Tools to Promote Nursing Student Retention in the First and Second Terms

Claire-Andrée Frenette-Leclerc, R.N., Ph.D. Infiressources

Thérèse Sirois, educational advisor, Cégep régional de Lanaudière (Joliette)

Infiressources interviewed Ms. Thérèse Sirois, educational advisor, Cégep régional de Lanaudière. At the Congrès de l’Association des enseignantes et enseignants en soins infirmiers des collèges du Québec (AEESICQ) held on June 1, 2009, in Saint-Jean-sur-Richelieu, Ms. Sirois gave a workshop entitled "Des outils pour favoriser la rétention de nos étudiantes en 1re et 2e

sessions" (Tools to Promote Nursing Student Retention in the First and Second Terms). I met Ms. Sirois to discuss her work and to find out more about this workshop and activities to help nursing students achieve academic success.

Infiressources: What were your goals during the presentation of this workshop to CEGEP teachers? Thérèse Sirois: I tried to answer a few basic questions in this workshop. Who are our students? What are their needs? How can we help them to pull through the first term and to succeed in their studies? I wanted to introduce the teachers to on-line reference materials developed for students at the Cégep régional de Lanaudière à Joliette (see http://www.cegep-lanaudiere.qc.ca/Repertoire/000701/default.asp?SiteId=3&ResId=701). The Cégep régional de Lanaudière à Joliette has made this guide available to the college network. It is available on-line and can be downloaded by any user.1 Infiressources: Before going into greater detail on this guide to help students accomplish their intellectual role, can you please say a few words on who our students are and what needs they have? Thérèse Sirois: My workshop presentation to 35 nursing teachers contained 41 PowerPoint slides.2 I covered the main differences between high school and CEGEP, the transition from one level to the next, student attributes, and how students experience the first term. I began the presentation with the study by Gingras and Terrill entitled 1 Cégep régional de Lanaudière. Outils d'aide à l'apprentissage : la boîte à outils. Available at http ://www.cegep-lanaudiere.qc.ca/Repertoire/000701/default.asp?SiteId=3&ResId=701. 2 Thérèse Sirois. Profession : étudiant-étudiante. Available at http://aeesicq.org/A14.pdf. Note: To help with reader comprehension, Infiressources conducted this interview in synchrony with the slide presentation.

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Caractéristiques étudiantes et rendement scolaire – Dix ans plus tard (attributes of students and academic performance – 10 years later) prepared by the SRAM at the beginning of the millennium. I pursued the presentation with a study on student results at the CEGEP level over the 10-year period from 1992 to 2002. This report was published in 2006.3 The conclusions of the study indicated that while grades are the best indicator of future success at the college level, the time devoted to studying in high school remains a key factor for graduation, even among the best students (see PowerPoint slide 4). In addition, the significance of the first term is felt both by strong and weak students alike. Regardless of whether the students have a 60-to-70% average or an average of 80% and above, there remains a 60% gap between those who fail and those who eventually graduate. This implies that even if the student had an excellent GPA in high school, he faces a high probability of never obtaining a college diploma (DEC) in any program if he fails during his first term. This probability applies both to strong and weak students alike (see slide 5).

Graduation rates by high school average and hours spent studying weekly

(1992 sample)

When the study began in 1992, the factors which indicated likely success in CEGEP were the time devoted to studying in high school, parental support, motivation prior to

3 Johanne Lacroix. "Le Carrefour de la réussite, toujours là pour vous appuyer!" Le Carrefour, vol. 2(1): p. 2-4. Available at http://www.fedeCEGEPs.qc.ca/carrefour_pdf/bulletin/bulletin_vol2_no1.pdf?PHPSESSID=33d827744bd233fcd0126ab345679a53.

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admission, and being admitted to the program of first choice. In 2002, factors which were added included the academic level of the parents and the absence of financial problems. During the conference, I noted that awareness of "false needs" such as owning a cell phone or a car needs to be raised among students (see slides 6 and 7). I then introduced the characteristics of the transition from high school to CEGEP. I wanted to show the teachers which resources the students possessed upon admission.

% graduation

High school average

Failed classes1s t session

0123

4 ou+

Graduation rates by high school average and hours spent studying weekly

(1992 sample)

Both strong and weak students alike feel the impact of the first term

During the first term, they must adapt successfully to a new environment and develop their autonomy while simultaneously requiring relatively thorough supervision in order to succeed. That is the message which I want teachers to understand (see slides 9 and 10). A document developed by the Fédération des Cégeps entitled Jusqu’à la réussite (until success is achieved) focuses on the same message.4 With the tools which we have developed, I am trying to help students to put into practice this message, which encourages them to organize their studies, to develop efficient work habits, and to consolidate their academic and professional aspirations in order to remain motivated and committed to success.

