What Makes Nursing Students Satisfied with Their Academic Advising and Counseling Services: A Cross-sectional Study

doi:10.21203/rs.3.rs-3624130/v1

Background: Nursing education is demanding, necessitating supportive services such as academic advising to help students achieve their academic goals.

Purpose: Although academic advising services are well established, research evaluating those services is minimal. Thus, this study aims to determine the predictors of academic advising satisfaction among nursing students.

Methods: This cross-sectional study used an online survey for undergraduate nursing students from Egypt and Saudi Arabia.

Results: A total sample of 1,134 students completed the survey. Students with higher grade point average (GPA) (OR: 1.41, 95% CI, 1.07-1.87) and frequent meetings with the advisor (OR: 2.91, 95% CI, 2.10-4.04) were more likely to be satisfied with academic advising. However, fourth-year students (OR: 0.48, 95% CI, 0.30-0.75) and those who self-reported any mental disorders (OR: 0.54, 95% CI, 0.38-0.76) were less likely to be satisfied with their academic advising.

Conclusion: Future research should explore these students' options for improving academic advising services.

academic advising

academic counseling

nursing students

satisfaction

predictors

Undergraduate nursing education is demanding, which stresses and burdens students’ mental health and academic achievement and usually increases their attrition rate (Chan et al., 2019). Nursing students encounter several academic stressors, mostly during clinical placement (Ab Latif & Mat Nor, 2019; Riley et al., 2019; Van der Walt et al., 2019). Also, time management is challenging when balancing academic, personal and social commitments (Rafati et al., 2020; Soares de Souza et al., 2016). Thus, enhancing nursing students' academic and learning experiences is essential for improving their learning process, academic performance, and mental health (Alvarez et al., 2019). This can be achieved through student support services such as academic advising and counseling (Harandi et al., 2017; Stallman, 2012).

Academic advising and counseling services at the university level are geared toward helping students reach their academic outcomes by keeping track of their attendance and performance. Additionally, it aids in directing students toward helpful resources, such as social, psychological, and/or other health care. Nevertheless, many students may go unscreened and unattended when counseling and treatment are needed (Khubchandani et al., 2016). The COVID-19 pandemic has disrupted nursing education and has highlighted the significant role of academic advising in supporting students during their academic path (Mulyadi et al., 2021). It forced the transition to online teaching for theory and clinical courses, (Dewart et al., 2020) and the delivery of academic advising (Nicklin et al., 2016). Moreover, the pandemic challenges have significantly impacted nursing students’ mental health, causing mounting depression, anxiety, fear, stress, and sleep disturbances (Mulyadi et al., 2021).

Academic advising is an integral aspect of university life (Holland et al., 2020), particularly among nursing students who experience higher levels of stress (Pulido-Criollo et al., 2018). Gordon-Starks (2022) stated that academic advising is a relationship building in which academic advisors play a pivotal role in influencing their advisees’ lives while guiding and mentoring them during their academic path. In addition, Hamlet (2017) reported that effective academic advising needs time and knowledge. One of the common recommendations to improve academic advising is increasing training opportunities for advisors (Alshuaybat, 2021; El-Sheikh et al., 2019). Likewise, the research highlighted the influence of advisors’ knowledge and skills on students’ satisfaction with their academic advising (Golshah et al., 2022).

Evaluating nursing students' satisfaction with their advising and counseling service is vital for ongoing improvement (Gordon et al., 2012). Worldwide, there is a paucity of studies addressing academic advising in nursing education (Chan et al., 2019). In the Middle East, a few studies have been conducted on academic counseling and student assistance services for university students (Al-Ansari et al., 2015). Academic advising and counseling services and educational programs launched in Egypt and Saudi Arabia are well established. The universities and colleges in these two countries collect data about students’ feedback and academic advising evaluation. However, the analyses and utilization of such data are limited. To our knowledge, until now, no previous research has attempted to examine the predictors of students’ satisfaction regarding their academic advising in Egypt and Saudi Arabia. Therefore, the current study attempted to address the gap in evaluating academic advising and add to the nursing literature.

