criteria on methodological quality (Popay et al., 1998). These include the epistemological basis of the research, flexibility of design, evidence of purposive sampling, adequate description and quality of the data with evidence of theoretical conclusions to the work. The proforma for quantitative research was adapted for used with the triangulation of data in the research paper by Malik (2000). The success of the authors in answering their research question and the appropriateness of their conclusions bears some weight as to whether the findings can be generalised across other University settings and nurse education domains. A summary of the critique of the seventeen papers is included in Appendix One. 4.7 Summary The literature for this review was obtained following a systematic process and documenting the search strategy carefully. A research critique of each study was undertaken using a review proforma accessed on-line and adapted to be relevant for this review (Appendix Two). A summary of the seventeen articles is presented in Appendix One. A synthesis of these critiques is presented in the synthesis of results and further analysis of the consistent themes across the studies found in the discussion chapter. 43 Chapter 5 - Synthesis of Results 5.1 Introduction In order to answer the research question ?What are the key dimensions of the personal tutor role for nurse education today?? it is necessary to examine the underpinning epistemology and theoretical perspectives (Hart, 2001) within the seventeen selected research papers. The final seventeen articles selected fall both within interpretivist and positivist paradigms. In the qualitative studies selected the reflexivity of the researcher and the relationship between the researcher and respondent is considered to be a strength of the research process, not a bias (Denzin and Lincoln, 2003). This gives thick, rich descriptive data pertaining to student and lecturers? experiences of personal tutoring. The researchers have all looked for meaning from their respondents as to their perceptions and experience of personal tutoring. Meaningful explanations help understanding of experiences and encounters between students and their personal tutors and give value to the participants? subjective knowledge. Triangulation of methods of data collection from both qualitative and quantitative paradigms are utilised in one paper (Malik, 2000). Conclusions of whether these experiences of personal tutoring can be generalised across other contexts or utilised in educational policy may then be made. This chapter utilises criteria (Popay et al., 1998) to synthesis the methodological quality of the seventeen articles used in the review. These criteria are evident in the Critical Review Form (Appendix Two) and a summary of each critique is presented in Appendix One. 44 5.2 Epistemology ? The primary marker The first category, called the primary marker, details whether the researcher has paid attention to the nature of the knowledge that informs the research. This also includes the philosophical approach of the researcher. The epistemological approach of constructivism requires that meaning comes from the researchers engagement with the realities in the world (Crotty, 1998) and meaning is thus constructed from the research participants views. Whilst no researcher specifically stated an interpretivist approach, Richardson (1998; 615), acknowledged that her ?positivist-orientated, Anglo-Saxon values? had been challenged by personal and professional experiences to value the more humanistic, interpretative approach adopted within the research. Owen (2002; 11) discusses the value of allowing respondents to speak and to not ?squeeze complex social situations? into boxes that have been pre-coded, thus valuing the construction of meaning from the students interviewed. Dobinson-Harrington (2006) includes in her aim that the research is a means of gaining insight into the process of the tutor role and understanding from the tutees? and tutor perspective in the context of nurse education. This research paper explores the knowledge gained by the students and lecturers of experiencing personal tutoring and constructs knowledge from their understanding of the experience. Knowledge being generated around what was important to the students led to the research being qualitative in nature (Drew, 2001). The inter-cultural tutor-student relationship is explored from a tutor perspective, that again although not explicitly stated, explores 45 understanding from an interpretivist perspective (Koskinen and Tossavainen, 2003). The rest of the papers do not explicitly discuss the epistemological approaches. Emphasis however has been given to the interpretation of meanings as expressed by the participants. Evaluation of restructured personal tutor support systems as experienced by the students and tutors is explored in five papers (Connell, 2006; Ellis et al., 2006; Malik, 2000; Owen, 2002; Sayer et al., 2002) to generate knowledge derived from the experience. In social science research this connection from epistemology to research design may be implicit or simply not acknowledged (Pope and Mays, 2000). Where the research is of an applied nature the need for a theoretical perspective to drive the research is lessened (Hixenbaugh et al., 2006). 5.3 Adaptive and responsive research design Those papers identified that have discussed their approach to gathering knowledge around the personal tutor have also been explicit in stating the design of the research. Three papers utilise a grounded theory approach (Drew, 2001; Richardson, 1998; Wilcox et al., 2005). They show evidence of developing hypothesis and theory from the data collected through induction, which can later be verified by further observation and deduction (Cohen and Manion, 1994). This allows for the researchers to develop rich data with thick description, but may be criticised for its design of focusing on the early development of analysis and emerging themes (Denzin and Lincoln, 2003). A constant comparative method of data analysis is utilised within grounded theory (Denzin and Lincoln, 2003) 46 to analyse interview transcripts and this is evident (Wilcox et al., 2005). Richardson (1998; 616) does not purport to utilise grounded theory in its entirety, but to utilise document analysis and semi-structured interviews as methods of creating a ?theory of action as it is experienced? through the participants. Phenomenology is used to search for meaning within personal tutor encounters and gain insight into the roles and responsibilities of the tutee and tutor in nurse education (Dobinson-Harrington, 2006). This work can be criticised for not differentiating between the early interpretive approaches of Hursserl to the later Hiedeggerian approach to understanding how the respondents? past influences their perception of events (Silverman, 2005). The work does give thick descriptions from the participants, allowing for discussion and interpretation. An ethnographic approach is utilised to understand the participant?s behaviour in the social and cultural context (Koskinen and Tossavainen, 2003). The authors do not specify the use of ethnography until data analysis, using Spradley?s (1980) developmental research sequence to determine parts and relationships between different parts of the data. By utilising this approach they reach understanding of the nurses? beliefs, motivations and behaviour to personal tutoring. This piece of research is of a high quality and meets all the demands of the criteria (Popay et al., 1998). 47 One paper conducts the research in the spirit of action research (Owen, 2002). With action research the emphasis is on the action and research methods, combining research and practice (Parahoo, 2006). Collaboration between researcher and practitioner through the research cycle enables any outcomes to be put into practice (Silverman, 2005) and is a strength of this work. A case study of the Humanities Faculty is identified but further consideration of the type of case: what is common and what is particular about the case (Denzin and Lincoln, 2003), is not explored. The work is rich in description and illuminates the meaning people bring to the phenomena as well as preserving complexities of human behaviour (Greenhalgh and Taylor, 1997). One paper undertakes an exploratory study using a qualitative approach as outlined by Denzin and Lincoln (1998) but does not qualify the design of the study further (Rhodes and Jinks, 2005). A major weakness with this study is the identification of method over design. The method was selected ?as it suited the purpose of the study? (Rhodes & Jinks, 2005; 391) rather than to allow the epistemology and design of the study to influence the methods used. The five papers evaluating a personal tutorial system (Connell, 2006; Ellis et al., 2006; Malik, 2000; Owen, 2002; Sayer et al., 2002) also move from epistemology to method without elaborating on a design to their study. A further paper discusses the use of an interpretive, deductive approach (Ellis et al., 2006). In summary, the strength of the papers can be seen from the knowledge that informs the basis of the study and the approach to data collection. Three papers, (Hart, 1996; Hartwell and Farbrother, 2006; Hixenbaugh et al., 2006) 48 do not address the epistemological approach and research design. This may be seen as a weakness of these research papers and undermines their use in informing educational theory and practice. 5.4 Purposeful sampling An important aspect when considering the quality of the research is to explore the sampling technique carried out by the researchers. The number and characteristics of the respondents taking part in the study naturally follows from the epistemological stance and the design employed by the researcher (Popay et al., 1998). The most common form of sampling found in qualitative studies takes the form of a non-probability, purposive or purposeful sampling (Parahoo, 2006). The samples in the research papers have deliberately been chosen by the researcher on the basis that these are the best available people to provide data on personal tutoring. Three papers select only tutors as being the sample from which data is gathered about the personal tutor experience (Easton and Van Laar, 1995; Ellis et al., 2006; Rhodes and Jinks, 2005). Acknowledgement is made that the construction of the focus groups was considered to be representative of all staff groups (Ellis et al., 2006). One paper selected tutors and student counsellors from whom to collect data (Hart, 1996) and another utilised students, tutors and Heads of Department to gather data evaluating the personal tutor system (Connell, 2006). A further paper collected data from students, tutors and educational managers (Richardson, 1998). The direct relationship between the epistemology, design and sample can be seen in this study. The sample was made up of four 49 students and when further data was required four more students were added to the study. Clearly following an ethnographic approach to sampling is a strong point of this paper. Five papers only included students in their sample (Drew, 2001; Hartwell and Farbrother, 2006; Owen, 2002; Sosabowski et al., 2003; Wilcox et al., 2005). The remaining eight studies took both tutors and students into their sample size, often using a mixed method of data collection. The knowledge generated from these groups of respondents allows for a deep understanding of the structure and process of personal tutoring as they experienced it. 5.5 Ethical approval Inclusion of how the researchers obtained ethical approval is one of importance. Ethical dilemmas may present during the collection or interpretation of the data (Polit and Beck, 2008), especially when working within the qualitative paradigm. Only four of the seventeen pieces of research explicitly discussed details of application for ethical approval. Two papers gained consent for their research from the Universities ethical committee (Dobinson-Harrington, 2006; Newton and Smith, 1998). Two papers gained ethical consent from the University and hospital or community where the data collection took place (Koskinen and Tossavainen, 2003; Rhodes and Jinks, 2005). All of these papers and a further paper (Richardson, 1998) discuss gaining informed consent from the respondents and the guarantee of anonymity and right to privacy (Denzin and Lincoln, 1998) within the finished research article. The rich and detailed character of 50 qualitative research means the researcher has close engagement with subjects (Silverman, 2005) and therefore not to gain ethical approval or informed consent must be seen as an inherent weakness in the rest of the papers (Charmaz, 2004). All Universities and NHS Trusts have ethical bodies or committees from which to seek approval, providing confidentiality and safety for the sample population (Polit and Beck, 2008). 5.6 Adequate description The authors that followed a systematic approach to the research process also have evidence of in-depth descriptions of the experience of personal tutoring (Dobinson-Harrington, 2006; Drew, 2001; Koskinen and Tossavainen, 2003; Owen, 2002; Rhodes and Jinks, 2005; Richardson, 1998; Wilcox et al., 2005). Evidence of detailed description is a mark of quality of the research (Popay et al., 1998). The description should include context and evidence concerning the experience of personal tutoring as a quality process. Triangulation of data collection is evident from a mixed method approach of interviews, a focus group, free-text passages in a survey and email communications to ten student representatives (Malik, 2000). Direct quotation from text passages is used to illustrate the student?s view of the personal tutor (Koskinen and Tossavainen, 2003; Newton and Smith, 1998). This thick description (Denzin and Lincoln, 2003) allows for interpretation of meaning from the personal tutor encounters. The final discussion then interprets the respondents? replies in order to reveal the importance of the personal tutor role and find meaning in the encounters (Owen, 2002; Wilcox et al., 2005), for students, personal tutors and for the benefit of the University as a whole. 51 5.7 Data quality ? sources of knowledge The evidence of data quality depends on whether the researcher has used a variety of data collection methods around the same issue (Popay et al., 1998). The nature of the researcher?s involvement in the whole process of the research should also be evident. Thus the methods of data collection chosen should reflect the epistemology, the research design and the role of the researcher. Qualitative research is enhanced by the reflexivity of the researcher (Pope and Mays, 2006). Three main methods of data collection utilised in the papers are face-to-face interviews, focus groups and participant observation. 5.7.1 Interviews Nine authors utilise 1:1 interviews as their data collection method and six utilise focus group interviews. Dobinson-Harrington (2006) conducted private audio taped interviews using a system of laddered questions to lead students through actions, knowledge, feelings, attitudes and values. This led the students through the least invasive questions first, through to a deeper understanding of the personal tutor encounters. The presence of the interviewer can introduce bias by the respondents giving socially desirable answers or moulding their answers to fit the occasion (Parahoo, 2006). Personal characteristics of the interviewer can all affect the interview (Popay et al., 1998) and the author does not elaborate on these factors. Hart (1996) utilises semi-structured interviews with tutorial staff to collect information on the range of skills used in personal tutoring in order to develop a 52 questionnaire. The results of the interviews were analysed in terms of common skills/behaviours and then formulated into a topic guide for the questionnaire. This makes the interview more focused than a semi-structured interview (Charmaz, 2004). One paper utilises semi-structured interviews to obtain the view of staff on tutor support to first year students (Hartwell and Farbrother, 2006). As a member of faculty the researcher does not elaborate on her relationship with the staff members and biases introduced by this relationship are not discussed. In contrast, Hixenbaugh et al., (2006) reduces bias by utilising two independent interviewers who encouraged free and confidential contributions. Acknowledgement is made that in-depth interviews would give a more valuable representation of the value as to the personal tutorial (Owen, 2002). Another study used an interview schedule that utilised a topic list approach, selected from the literature reviewed (Rhodes and Jinks, 2005) thus ensuring a semi-structured approach. The researcher acknowledged that she knew the participants and took measures to ensure confidentiality. The ethical dilemma of interviewing participant students who are allocated to the tutors? link areas are discussed (Rhodes and Jinks, 2005). One question was asked twice in different ways to try to test the reliability of the schedule, suggesting that this was little more than a questionnaire delivered personally. They discuss the ability to send transcripts to the interviewees, with freedom for them to amend or delete part of the interview, or dictate what evidence is utilised as data. Thus researcher bias is acknowledged and minimised (Parahoo, 2006). In a 53 grounded theory study, qualitative interviews lasting one hour were carried out using an interview guide (Wilcox et al., 2005). Students were asked to narrate their experiences with specific time frames, such as their first day or their first week. Only one study (Ellis et al., 2006) introduced interview technique training for the researchers to enhance the reliability of the interview process (Parahoo, 2006). In summary, the difficulties that arise from using interviews to collect data can be seen in these research papers In order to obtain the opinion of the respondents an open structure to the interview guide allows for students? opinions to be captured (Wilcox et al., 2005). Researcher bias should be acknowledged and minimised. Before undertaking this method further training in interview techniques is necessary and this should be included in the research process (Pope and Mays, 2006). 