4 http://www.rccfc.ca/pdf/PERSPECTIVES.pdf

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REACHING FOR SUCCESS

From : Perspectives collégiales. Fédération des cégeps. Vo 4, no 5 mai - juin 2009

A Critical Step Forward: the First Term in CEGEP

The student must :

. take charge of the organization of his studies :Maturity and autonomyReaching out to the teacherActive participation (attending classes)

. acquire effective work methods :Knowledge of CEGEP requirementsEffort and consistency in studying

. consolidate his academic and professional :OrientationMotivation and commitment to success

Infiressources: I understand that it is with these objectives in mind that you created the Guide pour la Réussite au Cégep. Profession : étudiant – étudiante (a student guide to achieving success in CEGEP). Can you tell us more? Thérèse Sirois: I was a counsellor at the Cégep régional de Lanaudière à Joliette. I worked with regular students, in particular those in the nursing program. Some students in this group were having trouble. They had trouble with organization, trouble developing good study habits, trouble preparing for exams, trouble taking course notes. These students had short, medium and long-term time management issues which had an adverse impact on their academic success. Many had trouble dealing with the transition from high school to CEGEP, especially those who had drifted through high school on their own intellectual abilities. When arriving at CEGEP, they would hit a brick wall because they could no longer study at the last minute. The drop-out and failure rates in nursing were high due to the heavy workload. Many failures could be attributed to the initial orientation. When dealing with such circumstances, I can only respect the student’s decision to withdraw. Along with the nursing teachers, we have indeed identified intellectual work methodology issues. First-term nursing students are not the only ones to face such issues. That is why I began developing tools for all those who could benefit from them. I worked with François Hétu, an intern who has a bachelor’s degree in psychology and who was about to initiate preparatory courses in order to pursue advanced studies in career studies. Together, we identified the general aspects of intellectual work

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methodology that we feel should be pursued with students. We identified 11 tools and developed files. Finally, we added a twelfth file which summarizes the first eleven. I would go over the twelfth file with some students, and this overview was often sufficient.

Topics • Attention and concentration• Memory• Note taking• Stress management• Reading and studying• Preparing for exams• Passing exams• Written assignments• Teamwork• Time management• Planning• Toolbox

François surveyed the literature before we began developing the files. The tools form a paper document. When meeting students in my office, I feel that it is important that they be given a hard copy (paper) which they can consult at their convenience. A student who has difficulty may feel intimidated when dealing with a teacher while making eye-to-eye contact without having any documentation at hand. Working side-by-side together with a paper copy is easier and less intimidating for the student. Infiressources: Could you please describe the files? Are they standardized? Do they have any unique features? Thérèse Sirois: The platform of every file is based on the same model.5 By clicking on the URL at the bottom of the page, the first file on paying attention and concentrating pops up. The same concepts are found in each file. Profession – étudiant et étudiante (profession: student): Being a student is a profession which involves a significant number of responsibilities. The document as a whole is a puzzle. Each file is a piece of that puzzle. All pieces must be assembled to view the puzzle. Students often master certain skills more than others. Success is easier to attain if they can fit all the pieces together.