Study design

The lack of evaluation of academic advising and counseling services drives the need to assess the predictors of nursing students’ satisfaction. Thus, the current study asks the research questions: 1) what are the differences between satisfied students and those unsatisfied with their academic advising? and 2) What factors are associated with nursing students' satisfaction with academic advising and counseling services? A cross-sectional design was utilized using an online quantitative questionnaire to answer the above research questions.

Settings and sampling

The study investigators collected data from university nursing schools in Egypt and Saudi Arabia using an online survey. Data collection started in March 2021, when COVID-19 restrictions were reduced; as a result, students were back to clinical training in labs and hospitals. At the same time, theory classes and academic advising sessions were delivered online. For both locations, academic advising aims to help students reach their educational outcomes by keeping track of their attendance and performance. Additionally, it supports directing students toward helpful resources, such as social, psychological, and other health services. Academic registration differs from one site to another. Academic advisers and academic affairs employees in Egypt help students with course registration and academic timetables to prevent course overlap. In Saudi colleges, academic affairs staff—not advisors—are responsible for course registration.

The study participants included undergraduate nursing students from the first to the fourth year who gave informed consent and were selected using the convenient sampling method. Exclusion criteria included postgraduate students and those who refused to participate in the study, with a target population of 3,524 undergraduate nursing students (2,974 in Egypt and 550 in Saudi Arabia). The estimated sample size of 1,000 students is based on Boateng and colleagues' (Boateng et al., 2018) recommendations to measure the psychometric properties of the developed student academic advising and counseling survey (SAACS) (anonymous for revision., 2023).

Data Collection

The researchers started data collection after granting the Institutional Review Board (IRB) in Saudi Arabia and Egypt. All undergraduate nursing students received the survey link via emails and social media platforms that students use, such as WhatsApp groups. The students received emails every week to enhance the response rate. The investigators utilized the same data collection procedures in both locations. Data collection at each location took place from March to April 2021. This study was conducted according to the World Medical Association Declaration of Helsinki (World Medical Association, 2022). The informed consent was included at the beginning of the survey questionnaire. It consisted of clear statements of the study's objectives, participants' rights to confidentiality and voluntary participation, risks, benefits and withdrawal from the study.

Instruments

Socio-demographic, health information, and data about student academic advising and counseling evaluation were collected. The socio-demographic questionnaire included students’ age, gender, academic year, marital status, number of children, residence, GPA, employment, leisure activities, physical and mental problems/disorders, frequency of individual meetings with the adviser, and preferred way of communication with academic advisors. The researchers developed the Student Academic Advising and Counseling Survey (SAACS) after a thorough literature review. (Al-Omari & Khasawneh, 2014; Carroll et al., 2013; Stallman, 2012; Szymanska, n.d.) The SAACS included a Likert scale of 18 items. Five points ranked seventeen items (strongly agree = 5 to strongly disagree = 1). Though, item 18 was assessed as strongly satisfied (equal 5) to strongly dissatisfied (equal 1). As per the survey validity, it has only one factor, which accounted for 73% of the total variance. The survey has an excellent internal consistency with a Cronbach’s Alpha 0.969 (95% CI: 0.966–0.972) (anonymous for revision., 2023). The higher the number of the SAACS tool, the higher the satisfaction with academic advising services.

Statistical Analysis

Means and standard deviations were used to summarize continuous data. Student t-test or Welch t-test (in case of unequal variances) were used to compare continuous variables between groups; despite the ordinal nature of the 5-point Likert scale items, we used t-test to compare them between groups as it was found to outperform the nonparametric methods in comparing discrete numeric variables (Fagerland et al., 2011) and simulation studies proved that they have the same power (de Winter & Dodou, 2019). The categorical variables were summarized using frequencies and percentages. The Chi-square test or Fisher’s exact tests were used to compare categorical variables as appropriate.