5.7.2 Surveys Six papers utilise surveys to collect data (Connell, 2006; Easton and Van Laar, 1995; Hixenbaugh et al., 2006; Newton and Smith, 1998; Sayer et al., 2002; Sosabowski et al., 2003). All include free-text answers within the survey as well as descriptive statistics and frequency to collate their results. Descriptive statistics use a numerical analysis to count the number of times a value appears in the data (Parahoo, 2006) in terms of sample size or responses to questions. They are not for statistical analysis or correlation and no inferences can be drawn from them. Descriptive statistics are used to support qualitative research by carefully documenting the research process 54 (Hixenbaugh et al., 2006) and to report frequency in terms of percentages (Sosabowski et al., 2003) and in terms of total numbers (Maltby et al., 2007). 5.7.3 Focus group interviews Six papers utilised focus group interviews either as the method of choice or to gain a picture of the personal tutor encounters from an alternative perspective (Drew, 2001; Ellis et al., 2006; Hartwell and Farbrother, 2006; Hixenbaugh et al., 2006; Malik, 2000; Owen, 2002). Strengths of focus group discussions are that meaning is revealed into the discussion topic (Parahoo, 2006). Focus groups generate evidence of diversity and difference, either in the groups or between groups, so a wide variety of issues are represented (Pope and Mays, 2006). Themes common to all groups and where individual group comments differed these were highlighted (Ellis et al., 2006). Confidentiality of the data was to each group and therefore comparisons between groups were not explored. Focus groups were used as a way to develop sections in the questionnaire but discussion of the retrieval of data was limited. A focus group was used as a means of triangulation in two studies (Malik, 2000; Owen, 2002). The main difficulty faced by researchers utilising the method of focus group interviews is representation of the data to reflect individual speakers and differentiation between opposing statements of speakers (Flick, 2006). In all six papers utilising this method none of the difficulties attached to utilising and managing focus groups were discussed and none of the papers discussed how data was documented and organised. These are significant omissions from the papers and detract from the trustworthiness of their findings. 55 5.7.4 Participant observation Two studies utilise participant observation for their data collection method. In a grounded theory study (Koskinen and Tossavainen, 2003) the epistemology and design of the research is linked to the methodology and methods of data collection. Participant observation data analysis is undertaken using research sequencing (Spradley, 1980). Participant observation is the method of choice in ethnographic studies and this paper utilises this approach to see things from the subject viewpoint and look for patterns in the behaviour and thoughts of the participants, comparing one to the other (Polit and Beck, 2008). The main limitation of using participant observation comes from the selection of observation that is undertaken (Pope and Mays, 2006). The researchers attended all fourteen tutorials across a range of practice settings demonstrating the nine dimensions of the purpose of observation (Polit and Beck, 2008). Important details of the tutor-student relationship that could be taken for granted were captured. Field notes were transcribed within 24 hours and a diary of personal observations and feelings was kept throughout. This attention to the methodology and underpinning nature of the knowledge generated makes this research the strongest piece within this review. In contrast, the other study purported to utilise observation sessions (Owen, 2002), did not detail evidence of the observations or how the data was produced from these observation sessions. 56 5.7.5 Document analysis Document analysis as a method consistent with grounded theory design was used in one study (Richardson, 1998). College documents were analysed for words and phrases consistent with the personal tutor role, which uncovered two meanings; meeting academic criteria through competence and facilitation roles. The researcher does not give further detail on which measurements were applied to characterise and compare these documents, or if course validation documents were the only documents used. 5.8 Analysis and interpretation of meaning Description provides important information about the topic and should allow for interpretation of meaning by the researcher, giving interpretive validity (Popay et al., 1998). The authors that followed a systematic approach to the research process (Dobinson-Harrington, 2006; Drew, 2001; Koskinen and Tossavainen, 2003; Owen, 2002; Rhodes and Jinks, 2005; Richardson, 1998; Wilcox et al., 2005) all provide detailed descriptions of the context and experience of students and personal tutors which is termed thick description (Denzin and Lincoln, 1998). The intention and meaning of the power of first impressions (Dobinson-Harrington, 2006) has pertinent student statements giving both positive and negative examples of their first impressions of personal tutors. Where triangulation of data collection has been used (Malik, 2000) the researcher presents tables of quotations to support inferential statistics. This is a strong research paper with evidence from both qualitative and quantitative paradigms. Detailed descriptions of inter-cultural sensitivities within human interactions are presented (Koskinen and Tossavainen, 2003), 57 allowing for the significance of culture to the tutor-student relationship to be explored. 5.9 Generalisability The extent to which findings can be generalised to other situations is termed ?assessing for typicality? (Popay et al., 1998; 348). The extent to which inferences can be made to other Universities can only be made where there are links to other bodies of knowledge. Richardson (1998) links the understanding of tacit knowledge (Polanyi, 1958) to the experience of personal tutors undertaking personal tuition their own way and developing practice based evidence from personal theory. Rhodes & Jinks (2005) linked their findings of good and poor students from interviewing lecturers, to the work of the Unpopular Patient (Stockwell, 1972). These two pieces of research have strong links to other bodies of knowledge, increasing the trustworthiness of their findings. Where sampling techniques are adequately described the findings may then be transferable to other situations (Charmaz, 2004). Six papers (Connell, 2006; Drew, 2001; Ellis et al., 2006; Malik, 2000; Sayer et al., 2002; Sosabowski et al., 2003) all described the number of students taken from different level of learning. Stratified sampling in qualitative research is also a way to ensure that a representative range is achieved (Pope and Mays, 2000). 58 5.10 Quantitative analysis Triangulation of data collection methods across qualitative and quantitative paradigms is used in only one paper (Malik, 2000). This triangulation of methods is often used to cross-validate findings from different approaches. However, Cresswell (1994) disagrees with the practice of triangulation to support validity as the conflict in paradigms can produce similar, inconsistent or divergent results and hence inconsistency appears as to which result should then take precedent. Mallik (2002) utilises the combined methods to appreciate the context and nature of personal tutoring. Inferential statistics are utilised to establish that relationships exist between variables (Maltby et al., 2007). Calculation of p may be influenced by sample size (Thompson, 1994) with smaller samples being less representative of populations. A sample of 139 students and 19 tutor questionnaires were returned (Malik, 2000). On applying SPSS to the analysis with Pearson chi-squared correlation, Mallik?s (2002) findings were found to be of statistical significance. A P value of 0.0004 indicating whether meetings with a personal tutor were held termly or monthly was of great significance. A low success rate of the personal tutor system was associated with not having met their tutor within the previous 10 weeks (P= 0.002). A high student success rating was associated with regular, frequent meetings and being actively sought by tutors for follow-up meetings was found to be highly significant (P=0.0004). A high response rate of 96.5% indicated the depth of student feelings as compared to the 67% for tutors. Linking these findings to the qualitative data collected allowed for student perceptions of their relationship with their personal tutor to be explored. The 59 context of why students failed to follow up contact with their personal tutor (Malik, 2000) was also explored. 5.11 Relevance to practice or educational policy Finally, it is significant to ascertain the importance of the research to practice or policy development. The relevance of the research to the different stakeholders in education (Thomas and Pring, 2004) add to its? utility in guiding decisions made about student learning and integration into University life. The skills and training needs of lecturers for the role can be examined and the overall value of the resources used to maintain and develop the personal tutor system can be evaluated. As a result of their research, policy and practice around personal tutoring in one University was improved to establish a more positive student experience (Hartwell and Farbrother, 2006). Codes of practice and guidelines on personal tutoring emerged to enhance this delivery (Hixenbaugh et al., 2006). The five papers that provide an evaluation of a personal tutorial system (Connell, 2006; Ellis et al., 2006; Malik, 2000; Owen, 2002; Sayer et al., 2002) all recommend training and sharing best practice for lecturers undertaking the role of personal tutor. 5.12 Summary Analysis of the methodological approaches in the seventeen studies selected for this review has revealed a variable quality. The epistemological approach of the research was explicit in few papers (Dobinson-Harrington, 2006; Drew, 2001; Koskinen and Tossavainen, 2003; Richardson, 1998; Wilcox et al., 2005). Attention to detail when reporting sampling technique has been 60 maintained in more papers (Hixenbaugh et al., 2006; Newton and Smith, 1998; Rhodes and Jinks, 2005). Evidence of discussion and interpretation of meaning has been robust (Ellis et al., 2006; Owen, 2002). Triangulation was used infrequently (Malik, 2000), but where it was utilised it added clarity and focus to the context of the personal tutor relationship with students. Study designs were limited in breadth and this may reduce the overall strength of the review. Papers that used clear methodological processes and papers evaluating the role of the personal tutor provided trustworthy data that may be generalised to other Universities. 61 Chapter 6 - Analysis 6.1 Introduction Following the detailed exploration of the quality of the research undertaken in these seventeen papers, this chapter will undertake an exploration of the common themes. Thematic analysis of the papers allowed for the words and sentences to be clustered to form the emerging themes. These are also displayed on a mind map (Appendix Three). 6.2 Emerging themes From the reviewed studies it is possible to clearly demonstrate three emerging meta-themes: Demonstration of a relationship, Maximizing learning and Recognition of a professional role. These three meta-themes are divided into sub-themes as can be seen in Table Five. The papers are arranged in alphabetical order. 62 Meta Themes Demonstration of a Relationship Maximising Learning Recognition of a Professional Role Sub Themes P er so na l S up er -v is io n C ur ri cu lu m Is su es C on fid en tia lly A ss es sm en t P ra ct ic e Is su es E m pl oy ab ili ty S ta ff D ev el op m en t a nd Tr ai ni ng C en tr al S up po rt S er vi ce s W or kl oa d C od e of P ra ct ic e Connell R.A. (2006) ? ? ? ? Dobinson- Harrington A. (2006) ? ? ? ? Drew S. (2001) ? ? ? ? ? ? ? Easton S. & Van Laar D. (1995) ? ? ? Ellis J. S. et al., (2006) ? ? ? ? ? Hart, N. (1996) ? ? ? Hartwell, H & Farbrother C. (2006) ? ? ? ? ? Hixenbaugh P. et al., (2006) ? ? ? Koskinen L. & Tossavainen K. (2003) ? ? ? ? ? Malik S. (2000) ? ? P e r C u C o A P r E m S t C C 63 Newton A. & Smith L.N. (1998) ? ? ? ? Owen M. (2002) ? ? ? Rhodes S. & Jinks A. (2005) ? ? ? ? ? ? ? Richardson R (1998) ? ? Sayer M. et al., (2002) ? ? ? ? Sosabowski, M. H. et al., (2003) ? ? ? ? Wilcox P. et el., (2005) ? ? Table 5: Analysis of themes In order to identify themes from the literature the data has to be broken up into parts (Parahoo, 2006). Individual words constitute an easy unit to work with and these may be clustered together based on similarity. As in content analysis (Polit and Beck, 2008) the content of the narrative data was analysed to identify prominent themes and patterns among the themes. Clustering of words and sentences allowed for the emergence of nine sub-themes but 64 naming and coding of units was not undertaken. On further analysis the emergence of over-arching or meta-themes became apparent within the framework. A mind map of the themes was undertaken (Appendix Three). Personal supervision, curriculum issues and confidentiality were linked to the meta-theme of demonstration of a relationship between the personal tutor and the student. This revealed how the tutorial relationship was initiated, developed and maintained and how it could be influenced by decisions taken in the running and organisation of the curriculum. The meaning of pastoral care is explored through a relationship of personal supervision and the ability to form a relationship with a personal tutor before a crisis point arises is a key feature to this relationship. Student expectations of the personal tutor role are considered very low and not linked to an understanding of curriculum issues such as development of key skills, portfolios and undertaking reflection. Issues of confidentiality arise when personal issues may need to be divulged to others within the University, or if the personal tutor can represent individual students to the appropriate committees and bodies within the institution. The benefit to the University in terms of retention of students is also highlighted. The second theme of maximizing student learning is evident within the selected papers. The dilemma exists as to whether the personal tutor is a facilitative role, enabling personal and professional development, or by introducing summative assessment into the encounters the relationship is changed. Five papers explore the possibilities of sustaining a personal tutor- student relationship throughout the three years, or whether it is beneficial to 65 sustain the relationship from theory into the practice arena. Surprisingly only two papers explore long-term outcomes of the personal tutor relationship as being of benefit either from further education to higher education or from higher education to employment. The third theme to emerge is the recognition of the personal tutor as a professional role. Lecturers noted the increase in workload as a personal tutor and that not all lecturers were undertaking this role. Some considered that not all lecturers were capable of the personal tutor role and that high quality personal tutoring should be recognised and remunerated. The identification of further training for the personal tutor role and support needs in terms of protected time is highlighted as being of central importance. The significance of published guidance on the personal tutor role was seen to be of value to both students and personal tutors in managing expectations of student support. The ability to refer students to further support services through the University was also highlighted as essential. As seen from Table Five the analysis of themes, these papers represent a comprehensive view of the personal tutor system as students and tutors in higher education presently experience it. The pertinence of these papers specifically to nurse education and the development of the personal tutor system both on campus and in nursing practice needs further analysis and discussion. 6.3 Summary 66 This chapter has recognised the emerging themes from the seventeen papers included in this review to answer the research question ?What are the key dimensions of the personal tutor role for nurse education today?? The meta- themes and sub-themes will be explored in greater depth in the following discussion chapter, in light of the background literature. 