5 http://www.cegep-lanaudiere.qc.ca/fichiers/guide-01.pdf

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The files reach out to the widest audience possible by using pictures of students of different genders and cultures. Each file contains a logo with a key phrase (e.g., C’est si facile de se retrouver la tête dans les nuages, literally "It’s so easy to get distracted”). Each self-improvement tip is identified with a check mark. Each file contains a picture of a student with a sentence referring to its subject. Further tips are provided along with a short text. For example, Pour en savoir plus (to find out more) will refer the student to a book or a web site. Each file contains the same categories and logos. This allows the student to search more effectively for specific information, tips and theories on achieving success. The student can find information on preventive strategies (e.g., procrastination), stress management, self-discipline and organizational strategies. Examples are also provided (e.g., note taking). Additional files on how to prepare a study schedule6 and on how to visualize the term as a whole as a series of lectures, exam dates and assignment due dates are available.7 One file provides a visual perspective of the upcoming week. This allows students to plan their activities and priorities. The student must also plan free time for himself. Without planning, this is sometimes difficult to achieve. Another file can be used to set up a team contract to improve cohesion, to assign responsibilities and to meet deadlines.8 An example is provided on the assignment of responsibilities to team members. A template can be filled out. The students decide which tasks are required, to whom they are to be assigned, and when deadlines are to be met. Each team member then signs this contract and agrees to fulfill his part of the commitment. The template contains space to insert the phone numbers of each team member. They take the contract home. Students can ask their teacher to sign the sheet. This can be used as leverage to obtain everyone’s cooperation. A long list of references encourages students who are curious to conduct further research on their topic (e.g., at other CEGEPs, at universities or anywhere else in the world).9 Infiressources: How do you use these tools when dealing with a student at risk? Thérèse Sirois: When a student knocks on my office door, I first try to identify the source of his problem. We then focus on that aspect together. Depending on the needs of the student, we will work with one or two tools at a time. The work is individual and both extremely adapted and customized. The student can then decide to move further ahead. This can encourage him to read other materials, to develop his autonomy and to improve his intellectual work methods.

6 http://www.cegep-lanaudiere.qc.ca/fichiers/grille_semaine.pdf 7 http://www.cegep-lanaudiere.qc.ca/fichiers/grille_session.pdf 8 http://www.cegep-lanaudiere.qc.ca/fichiers/guide-09.pdf 9 http://www.cegep-lanaudiere.qc.ca/fichiers/references.pdf

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For example, I will examine how the student takes notes if he has trouble in this area. I will examine his course notes and their organization. I will let the student consult a document. I will schedule another appointment with him and monitor his progress when I see him again. “Does this make sense to you now?" or "I see that you used markers, that the work is more clearly divided and easier to follow for study purposes." The student starts to see the light at the end of the tunnel. I support him to an extent by providing positive encouragement and positive feedback. Trust is built gradually. The student feels more confident and we eventually move on to other topics. Each file addresses the student in French in the second person singular (informal “tu” form). The file can be used as an aid by counsellors, teachers, students and even parents. Parents of high school students can use these files to help their teenagers prepare for CEGEP and can continue using them to help their kids once they enter college. Students can also use them to help each other. Infiressources: You did much more than just present the learning tools during the workshop. You personalized the student who needs help. You called her Cathy. Why? Thérèse Sirois: The goal of the presentation at the AEESICQ was to review with teachers what they can do with students who have learning problems. This is your average clientele, not one with attention deficit disorder. I provided an example. The student who has trouble taking notes must listen to the teacher and must identify what is relevant and what is not during the lecture. The structure of the syllabus must be outlined. The teacher posts the lecture on the board. This section of the workshop was developed in

cooperation with Chantal Guilbault, a nursing teacher at the Cégep régional de Lanaudière à Joliette and with two of her coworkers, Dominique Dhaiti and Catherine Larouche. The latter participated in the presentation of the workshop. During the workshop, we used Cathy as an example. She is your typical nursing student. We discussed the main problems which she might encounter, using

class notes as a concrete example.10 Slides 21 to 33 of the PowerPoint presentation outlined her trajectory and offered tips and solutions to her 11

Cathy: A Nursing Student

• High school record– GPA: 75

– No failures, always succeeded at succeeding

• Studies– Hours spent studying in high school: 3 to 4 per week

– Last-minute studying (the night before the exam)

• Conclusion: Cathy must improve her intellectual work method and study skills.

problems.

