problem based learning in mental health nursing: the students' experience

Feature Article_788 175..183

Problem based learning in mental health nursing:The students’ experience

Carol Cooper and Neil CarverDepartment of Mental Health and Learning Disability, University of Sheffield, Sheffield, UK

ABSTRACT: Problem based learning (PBL) is well established within the field of health-care edu-cation for professionals worldwide, although little has been done to explore the experiences of studentsundertaking a PBL course in mental health nursing. Without firm evidence of the benefits of PBL,educationalists in mental health might be reluctant to view it as an option in curricula design. This UKstudy examined the experiences of pre-registration post-graduate mental health student nurses under-taking a 2-year educational course in which all teaching and assessment followed a PBL philosophy.Focus groups were used throughout the course to elicit in-depth qualitative data that was analysed byapplying a constant comparative method. The analysis of the data uncovered the following broadthemes: ‘moves to autonomy, ’surviving the groups’ and ‘the impact of PBL’. The findings show thatparticipants had mainly positive experiences and gained a range of study and interpersonal skillscentral to mental health nursing. Participants described initial anxieties resulting from engagement inPBL. However, they increasingly gained confidence in this approach, exercising increasing controlover the PBL process. Despite this increased autonomy, participants continued to value the input ofskilled facilitators. A recurring issue centred on the potential for interpersonal conflict within thestudent group and its impact on their learning. It is suggested that more research is needed examiningthe use of PBL in mental health nursing.

KEY WORDS: education, mental health, nursing, problem based learning, psychiatric nursing.

INTRODUCTION

Problem-based learning (PBL) is a teaching and learn-ing approach originally devised for medical educationin Canada (Barrows & Neufeld 1974). According to theProblem-based Learning Special Interest Group (2009)

based in the UK, there has been a marked increase inthe use of PBL in health-care education worldwide (e.g.in dentistry (Lohman & Finkelstein 2000), physiotherapy(Dahlgren & Dahlgren 2002), occupational therapy(Hammel et al. 1999), and psychology (Dahlgren &Dahlgren 2002)). PBL has become a popular approachin nursing education (McGarry et al. 2010), although itis implemented in various ways. Indeed, Savin-Baden(2006) outlines eight different modes of implementingPBL available to educationalists.

In essence, however, PBL is a student centredapproach to teaching and learning in which students areexposed to trigger learning materials based on ‘real lifeproblems’ (Matheson & Haas 2010; p. 9). Students workin small groups to explore and examine the issues thatarise from the learning materials. Individual studentsaddress their own learning needs and are also tasked with

Correspondence: Carol Cooper, Faculty of Health and Wellbeing,Sheffield Hallam University, 36 Collegiate Crescent, Sheffield, SouthYorkshire, S1 1WB, UK. Email: [email protected]

Carol Cooper, PG Dip (Ed), BMed Sci, RMN.Neil Carver, MA, BA, Dip Couns, RNT, RMN.Present address: Carol Cooper and Neil Carver, Faculty of Health

and Wellbeing, Sheffield Hallam University, 36 Collegiate Crescent,Sheffield, South Yorkshire, S1 1WB, UK.

Author contributions: CC was involved in the study design, the datacollection and analysis, and the writing of the article. NC participated inthe data collection and analysis and the writing of the article.

Accepted October 2011.

International Journal of Mental Health Nursing (2012) 21, 175–183 doi: 10.1111/j.1447-0349.2011.00788.x

© 2012 The AuthorsInternational Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

examining some of the specific issues that arise. A formalreview of progress takes place before the collated infor-mation is fed back to the group. This process of learningis ‘active, self directed and cyclical’ (Matheson & Haas2010; p. 10). The involvement of the lecturer in thisprocess is essentially that of facilitator.

There are a whole series of benefits associated withPBL. These include the idea that PBL encourages deeperlearning, in which there is genuine understanding of anissue as well as the reflective application of interpersonalskills and/or knowledge (Westcott et al. 2010).