67 Chapter 7 ? Discussion 7.1 Introduction The seventeen studies included in this review give a comprehensive account of the personal tutor role as experienced within further and higher education. This chapter will explore the themes identified within those studies to answer the research question ?What are the key dimensions of the personal tutor role for nurse education today?? The three main themes from the analysis for discussion are: Demonstration of a Relationship; Maximising Learning; Recognition of a Professional Role and each of these incorporate sub themes as demonstrated in Table Five. 7.2. Demonstration of a Relationship 7.2.1 Personal Supervision The notion of pastoral care as based on the Oxford model has been outlined (Earwalker, 1992), however the intervening years have seen a large expansion in higher education and a questioning of the pastoral care system. The nomenclature of personal tutor implies that the tutor shows some personal interest in the individual student. Owen (2002) found there was dissonance between student and staff frame of reference for the personal tutor role. Students in the study perceived inequality in accessing their personal tutor and inequity of support given. Some staff members were fearful of being overwhelmed, with no training, guidance or reference points in providing pastoral care. This work utilises an action research approach and reflexivity of the researcher is evident. Weaknesses within the work lie with 68 the data analysis. The work is rich in description leading to a meaningful picture emerging from the data (Parahoo, 2006). i) Induction The personal tutor role was found to begin at the process of induction into higher education. By establishing timetabled sessions with a personal tutor in a formal induction week the students gained insight into course expectations (Connell, 2006). Sessions were planned to include academic development and focus on University life. This gave the students a personal commitment within the University and introduced academic development. It was also the beginning of a relationship between student and tutor that could be drawn on in subsequent years. By creating focus at each academic level (Connell, 2006) ? academic and personal, academic and professional and academic and student choice ? the tutorial time was utilised more effectively by both student and staff. This removed the luck of the draw allocation of personal tutors (Dobinson-Harrington, 2006; Sayer et al., 2002) and gave guidance to tutors to instigate supportive dialogue with students (Koskinen and Tossavainen, 2003). If this process was begun in further education (Connell, 2006), then the learner?s journey into higher education would also be eased. Utilising a diverse sample of students, tutors and Heads of Department (Connell, 2006) can be seen as a strength of this work, but the lack of procedural rigour with which the data was collected makes it difficult to rely on its trustworthiness. In contrast, Dobinson-Harrington (2006) utilised a phenomenological approach to evaluate students? and tutors? perceptions of the personal tutor encounters. The robustness of this research is evident in 69 the epistemology, data collection to data analysis and this adds credibility to the findings. ii) Classroom contact Timetabled classroom sessions gave students some security (Drew, 2001) and this allowed first year students to experience the tutor in a safe group experience before moving to an individual one (Wilcox et al., 2005). Experiencing personal tutors as being approachable and supportive helped students gain in confidence (Hixenbaugh et al., 2006) and decreased the need for contact in the second year. Richardson (1998) found the role of personal tutor as one who could be there and help with the reality of being a student nurse. The use of a grounded theory approach (Richardson, 1998; Wilcox et al., 2005) allowed for a constant comparative method of data analysis to be undertaken (Polit and Beck, 2008). Richardson (1998) studied four students and following data analysis expanded to four more students and four teachers. This utilised a grounded theory approach to sampling technique but is considered a small sample size (Polit and Beck, 2008). The larger sample of 34 students (Wilcox et al., 2005) is considered to meet grounded theory sampling techniques (Polit and Beck, 2008). The results of both these studies are considered robust and the findings contribute to theory development and future research. Responsibility for making and maintaining contact was found to be problematic. Students who made minimal effort to contact their personal tutor and had not met them within the last ten weeks were indicative of a failure in 70 the personal tutor system. Three papers recommended enforced, timetabled meetings so that the support became enabling to students (Hixenbaugh et al., 2006; Malik, 2000; Owen, 2002). In contrast, some students expressed the personal tutor encounters as being bureaucratic (Sosabowski et al., 2003) rather than demonstrating a genuine interest in the student or their learning. Timetabling the events to happen did not always make them a learning experience. One paper monitored attendance at personal tutorials (Malik, 2000) and found a degree of non contact, despite whether students were doing well or not. Students often made minimal effort to obtain tutorial support (Malik, 2000; Owen, 2002) and recommendations included that tutors should actively seek out non attending students. Triangulation of data collection methods increased the reliability within this study (Malik, 2000). Respondent validation was obtained (Malik, 2000) by feedback of the results to the original focus groups, thus increasing trustworthiness of the data. A weakness identified in both these studies is the lack of ethical approval and informed consent by the participants. One paper evaluated a very different approach to personal tutoring (Sayer et al., 2002). A pastoral pool of personal tutors was allocated to students that were not dependent on a tutor/ tutee pairing or academic progress. The uptake of personal tutor encounters was low at 2.7-5.3% and the limitations of student self-referral were acknowledged. This research appears completely contradictory to the notion of establishing a relationship with a tutor within the curriculum. A broad, purposive sampling technique was utilised allowing for 71 variation in perspectives and views but ethical approval or informed consent from the participants was not evident. iii) Establishing a relationship One conclusion that may be drawn is that the single most important factor to the success of the personal tutor role is the establishment of a relationship with a personal tutor at the beginning of the course and its maintenance throughout the curriculum. However, a note of caution was issued when accepting the development of a relationship (Bowers, 2006). Entering a social relationship with the student as suggested in earlier work (Earwalker, 1992) may be hazardous for academics, giving the message to students that they are available at any time. Technology in the form of mobile phones and emails can make lecturers accessible twenty-four hours a day. Students feel they have access to their personal tutor more readily and students in distress may make significant demands of lecturers, some of who may be anxious themselves as a result of being confronted with difficult or stressful situations. (Easton and Van Laar, 1995) Aspiring professionals are now seeking learning that is more flexible and fits into busy work and domestic life and the development of learning in a Virtual Learning Environment is gaining prominence (Salmon, 2002). This requires a shift in the pedagogic delivery of information away from lecturer-seminar format to the development of the individual via an online environment. Tutors are being required to demonstrate the building of tutorial relationships online (McNeill and Fawkes, 2006). A limitation to this review therefore, is that the 72 papers focus on delivering the personal tutor system without the use of modern technology via mobile phones, emails and a Virtual Learning Environment now utilised by Universities, or by using developing technology of podcasts or blogs. 7.2.2 Curriculum Issues i) Curriculum knowledge The introduction of PDP was seen to link the academic development part of the role with the student?s own personal development and learning through the use of Portfolios (NCIHE, 1997). Evidence of learning and development of key skills was documented and reviewed by the personal tutor. This gave the personal tutor a responsibility to understand the curriculum and course of their personal tutees. Evidence of difficulties arose if the personal tutor did not understand the whole curriculum (Malik, 2000) and was unable to guide students through their difficulties. Tutors were expected to provide informational and appraisive support (Wilcox et al., 2005). Students expected personal tutors to be able to give information on examinations and regulations (Sosabowski et al., 2003) and those tutors who performed this function were deemed to work in an excellent rather than merely competent manner. ii) Cultural issues Students who engaged in intercultural personal tutoring were dependent on others for feedback (Koskinen and Tossavainen, 2003) and a smaller group size facilitated this process. Arguably in higher education, due to increased diversity and widening participation (Department for Education and Skills, 73 2003), all tutorial encounters have an intercultural perspective. This ethnographic research is a robust study of the personal tutor relationship from a tutor perspective. Triangulation of data collection methods using interviews, participant observation, field notes and diary entries contributed to the trustworthiness of the findings (Polit and Beck, 2008). Data collection and analysis using a twelve step sequence (Spradley, 1980) focused on the meaning of terms (and symbols) used within a culture. Further analysis for interrelationships and comparative relationships (Polit and Beck, 2008) allowed for three themes of cultural shock, tutor-student relationships and intercultural sensitivities to emerge. Pastoral aspects were found to be particularly important in intercultural tutoring and learning, in order to become interculturally sensitive. The reflexivity of the researcher added to the credibility of the research (Polit and Beck, 2008) and there was careful deliberation of the role and biases of the researchers. iii) Reflection Professional development also included the utilisation of reflection as a personal development tool to be incorporated in PDP (Department for Education and Skills, 2003). Students found reflection difficult (Ellis et al., 2006; Rolfe, 2002), but early introduction to reflection facilitated student learning of reflective processes and strategies for incorporating them into professional development. This led to students being more independent (Dobinson-Harrington, 2006) and more able to problem-solve for themselves (Connell, 2006). Reflection is an important part of a non-hands on approach utilised by nurse teachers in practice (Newton and Smith, 1998). Tutorials and 74 discussion held in the practice placement areas used reflection as a means of helping students to learn from their experiences (Rolfe, 2002); formulating theories, testing and modifying these according to the practice situation. Personal development is actively taking place and links to the significance of personal theory in practice (Newton and Smith, 1998). A theoretical perspective is absent from this work, although ethical approval and consent from all participants was obtained. There was no evidence of strategies to ensure the trustworthiness of the data and therefore although the findings of this research relate to the role of the personal tutor within the practice placement they are not as credible as in other papers (Richardson, 1998). Further evidence of how personal tutors can broaden the focus of reflection for students to incorporate personal and professional problem solving into the PDP is needed. 7.2.3 Confidentiality A further theme highlighted in this review is the issue of confidentiality. There are two elements to confidentiality within the personal tutor role (Rhodes and Jinks, 2005); one of disclosure of practice placement issues and secondly, disclosure of personal problems to their tutor. Students felt it was legitimate to discuss poor practice of fellow students or clinicians with their personal tutors and take no responsibility for this disclosure themselves. Tutors needed to remind students that they had a responsibility for action on anything that might jeopardise patient care or other student?s health and well-being. 75 Guaranteed confidentiality of personal issues was given top priority in a list of terms presented to the students (Sayer et al., 2002). Many students felt deeply the undignified nature of having to discuss problems with tutors. This work did not detail the epistemological approach and design of the study but increased the trustworthiness of the data by triangulation of data collection in both the sources and the methods used. A total sample of 367 questionnaires, 28 members of staff and 79 tutorial record sheets were analysed. This broad sampling technique allowed for maximum variation in perspectives and views (Parahoo, 2006) of the personal tutor role. There is a tension between the need to assure students of confidentiality and the belief that sharing information with others involved in student support will help support the staff in the role. Personal tutors are encouraged to establish a relationship with their tutees and may hold confidential knowledge about an individual student but should not or may not divulge that information either to an Examination Board or a Mitigating Circumstances Panel without the students expressed consent. As Universities move towards greater centralisation of these bodies (Jary and Parker, 1998) the role of the personal tutor becomes more constrained. 7.2.4 Summary The tutor-student relationship is crucial for the integration of students into University. Ideally the process begins in induction week, is maintained throughout the course and is intact at the end of three years (Wilcox et al., 2005). For those struggling to learn in a different culture or in a different 76 language the journey to independent learning could be more difficult and require more support (Koskinen and Tossavainen, 2003). The effect of this relationship for the tutor has not been explored consistently within the papers reviewed, especially with the introduction of new communication technology. The effect of inconsistent personal tutoring is also not explored within the studies included in this review and this could therefore be considered a weakness of this review. 7.3. Maximising Learning 7.3.1 Assessment Introducing the element of periodic review into the tutor/tutee relationship was found to be problematic (Drew, 2001; Ellis et al., 2006). If PDP or Portfolio was assessed summatively, assessment and appraisal became blurred and the dynamics of the relationship were altered. By keeping PDP formative it takes place in an atmosphere more like appraisal, facilitating individual students to improve the way they worked and learnt. Students could not accrue academic credits for this formative work (Sosabowski et al., 2003). This evaluative study of tutors? perceptions concerning PDP (Ellis et al., 2006) was strengthened by the use of focus groups and analysis of reflective logs for data collection. Primary analysis was undertaken using a thematic framework, indexing and mapping and validated by a second author. The reflexivity of the researchers was not discussed and bias may have been introduced at the data analysis stage. An area of good practice highlighted was twice-yearly meetings allowing for the students to work with the tutor to produce a PDP that would subsequently be reviewed. This is the only paper 77 that evaluated the introduction of PDP. Further student-based qualitative research to explore issues related to PDP development is advocated. 