We classified the participants as satisfied and dissatisfied according to their mean SAACS score; those with a mean SAACS score of more than 3 were considered satisfied with academic advising as it corresponds to more than 50% of the maximum total score on a percentage scale. Otherwise, they were considered dissatisfied. We conducted an exploratory bivariate analysis to test the associations between the participants’ characteristics and their satisfaction with academic advising using Chi-square test for categorical variables and a t-test for continuous variables. Variables with p values less than 0.25 were included in multivariable logistic regression analysis in accordance with Hosmer & Lemeshow recommendations (Hosmer et al., 2013; Hosmer & Lemeshow, 2008) followed by backward elimination to determine the important determinants of satisfaction with academic advising with their adjusted odds. We conducted a multiple logistic regression where we regressed the GPA missing data on all other variables. The results showed an association between missing and each of the academic year, depression, eating disorder, and social support, suggesting the missing GPA was not missing completely at random (MCAR). Therefore, we imputed the GPA by multiple linear regression techniques. R statistical package, version 4.1.3 was used for data analysis. (R Core Team, 2020)

Ethical Considerations

Institutional Review Board (IRB) approval was secured from the National Committee of Bioethics at King Abdullah International Medical Research Center (Registration number: H-01-R-005) in Saudi Arabia and the Faculty of Nursing Research Ethics Committee in Egypt (Registration number: 0220). Anonymous online surveys were sent to students through their emails with an invitation explaining the aim of the study and the participants’ rights regarding voluntary and free participation with options to agree or disagree on participating. Informed consent was obtained from each participant who completed the survey. The participants were assured that data would be used only for research purposes, and their privacy and confidentiality were protected. No identifiers or personal information were collected or stored, including participants’ names, IDs, etc.

Participants charectristics

A total of 1,134 nursing students completed the online (729 from Egypt and 405 from Saudi Arabia) with a response rate of 32.2%. The total column in Table 1 demonstrates the study participants' characteristics in the total column. The average completion time is 7.3 ± 19.1 minutes. The majority of participants (81.9%) were female, 95.6% were single, 93.8% lived with their families, and 92.3% were unemployed, with a mean age of 20.3 ± 1.4 years and an average GPA of 3.5. Over a third of the participants did not meet with their advisers (36.5%), and more than half of the students (51.6%) chose to communicate with their advisors via social media. More than a quarter of students reported suffering from any mental illness (28.7%), and insomnia (18.3%) was the most common psychological complaint. At the same time, the most common physical disorder was headache (20.4%).

Academic advising evaluation

Table 2 shows the SAACS mean score. All items were satisfactory (above 3.0) and ranged from 3.1 to 4. The highest score (4.0 ± 0.8) was for item 5 “My advisor treats me with respect”. Noticeably, the lowest scores were for items related to personal issues such as item 3 “I feel comfortable speaking with my advisor about a personal matter” (3.2 ± 1.1), item 8 “My advisor gives attention to my personal and social development” (3.2 ± 1.1), and item 14 “My advisor is sensitive to my psychological changes” (3.1 ± 1.1).

Satisfied and dissatisfied group differences

Table 1 summarizes the results of the exploratory bivariate analysis of academic advising satisfaction. The results show significant differences (p values less than 0.05) between groups in their academic advising satisfaction for the following variables: residence type, frequency of leisure activities, self-reporting of any mental disorders, self-reporting of any physical disorders, frequency of meetings with the advisor, and preferred ways of communication (face to face). Students who were satisfied with their academic advising services lived with their classroom mates, had leisure activities, self-reported any mental and physical disorders, always met with academic advisers, and preferred face-to-face communication. Additionally, there was no significant difference between satisfied and dissatisfied groups for other variables in Table 1, such as country, age, academic year, marital status, having children, employment and GPA. Also, some items of preferred ways of communication (such as email, phone, text and social media) were not significantly different between groups.

Factors associated with satisfaction of academic advising

The results of the multivariable logistic regression analysis with backward elimination performed on all the variables with p values less than 0.25 are shown in Table 3. Following backward elimination, the optimal prediction model included the academic year, marital status, GPA, self-reporting of any mental and physical disorders, and frequency of meeting with the advisor. Students with higher GPA scores (OR: 1.41, 95% CI, 1.07-1.87), frequency of meetings with the advisor of once/rarely (OR: 2.91, 95% CI, 2.10-4.040), sometimes (OR: 12.57, 95% CI, 7.33-21.56), often/always (OR: 20.18, 95% CI, 8.03-50.73) were more likely to be satisfied with their academic advising and counseling services. In contrast, students who self-reported any mental disorder (OR: 0.54, 95% CI, 0.38-0.76) and were in the fourth academic year (OR: 0.48, 95% CI, 0.30-0.75) were less likely to be satisfied with their academic advising and counselling services.