According to the Problem-based Learning SpecialInterest Group (2009), research into PBL occupies fourmain areas: curriculum design, facilitation, effectivenessof learning, and student experience, which is the mostresearched category. This report, however, suggests thatthe bulk of this work is focussed on evaluating particularmodules or units that use PBL rather than whole coursesor programmes. Only one research study discusses theuse of PBL within a mental health nursing programme.Wood (2005; p. 195) finds that UK mental health nursingstudents engaged in PBL become: ‘more self motivated,autonomous and reflective as learners’. However, Woodfocuses on wider issues in mental health nurse educationrather than PBL per se. Without clearer and more sub-stantive evidence of the benefits of PBL, educationalistsin mental health might be reluctant to view it as an optionin curricula design.

BACKGROUND TO THIS STUDY

The present study aimed to address this gap in the litera-ture by exploring the experience of two cohorts of stu-dents undertaking a pre-registration post-graduate PBLcourse in mental health nursing. In the UK, students witha health related degree may undertake a 2-year courseto gain both a post-graduate diploma as well as mentalhealth nurse registration. The choice to base this courseon PBL arose from a desire among nursing lecturersto use less didactic and traditional teaching methods.Its development is fully described elsewhere (Cooper &Gunstone 2007).

The course comprised four units, each of 6-monthsduration. Learning in each unit was based on five triggersalong with two or three fixed resource sessions. In com-parison to the trigger group work, fixed resource sessionsare more didactic in nature but designed to cover specificmaterial linked to the triggers (Wilkie & Burns 2003).Trigger work in each cohort took place in two groups ofup to 10 students facilitated by a tutor. This was guidedby a process originally outlined by Schmidt (1983) and

referred to as the ‘Maastricht Seven Step Model’ (Mathe-son & Haas 2010). Students establish an understandingof outstanding issues in the trigger and, ultimately, moveto a synthesis of knowledge acquired through theirindividual investigations of varying facets of the triggerproblem.

Course assessments reflected PBL philosophy andincluded case presentations, the analysis of a taped coun-selling intervention, a poster presentation, essays and apatchwork text. The latter is described as a sequence ofshort pieces of writing joined by a reflective commentary(Scoggins & Winter 1999).

METHOD

This longitudinal, qualitative study utilized focus groupscarried out in the first week, at the midpoint, and in thefinal week of the course. Each cohort was divided intotwo, so that there were six focus groups of up to eightparticipants in each. Focus groups were chosen as themeans of data collection for this study as this is a recog-nized method of obtaining rich data from multiplesources with the immediate opportunity to validate par-ticipant responses (Krueger 1994). Participants have theopportunity to reflect on and react to the opinions of otherparticipants (Parahoo 1997). The resulting group synergygives the researcher greater breadth and depth of under-standing of participants’ views and experiences. (Loebet al. 2006). Each focus group was approximately 1 hourin duration and was facilitated by a researcher.

Ethical approval was granted by the UniversityResearch Ethics Committee. All 32 students enrolled inthe course were invited to participate in the study but 2declined. In addition to written consent, verbal consentwas obtained from each participant before each focusgroup. All focus groups interviews were tape recordedand transcribed verbatim.

Transcripts were analysed after each group using aconstant comparative method based on Burnard (1991) inwhich both authors independently scrutinized the dataand agreed on the themes that emerged. To increase thetrustworthiness of the analysis, these themes were fedback to participants to expand or clarify their meaning, aprocess known as ‘member checking’ (Moule & Goodman2009). The following themes were identified: ‘moves toautonomy’, ‘surviving the groups’ and ‘the impact of PBL’.The results section below describes the development ofeach of these themes at each sampling point, revealing thechanging nature of the students’ experience throughoutthe course.