7.3.2 Practice Issues The personal tutor role takes on a different dimension for professional courses with practice placements. The role in the practice arena may be significant to the development of theory from practice (Richardson, 1998). As practice becomes more central to the student experience, nurse education will be looking to underpin professional knowledge and values with practice-based evidence (Thomas and Pring, 2004). i) Professional Culture The culture of the nursing profession was often found to be at odds with the values transmitted through the personal tutor role (Dobinson-Harrington, 2006). Nursing professional culture is not the same as the culture on University campus (Dobinson-Harrington, 2006) and if students got into difficulty or faced complaints it was often from a perspective of being an apprentice within the practice area. Personal tutors who straddled campus and clinical placements gained insight into what it meant for the students to be in transition (University ? clinical placement ? independent learner) and could ease the path for the student (Dobinson-Harrington, 2006). This phenomenological study utilised interviews from a large sample size of personal tutors and students. There was little evidence of the reflexivity of the researcher but a meaningful picture of the phenomena emerged. The findings of high quality personal tutoring were evident across multiple sites with diverse student journeys. Fourteen students described their best practice 78 learning experience as being student-centred, where their own needs were being met. Collaboration and negotiation between the three key players of student, mentor and practice tutor were high to ensure learning needs were met. Role classification was highlighted as a priority for personal tutors and to meet student expectations. Whilst there were some weaknesses in the methodological processes in this study it was powerful in showing the meaning of personal tutoring for both student and tutor. ii) Tacit Knowledge Personal tutors? views on their students (Rhodes and Jinks, 2005) maintained a similar pattern to a classic piece of research on the popularity of patients amongst nurses (Stockwell, 1972). Popular patients were given more time, had more personal instruction and were allowed lapses in following the rules. Evidence from the study (Rhodes and Jinks, 2005) suggested that this could be true for popular students too. They ascertained that motivated students who used personal tutor time well were popular among tutors. There was little evidence of proactive intervention for students who had poor attendance or reported health or personal problems. Avoidance behaviour was often labelled as being disinterested or being independent. If a student disclosed personal problems, the personal tutor was in the dilemma of knowing the student but being unable to activate University resources to enable learning. Interviews with teachers and managers found elements of staff undertaking duties in their own way (Rhodes and Jinks, 2005). Tutors took elements from their own experiences as teachers, nurses and their private lives (parenting) 79 to make the role rather than take the role prescribed. This tacit knowledge (Polanyi, 1958) was seen to have a great effect in the understanding of the personal tutor role. Opportunities to explore shared concepts of the role were questioned and good practice incorporated into structural codes of practice. This piece of research demonstrated weak methodological processes in outlining the design of the study but utilised a pilot study for the interview process before selecting a purposive sample of nurse lecturers. Characteristics of the sample were outlined and respondents asked to validate the transcripts of their interviews. Procedural rigour in data collection and analysis lend credibility to the research findings, as does a discussion of researcher reflexivity and bias (Polit and Beck, 2008). Negotiation and collaboration with the practice area for the best student experience and working to facilitate learning in practice are key outcomes from this piece of research. Findings reveal that there is a link between how pre-registration nursing students are cared for by nurse teachers, on influencing student behaviour when delivering patient care. Socialization of nurses and the role modelling of caring behaviours (Melia, 1987) is too important to the nursing profession to be lost in the debates around the role of the personal tutor. 7.3.3 Employability Two papers identify employability as part of the personal tutor role, with commitment to PDP. Self-management is found to be weak in first year students and attaining this skill is a gradual process encouraged through attendance and monitoring (Hartwell and Farbrother, 2006). A PDP framework enabled students to develop positive attitudes to learning throughout life and 80 encouraged reflection on skills gaps (Dobinson-Harrington, 2006). This can be seen as adding value to the course by the University for students (HEFCE, 2006). A diagrammatic representation of the personal tutor interface with employability is represented by this research and linked to retention and progression of students within the University. This research (Hartwell and Farbrother, 2006) has weaknesses in the reporting of the epistemological underpinning and design of the study although robust data collection and analysis measures were outlined. Data collection included focus groups of students and semi-structured interviews with personal tutors. Analysis was undertaken using NUD*IST, a computer-assisted qualitative data software package. These increased the credibility of the research (Parahoo, 2006) and the findings of an enhanced personal tutor system strengthening employability beyond academic tutoring. 7.3.4 Summary Inclusion of PDP as summatively assessed work may prove to be problematic within the personal tutor role. Students achieve credits for their work but this may affect the relationship they develop with their personal tutor. The benefit of evidence of self management and skills acquisition for future employers (Department for Education and Skills, 2003) may prove to be more important. Universities are under increasing pressure from the government to provide value added experiences to promote employability (QAA, 2004). The role of the personal tutor to support clinical placements is under researched. Clashes with new clinical practice roles are evident from the literature but not sufficiently analysed. 81 7.4. Recognition of a Professional Role 7.4.1 Staff development and training A common theme for the attention of Universities and lecturers is the recognition of the professional role for the personal tutor. Lecturers spoke of the role being paid lip service (Richardson, 1998), with lack of status and time allocated to perform the role. This lack of clear vision for personal tutoring did not mean that authors were advocating a simple answer. Acknowledgement was made that one-size did not fit all and would not satisfy all the students all the time (Sosabowski et al., 2003). This research had clear description of the level 1 and level 2 cohorts being studied across an age range of 18-36 years. Data analysis was poorly reported but thick rich description tabulated into positive and negative answers to questions allowed a meaningful picture of personal tutoring to emerge. Recommendations included the development of a personal tutor policy for each University including all stakeholders? views. A guide for both students and staff would reduce the dissonance between expectations of the role (Connell, 2006) and standards for student support and guidance (QAA, 2004) could be reflected in a Code of Good Practice. In addition to role classification, continued training and support for personal tutors was advocated (Owen, 2002). Tutors in further education felt equally unprepared for the personal tutor role (Hart, 1996) and evidence suggests that untrained tutors behaved differently when undertaking the role. They became more talkative, asked more questions and offered more advice and made little use of restatement or reflective skills. Recommendations include 82 giving staff additional remuneration in the form of a reduction in teaching hours or a promotion to recognise and acknowledge the extra support given to students when this role was undertaken (Dobinson-Harrington, 2006). Attracting lecturers to this role can be difficult (Sayer et al., 2002) and warrant specialist training. In nurse education all lecturers are required to undertake the personal tutor role and further remuneration would be unlikely as it is seen as being inclusive in the nurse lecturers role (Dobinson-Harrington, 2006). Skills training for personal tutoring and awareness of appropriate student referral pathways needs to be part of University induction processes. Knowledge of the role and skills utilised may be included as a component part of a Post-Graduate Certificate in Education (Owen, 2002). Further counselling skills training (Ellis et al., 2006) could be offered to enhance the role of the personal tutor and allow staff development opportunities. These measures could prevent lecturers feeling overwhelmed (Owen, 2002) or being distressed themselves (Easton and Van Laar, 1995). The identification of lecturers? educational needs is of paramount importance to the reflective practitioner. Whilst the findings of this research (Easton and Van Laar, 1995) highlight the significant demands placed on lecturers by students in distress, a limitation of the study is that the survey was returned by less than half of the respondents. It may be that those responding saw that helping distressed students was part of their work. With this poor response rate the findings cannot be generalised. 83 7.4.2 Workload Tutors facilitate student progression (Ellis et al., 2006) and utilising this time in group timetabled activities may alert personal tutors to identifying problems early. Protected time for personal tutors to undertake this role may be the way forward (Owen, 2002) and high quality personal tutors should be recognised and remunerated (Dobinson-Harrington, 2006). i) Timetabled hours By embedding academic tutor time within the curriculum, tutors gain knowledge of a group of students (Hixenbaugh et al., 2006) and can then utilise PDP development as a starting point in developing a relationship with individual students. Structured meetings included active learning exercises (Hixenbaugh et al., 2006). Achieving this through timetabled activities leads personal tutors to have parity and equity of workload and prevents them acting in their own self-interested manner (Owen, 2002). This system also promoted students independence and shifted the locus of control away from the HEI back to individual students. The number of students allocated to each personal tutor varied greatly. Hixenbaugh et al., (2006) found that over half the staff asked felt that 30 students was about the right number that one personal tutor could manage, whilst 34% felt this was too many. Surprisingly the number of students a personal tutor could manage was not well documented within the papers reviewed. Conversely, there is also recognition that compliance with the supervisor/ supervisee role does not always lead to good interpersonal relationships but 84 fulfils the Universities obligation in the provision of student support (Malik, 2000). Emphasis is on attendance but disagreement occurred as to who was actually responsible for making the personal tutor encounter happen. Agreement that the relationship was a partnership was evident (Sosabowski et al., 2003) but that the tutor must take the greater initiative if the student did not. Personal tutors should actively seek a student who did not attend (Malik, 2000). Higher success rates were linked with regular and frequent meetings and low success associated with not having met during the last 10 weeks. Students were well aware of the pressure on lecturers? time and the dilemmas involved for individual lecturers, but they also valued the role. This grounded theory study (Sosabowski et al., 2003) used both face-to-face interviews and telephone interviews to collect data of which one strand was linked to student support. A purposive sample of 34 students allowed for rich description of the context and a meaningful picture to emerge. Training for such in-depth interviews is often required (Polit and Beck, 2008) but was not detailed within the study and this is an obvious weakness to the validity of the study. It is difficult to generalise from this study in one University but it does contribute to the understanding of the role of personal tutoring. This merging of academic and personal tutor work has caused some of the identified problems. As recognised, the central tenant of the personal tutor is to assist students in fulfilling the requirements of the course (Wheeler and Birtle, 1993). The personal tutor role is giving way to an encompassing role of personal supervision, facilitating organisational effectiveness for HEI?s and meeting standards of quality management and enhancement (QAA, 2004). A 85 supervisory relationship encouraging both academic and personal development within published criteria supports both students and lecturers (Hartwell and Farbrother, 2006; Owen, 2002). 7.4.3 Role of Central Support Services As recognised in the literature review, Central Student Service run by professionals expanded its role in Higher Education in the late 1980?s. The uptake of University counselling services at 2.7-5.3% (Sayer et al., 2002) is in marked contrast to the 54% of students who turn to their personal tutor with problems (Owen, 2002). The conclusion was that the pastoral pool of personal tutor support was a replication of Central Student Services, with its main failure being the lack of established regular contact and a relationship between tutor and tutee (Sayer et al., 2002). Many colleges are unlikely to be able to fund extensive counselling services (Hart, 1996a) and personal tutors are more likely to pick up initial student problems and to be a front line for further referral to counselling services. Students mainly utilised the career services (Drew, 2001). If the expanded role of student services was widely published and included in policy guidance, personal tutors would have a referral pathway and students a self-referral pathway. Referral of students to other professionals was seen to be a key feature of the personal tutor system (Ellis et al., 2006). This mainly covered aspects of ill-heath and referral to occupational health, G.P.?s or to professional counsellors (Rhodes and Jinks, 2005). The University has a duty 86 of care to lecturers and students to publish up-to-date access to places of referral and to facilitate utilisation and self-referral to these resources. 7.4.4 Summary Staff development and training is required to undertake the role of personal tutor (Owen, 2002). Skills of reflection, counselling and facilitating academic development are important facets of the role (Ellis et al., 2006) and inclusion of these skills both within postgraduate education and as seminars for professional development of lecturers would enhance the personal tutor role. Knowledge of confidential referral pathways for students in distress is a vital support for lecturers undertaking the personal tutor role. It is important that HEI?s acknowledge the value of the role and consider remuneration for lecturers undertaking this work (Owen, 2002). 7.5. Conclusions The findings of this review indicate the importance to the student of developing a relationship with a personal tutor within the HEI from induction of the course (Connell, 2006). This facilitates integration into higher education and links the student to the University. This induction process is particularly important for nursing students who spend time on clinical placements (Dobinson-Harrington, 2006). The learning potential of the student is improved with timetabled, regular contact and interaction with the personal tutor, both for academic development and support within clinical practice (Malik, 2000). The benefit to the HEI is evident in the demonstration of key skills through PDP (Hixenbaugh et al., 2006) and completion of the course (Wilcox et al., 87 2005). The work of personal tutoring is enhanced with training and development, both for qualified and unqualified lecturers (Hart, 1996; Owen, 2002) and where standards of good practice are published and widely disseminated. Diverse centralised student support services are also essential to the delivery of quality student support (Hartwell and Farbrother, 2006). 88 Chapter 8 - Implications and Recommendations 8.1 Introduction This review has established the key dimensions of the personal tutor role and the importance of establishing a personal tutor-student relationship within the University. Several implications arise from this review leading to recommendations to enhance the quality of personal tutoring within nurse education. 8.2 Recommendations 1. Quality of Research The quality of the research papers included in this review is variable. As demonstrated from the synthesis of results, the connection from epistemology to research design is implicit or simply not acknowledged in many of the papers. Whilst recognizing that this may be acceptable in social science research (Pope and Mays, 2006) it is not widely accepted as good research practice. In many papers the authors move quickly to the method of data collection with little elaboration on the design of the study. Only five papers gained ethical approval for their study and this lack of ethical approval and informed consent from the participants must be seen as an inherent weakness in the rest of the articles (Polit and Beck, 2008). Thick description and interpretation of meaning (Denzin and Lincoln, 2003) from the personal tutor encounters was apparent in the qualitative methods utilised. Where these were also supported by triangulation from a mixed method approach (Malik, 2000) the quality and trustworthiness of the data was improved. Generalisability of the studies is hard to establish either to other Universities 89 or to other bodies of knowledge. Thus from this review it can be seen that the quality and writing of research papers for publication on the personal tutor role must be improved to allow for trust and utilisation of their findings. Recommendation 1: Further research into the role of the personal tutor establishing clear designs for the studies and underpinned by the nature of the knowledge that has informed each study. Recommendation 2: Ethical approval and informed consent from the research participants should be evident in these research papers. 2. Variety of research methods The search strategy utilised in this review revealed the limited methods undertaken to gain understanding of the personal tutor role. The most common research method was interviews of students, personal tutors or both. Further methods such as longitudinal studies could reveal relevant information (Parahoo, 2006). Collecting data at three- or six-month intervals, from the time of induction may provide a picture of the development of the personal tutor role over time and the long-term outcomes of the personal tutor-student relationship. This would allow for the needs of second and third year students to be explored. The concerns of the personal tutor in supporting nursing students across three years may benefit from such longitudinal studies. The use of reflective accounts and diaries in which personal tutors may record their interactions over time may be another way to investigate what happens within the personal tutorial. 