In the current study, there were differences between the two groups according to their satisfaction with academic advising services in their residence type, frequency of leisure activities, self-reporting of any mental and physical disorders, frequency of meetings with the advisor, and face-to-face ways of communication. Also, the predictors associated with higher academic advising satisfaction included higher GPA scores and frequent meetings with the academic advisor. On the other hand, predictors associated with significantly lower academic advising satisfaction included self-reporting of any mental disorder and being in the fourth academic year.

A high GPA is synonymous with academic achievement of learning outcomes. Similar studies found a significant positive correlation between students’ GPA and their satisfaction with academic advising (Lombardo et al., 2018; Mohammed, 2021). Several encounters with the advisors might indicate the effectiveness of academic advising since students frequently use this service. Also, students often reach out to their advisors or are contacted frequently by advisors, which is considered a student support system. It gives them a sense they are not alone and that someone is looking after them, especially during stressful times. In addition, students tend to value the support of their academic advisors (Holland et al., 2020; Snyder & Quinn Griffin, 2020). Likewise, a Jordanian study reported that students demanded frequent meetings with their advisors to improve their academic advising services (Alshuaybat, 2021). Thus, it is no wonder that those variables predict students’ satisfaction with their academic advising.

In contrast, mental illnesses such as anxiety and depression make people look through gray lenses of self, others, and surroundings due to losing interest, worthlessness, hopelessness, frustration, pessimism, anger, tension, and helplessness, which might lead to a sense of dissatisfaction. Also, mental illness significantly affects relationships with others and makes them unsatisfactory. A supporting study found that people with mental illnesses report less life satisfaction than those without (Meule & Voderholzer, 2020). Further, one of nursing students' most reported mental health issues is anxiety (Onieva-Zafra et al., 2020), which might explain why students who reported having mental illness expressed lower satisfaction with their academic advising. Similarly, a Chinese study found that final-year nursing students suffer from higher psychological impairment than junior ones (Smit & Stavrulaki, 2021), which might clarify the lower satisfaction with academic advising services. Sometimes, it is not easy to judge which comes first or causes the other, mental illness or dissatisfaction in general, since both are strongly mingled, and improving either one improves the other.

Senior or final-year nursing students face many stressors, which include anticipation of graduation (Chaabane et al., 2021; Lavoie-Tremblay et al., 2022). This stress adds to their academic burden and challenges. Also, on top of that, they are about to face another transition from academia to real-life practice and the job market. One of the significant challenges that final-year nursing students face is preparing for the licensure exam and looking for career opportunities. These stressors may impose the need to seek academic advising services and lower their satisfaction.

Strengths and limitations

One of the study's strengths was the large sample size, which contributed to the power of the results. The current study is the first to examine nursing students' satisfaction with academic advising services in two countries in the Middle East. However, the current study utilized a quantitative cross-sectional design, and no qualitative approach was used to understand the experience of academic advising and counseling in nursing schools. Further studies might use thematic analysis of focus groups for in-depth evaluation of the academic advising process since students prefer closed-ended questions over open-ended ones in the surveys that tackle their evaluation of the provided services. An additional limitation is that the results of this study are generalized only to the two data collection settings.

Implications for Practice

Academic advising is about establishing a therapeutic relationship between academic advisors and advisees, which requires time and skills. Students need academic advising in a supportive and friendly environment to achieve their academic goals. Shedding some light on the predictors of academic advising satisfaction might help improve the services provided for nursing students, which mainly include increasing the frequency of meeting with the advisors, routine screening and early detection of mental health problems, and paying some attention to final year/senior students who face increasing levels of stressors.