176 C. COOPER AND N. CARVER


RESULTS

Moves to autonomyThis theme is concerned with students becomingautonomous learners and their changing relationshipswith their facilitators. At the outset, some participantswere attracted to PBL as they thought it would givethem greater ‘ownership’ over their learning. Neverthe-less, there were anxieties. As one stated, PBL had ‘thepotential to go hideously wrong’ or ‘be fragmented, piece-meal and not very rigorous’.

In addition, there was concern about the absence ofteacher-led taught sessions and the possible impact of amore facilitative style of teaching:

I’m a bit worried in case I don’t know what I need tolearn.

They recognized that some areas of knowledge couldbe so vast that without direction they would ‘drown’. Par-ticipants also acknowledged that, without previous knowl-edge or experience it was ‘hard to get started’.

At the end of year 1, participants were ambivalentabout several aspects of their experiences but also recog-nized that their anxieties could arise from being a studentin any course. Some still voiced fears that they were notdirected to appropriate material nor guided to ‘get deeperinto stuff’. The following quotes, from different students,further demonstrate these anxieties:

We can’t know everything but we need to know what themost important things are.

In a year I’m going to be qualified . . . don’t know if whatI am learning is the right stuff.

We’re all novices, we’re not experts and sometimes youneed that expertise. You need reassurance as well, we’reall learning off each other but none of us really know whatwe are doing sometimes.

Some participants felt that this was not just attribut-able to their lack of knowledge in mental health but theirlack of teaching skills, making it ‘very hard . . . to learnfrom ourselves’. However, some participants were morepositive:

Personally I think that . . . we must be hitting the mark orelse the lecturers who are there would say we’re not.

In addition, one participant stated:

I do think that this is a very independent style of learningand does mimic what you eventually end up having to doanyway. I do think that’s useful, the getting thrown in atthe deep end and (having to) swim.

At this point, participants also enjoyed exercising somecontrol over what they studied:

We come up with different ideas, perhaps things that wewouldn’t get in lectures.

In addition, the fixed resource sessions were valued,particularly in addressing new and complex material: forexample, aspects of mental health legislation.

Despite this, there were still mixed feelings aboutmissing or misunderstanding material, even though theyfelt they were ‘on the right track’.

The focus groups at the end of the course showedparticipants were significantly less anxious about per-ceived gaps in their knowledge. The following point wasechoed by the whole group:

You have to realize that you don’t have to know everythingand that is the whole point of this.

In addition, participants were taking more control overtheir learning needs:

We decide what we want to know now . . . we need afacilitator who will listen to us when we say actually we’vealready done that.

They were also exercising greater control over the PBLprocess itself:

We actually changed the way we fed back. I thought thatworked extremely well.

In addition, they felt formal review sessions were nolonger necessary:

It’s about communication and clarification . . . we do it aswe go along.

Looking back, however, participants still found that thebeginning of the course was difficult:

I felt so completely lost and confused the whole time . . .I think it would have been more helpful to have hadsomething more solid . . . at the start.

Participants felt this could be improved by having agreater proportion of lectures as fixed resource sessions,more guidance in presentation and research skills as wellas more group building sessions.

Despite their increased autonomy, participants stillstated that they required academic support for assessedwork from tutors. In addition, they would have preferredfacilitators to be formally responsible for addressingissues of quality in presentations rather than having toconfront peers themselves. Although they wanted more

PROBLEM BASED LEARNING IN MENTAL HEALTH NURSING 177


direction at the outset they now felt that this was anecessary part of their learning and, in some ways, wasbeneficial:

We wouldn’t have been able to develop as much overtime.

The participants’ increased autonomy was alsoreflected in discussions regarding facilitator style. Bythe end of year 1, participants were expressing unhappi-ness with what they perceived as a ‘laissez-faire’ style offacilitation:

I know you have somebody (the facilitator) sit in but moreoften than not they just sit there and say ‘you tell me’.I had thought there would be a bit more involvement.