90 Recommendation 3: Further research utilising a wider variety of methods to explore the benefits of a personal tutor for all nursing students. Recommendation 4: Further comparative research into support mechanisms for student nurses whilst in clinical placement. Recommendation 5: Further evidence of the use of reflection in practice to develop knowledge and skills. 3. Emerging technology Within the review papers there is a lack of consideration for new and emerging technology and how this may shape the personal tutor role. Many people now entering University are able to use the Internet and have email facilities. Establishing a relationship may mean an online relationship. For students who do not know how to undertake this skill, acquiring it is important preparation for the workplace. Documenting skills acquisition through PDP and supported through the personal tutor mechanism ensures equity for all students to gain this skill and contribute to new technological developments such as discussion forums, chat rooms, blogs or pod casts. Research needs to be undertaken to establish if students feel satisfied with online tutorial relationships and other new ways of learning support. For personal tutors the number of students that can be supported online has yet to be explored. Consideration of how long it takes to support a group of students online as 91 compared to a timetabled hour session in the classroom needs further research. Recommendation 6: Further inclusion of new technology such as virtual learning environments and online course work and assessment to be included in nursing curriculum. Recommendation 7: Further research to include the use of tutorial support via a virtual learning environment or using mobile technology. 4. Personal tutor guidelines As seen by this review, each University needs to establish its own procedures for the personal tutor system to work and to be explicit with students about what that entails (QAA, 2004). It is important to facilitate student and staff relationships by timetabling personal tutor time into the working week. The personal tutor can enhance the effectiveness and efficiency of delivery of student?s first year experience at University (Wilcox et al., 2005). Utilising academic focus (Connell, 2006) to structure and employ timetabled sessions allows for this relationship to build before a crisis occurs and the student seeks help. It can foster a sense of belonging in what can be an impersonal environment and thereby ease transition into higher education. Issues of confidentiality should be highlighted and reference made to University central registry mechanisms for extensions and mitigating circumstances (Malik, 2000). 92 Recommendation 8: Each University to publish guidelines or Principles of Good Practice for the role of the personal tutor, giving students clear expectations of the role. Recommendation 9: Each University to publish guidelines or Principles of Good Practice for the role of the personal tutor, giving lecturers clear expectations of the role. 5. Establishing a Relationship This review has show that establishing a relationship between student and personal tutor is important and benefits both the student and the University. This process should commence at induction into higher education and incorporate regular timetabled sessions (Connell, 2006). Introductory week sessions should consist of exercises that settle students into the University campus and University expectations. This relationship can be built on in the subsequent years to include aspects of academic development and strengthen support for student writing. Development of the relationship ensures that the student is known within the University system, supported and tracked until the end of the course. Recommendation 10: A structured timetabled personal tutor programme should commence at induction to the University and be built upon in subsequent years to strengthen personal and professional development of each individual student through Personal Development Plans (PDP). 93 6. Consistency of Support The experiences of students who do not consistently have the same personal tutor throughout their time at University are of concern. Keeping the same personal tutor may not always be possible and an understanding of how this affects student progress in their course would be beneficial. The reasons why students fail to meet with their personal tutors throughout the year also requires further investigation (Malik, 2000). Links between academic interactions and retention of students may then be clearly demonstrated. Recommendation 11: Further research, utilising different methods such as longitudinal studies and diary keeping, into the long-term effects of personal tutoring for students on issues such as retention to the course. 7. Recognition of a Professional Role The review papers found that the role of the personal tutor was unclear and that lecturers felt unprepared and untrained for the work that was expected of them (Richardson, 1998). Skills of counselling, reflection and knowledge of referral pathways (Easton and Van Laar, 1995) were cited as being most useful when dealing with individual student concerns. Also knowledge of the whole curriculum was found to be important when guiding and supporting students. There is no optimum number of students that any one personal tutor should support but careful consideration for large numbers of students approaching one personal tutor should be noted. 94 Recommendation 12: The role of the personal tutor to be included in all Post-graduate training for teachers and lecturers and update skills training for all lecturers. Recommendation 13: Evidence of acknowledgement of workload for personal tutors and equity of numbers of students allocated per tutor. 8. Central Support Service The role of Central Support Services within each University needs to be clearly recognised and advertised (Sayer et al., 2002). Students should be aware of how to self-refer to any of the services such as counselling, monetary advice or student accommodation. Personal tutors should also be aware of how to refer students to any of the student support services on offer, including occupational health clearance checks for student nurses returning to clinical practice areas. Recommendation 14: Access to Central Support Services should be widely published and disseminated across each University. 9. Nursing Practice Placements There was only one research article (Newton and Smith, 1998) that specifically explored the role of the personal tutor in nursing practice placements. Nurse lecturers have been criticised for not maintaining their clinical competence (Humphreys et al., 2000) and becoming less involved in the practice area. The personal tutor role may be an ideal way to support 95 students and maintain clinical competence, if links to hospital areas could coincide with personal tutor link requirements. This does require considerable communication skills and supporting infrastructure on the part of the University to organise this. It may be unrealistic for personal tutors to see their personal tutees across a wide geographical area. For personal tutors to link to one or two hospital trusts or areas may lessen travelling time. This may reflect the fact that nurse lecturers are often fulfilling the two roles of personal tutor and link lecturer to their students. However, supporting their own personal students both in the academic areas and in limited clinical practice areas would strengthen the links between the Trust hospitals and the Universities (UKCC, 1999). Recommendation 15: Personal tutors have responsibility for their nursing students when on campus and in clinical practice. Organisational systems whereby student nurses can access their personal tutor whilst on clinical practice should be enhanced. 10. Collaboration and Partnership working Students find the development of their PDP difficult and often are unable to see the developmental benefits from engaging with it (Connell, 2006). Extending student support utilising PDP to University partner colleges in further education developments may be beneficial. For nurse education, students on Access to Nursing Courses would then actively be involved in documenting and recording their personal development, enhancing the skills of reflection and action planning. 96 Recommendation 16: Extend student support to University partner colleges in further education so PDP is incremental and developmental across the sector. 8.3 Limitations of the Study This review has demonstrated the dimensions of the personal tutor role and the need for further research evidence into the effects of the personal tutor- student relationship. Additional research into the effect of inconsistent personal tutoring for the student may lead to a greater understanding of how to maximize student learning potential. Whilst undertaking this comprehensive review of the literature, limitations of the study are apparent. The review had to be undertaken within a time frame. After the literature search was complete the Higher Education Academy held the third conference on personal tutoring. Papers from this conference are not yet available but will contribute to the understanding of the personal tutor role, especially utilising the advances in new technology. The methodological limitation to the review may lie with the critical review form used. Many examples of critical review forms exist within the literature and online through the Internet. The McMasters review form (Law et al., 1998) was adapted to reflect a nursing and educational critique, however the author now appreciates more the specific content design within the form and may design their own form in future academic work. A judgement about the rigour 97 of each study has not been turned into an evaluative score on the summary of results table (Appendix One). This may have reflected the strengths and weaknesses of each study more readily. Thematic analysis essentially involves the identification of patterns and themes apparent in the review papers. This review mainly concentrated on the pattern of evidence related to the dimensions of the personal tutor role. Methodological themes are also apparent within the review and through a synthesis of results have given rise to methodological features that the most rigorous studies have in common. A matrix of these themes would have enhanced the depth of understanding of methodological issues. Themes apparent from the body of researchers undertaking inquiry into the personal tutor role may also have been considered. The summary of papers included in the review assisted initially in identifying themes and patterns across the seventeen papers and additional matrices of different themes may have identified further patterns for discussion. Exploration of other nursing roles that link to practice areas may have also been beneficial to this review. Establishing who is the best person to support students in clinical practice is a dilemma that the nursing profession has yet to provide evidence on. Many Universities use a system of link lecturers or practice educators and do not use the personal tutor to support clinical practice. 98 This review has demonstrated rigour within the review process. Data has been accessed from recognised databases, with key words and descriptors clearly evident. Whilst the literature retrieved mainly fell within the qualitative paradigm, triangulation of data collection from different sources or by different methods was evident in the papers reviewed. Validity of the research process has been maintained by making explicit guiding assumptions of the review process. The need for further research into the role of the personal tutor for nurse education is apparent. Little is know of the long-term effects of inconsistent person tutoring for the student and there is little evidence of the nature of interactions with personal tutors for personal development. Research into the educational needs of personal tutor is also essential. 8.4 Summary The implications and recommendations that arise from the literature reviewed may enhance how personal tutoring is delivered to student nurses. An increase in the quality of the research into personal tutoring would allow educationalists to trust the findings more readily. The needs of all student nurses for personal tutoring across campus and clinical placements are vital to their personal and professional development. 99 Chapter 9 - Conclusion 9.1 Introduction In answering the research question ?What are the key dimensions of the personal tutor role for nurse education today?? this review has examined the historical context of the personal tutor role alongside new government policies and statutory bodies directing higher education. A detailed search of relevant educational and nursing databases revealed articles to answer the research question. Application of the inclusion/exclusion criteria gave rise to the best available evidence in the seventeen papers used in the review. Detailed analysis and synthesis of the papers for methodological quality and emerging themes demonstrated the key dimensions of the personal tutor role included in the discussion. 9.2 Review of Objectives The first objective was to investigate the student expectations and experiences of personal tutoring in higher education. The literature clearly reveals a dissonance between the students? and the tutors? expectations of the role. Twelve papers sought student opinion of their experience with a personal tutor. It is important for students to establish a relationship with a personal tutor at induction to the University. This relationship could then be built upon in timetabled group sessions, allowing students to gain in confidence before needing individual tutorial support. Responsibility for maintaining contact was found to be problematic but also indicative of failure of the personal tutor system. Some students made minimal effort for tutorial support and recommendations included tutors actively seeking out these 100 students. This appears to be at odds with the tutors? perceptions that students must seek out individual support. However, one conclusion from the papers is that establishing a relationship with a personal tutor from induction week and maintaining the relationship throughout the course is a key factor in the future success of the student. The second objective was to analyse and explain how the personal tutor role can maximise learning potential within nurse education. Knowledge of the whole curriculum was found to be important to student support, giving student-centred guidance. Students expected personal tutors to provide information pertinent to the University, including information on examinations, regulations and referral pathways for further advice, such as monetary or counselling support. The maintenance of a personal portfolio or PDP was seen to link the student?s academic and personal development. Students who were undertaking studies in a different cultural background were found to be very dependent on feedback in order to facilitate deeper learning. Pastoral aspects of the personal tutor role may counterbalance cultural shock for these students. Reflection is seen as a central tool for students to use in personal and professional development. Although students found reflection difficult, early introduction and facilitation of the reflective process was advocated. Personal tutors were encouraged to use reflection on practice as part of teaching within the clinical area. This encouraged students to be more independent and increased their ability to manage themselves and their learning. Using 101 reflection as part of portfolio or PDP development enhanced positive life-long learning and added value to the course, although summative assessment may prove to be problematic. Evidence of student self-management and skills acquisition through PDP for future employers is essential. The third objective was to explore the key skills, training and development needs for nurse lecturers undertaking the personal tutor role. The review highlights the need for the personal tutor role to be given recognition as a professional part of the lecturer?s role and not just an add-on for some nurse lecturers to undertake. Lack of a clear vision for the role allowed for it to be perceived as low status with minimal timetabled hours allocated to carry out the role. Identification of lecturers? educational needs was recognized as being important for additional skills training. Counselling skills, knowledge of University regulations, familiarity with student support services and facilitation of academic development and reflective skills are all staff development opportunities and could be offered both within and outside of a Post-Graduate Certificate or Diploma in Education. Student support services, central to the University, become an additional resource, either for tutor referral or for student self-referral. Whilst each University may utilise government directives for the personal tutor role in a different manner, these should be published and explicit, leading to less ambiguity. Nurse lecturers would have a clearer understanding of the duties and responsibilities of the role. Collaboration and partnership working with colleges of further education may extend knowledge of the personal tutor 102 role. Students would be able to develop evidence of personal and professional development over a longer time frame and gain earlier insight to its relevance to employers. Emerging new technology allows for learning and teaching to be undertaken in a variety of formats. These include the use of e- learning strategies, online discussion forums, pod casts and blogs. Incorporating these into the personal tutor role may allow for greater flexibility and freedom, both for the personal tutor and student, whilst still maintaining the quality of support for individuals. Further research of the needs of nursing students from their personal tutor is required. A wider variety of research methods such as longitudinal studies may provide a clearer picture of the development of the personal tutor role over time. The needs of second and third year nursing students from their personal tutor requires further exploration. 