10 http://www.cegep-lanaudiere.qc.ca/fichiers/guide-03.pdf

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We worked on communication in the classroom. It is essential that teachers remember their syllabus and write down on the board the topics to be covered during the lecture. Many teachers forget to do this. The teacher must provide the syllabus to his students so that they can follow the overall structure and thought process and take notes. It has been proven that a teacher’s voice and manner of presenting a subject change when covering an element of an upcoming exam. His manner of communicating highlights an essential course element. Teachers must teach their students to identify hints and to take them into consideration so that they can jot them down for studying and examination purposes. Note legibility and clarity make studying easier. The notes should be well organized, properly structured and placed in a clearly identified binder. The teacher may suggest a few simple strategies such as using highlighters and symbols to identify important notions and writing down symbols such as an asterisk or a star to indicate significant elements. Taking notes during lectures helps the student to focus. Personally, I disagree with the idea of handing out detailed course notes. There should be a few holes and spaces to fill in order to keep the students alert. On the other hand, it is unnecessary to rewrite the notes in the evening. This can constitute a waste of time if this exercise does not structure studying. The teacher can make a PowerPoint presentation, but should respect certain limits. If the PPT presentation is neither related to the syllabus nor to the printed course notes purchased by the students at the cooperative, use of the slides should be limited. Their use would only confuse the students and complicate their studies. It is essential that teachers always follow the same structure to help first and second-term students. Using an integrative diagram can help to improve student retention of course material. It is easier to assimilate a subject in blocks or as a whole visually (e.g., an example of pain assessment). The student assimilates the integrative diagram and identifies symbols for each branch of the diagram. He then tries to remember the branches by assimilating the symbols. After reflection, he compares and validates his comprehension. In the third or fourth stages, he remembers the symbols, positions them on the appropriate branch and automatically reconstructs the concepts to arrive at a reference diagram. It will then be easier to remember the matter studied during exams.

11 Thérèse Sirois (June 1, 2009). Guide pour la réussite au cégep. PowerPoint slide presentation available at http://www.infiressources.ca/fer/depotdocuments/Outils_d_aide_a_l_apprentissage-TSirois-AEESICQjuin2009.pdf. See slides 21 to 33.

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The teacher who wishes to help the student structure a complex subject by introducing him to the integrative diagram is in fact teaching his pupil how to study.12 This is an excellent pedagogical strategy. During the first and second terms, students are introduced to the integrative diagram. The teacher can create one with them as a group in the classroom. The student or a team can then be asked to develop a diagram. Each student or group is likely to produce a different integrative diagram. Creation fosters the structuring of thought. I showed teachers an integrative diagram on elements omitted by a student on COPD: pathologies, pharmacology, monitoring of symptoms, etc.13 The teacher – especially during the first term - should cover note taking with his students. For example, copying notes from others is not always practical because this does not always translate into assimilation of the subject matter. Some students attempt to write down the entire lecture. The teacher can suggest that the students use abbreviations, with emphasis on the beginning and ending of the lecture where most of the subject matter is summarized. A good teacher will introduce the structure of his class in the first few minutes. During the final 15 minutes, he will highlight the main points of the lecture and summarize the content covered.

12 Thérèse Sirois (June 1, 2009). Available at http://www.infiressources.ca/fer/depotdocuments/Outils_d_aide_a_l_apprentissage-TSirois-AEESICQjuin2009.pdf. See slide 23. 13 I, Nadine Sylvestre, hereby authorize the Cégep régional de Joliette to use my integrative diagrams for pedagogical purposes and in publications.

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Infiressources: You also covered other learning strategies with the teachers using the files that you have developed. Thérèse Sirois: There are obviously other learning strategies.14 You can learn while speaking out loud, especially what needs to be learned by heart. Speaking out loud and listening to yourself repeat the subject matter is an important learning method. Mnemonic tricks such as associating subject notions with other unrelated notions can be helpful. It is sometimes easier to remember strange facts. I read the other day that a boa can eat only once every 300 days. I remembered that. A cartoon can be a great mnemonic tool.15 For example, the student can draw a patient with acute pulmonary edema, but with all of the symptoms grossly exaggerated (e.g., foaming of the mouth, profuse sweating, pain, obesity, high blood pressure, etc.). The student will remember the main highlights of his drawing. It is a scientific fact that sleep is good for the memory. It is important to review the course material covered during the day before going to bed. Along with the files on reading and studying, I spoke of the student who shows up in class the day before an exam in a state of panic.16 With the teachers, I covered the retention curve contained in the file. Is it helpful or not to work in groups? If the questions are divided among students who do not work well together, then the answer is no. Only a fraction of the subject matter is covered under such circumstances. The teachers must insist on the importance of preparatory reading before classes. Preparing for exams (la préparation aux examens): Last-minute studying or cramming is good if the topic has been repeatedly studied during the term.17 Students can consult the files on term planning and weekly planning to prepare for the exams. Students should attempt to anticipate exam questions in order to alleviate stress and to be prepared for them. Furthermore, students should ask themselves whether they are able to explain the subject matter to their peers. The question to ask oneself is: "If I can’t explain it, then do I understand it?” The student who subsequently fails will do so not as a result of stress, but rather as a result of lack of comprehension of the subject matter. If the student is able to explain the content and fails, then stress management may be an issue. Passing exams (la passation des examens): In my workshops, I recommend that teachers give study tips to their students.18 For example, students should avoid asking themselves last-minute questions before the exam and looking up answers in their textbooks. This only increases stress and can result in confusion. The students should read all the exam questions before answering any. They should answer the easy questions first.