. . . it’s their (facilitator) mission to guide you . . . we havegone away and done things independently and we stillneed a bit of reassurance from them that it’s right . . . so ithelps if they have input.

In contrast, participants were unhappy with facilitatorswho did not appreciate their understanding of PBL:

We’ve had people (a facilitator) come in and say no you doit like this, I don’t like the way you want to do it. Thenwe’re left thinking: hang on a minute, we were gettingquite good at this.

In general, they preferred active, involved facilitatorswho encouraged them to question material more and gaveconstructive criticism on the content and style of theirpresentations. In addition, they wanted facilitators whowere ‘inspirational teachers’ and ‘passionate about theirspecialist areas’.

They also wanted to learn from their facilitators’ clini-cal experience but wondered if lecturers were inhibited indiscussing these matters because of their perceived role asPBL facilitators.

Surviving the groupsThis theme describes students’ experience of group workand the strategies used to address interpersonal tensionsthey encountered. Even at the outset of the course, par-ticipants saw small group working as attractive in offeringmutual support and the opportunity to share knowledge:

We get further by working with each other than we wouldon our own.

Despite this, several specific anxieties were raised.First, some participants felt they were disadvantaged asthey had less academic or practical experience of mentalhealth than their peers. Second, participants feared notbeing taken seriously and doubted their own ability to

‘teach’ their peer group. Third, although they recognizedand valued the formal roles within the groups (scribe,chair and facilitator), there was still concern that thegroup work would not be effective. Finally, they alsovoiced general concerns about being reliant on othergroup members and letting fellow group members down:

Something I’m concerned about . . . people not pullingtheir own weight . . . myself included.

In the following quote the interviewer has establishedthat everyone in the focus group feared letting othersdown and attempted to reduce anxieties in discussing thisissue through the use of humour:

(Interviewer) . . . so everyone’s eyeing each other upthinking: who’s the lazy one?

(All) Laughter

(Participant) There’s lots and lots of everyday reasons whypeople can’t do the things that they say they’re going to doand it’s not about being lazy . . . I think we’re all respon-sible enough to sort of pick up the pieces . . . but it is anissue.

Some felt that collective group work might distractfrom their personal learning:

I think people find their own rhythm and pace in thingslike that (ways of learning) . . . I like being left aloneto go and find out things . . . but that doesn’t mean I’manti-PBL, just that it’ll be new.

By the end of year 1, participants felt that the successof PBL was largely dependent on group cohesion and themotivation of individual students. However, they recog-nized that interpersonal conflict could undermine thissuccess. Participants felt it was difficult to give peers con-structive criticism as they were ‘all friends’.

They were also reluctant to increase the standardsof their presentations, or, as one put it ‘raise the bar’. Theybelieved that this increase in expectation would result inunreasonable demands on their peers. The alternative, ofaccepting low standards, was equally unacceptable. Asone said:

The stuff that we feed back is all at different levels whichcan be conflicting and confusing.

Although interpersonal conflict was viewed as undesir-able, learning to manage it was seen as a benefit:

It’s good practice for when you go into the workplace. . . you’ve got to get on with people you might not behappy working with or don’t work that well with. . . you’ve got to get on with it.



Individual contributions to the group trigger workwere not considered part of the assessment process andwere not graded. Participants felt that this led to a senseof demotivation and increased interpersonal tension, aview that was reiterated at each sampling point:

It just feels like: oh it’s extra homework, and you’re notgetting a grade . . . so why should I give it as much of apriority?

As another said:

It’s like it doesn’t feel like there is anyone checking. . . It’s not only that, it’s that we have to trust everybodyelse and what they’re doing. Sometimes you feel you can’tbe bothered, because it’s not going to get marked so youdon’t put as much effort into it and if everyone is doingthat then we’re in trouble.

As mentioned earlier, participants were reluctant tochallenge their peers regarding the standard of presenta-tions and felt this role should fall to the facilitators.