9.3 Summary The role of the personal tutor is dynamic and complex. The findings of this review point towards the importance, for the student nurse of a relationship with a personal tutor within the HEI. This ideally should commence at induction and continue for the duration of the course. The learning potential is maximized where this is followed up with timetabled group sessions and regular contact with the personal tutor maintained. Completion of a personal portfolio or PDP through this relationship strengthens student learning and development. The work of personal tutoring must be underpinned with skills training for nurse lecturers and standards of good practice published within HEI?s. This is an exciting and evolving time for the personal tutor role. Further 103 research into the areas highlighted within the study may lead to greater understanding and fulfilment of this crucial role. 104 Chapter 10 - Personal Reflection Whilst working on this dissertation my abilities as both a researcher and writer have developed. Each section has required different skills in order to undertake the task. I have developed further expertise in searching databases and retrieving online literature. My understanding of epistemology and theoretical perspectives, methodology and research methods has been extended and skills of critiquing research literature have increased. All of these developments have not take place in isolation and required balancing across chapters. The discussion and implications arising from the themes allowed my writing skills to develop further. I will take forward the recommendations and conclusions from this review for pre-registration undergraduate nursing students within my Faculty. Whilst undertaking this review I used Endnotes?, a reference management system and Mind Genius?, a mind mapping software programme. These tools will be utilised in further academic work. This has been a huge undertaking personally in order to further my professional and academic career and would not have been possible without the support of family, colleagues and friends. 105 References Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. California: Addison-Wesley Publishing Company. Bowers, K. (2006). Personal tutoring - ought we to dispense with the pastoral element? In: Second Annual Conference on Personal Tutoring. St. John University College York: The Higher Education Academy. Bullock, K. and Wikeley, F. (2004). Whose learning? Maidenhead: OU Press. Charmaz, K. (2004). Premises, Principles, and Practices in Qualitative Research: Revisiting the Foundations. Qualitative Health Research 14 (7), pp.976-993. Clarke, C. (2003). The Future of Higher Education. In: DfES, ed. The Stationery Office. Cohen, L. and Manion, L. (1994). Research methods in Education. 4th ed. London: Routledge. Connell, R. (2006). "Am i bovvered?" Tutor and student Reflections on Progress Tutoring. www.heacademy.ac.uk. [Online]. Retrieved on 15th March. Cooper, H. (1998). Synthesizing Research: A Guide for Literature Reviews. London: Sage Publications Ltd. Cotterill, P. and Waterhouse, R. L. (1998). Speaking Confidentially, or How Long Have I Got? The Demise of the Personal Tutorial in Higher Education. In: Jary, D. and Parker, M. (eds.) The New Higher Education: Issues and Directions for the Post-Dearing University. Stoke-on-Trent: Staffordshire University Press. Crotty, M. (1998). The Foundations of Social Research. Meaning and Perspective in the Research Process. London: Sage Publications Ltd. Davies, D. and Dodd, J. (2002). Qualitative Research and the Question of Rigour. Qualitative Health Research 12 (2), pp.279-289. Denzin, N. and Lincoln, Y. S. (1998). Collecting and Interpreting Qualitative Materials. London: Sage Publications Ltd. Denzin, N. and Lincoln, Y. S. (2003). Strategies of Qualitative Inquiry. London: Sage Publications Ltd. 106 Department for Education and Skills (2003). The future of higher education. London: Department for Education and Skills. Department of Health (1999). Making a Difference. Stengthening the nursing, midwifery and health visiting contribution to health and healthcare. London: Department of Health. Department of Health (2001). Agenda for Change: Modernising the NHS Pay System. London: Department of Health. [Online]. Retrieved on 15th April 2007. Dobinson-Harrington, A. (2006). Personal tutor encounter: understanding the experience. Nursing Standard 20(50) August 23, pp.35-42. Drew, S. (2001). Student Perceptions of What Helps Them Learn and Develop in Higher Education. Teaching in Higher Education 6, 3, pp.309-331. Earwalker, J. (1992). Helping and Supporting Students. Buckingham: The Society for Research into Higher Education & OU Press. Easton, S. and Van Laar, D. (1995). Experience of Lecturers helping distressed students in Higher Education. British Journal of Guidance and Counselling 23 (2). Ellis, J. S. et al. (2006). Tutor perceptions of the use of a reflective portfolio within a pastoral tutor system to facilitate undergraduate personal development planning. European Journal of Dental Education 10, pp.217-225. Evans, J. and Benefield, P. (2001). Systematic Reviews of Educational research: does the medical model fit? British Educational Research Journal 27 (5), pp.527-541. Fink, A. (2005). Conducting Research Literature Reviews: From the Internet to Paper. London: Sage Publications Ltd. Flick, U. (2006). An Introduction to Qualitative Research. 2nd ed. London: Sage Publications Ltd. Gardener, G. (2006). New perspectives on old debates: Re-engineering the theory-practice gap. Australian Journal of Advanced Nursing 24 (2), pp.7-8. Gidman, J. (2001). The role of the personal Tutor: a literature review. Nurse Education today 21, pp.359-365. 107 Grant, A. (2006). Personal tutoring: A system in crisis? In: Thomas, L. and Hixenbaugh, P. (eds.) Personal Tutoring in Higher Education. Stoke on Trent: Trentham Books. Greenhalgh, T. (2006). How to Read a Paper. 3rd ed. London: BMJ Books. Greenhalgh, T. and Taylor, R. (1997). How to read a paper. Papers that go beyond numbers (qualitative research). British Medical Journal 315, pp.740- 743. Hart, C. (2001). Doing a Literature Review: Releasing the Social Sciance Research Imagination. London: Sage Publications Ltd. Hart, N. (1996). The role of the tutor in a college of further education: A comparison of skills used by personal tutors. British Journal of Guidance and Counselling 24 (1), pp.83,14p. Hartwell, H. and Farbrother, C. (2006). Enhancing the first year experience through personal tutoring. Personal Tutoring in Higher Education. Stoke on Trent: Trentham Books. Hawker, S. et al. (2002). Appraising the Evidence: Reviewing Disparate Data Systematically. Qualitative Health Research 12 (9), pp.1284-1298. HEFCE (2006). National Student Survey 2006. HEFCE Publications. Bristol. Hixenbaugh, P., Pearson, P. and Williams, D. (2006). Student perspectives on personal tutoring: What do students want? In: Thomas, L. and Hixenbaugh, P. (eds.) Personal tutoring in Higher Education. Stoke on Trent: Trentham Books. Humphreys, A., Gidman, J. and Andrews, M. (2000). The nature and purpose of the role of the nurse lecturer in practice settings. Nurse Education today 20, pp.311-317. Jaques, D. (1990). Being a Personal Tutor. Oxford: Educational Methods Unit. Jary, D. and Parker, M. (eds.) (1998). The New Higher Education: Issues and Directions for the Post-Dearing University. Koskinen, L. and Tossavainen, K. (2003). Relationships with undergraduate nursing exchange students - a tutor perspective. Journal of Advanced Nursing 41(5), pp.499-508. 108 Law, M. et al. (1998). Guidelines for Critical Review Form - Qualitative Studies. [Online]. Retrieved on 20th March from: http://www- fhs.mcmaster.ca/rehab/ebp/pdf/qualguidelines.pdf Malik, S. (2000). Students, tutors and relationships: the ingredients of a successful student support scheme. Medical Education 34, pp.635-641. Maltby, J., Day, L. and Williams, G. (2007). Introduction to statistics for nurses. Edinburgh: Pearson Education Ltd. McNeill, B. and Fawkes, J. (2006). Tutoring for mass professional education. Personal Tutoring Conference. York: Higher Education Academy Online Casebook. Melia, K. M. (1987). Learning and Working: The Occupational Socialization of Nurses. London: Tavistock Morse, J. et al. (2002). Verification Strategies for Establishing Reliability and Validity in Qualitative Research. International Journal of Qualitative Methods 1 (2), pp.1-18. National Audit Office (2002). Improving student achievement in English higher education. London: The Stationery Office. NCIHE (1997). Higher Education in a Learning Society, Report of the National Committee of Inquiry into Higher Education. HMSO. London. Newton, A. and Smith, L. N. (1998). Practice Placement supervision: the role of the personal tutor. Nurse Education Today 18, pp.496-504. Oakley, A. (2002). Social Science and Evidence-based Everything: the case of education. Educational Review 54 (3), pp.277-286. Owen, M. (2002). 'Sometimes you feel you're in niche time.' The personal tutor system, a case study. Active learning in higher education 3 (1), pp.7-23. PADSHE (2002). Personal and Academic Development for Students in Higher Education. [Online]. Retrieved on April 2007 from: www.nottingham.ac.uk/padshe/ Parahoo, K. (2006). Nursing Research: Principles, Process and Issues. 2nd ed. Basingstoke: Palgrave Macmillan. Polanyi, M. (1958). The Study of Man In: The Lindsay Memorial Lecturers London: Routledge, Kegan and Paul. 109 Polit, D. F. and Beck, C. T. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice 8th ed. Philadelphia: Lippincott Williams & Wilkins. Popay, J., Rogers, A. and Williams, G. (1998). Rationale and Standards for the Systematic Review of Qualitative Literature in Health Services Research. Qualitative Health Research 8 (3), pp.341-351. Pope, C. and Mays, N. (2000). Qualitative Research in Health Care. London: BMS Books. Pope, C. and Mays, N. (2006). Qualitative Research in Health Care. 3rd ed. Oxford: Blackwell Publishing Ltd. Porter, S. (2007). Validity, trustworthiness and rigour: reassessing realism in qualitative research. Journal of Advanced Nursing 60 (1), pp.79-86. Pring, R. (2000). Philosophy of Educational Research. London: Continuum. QAA (2001). Quality Assurance Agency Policy Statement on a progress file for Higher Education. [Online]. Retrieved on 30th March 2007 from: http://www.qaa.ac.uk QAA (2004). Quality Assurance Agency Code of Practice for the assurance of academic quality and standards in higher education. [Online}. Retrieved on 24th April 2007 from http://www.qaa.ac.uk/academicinfrastructure. Rhodes, S. and Jinks, A. (2005). Personal tutors' views of their role with pre- registration nursing students: An exploratory study. Nurse Education Today 25, pp.390-397. Richardson, R. (1998). The role of personal tutor in nurse education: towards an understanding of practice in a college of nursing and midwifery at a particular point in time. Journal of Advanced Nursing 27, pp.614-621. Rolfe, G. (2002). Reflective practice: where now? Nurse Education in Practice 2, pp.21-29. Rolfe, G. (2006). Validity, trustworthiness and rigour: quality and the idea of qualitative research. Journal of Advanced Nursing 53 (3), pp.304-310. Salmon, G. (2002). E-Moderating - The key to teaching and learning online. London: Kogan Page. 110 Sayer, M. M., Colvin, B. T. and Wood, D. F. (2002). The Pastoral Pool: an evaluation of a new system of pastoral care provision. Medical Education 36, pp.651-658. Scott, P. (1998). Mass Higher Education: A New Civilisation? In: Jary, P. and Parker, M. (eds.) The New Higher Education: Issues and Directions for the Post-Dearing University. Stoke-on-Trent: Staffordshire University Press. Shore, C. and Selwyn, T. (1998). The marketisation of Higher Education: Management, Discourse and the Politics of Performance. In: Jary, D. and Parker, M. (eds.) The New Higher Education; Issues and directions for the Post-Dearing University. Stoke-on-Trent: Staffordshire University Press. Silverman, D. (2005). Doing Qualitative Research. London: Sage Publications Ltd. Sosabowski, M. H. et al. (2003). Enhancing Quality in the M. Pharm Degree Programme: Optimisation of the Personal Tutor System. Pharmacy Education 3 (2), pp.103-108. Spradley, J. (1980). Participant Observation. New York: Holt, Rinehart & Wilson. Stockwell, F. (1972). The Unpopular Patient. London: Royal College of Nursing. Thomas, G. and Pring, R. (eds.) (2004). Evidence-Based Practice in Education. Conducting Educational Research. Maidenhead: OU Press. Thomas, L. (2006). Widening participation and the increased need for personal tutoring. In: Thomas, L. and Hixenbaugh, P. (eds.) Personal tutoring in Higher Education. Stoke on Trent: Trentham Books. Thompson, B. (1994). Practical Assessment, Research and Evaluation. [Online]. Retrieved on 10/9/07 from: http://pareonline.net/getvn.asp?v=4&n=5 UKCC (1999). Fitness for practice: the UKCC Commission for Nursing and Midwifery Education. London: UKCC. Wheeler, S. and Birtle, J. (1993). A Handbook for Personal Tutors. Buckingham: The Society for Research into Higher Education & OU Press. Wilcox, P., Winn, S. and Fyvie-Gauld, M. (2005). 'It was nothing to do with the university, it was the people': the role of social support in the first-year experience of higher education. Studies in Higher Education 30 (6), pp.707- 722. 111 111 Appendix 1 - Summary of papers included in review *PT = personal tutor PAPER 1 Methodology Data Collection Findings Conclusions Critique Summary Connell R.A. (2006) Survey with descriptive statistics Sample 309 students (106 Level 1 108 Level 2 93 Level 3) Across 15 programmes Tutors 33 forms returned Response rate of 48% 5 Heads of Departments Questionnaire 7 pages regarding PT role and student progress Mixture of forced and free response questions Anonymity guaranteed Staff questionnaire around effectiveness of role Semester 1 70% (Yr 1), 63% (Yr 2), 51% Yr 3 had met with PT Semester 2 55% (Yr 1), 41% (Yr 2), 26% Yr 3 had met with PT Staff 70% willing to undertake PT role although 30-35% felt unconfident at providing reflection and progression advice Most std valued the role Low level felt uncomfortable Perceptions of std and tutor role varied Reflection and action planning as lifelong learning skills not appreciated by students and staff. Students 70% students felt they had been helped to settle in and stay focused 33% felt they had not been helped to build on their academic achievements and set goals ? Develop PT guide for students and staff ? Create focus at each level ? Develop reflection and action planning ? Develop CV?s and prep for interviewing ? Strengthen induction week tutor-student relationship ? Staff development Questionnaire with forced choice and free responses Informed consent tacitly gained by asking the students to fill in the questionnaire but this was done in class and the students may have felt under duress. Likert scale utilised but with positive scale. Study carried out in further education so questionable if transferable to higher education Results specific to one area at one point in time 112 PAPER 2 Methodology Data Collection Findings Conclusions Critique Summary Dobinson- Harrington A. (2006) Qualitative- Phenomenology Ethical permission Sample Purposive, random 36 Personal tutors 46 Diploma/Degree students (Adult, Child and Mental Health branches) 27/34 from London University 9/10 from NE England University No comparison made between Universities 50% sample mature students Remainder 21-25 years Interviews 1:1 Students ? Laddered questions from Action/Knowledge/ Feelings/Attitude/ Values Data analysis to identify themes not described ? Learner Isolation Norms of learning on campus and in practice Students felt as if they were on a conveyor belt moving from lecturers to seminars to skills labs PT frustrated by no time to make sense of learning Time ? for PT and students to be accessible ? Support work Student?s ?help? and questioning did not help. Students? view of good or bad PT based on luck of the draw. PT level of interest in std crucial PT looking to discuss self help PT role conflict of support with disciplinary and coaching role Support for mixed ability was viewed as ?labour intensive? ? Managing transition From nursing schools to higher education culture Professional obligations with practice placements Learners journey to higher education Teaching workload Demonstration of relationship rather than a safety net Learning conducted in multiple ways over multiple sites with diverse std journeys Learners adopt consumerist view of PT of problem solving rather than facilitating students to solve problems High quality PT be recognised and remunerated Role classification for PT and students to meet std expectations Mutual trust, engagement, respect and accepting responsibilities elements of PT role Phenomenology utilised Interviews 1:1 utilizing laddered questions from action/knowledge/ feelings. All interviews were audiotaped and transcribed. Methods of data analysis not described No strategies utilised to ensure trustworthiness. There was no variation in method of data collection Single researcher involved in data collection. 