Globally there is a critical shortage of nurses despite increasing health needs and demands for an expanded role of the nursing profession in the delivery of complete health care (1). Additionally, as of 2006 World Health Organization (WHO) report, it was estimated that countries with fewer than 23 physicians, nurses and midwives per 10 000 inhabitants fail to achieve adequate coverage of quality and cost-effective health care services to the people (2). Nursing represents the glue that holds the patient’s experience with the health care system. Across the entire spectrum of care needs and patient role experiences, there is a high demand for competent professional care and support from the Nurses.
Currently, nursing professionals make almost 50% of the health workforce worldwide. Of the 43.5 million Healthcare Workers, 20.7 million (50%) are nurses and midwives. Global projection of the shortage of nurses and midwives by 2030 is in a moderate decline by 7.6 million for the developed countries whereas trends show a worsening situation for the African and Eastern Mediterranean regions if the current trend continues (3). According to the human resource for health strategic plan 2008–2013 report by Ministry of Health and Social well-fare (4), the shortage for nurses in Tanzania ranged from 65% in public health facilities and 86% in private health facilities indicating that Tanzania’s health system faces a shortage of nurses, which requires urgent measures.
On the other hand, increased burden of new diseases, increased population aged over 60 years old, advances in science and technology, increased patient autonomy and demands for quality and affordable care; all call for a new thinking towards nursing as a profession, its body of knowledge, learning pedagogy and scope of practice (3,5,6). Corresponding to the complexity of the nursing body of knowledge and the expanding roles that graduate nurses are expected to carry, today the nursing curriculum is highly loaded with both robust content and rich practical experiences (7). The curriculum is lined up to ensure that nursing graduates are highly motivated to learn for them to have higher levels in cognition, critical thinking becomes real-world problem solvers (8,9).
Recent changes in nursing education, have led to the desire to provide meaningful teaching and learning, which motivate students to learn on their own with minimal full support from instructors. Motivation to learn is a measure of quality assurance towards competence which indicates that professional nurses are being prepared to carry out nursing practices in solving real-world problems in rapidly changing environments (10).
Motivation holds a biological, social, cognitive, and emotional feeling of enthusiasm, interest, or commitment, which makes an individual student want to continue to perform well in studies. It is classified as intrinsic motivation to know, intrinsic motivation toward accomplishment, intrinsic motivation (to experience motivation), extrinsic motivation (Identified), extrinsic motivation (Introjected), extrinsic motivation (External regulation), and Amotivation. The measurement of motivation to learn this continues to be a critical issue in the nursing education grounds (11).
Carroll (12) described the academic motivation and academic achievements to be two significant factors in the analysis of academic performance for students. It refers to student’s inner desire that guides behavior towards learning and academic achievements influenced by both, internal and external factors. Motivation plays a major role in explaining behaviors, predicting the effects of actions and guiding behavior to achieve objectives. It does not only promote learning but also in an intermediate to learning which helps students to have smooth relationships, decrease stress, increase creativity and promote open learning (13). Various scholars, refer an academic motivation to as the required stimulation to do the assignments, to achieve the goals or to acquire a certain degree of competence in one’s work and consequently gain academic achievements (14–16). It is a key factor in a student’s academic performance in a problem-based environment. It can be classified as intrinsic motivation (to know), intrinsic motivation (toward accomplishment), intrinsic motivation (to experience motivation), extrinsic motivation (Identified), extrinsic motivation (Introjected), extrinsic motivation (External regulation), and Amotivation.
Motivating nurse students to learn while they are at school has been observed to bring hope in producing graduates who will be able to address societal health needs and create contemporary society’s awareness of the current educational systems, management of nursing education systems, and blend well with the advanced science and technology (17). It is an essential component to ensure competent graduates who can exhibit safe, ethical and legal practice and is a critical issue in the nursing education grounds (14,16,18). Duiker (10) found out student’s motivation in education is often driven by two questions “Can I do this task?”(Beliefs on one's capabilities, belief about factors which cause success and belief about one's low influence on success) moreover, “Why am I doing this task?” (Task values-interestingness, importance, utility, goal orientation).
Gattinger (15) embraces that, the choice and volition regulate students with autonomous motivation. Autonomously motivated students to study in a self-empowered or self-directed manner. Intrinsic motivation is the highest level of autonomous motivation. Students with intrinsic motivation study because studying in itself is enjoyable or interesting. However, also more identified forms of extrinsic motivation are considered to be autonomous (20).
These students will have an extrinsic reason for studying, but that reason integrates with their fundamental goals and needs. For example, a psychology student may voluntarily choose to invest effort in a statistics course, even if s/he does not find this enjoyable because this course will help him or her achieve a major life goal: becoming a psychologist (21). In other words, tasks that are interesting or relevant can elicit autonomous motivation. Regarding goal orientations, the assumption is that autonomous motivation has close links with mastery goal orientation.
Researchers describe controlled motivation, on the other hand, is regulated by internal or external pressure. Students with introjected motivation run by internal pressures such as shame or guilt. Students with external motivation are keeping pace by external contingencies, such as demands of others, the threat of punishment, or extrinsic rewards. The concept of introjected motivation closely aligns with having a performance goal orientation, whereas the idea of extrinsic motivation is assumed to have positive associations with instrumental motivation/high utility value in an FPBL environment (14,22,23). In addition to autonomous and controlled motivation, motivation is distinguished. Amotivation is written off as the relative absence of motivation. It is a state in which students lack an intention to act and a sense of personal causation. Amotivation can occur when the task or activity is not valued when students do not feel competent to do a task, or when they believe acting will not lead to the desired outcome (17).