In the final focus group, participants felt able to discusspreviously unmentioned difficulties experienced at thebeginning of the course:

It was like a bit more of a competition at first wasn’t it?Because you think if I don’t do it like this and everyoneelse has, what will they think?

It was also apparent that the ways in which theythought about interpersonal tensions in the group hadchanged:

It helps working a lot with people that at first you mayhave difficulty with. For example in the first trigger groupwe clashed terribly and you look at us now . . . that’s abrilliant learning experience because there will always bepeople that you clash with and you’ve got to learn toaccommodate that . . . It’s finding that way to get on withpeople even if you’ve got personalities that clash.

It was also stated that although they were not confidentenough to confront fellow students at the beginning of thecourse they now felt able to. Two features of the groupwere identified as being useful in minimizing the poten-tial for conflict. The first was the small size of the triggergroups and the second was that the trigger groups werereconfigured with different membership at the beginningof each unit of the course.

Impact of problem-based learningThis theme describes the value of undertaking a PBLcourse as described by participants. At the outset of thecourse, participants hoped that PBL would increasetheir ability to develop skills and confidence in accessing

information. They also felt it would enable them to utilizetheir different educational and personal backgrounds andbe effective in modelling nursing practice through theanalysis of clinical scenarios. Nevertheless, participantsquestioned whether PBL could be effective by virtue ofits novelty. In contrast, they believed traditional teachingmust be ‘safe’ as:

It’s been around for so long.

It was noteworthy that this observation was based onpersonal experience rather than any appraisal of researchevidence.

By the midpoint of the course it was apparent thatsome of the hopes above had been realized and partici-pants reported increased abilities in the following skills:research, group work, presenting and teaching, time man-agement and task prioritization. By the end of the courseparticipants stated that:

PBL does work.

Another said it had ‘few downsides’.They also reported an increase in confidence relating

to their practice. In relation to some areas, participantsdemonstrably attributed this skill acquisition to PBL. Forexample, one participant stated that PBL ‘makes you a bitmore diplomatic’. Another commented:

It makes you mix and work with people.

However, one participant felt that their skills hadimproved simply because they had matured rather thanbecause of PBL.

In addition, participants reported that as learners they:felt more engaged, learnt more and achieved a greaterdepth of learning than in lecture driven courses. Onecommented:

I think it’s a much more enjoyable way to learn and if youenjoy something then obviously you are more likely to getmore out of it.

Another stated:

When we present our work we can relate it to practice andwe can bring in examples which I think in a lecture wewouldn’t be able to do.

In highlighting the value of contributions from theirpeers, one participant stated:

I don’t like lectures . . . you only ever learn what the lec-turer thinks is important.



Nevertheless, some expressed concern about the depthof knowledge gained from their peers’ contributions asopposed to that acquired through their own personalstudy. As one stated:

You feel like you know one part very well and that sort ofmakes you feel like you don’t know the others as well.

One participant felt that the course had not ‘taught methat much’, but acknowledged that perhaps this was theirresponsibility.

Mirroring findings mentioned earlier, commentsmade in the final focus groups showed that being a novicestudent on a PBL course was perhaps more difficult thanparticipants had described in the earlier focus groups. It isnoteworthy, however, that in looking back, participantsfelt those experiences were ultimately valuable:

I think the PBL course is what you make it . . . It’s onlynow that I can see the positives sides of it . . . It’s all aboutadult learning and the emphasis is on you.

Given their overall experience, participants felt thatPBL students should ideally be graduates with alreadydeveloped information finding skills. They also felt theyshould possess a level of maturity they themselves feltthey did not have at the age of 18:

I think if you went straight onto PBL with no idea on howto search (the literature) . . . you would spend all yourtime just working out how to do it and not learninganything.

Finally, participants clearly had anxieties about quali-fying as a nurse although no-one overtly stated that PBLhad not prepared them for this. They also felt that theiranxieties were the same as anyone starting a new career.As one stated:

You know, it’s that kind of time isn’t it?