113 PAPER 3 Methodology Data Collection Findings Conclusions Critique Summary Drew S. (2001) Qualitative Focus group discussions Sample 263 students from arts, professional, technical and business studies x8 Year 1 groups x2 Year 2 groups x3 Year 3 groups x1 Postgraduate group TOTAL = 14 Reports Small sub group discussions General whole group discussions Students individual views in writing Four student factors ? Self management ? Motivation and needs ? Understanding ? Support across 3 contextual factors ? Course organisation, resources and facilities ? Assessment ? Learning activities and teaching Support ? Clear academic structure ? Accurate information ? Class contact=security ? Meeting a wide range of students ? Formative assessment important in terms of progress/ strengths and weaknesses ? Identified tutor/personal ? Staff expertise and availability for 1:1 support ? Peers not a replacement for staff ? Support in practice Comparisons made to QAA (1998) standards, although QAA did not feel to reflect connections to student experience Central University Support Systems other than Careers advice need to be in place. A well-organised member of staff was a role model. Cancelled lecturers were not looked upon favourably Little discussion of theoretical perspectives and underpinning ontology. Referral to an earlier study. No quantification of the data is commented on. Findings indicate what is important to the student but there is no weighting of the themes Thematic analysis not clear Lack of epistemological underpinnings a weakness. Also a lack of clarity around ehtical issues and consent 114 PAPER 4 Methodology Data Collection Findings Conclusions Critique Summary Easton S. & Van Laar D. (1995) Survey Sample All lecturers at British Polytechnics (now Universities) 567 questionnaires sent 231 (41%) returned Sample characteristics 21% were female Average age was 45 years with a range of 27-65 years The average no. of years as a lecturer was15. Senior Lecturers = 65% Principle Lecturers = 22% Lecturers = 7% Readers = 2% Professiorial/HoD = 3% Questionnaire of 3 categories ? Biographical details ? No. of times dealt with a student in distress ? Lecturers opinion on their role with distressed students 97% stated they had ?counselled? students. in the past year over a range of problems 70% stated it was an important part of their work. Few respondents had received any training A fifth of respondents felt dissatisfied with the support they offered 46% indicated they were sometimes dissatisfied with the support they offered 5% felt it was not an important part of their work The majority of respondents added qualitative data Biographical indicators did not affect responses. Limitations of the study were acknowledged as being a poor % of returned questionnaires. Further research was advocated to gain more depth: ? Via diary approach for lecturers ? Students perspective of receiving help Highlighted significant demands made of lecturers by students in distress Lecturers feeling of being overwhelmed, distressed themselves or dissatisfied. Importance of training, support and formal set of guidelines highlighted The results need to be treated with caution as the survey was only returned by less than half of the respondants it was given to: 567 sent and 231 returned (41%) The survey depended on memory of the lecturers to remember and record incidents. The majority of respondents included qualitative data No other methods of data collection or details of member checking or verification of results by other researchers was evident. 115 PAPER 5 Methodology Data Collection Findings Conclusions Critique Summary Ellis J. S. et al., (2006) Qualitative Focus groups of tutors who had not been involved in development of Portfolios. Sample 10 tutors x2 groups of 5, randomly selected representing different seniority of Faculty (37% of available pool) 9 male 1 pre-clinical only 2 clinicians The rest clinical academics varying in seniority Semi-structured questions Audio-taped and transcribed Analysis using deductive framework looking for key themes. Validated by second author ? Scheduling of tutorial meetings ? timetabled but need to be flexible ? Structure of periodic review ? self review gave encounter meaning ? Use of reflection Students found use of reflection difficult. Identifying some students over reflect and take it into their personal life. ? Concern that use of portfolios moved PT role to appraiser ? Recognition for further training or Year tutors who had further training Implications of undertaking periodic review (summatively assessed) in PT sessions detrimental to PT role ie: Tutor V Assessor Protected time for PT/std encounter Need to defer students who come expecting immediate help Prescription of the PT/student encounter Students to come with reflections and PDP or send to tutor prior to session Need for further training for tutors in basic counselling skills Awareness of appropriate referral pathways Focus group interviews based on semi- structured questions relating to the use of periodic review and reflective logs during formal tutorial sessions. Indicative quotations are coded according to participant number, male or female and their status at the time of the focus group. Emergent themes mapped diagramatically. The analysis was stated as deductive and interpretive in nature which needs further qualification 116 PAPER 6 Methodology Data Collection Findings Conclusions Critique Summary Hart, N. (1996) Survey and Interviews informed the design of a questionnaire. Original 18 questons refined to 15 Then pilot study took place Sample A random sample of 40 tutors from the college were chosen and demographics described A second sample of 20 student cousellors employed in further education colleges from the BAC register The 2 samples were unmatched in terms of qualifications and experience Questionnaire posted with pre-paid reply envelopes Clear descriptions of site and participants. Researchers credentials and relationship to participants absent. Researchers credentials and relationship to participants absent. No evidence of informed consent or ethical considerations ? Demographic Information Tutors 40-49 age and 50/50 male/female and no training Counsellors were younger age range, more female and trained to Certificate and Diploma level ? Perceptions of tutorial role Strong agreement between groups at rating academic support and student development a priority ? Confidence in dealing with problem Tutors felt confident with course guidance, attendance and discipline Counsellors felt confident with family and relationship problems ? Importance of skills Availability/encouragement Tutors valued advice giving and counsellors rated promoting self understanding higher ? Frequency of counselling skills Listening skills utilised by both Reflecting and paraphrasing estimated double by counsellors Questioning estimated used more by tutors Tutors and counsellors share views on the aims of tutorials. Support valued and discipline rated last. Tutors still saw their role dealing with academic support. Advice giving rated important by tutors Promoting self understanding Move locus of control back to individual and away from establishment. Counselling skills or confident helper? Modelling not a skill used by counsellors but sometimes used by tutors Use of boundaries for tutor difficult when in position of responsibility. Clearer clarification needed Further research into training needs and difference between perceived and actual behaviour in tutorials. Questionnaire developed from semi- structured interviews and then piloted. Concepts clarified around theme headings. Utilised descriptive stats. To emphasis importance of factors but not for any statistical inferences to be made. No evidence of ethical approval or informed consent Limitations were training and status of the sample selected 117 PAPER 7 Methodology Data Collection Findings Conclusion Critique Summary Hartwell, H. & Farbrother C. (2006) Qualitative Focus groups with first year students Sample Sample size of 70 (30 men and 40 women) Students were a purposive sample of representative students from Hospitality faculty Semi-structured interviews with 5 faculty staff Focus groups lasted half an hour. Semi-structured interviews undertaken in personal offices. Analysis undertaken using NUD*IST with coding directed by the literature and based on a conceptual framework of PDP allowing for themes to be incorporated. ? Use of Stepping Stones ? a pre admission web site ? Personal contact before a crisis ? Fostering a sense of belonging ? Easing transition to HE ? Feedback directly to staff ? Communication and goal setting for motivation ? Student self management support ? Discussion of feedback opportunities ? Cheaper to retain than recruit Diagrammatic representation of Student Development Process Model Diagrammatic representation of the personal tutor interface with employability ? Personal tutoring can be an adjunct to academic tutoring ? PT explicit within programme ? PDP website utilised in sessions ? Diagrammatic representation of student support ? PT enhance the effectiveness and efficiency of delivery of first year experience ? Need for institutional code of practice and guidelines for PT?s ? Statement of good practice and standards Focus groups of first year students to ascertain their views on the staged induction programme of personal tutoring Semi-structured interviews of staff to ascertain their views.Analysis using NUD*IST (Non- numerical Unstructured Data Indexing Searching and Theorising) computer package. Limitations of epistemology underpinnings and of ethical approval and consent 118 PAPER 8 Methodology Data Collection Findings Conclusions Critique Summary Hixenbaugh P. et al., (2006) Survey with descriptive statistics Interviews Questionnaire Sample 735 1st year students on West London campus distributed in core modules 86 Staff sent by email Interview Sample 8 1st year students from 4 Faculties 15 students over 1st, 2nd and 3rd years from Psychology Faculty Focus group of 48 students from 1st year Psychology Questionnaire with Likert scale for answers (1-5) ? Staff 38 (out of 86) returned 52.6% thought 30 students right number 34% thought this too many students Agreement that 1st years need more support ? Students 281 (out of 735) returned 70% met PT during induction 90% knew their PT 55% reported not needing PT although had seen them 15 times 26% had not discussed their concerns PT Majority felt PT was for pastoral and academic need Majority wanted more office hours Interviews All but 1 student was happy with initial contact Need for contact decreased in 2nd year but knew PT was there Accessibility and approachability important PT needs to know the curriculum and University processes System could be more structured and active Enforced meetings Students made to contact PT more often ? by email/phone Selection of PT interested in this work Coverage for absenteeism Relationships are at the heart of the std experience of HE Use of e-mentoring by 3rd year students ? Regular, frequent scheduled meetings ? Feedback on progress ? PT who are enthusiastic and care ? Approachable, accessible and reliable Flexibility of sampling was demonstrated by using course reps form different faculties Techniques of data analysis not explored Triangulation achieved by collection of data from different sources Limitations of: Informed consent and ethical considerations absent. The review targets the first year experience and thus the data does not extend across all undergraduate Epistemological underpinnings not discussed 119 PAPER 9 Methodology Data Collection Findings Conclusions Critique Summary Koskinen L. & Tossavainen K. (2003) Qualitative Ethnographic Ethical permission Role of researcher acknowledged Sample 46 British undergraduate nurses Over 3-4 month period All 4 branches 7 Finnish tutors with 8- 20 yrs experience Assigned 2-8 students Informed consent Participant observation Research diaries Group interviews Background questionnaires Data Analysis by Developmental Research Sequences (DRS) on 4 levels: Domain analysis Taxonomic analysis Componential analysis Thematic analysis ? Culture shock Mixing socially with work colleagues helps to overcome cultural sensitivities ? Aspects of the tutor-std relationship Pastoral ? caring, linking, orientating, negotiating and influencing. Pastoral aspects of importance for intercultural tutoring Clinical Aspects ? discussion of experiences and situations. Little reflection on client care. Academic aspects ? little academic dialogue or reflection on scientific or nursing knowledge ? Intercultural sensitivity What it is like to be different. Affect on nurse/patient relationship Personal growth rather than learn another culture Pastoral and clinical rather than academic in intercultural tutoring Need a wide supportive social network as studying in a different language is stressful Identification of problem students ? bored/non- attendees/language barriers Reflection needs to be explicit and integral Help is needed for tutors to instigate supportive dialogue with students Tutor not always able to meet student need. Personal tutor role as facilitator of practice is crucial in preparing and minimizing obstruction to learning in clinical area Utilised ethnographic approach well Role of the researcher decribed with clear sense of her involvement in the study - reflexivity of the researcher. Triangulation utilised. Conceptual framework of the three themes of the student-tutor relationship emerged, that was represented diagramatically. Three aspects were: culture shock, aspects of relationship, and intercultural sensitivities Limitations acknowledged. Process of data collection - two groups of different sizes and limitations of participant observation used only in exploratory phase. Further member checking of data not utilised. 120 PAPER 10 Methodology Data Collection Findings Conclusions Critique Summary Malik S. (2000) Survey and focus group methodologies for evaluation Sample Medical students 144 Year 2 and 3 students 60 in a failed position 84 in a pass position 139 responses Tutors 28 Year 2 tutors 19 responses Quantitative Survey ? 9 questions Tutor questionnaire to ?match? not the same one. Answers grouped to 1-5 Likert scale Anonymous but could identify self if wanted to contribute to individual discussion Data scanned and subjected to SPSS. Results presented in descriptive stats of number and percentages. Pearson chi-squared applied. Qualitative A focus group of volunteers. Free text passages from 139 student and 19 tutor questionnaires 10 student group reps emailed 1 tutor telephoned Interviews tape- recorded and analysed ? Contact and frequency of meetings Students make minimal effort for contact and will not push for it. Higher success rate was linked with regular and frequent meetings Low success associated with students initiating contact and not having met during last 10 weeks ? Academic activities Alarming amount of non-contact despite doing well or not. Regular meetings =success of relationship =success of PT scheme Involved trust and understanding ? Social activities and personal problems 93 students (67.9%) felt more social contact was desirable 63 students experienced personal problems but were more likely to approach a friend. 