The curricula in nursing institutions are challenged to motivate nursing students to acquire appropriate skills that will allow them to offer high-quality care to patients/clients (11). Challenges are still on enhancing student’s intrinsic motivation (to know), intrinsic motivation (toward accomplishment), and intrinsic motivation (to experience motivation) rather than extrinsic motivation (Identified), extrinsic motivation (Introjected), extrinsic motivation (External regulation) and decrease Amotivation. A lack of motivation for nurses will not only burn them but may also have destructive effects on the health of society and result in a waste of time and money. It is inevitable however for faculty members, managers and consultants to take a look at employing FPBE teaching pedagogy in nursing programs in order to enhance motivation to nursing students.
A global strategic direction 2016–2020 is to strengthen nursing and midwifery education. It has begun involving various stakeholders (expertise) and empowering educational system organs. They include academicians, policy-makers, government chief nursing, and midwifery officers, professional associations, educational institutions, individual nurses and midwives, non-governmental organizations, students and civil society to solve the noted education discrepancies (24). The emphasis also has been on the adoption and utilization of competency-based curricula in various educational systems.
Tanzania is among Sub-Saharan African countries, which has adopted competency-based curricula. However, no evidence shows how Health Science Colleges/Universities have changed to cater to new demands (4) However, no matter what happens, educators continue being challenged to motivate and prepare students for the future they cannot predict, and if they do not prepare them to be life-longer learners, they are doing them as dependent nurse professionals. Tutors and lecturers, still focus on developing course contents along with traditional instructional-based pedagogies with the hope that, learners will be motivated and develop the intended knowledge and skills automatically (25).
Educators find themselves utilize instructional teaching methods (traditional) more often because it is cheap, easy to implement, can cover an extensive course content at once and suitable for a large group of students (17). Professional schools subsequently are still having a difficult time in assisting their students to be motivated to learn in program modules (14). Likewise, students are trained in such a way they associate teaching and learning as the process, which involves preparing for a test or earning a grade (26). However, competency-based curricula aligned with facilitation in the problem-based environment (FPBE), has been seen to be a robust educational solution (27). PBL is a teaching pedagogy that uses real-world problems as the motivator of student’s self-directed learning process and makes students break the culture of academic silence within the classroom and outside the classroom (28).
Problem-based learning (PBL) pedagogy is rooting in a constructivist instructional approach (learner-centered). It began in the early 1760s at the medical schools at McMaster University in Canada whereby in the 1970s, the University of New Mexico with support from McMaster set a program and showed effectively working for students to be lifelong learners (29). Its aims were to motivate and help students construct an extensive and flexible knowledge base, develop effective problem-solving skills, become an effective collaborator, develop competences in their learning process.
Its emphasis is on academic motivation and knowledge construction rather than knowledge transmission. It motivates and makes students be a source of knowledge and skills. It advocates the philosophical and psychological concepts which assets students not taken like a blank slate (tabula rasa). They can build up new knowledge from their existing one (zonal of proximal development) while scaffolding being the support to help them achieve their significant developmental potentials (30).
Students in the problem-based environment demonstrate more enthusiasm and interest in the subject matter. It was seen to be a useful instructional alternative to conventional teaching pedagogy as many medical education students, could not see the relevance of first-year course materials like Anatomy and physiology to their future profession (32). Under FPBE pedagogy, the delivery of teaching materials is done by projecting questions or problems and let students discover the solutions on their own which are then the entire class (20).
Students are given opportunities to explore, investigate, analyze, synthesize, and carry out experiments and eventually reach their conclusions. The instructor’s roles are just to facilitate, direct, guide, and assist students to be motivated to learn. The instructor poses questions to the entire class and students in teams work together to discuss and reach an agreement on their answers, which then they share in the class (19,33). The teaching and learning environments are set to favor the implementation of facilitation in the problem-based environment. Its assessment process was through an observational checklist or scoring rubric according to the educational psychology, and philosophical criteria set out by the teacher, peer scoring, self-evaluation, portfolios, and critical incidents or anecdotal (34).
In the face of pons from the use of PBL pedagogy in delivering course content among students, it is argued that instructors are hesitant to try this method, as it requires additional planning. They often feel as if they are diminishing their professional reputation. They see themselves not doing their job especially when students are working together and actively discussing the materials instead of busily taking notes (35,36). They find themselves switch into lecture-based instructional pedagogies, as they are always ready-made and prescribed by the state or professional bodies and they need no extra preparation before teaching (37).
What is lacking; is understanding to what extent can new teaching methods like FPBE pedagogy be an alternative and effective teaching pedagogy in improving learning motivation to nursing students in solving real-world problems, (27). Available findings do not adequately show clearly whether course instructors are actively implementing facilitation in problem-based environment pedagogy as a means to motivate students to learn. There is a scarcity of locally nursing scholarly literature, on the subject in Tanzania. Likewise, little has been done to demonstrate the means through which Tanzanian nursing training institutions are actively implementing new instruction pedagogies (4).
The current study aimed at determining the effect of FPBE teaching pedagogy on motivation to learn among undergraduate nurse students in higher Tanzanian training institutions. It was guided by specific objectives including determining the effect of FPBE pedagogy on the level of intrinsic motivation, extrinsic motivation, and Amotivation to learn among undergraduate nurse students in higher learning institutions within Dodoma city. The null hypothesis was used to determine the effect of the independent variable over the outcome variable, which stated: “there was no significant difference in the levels of motivation to learn between nurse students under FPBE and their counterparts in the NFPBE in a higher learning institution, Tanzania.”