DISCUSSION

The findings above resonate strongly with other similarstudies of PBL outside of mental health nursing (e.g.in midwifery (Rowan et al. 2009)). This strengthensthe notion that there are common characteristics in PBLcourses regardless of the subject being taught. Mentalhealth educationalists might, therefore, feel more securein utilizing PBL research from other professional groupsto support its implementation.

More specifically, the findings chart the participant’s(mainly positive) experiences over the length of thecourse. At the outset, it is worth noting that the partici-pants themselves felt that PBL suited those with greater

educational maturity and believed its success in this casewas partly because of the extent of their previous educa-tional experience. Overall, the shape of the participants’journey appears to mirror that identified by Wood (2005).This described adaptation to PBL taking place but alsothe fact that students continued to require reassurancesthat they were ‘doing it right’ throughout the course.

Despite the need for reassurance, it is clear thatparticipants benefitted from the experience both as‘learners’ and in becoming mental health nurses. Whenparticipants contrasted their PBL experience with beingin lecture-driven courses, their statements demonstratePBL as a successful educational strategy. First, as shownelsewhere (e.g. Carlisle & Ibbotson 2005; Reynolds 2003),PBL was felt to lead to a greater breadth and depth oflearning. Second, participants recognized that it providedincreased opportunities for self direction, a finding alsonoted by Barrow et al. (2002) and Carlisle and Ibbotson(2005). Again, as demonstrated by others (Carlisle &Ibbotson 2005; Reynolds 2003; Sharp & Primrose 2003),PBL led to greater engagement and motivation in thelearning process.

In terms of becoming a mental health nurse, the find-ings show that engaging in the PBL process leads to theacquisition of skills argued to be central in mental healthnursing (Cooper & Gunstone 2007). There were manycomments relating to the positive interpersonal aspects ofthe group work, which participants hoped would carryinto mental health practice. Other skills highlighted byparticipants included: team working, communication,and interpersonal skills. These findings also mirror thosedescribed in the existing literature from other disciplines(e.g. Barrow et al. 2002; Carey & Whittaker 2002; Carlisle& Ibbotson 2005; McCourt & Thomas 2001; Reynolds2003; Sharp & Primrose 2003; Wakefield et al. 2003;Watmough et al. 2006; Willis et al. 2002).

The findings also provide insight into ways in whichthe student experience of PBL could be improved. At thebeginning of their course, participants anxieties centredon the process of PBL, concerns about mastering mentalhealth nursing and whether they would achieve the leveland breadth of knowledge required by the course. Thesefindings echo those of other studies of PBL groups (e.g.Rowan et al. 2008; Wood 2005).

The desire for more direction at the outset of thiscourse is also a finding in other studies (e.g. Rowan et al.2009). Taken at face value, this would seem to indicatethat greater levels of direction should be given at thecommencement of a PBL course. However, it is worthnoting that participants retrospectively report that copingwith the ‘lack’ of direction had been a beneficial part of



their learning experience. This might indicate thatPBL courses should utilize strategies to ‘hold’ participantsanxieties until they become articulate as PBL learners.However, this finding might represent a rationalizationon behalf of participants and PBL courses might need tobe more directive initially. Whatever takes place, Savin-Baden (2000) suggests that students will inevitably face asense of disjunction when engaging with PBL for the firsttime. She also suggests that this can ultimately be a posi-tive learning experience.

As the course progressed it is clear that participantsexercised increasing control over the PBL process. Whileon one hand this might represent ‘storming’ (Tuckman1965), it also seems to show the development of increas-ingly engaged and autonomous learners. If so, this sup-ports the idea that a PBL course must accommodatestudents’ need to have increased control as they progress.