A higher GPA and frequency of meetings with the advisor significantly predicted higher satisfaction with the academic advisor. Instead, self-reporting a mental disorder and being in the fourth academic year significantly predicted lower satisfaction with academic advising among nursing students. It is recommended that academic advisors offer more time and presence to support nursing students and enhance the effectiveness of academic advising services. Mental health problems, as well as academic challenges among nursing students, need additional consideration. We also recommend utilizing a mixed-method approach to examine the students’ evaluation and perception of the academic advising and counseling services in their settings.

Acknowledgments

A special thank you to Dr. Ehab Elmongui for his valuable statistical consultation and support.

Author contributions

All authors contributed to the study conception and design. Material preparation and tool development [Abeer Selim], [Abeer Omar], and [Shaima Awad], survey development and testing, and data collection [Wafaa Bin-Ali], [Heba Mohamed], [Azza Ahmed], and [Amira Mohammed Ali] and analysis were performed by [Abeer Selim] and [Abeer Omar], The first draft of the manuscript was written by [Abeer Selim] and [Abeer Omar]. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Disclosure of potential conflicts of interest

The authors of this manuscript declare that there was no conflict of interest either personally or financially associated with the current study.

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Table 1 Bivariate Analysis of Group Differences in Satisfaction with Academic Advising

Variables	Satisfied (n = 841, 74.2%)		Dissatisfied (n = 293, 25.8)		Total (n = 1134)		p
	n	%	n	%	n	%
Country							.151
Egypt	530	63.0	199	67.9	729	64.3
Saudi Arabia	311	37.0	94	32.1	405	35.7
Age in years (mean ± SD)	20.3 ± 1.5		20.4 ± 1.4		20.3 ± 1.4		.110
Gender							.655
Male	692	82.3	237	80.9	205	18.1
Female	149	17.7	56	19.1	929	81.9
Academic year							.076
First	213	25.3	62	21.2	275	24.3
Second	238	28.3	70	23.9	308	27.2
Third	213	25.3	83	28.3	296	26.1
Fourth	177	21.0	78	26.6	255	22.5
Marital status ^a							.122
Single	800	95.1	284	96.9	1084	95.6
Married	41	4.9	8	2.7	49	4.3
Divorced	0	0.0	1	0.3	1	0.1
Children (yes)	38	4.5	8	2.7	46	4.1	.244
Residence							.025*
Alone	20	2.4	1	0.3	21	1.9
With families or relatives	781	92.9	283	96.6	1064	93.8
With classroom mates	40	4.8	9	3.1	49	4.3
Current GPA (mean ± SD)^a	3.5 ± 0.6		3.4 ± 0.6		3.5 ± 0.6		.088
Employment							.880
Unemployed	778	92.5	269	91.8	1047	92.3
Part-time	56	6.7	22	7.5	78	6.9
Full-time	7	0.8	2	0.7	9	0.8
Frequency of leisure activities per week							.026*
None	167	19.9	77	26.3	224	21.5
Once/rarely	218	25.9	66	22.5	284	25.0
Sometimes	299	35.6	114	38.9	413	36.4
Often	115	13.7	27	9.2	142	12.5
Always	42	5.0	9	3.1	51	4.5