14 http://www.cegep-lanaudiere.qc.ca/fichiers/guide-02.pdf 15 http://www.infiressources.ca/fer/depotdocuments/Outils_d_aide_a_l_apprentissage-TSirois-AEESICQjuin2009.pdf. See slide 26. 16 http://www.cegep-lanaudiere.qc.ca/fichiers/guide-05.pdf 17 http://www.cegep-lanaudiere.qc.ca/fichiers/guide-06.pdf 18 http://www.cegep-lanaudiere.qc.ca/fichiers/guide-07.pdf

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Writing assignments (la redaction des travaux): Strategies contained in this file are practical for teamwork.19 As I mentioned at the beginning of this interview, the teacher can motivate his students by having them sign or initial a study contract. This reduces procrastination and guarantees more equitable teamwork.

All these tips and recommendations, for example on written assignments and time management, are included in the files which serve as learning tools. I just wanted to highlight the main points of the workshop given to nursing teachers to help them support their students in their learning.

Infiressources: In your workshop, you also covered the relationship between departmental life and student success. What relationship exists between these aspects of college life?

The final series of slides in the PowerPoint presentation mentions other, more general strategies which can affect life in the department.20 For example, the department may decide to include learning or knowledge-acquisition tools in the syllabus as early as the first term. One learning tool can be introduced every week.

Departmental Strategies

• Include the learning tools in the presentation of the nursing syllabus for the first term.

• Introduce one academic success tool per week over the course of the first term.

• Associate the learning tools with the student agenda.

• Refer students in difficulty to the academic success or program counsellor so that they can take the time to assimilate the learning tools.

• Add a mandatory meeting with the counsellor or a teacher when signing the academic success contracts of students who have already failed a course. MORE GENERALLY

• Introduce a project as part of the academic success plan which focuses on the development of intellectual work methods.

• Innovovate to earn the commitment of nursing students.

• Have second and third-year students mentor the first-year students to help them succeed.

• Plan for career-related activities in February (with your regional hospital centres).

• Encourage student participation in after-school activities which increase their interest in their program.

• Set up a room where department students can meet.

Among the other strategies which we proposed, it is worth mentioning interest in a department project for an academic success plan which is related to the development of intellectual work methods and the use of learning tools. Funding is currently available in the education system for such a project. All CEGEPs have an academic success plan (plan d’aide à la réussite). When teachers submit a project to help

19 http://www.cegep-lanaudiere.qc.ca/fichiers/guide-08.pdf 20 http://www.infiressources.ca/fer/depotdocuments/Outils_d_aide_a_l_apprentissage-TSirois-AEESICQjuin2009.pdf. See slides 31 to 34.

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students, funding is often available. A counsellor is usually responsible for the academic success plan. Teachers can submit projects within this framework. Teachers can also obtain a reduction in their workload to focus on intellectual work methods with their students. The workshop contained everything necessary to help teachers to develop and submit their projects to their respective CEGEPs. To alleviate staffing and orientation problems, and in accordance with the policies of each CEGEP, nursing departments can plan activities with employers during February to encourage career integration. Motivation is a factor for success in the first term. To motivate future students, teachers can develop presentations for high school pupils who wish to go into nursing. The Centre collégial de développement de matériel didactique (CCDMD) developed a great film on a day at work of a new hospital employee.21 I believe that this film is an excellent source of motivation to initiate high school students who wish to make a career decision. Still related to departmental life and in the current context of frequent last-minute hiring, it is important to inform teachers of the existence of the learning tools posted on the CEGEP’s web site. Their existence should be pointed out during departmental meetings and their use should be monitored whenever necessary. More generally, information about the existence of learning tools should be disseminated on the CEGEP's web site and in any other available media (e.g., student agenda). Infiressources: You are employed by the Cégep régional de Lanaudière à Joliette. How can teachers working for other CEGEPs get their students to consult your work? Thérèse Sirois: Along with François Hétu, we have developed files. The CEGEP has agreed to make them available on-line provided that they are attributed to their rightful institution. All these goals converge on improving the learning abilities of students regardless of which CEGEP they are attending. Infiressources: On behalf of Infiressources and all teachers who will benefit from your work, thank you.

21 http://www.ccdmd.qc.ca/ressources/?id=1267