Despite becoming increasingly autonomous through-out the course, participants continually valued the inputof skilled facilitators. They also had clear views on thequalities they felt were needed for effective facilitation.This also highlights the necessity for flexibility on behalfof the facilitator, a point recognized elsewhere (e.g. HaithCooper 2003). Participants here seemed to wish facilita-tors to become less directive throughout the course. Theyalso wished for ‘inspirational experts’ to teach them.Roberts (2010) suggests that most studies now supportthe idea that facilitators in PBL should be experts in thesubject taught as opposed to just being skilled facilitators.Finally, participants valued facilitators’ enthusiasm forthe subject. This led to increased motivation, a centralelement in the effective functioning of PBL groups (Williset al. 2002).

Participants clearly recognized that the success of PBLdepends on how well the trigger groups function at aninterpersonal level, a point noted elsewhere (Nieminenet al. 2006; Rowan et al. 2009; Willis et al. 2002). Thereare a series of indicators revealing strategies some partici-pants used to attempt to avoid interpersonal conflictwithin their groups. For example, assessing trigger work isa significant issue in PBL (see Willis et al. 2002) and it isnoteworthy that participants wanted their individual con-tributions to this to be assessed by the teaching team.Students felt that this would remove a major source ofinterpersonal conflict and would also motivate them toproduce higher quality work.

The evidence here suggests that participants did, infact, resolve some of these tensions successfully, but it isnot clear how they did this. Research by Seren and Ustun(2008) shows that conflict resolution skills in a PBL groupwere better developed than those in a conventionally

educated group, although it is not clear whether conflictresolution was formally taught or simply acquired as partof the PBL process. Significantly, Seren and Ustun (2008)cite evidence of the effectiveness of formal educationregarding these skills. Therefore, it would seem logicalthat rather than allowing students to develop ad hoc strat-egies regarding conflict resolution, PBL participants begiven some training in the early stages of a course. Cer-tainly, the role of the facilitator in addressing interper-sonal conflict needs to be explicit within the PBL process.

Despite the value of the findings above, the study hasseveral limitations. Although participants often attributedtheir development to the PBL process, this cause andeffect relationship is not always clear. In addition, partici-pants in later focus groups discussed experiences fromearlier in the course that were not mentioned in focusgroups at that time. This possible ‘censorship’ could beexplained by possible reluctance to criticize peers and thecourse in the presence of fellow students and lecturersinvolved in its delivery. Another explanation might be theparticipants attempting to avoid what Festinger (1957; p.3) has termed ‘cognitive dissonance’. In this case, partici-pants who had committed themselves to a course mighthave felt unable to criticize the course as it would indicatethey were perhaps mistaken in becoming a student inthe first place. Such dynamics might indicate that futureresearch regarding the experience of PBL should incor-porate post-qualification evidence collection.

A final point is that this study took place in uniqueorganizational circumstances in which many lecturersinvolved in the course design were being transferredto another university following a major change in thecontracting of nursing education. Although it is not clearhow this might have affected the findings, participants didstate that it had impacted on their morale.

CONCLUSION

This study has highlighted various aspects of students’experiences of undertaking a PBL course. The findingsshow that providing students are able to negotiate someof the potential pitfalls associated with PBL, they are ableto gain considerable benefits. Participants were able tosuggest several ways in which the PBL process could beenhanced and were clear as to the value of skilled knowl-edgeable facilitators.

The findings here show that students’ experiences ofPBL can be positive, adding weight to the enthusiasm forPBL within higher education and further demonstratingits value to mental health nursing. Nevertheless, for PBLto further advance its cause, more comparative research is



needed to demonstrate its value in relation to other edu-cational methods (Problem-based Learning Special Inter-est Group 2009). This would help to establish the extentto which PBL can be shown to produce unique benefitsfor mental health nursing students.

Finally, the findings here remind us that adult learnersare also simply fallible human beings who may lead busy,complex lives in which education is only a part.

ACKNOWLEDGEMENTS

Jayne Breeze also assisted with data collection. Neitherauthor has any affiliations or links that might have resultedin a conflict of interest with their role in this study.

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