12 students had financial problems but none approached their tutor Present system not successful for students or tutors Single most important factor is the establishment of a relationship with tutor Tutors should make first contact and then actively seek the student Initial aim should be to establish a relationship based on informality and trust Regular monthly meetings should be established These should include some social element Tutors should be given adequate time and resources for the role Knowledge of the curriculum is important Quantitative Data SPSS applied to data Findings of statistical significance ? Meeting held termly or monthly (P 0.0004) ? Not meeting tutor within previous 10 weeks (P= 0.002) ? Regular, frequent meetings with follow up (P=0.0004) Qualitative Data Ethics and consent not addressed. Flexibility in design and data collection demonstrated Respondent validation evident Triangulation of data collection improved rigour of findings Not conclusive whether interaction between student and PT leads to academic success 121 PAPER 11 Methodology Data Collection Findings Conclusions Critique Summary Newton A. & Smith L.N. (1998) Survey with descriptive statistics Pilot with student volunteers Research and Development committee agreement Student consent Sample 108 students following a 5-week placement in 4 branches in Foundation Studies (Yr1) 94 completed questionnaires (87% response rate) 81% female 14% aged 17-20 years Majority 21-30 years 16% 31-40 years Rest over 41 years old 47 std had previous experience as Auxiliary nurse Questionnaire 4 sections Demographics Std experience of teacher contact in placement Importance of interpersonal relations within learning Experience of the PT in supervising in college and in 4 placements Interpersonal relationships All students thought this important Group A thought that it was good to have 1 teacher Group B thought that it was not useful to have 1 teacher Importance of the Mentor Almost 90% accredited the learning of skills to the mentor and 80% stated mentor significant in relating theory to practice Few rated the Practice Placement Teacher (PPT)as important Past Experience of practice placement teaching Students who had seen less of the PPT expressed negativity towards PPT Role of PPT re tutorials and social role Working with student in direct patient care Use of reflection Student centred ? own needs met Students view of poor PPT ? disinterested and inflexible Satisfaction with PT 55 students (Group A) expressed some value in having their PT in practice 39 students (Group B) perceived no value Parameter used to rate quality of supervision was negotiation of the learning Inequalities of supervision exist. The PT would be ideal to negotiate student experience as they know the strengths and weaknesses of the student. Majority of students stated that practice supervision was of very little importance in the acquisition of skills If interpersonal relationships are important the PT role should be capitalized on in practice. Further research of a qualitative nature Themes developed around areas of demographics, student experience of link teachers, the importance of interpersonal relationships for learning and the of foundation studies where the same teacher supervised both campus and placemnt tutorials. Questionnaire was piloted with student volunteers and respondents on the pilot study were not included in the main study. A strength of study is all students provided informed consent. Ethical approval gained via the Research and Staff Development Committee of Lothian College of Health Studies. Limitations of no triangultion of data collection. 122 PAPER 12 Methodology Data Collection Findings Conclusions Critique Summary Owen M. (2002) Qualitative Case Study Spirit of Action research 9 subject routes Sample size Total sample number unclear In depth interviews Students and staff Over 5 Universities x1 Focus group interview at 1 University Gap between student and staff frame of reference for PT. University saw role to monitor, guide and advise and be first point of contact for std. Students Low expectations of PT No problem = no contact Support from family Availability and approachability Wanted to discuss academic progress Wanted to seek help for extensions and deferrals Helps to be taught by PT Keep PT over 3 years Staff Fear of being overwhelmed Inequitable workload Administration help Training ? no instruction (PGCE) Manual of guidance and reference points Other Institutions Increased No. of student Student support high priority by University Management and Faculty First year weekly meetings Integrated curriculum model worked best with all students taking the module and tutors running seminar groups. Impact of this model on learning needs to be undertaken by research Remain PT for 3 years (Continuity) Ring fenced time for PT role Very little evidence of how the participants were selected, especially outside of the Humanities faculty. Total sample size unclear for both tutor and student interviews Methods of data analysis not addressed No explanation of emerging themes or how types of data were utilised. No ethical issues discussed The role of the researcher in the data collection unclear and issues of reflexivity not addressed Limitations of the study were particularly evident during sampling, data collection and data analysis leading to questions whether this data was reliable.. 123 PAPER 13 Methodology Data Collection Findings Conclusions Critique Summary Rhodes S. & Jinks A. (2005) Qualitative Ethical approval Pilot of questionnaire Sample 10 lecturers including a range of characteristics Male/female New lecturer/experienced Adult/ Mental health trained Based on 2 sites Information sheet and consent form used Interviewees sent raw data transcripts to confirm results. Interviews Topic area guide In-depth, face to face and 1:1 Tape recorded Content analysis for themes ? Role of PT Academic and pastoral role Support becomes enabling Support v managerial duties ? Perceptions of personal students Good student and poor student characteristics linked to The Unpopular patient. ? Std attendance and progression Monitoring role of sickness and absence Time needed for struggling student ? Responding to students Referring students on Caring for students linked to caring for patients Confidentiality What to do with reports of poor clinical practice Caring for students closely linked to caring for patients and provided a role model for students through caring behaviours All encompassing role difficult to maintain with number of students Outcomes for students: Maximising learning Reducing stress Facilitating personal and professional growth Increase retention Tape recorded 1:1 interviews Pilot study carried out Schedule then amended Expert opinion by 2nd researcher sought before final schedule Ethics gained but not described Information sheet, consent form and covering letter to all selected. All agreed to participate All respondents were sent their transcripts and asked to confirm it was accurate and willing for data to be used. A framework of support to personal students emerged and was representaed diagramatically Limitations were the exploration of practice element to nurse education 124 PAPER 14 Methodology Data Collection Findings Conclusions Critique Summary Richardson R. (1998) Qualitative Grounded theory based on Glaser and Strauss Consent asked Sample Researcher approached own students 4 students then 4 more students 4 teachers 2 Educational managers Semi-structured interviews Audio-taped, transcribed and agreed before next interview Analysis breaking down and conceptualizing (as in Grounded Theory) Documentary analysis ? Gatekeeper Authority figure, controller, monitor, trouble-shooter and traditional role ? Supporter Encouragement, warmth, partnership. ?Being there? Values echoed in mentorship Darling 1984. Realism V Idealism ? ?Swampy lowlands? Uncertainty, subversion and confusion. Role paid lip service to Strategies for coping with uncertainty or return to rituals and rules. Changing tutors after 1st year Theory to practice and safe practice ? Up-to-datedness Awareness of std needs Stages of the course and what it is like for students Teachers referred to their own clinical practice, research and professional issues Getting inside to understand ? Doing it my way Bending the system/making a role Be wary of taken for granted shared concepts. Exploration of words and phrases representing values and assumptions Tacit knowledge challenges traditional values of roles by development of theory through practice Practice-based evidence Differences of what people say they do and what they actually do Influences of social, political and economic issues Further research related to practice Significance of personal theory in practice PT making the role their own A conceptual framework is developed around the significance of personal theory in practice and the development of theory from practice The researcher discussed her own positivist approach but within the research looked for a humanistic and interpretative approach. The researcher looked for development of personal theory through the concepts of "I" and "Me" and a distinction between behaviour and action. Triangulation of data collection Limitations of the study were the allusions to grounded theory but never actually stating its' use. Also the sample size was difficult to ascertain and the results of the educational managers was not presentaed as a clear distinct group. The relationship of the researcher to the participants is not clear. 125 PAPER 15 Methodology Data Collection Findings Conclusions Critique Summary Sayer M. (2002) Survey with descriptive statistics Sample Students 367 students completed questionnaire 201 1st Year (84%) 166 3rd Year (82%) 85% students below 21 years old 51% female Tutors 35 tutors sent questionnaire 28 completed (80%) 93% had been PT before 45% had 5 years experience 38% had over 5 years experience Questionnaire Questions around 4 topics ? Awareness of Pastoral pool (PP) ? Need for the PP ? Function of the PP ? How should the PP run Qualitative data also from PP confidential record sheets for frequency and content of PP encounter Student awareness and expectations 97; 99% (1st year/2nd year) were aware of PP 47; 90% knew how to contact the PP 19; 53% knew which member to approach 74% they would consider using PP A table provided for reasons why they would not use PP Functions and characteristics 80; 70%(48% PP) believed it should be for academic and personal problems 96 (33% PP) believed it should be confidential 75 (48%PP) believed it should be for academic and social problems Organisational features 290 (79%) students completed this area of ranking priority with guaranteed confidentiality top priority Staff issues included staff development, information, feedback and support Record sheets Total of 38 students used the PP 26 Yr 1/11 Yr 3/1 Yr 4 Dedicated faculty provide pastoral care. Pastoral care is available to those who need it not dependent on tutor/tutee pairing. Uptake was low 2.7-5.3% compared to other research. Limitations as based on self-referral. First year students have now been allocated to 2 PP members Monitoring of PP encounters easier Regular meetings, sharing, training Two recurring issues of academic progress and personal ill-health Academic difficulties met elsewhere although some blending did occur Ill health referral to GP low. Student fears of confidentiality Flexibility of the researcher was not addressed. No attempt for informed consent or desciption of ethical consent from Ethics committee. Presenting themes in the encounters were grouped together and descriptive statistics applied to the evidence of themes and the outcomes of the encounter. The main limitations of the study were the lack of ethical approval and the lack of informed consent. It could be argued that returning the questionnaire was informed consent. No evidence of consent to utilise student records. 126 PAPER 16 Methodology Data Collection Findings Conclusions Critique Summary Sosabowski, M. H. et al., (2003) Survey with descriptive statistics. Sample Level 1 and 2 students No total number given From tables L1=199 and L2 = 190 students Questionnaire 20 questions of which 7 were focused on the PT system Level 1 students 34% seen PT x2 41% seen PT x1 12% seen PT x0 Level 2 students 26% seen PT x2 45% seen PT x1 19% seen PT x0 66% L1 /67% L2 had found PT helpful. Some students expressed that it was beaurocratic rather than a genuine interest in them 63%/64% felt able to ask to change tutors. Must be a partnership but the tutor must take the greater initiative if the student does not. One-size-fits all approach does not work. Students have a restricted view of the personal tutor role To under-promise and over-deliver in order to manage student expectations of the PT role One-size-fits all approach will not satisfy ?all the students all the time?. A variable, flexible, approachable is necessary. Develop PT policy based on all stakeholders discussions and forums PT skills training programmes to enhance the role Minimum number of PT/student encounters per term Broaden knowledge of PT role to include discussion of learning and teaching strategies, information on exams and regulations and how to access student service All sampling and data collection methods not described Unclear how many questionnaires sent out and how many returned as total not discussed but are included in table III & IV. Unclear how questions were put together and no evidence of pilot study. Descriptive statistics utilised to add weight to amount of evidence A major limitation to the study is the lack of discussion from an epistsemological and methodological view point. Lack of description of sampling and data collection leads this to be a weak piece of research. 127 PAPER 17 Methodology Data Collection Findings Conclusions Critique Summary Wilcox P. et al., (2005) Qualitative Analysis using Grounded Theory for positive or negative contributing factors Sample size 22 students from Year 1 12 students who withdrew All from Applied Social Science Faculty Student Population descriptors Semi-structured face- face interviews 45mins- 1 hour OR Telephone interview Interview guide used Tape recorded and transcribed Academic reasons (not analysed) Material reasons (not analysed) Social support ? Making friends first year ? University not as expected ? Failed to connect with PT ? Friends withdrew ? Personal issues ? Accommodation ? University not as expected Link social support to personal development, student activities and independent working groups Students aware of conflict of time for PT Experiencing PT as approachable and supportive helped students gain confidence Tutor is a key support for students with stressful situations Tutors provide informational and appraisal support Student relations with Academic staff key - especially PT Grouping together of students and PT Integration into academic life in first year that is not directly connected to academic experience Students can change PT in first year PT awareness of anxiety and fear of first year student Problems with PT often led to withdrawal from course Student who live at home and mature students benefit from PT Lack of social support networks important factor for students deciding to leave No ethical issues addressed. The respondents were not asked for consent and the study did not seek ethical approval. The role of the researcher was not addressed. Flexibility was introduced by interviewees being encouraged to narrate experiences by specific time reference points eg; first week, a typical week. Remaining gaps in research knowledge acknowledged and the best methodology to capture student experience of tracing changes over whole time at University Attention needs to be given to look at how social relationships are accomplished (or not) Links made between social and academic interactions and retention of students. 128 This page is intentionally blank 129 Appendix 2 Critical Review Form Adapted from: Law, M., Lette, L., Pollock, N., Bosch, J., & Westmorland, M., 1998 McMaster University *With use of digital drop boxes CITATION: Comments STUDY PURPOSE: Was the purpose stated clearly? Yes Outline the purpose of the study. LITERATURE: Was relevant background literature reviewed? Yes Describe the justification of the need for this study. STUDY DESIGN: What was the design: ethnography Other design: What was the study design? Was the design appropriate for the study question? (eg., for knowledge level about the issue, ethical issues). Was a theoretical perspective identified? Yes Describe the theoretical perspective for this study. 130 Method(s) used: Participant observation Interviews Historical Focus groups Other Other Method: Describe the method(s) used to answer the research question. SAMPLING: The process of purposeful selection was described: Yes Sampling was done until redundancy in data was reached: Yes Was informed consent obtained? Yes Describe sampling methods used. Was flexibility in the sampling process demonstrated? Describe ethics procedure: DATA COLLECTION: Descriptive Clarity Clear & complete description of Site: Yes Participants: Yes Researcher?s Credentials: Yes Procedural Rigour Procedural rigour was used in data collection strategies: Yes Describe the context of the study. Was it sufficient for understanding the ?whole? picture? Describe how elements of the study were documented. What was missing? Describe data collection methods. How were the data representative of the ?whole? picture? Describe any flexibility in the design & data collection methods. DATA ANALYSIS: Analytic Preciseness Data analysis was inductive Yes Findings were consistent and reflective of data Yes Auditability Decision trail developed & rules reported Yes Theoretical Connections Did a meaningful picture of the phenomenon under study emerge? Yes Describe method(s) of data analysis. Were the methods appropriate? What alternative explanations were explored? Describe the decisions of the researcher re: transformations to themes/codes. Outline the rationale given for the development of themes. How were concepts under study clarified & refined, and relationships made clear? Describe any conceptual frame works that emerged. 131 QUANTITATIVE RESULTS Results were reported in terms of statistical significance? Yes No Not addressed What were the results? Were they statistically significant (ie., p<0.05). If not statistically significant was the study big enough to show an important difference if it should occur? Were the analysis method(s) appropriate? Yes No Not addressed What was the importance of the results? TRUSTWORTHINESS Triangulation was reported for Sources/data Yes Methods Yes Researchers Yes Theories Yes Member checking was used to verify findings Yes Describe the strategies used to ensure trustworthiness of the findings. CONCLUSIONS & IMPLICATIONS Conclusions were appropriate given the study findings Yes The findings contributed to theory development & future research Yes What did the study conclude? What were the implications of the findings? What were the main limitations of the study?