*Statistically significant of p < 0.05, ** statistically significant of p ≤0.001

Table 1, cont.,

Variables	Satisfied (n = 841, 74.2%)		Dissatisfied (n = 293, 25.8)		Total (n = 1134)		p
	n	%	n	%	n	%
Self-reported any mental disorders	206	24.5	120	41.0	326	28.7	< .001**
Insomnia	127	15.1	80	27.3	207	18.3	< .001**
Depression	73	8.7	44	15.0	117	10.3	.003*
Mood disorders	12	1.4	4	1.4	16	1.4	1
Anxiety	44	5.2	33	11.3	77	6.8	.001**
Eating disorders	52	6.2	33	11.3	85	7.5	.007*
Suicidal thoughts	14	1.7	12	4.1	26	2.3	.030*
Self-harm behaviors	13	1.5	8	2.7	21	1.9	.297
Obsessive-compulsive disorders	15	1.8	11	3.8	26	2.3	.086
Self-reported any physical disorders	298	35.4	134	45.7	432	38.1	.002**
Anemia	161	19.1	69	23.5	230	20.3	.126
Headache	163	19.4	68	23.2	231	20.4	.188
Gastrointestinal disease	57	6.8	36	12.3	93	8.2	.005**
Cardiovascular disease	6	0.7	7	2.4	13	1.1	.045*
Respiratory disease	24	2.9	13	4.4	37	3.3	.262
Endocrine disorder	13	1.5	7	2.4	20	1.8	.492
Frequency of meetings with the adviser					414	36.5	< .001**
None	223	26.5	191	65.2	344	30.3
Once/rarely	264	31.4	80	27.3	246	21.7
Sometimes	229	27.2	17	5.8	69	6.1
Often/ always	125	14.9	5	1.7	61	5.4
Preferred way of adviser communication					541	47.7
Face to face	384	45.7	157	53.6	101	8.9	.023*
Email	81	9.6	20	6.8	141	12.4	.183
Phone	112	13.3	29	9.9	83	7.3	.154
Text messaging	63	7.5	20	6.8	585	51.6	.806
Social media	440	52.3	145	49.5	541	47.7	.443

*Statistically significant of p < 0.05, ** statistically significant of p ≤0.001

Table 2 Student Academic Advising and Counseling (SAACS) Evaluation Results

SAACS item	Mean ± SD
1. My advisor is knowledgeable about the university college`s policies and procedures.	3.8 ± 0.9
2. I feel comfortable speaking with my advisor about academic matters.	3.6 ± 1.0
3. I feel comfortable speaking with my advisor about a personal matter.	3.2 ± 1.1
4. My advisor understands my academic development needs.	3.6 ± 1.0
5. My advisor treats me with respect.	4.0 ± 0.8
6. My advisor helps me set my academic plan and anticipate opportunities promptly.	3.6 ± 1.0
7. My advisor processes my requests on time.	3.6 ± 0.9
8. I can meet with my advisor in a reasonable amount of time.	3.5 ± 1.0
9. I am satisfied with the communication methods with my advisor.	3.6 ± 1.0
10. My advisor is knowledgeable about what applies to my major.	3.6 ± 1.0
11. My advisor gives attention to my personal and social development.	3.2 ± 1.1
12. My advisor evaluates my progress in meeting my graduation requirements.	3.4 ± 1.0
13. My advisor has positively impacted my continued enrollment in the nursing program.	3.5 ± 1.0
14. My advisor is sensitive to my psychological changes.	3.1 ± 1.1
15. I prefer to contact my advisor when there is a stressful situation.	3.4 ± 1.1
16. I would recommend my advisor to other students.	3.6 ± 1.0
17. My advisor is a source of social support.	3.5 ± 1.0
18. How would you rate the overall effectiveness of your advising process?	3.7 ± 1.0
Total score (Mean ± SD)	63.5 ± 14.6
Each item score (mean ± SD)	3.5 ± 0.8

Table 3 Predictors of Satisfaction with Academic Advising Using Multivariable Logistic Regression with Backward Elimination

Predictors	Unadjusted OR (95% CI)	P	Adjusted OR (95% CI)	P
Academic year ( first year is a reference)
Fourth	0.66 (0.45-0.97)	.036*	0.48 (0.30-0.75)	.001**
Third	0.75 (0.51-1.09)	.132	0.76 (0.50-1.16)	.210
Second	0.99 (0.67-1.46)	.958	1.06 (0.69-1.64)	.776
Marital Status (single or divorced vs married)	0.55 (0.25-1.18)	.125	0.47 (0.19-1.12)	.088
GPA	1.28 (1.01-1.61)	.040*	1.41 (1.07-1.87)	.014*
Self-reported any mental disorders	0.47 (0.35-0.62)	<.001*	0.54 (0.38-0.76)	<.001**
Self-reported any physical disorders	0.65 (0.50-0.85)	.002*	0.79 (0.57-1.09)	.152
Frequency of individual meetings with the advisor (never is a reference)
Once/rarely	2.83 (2.06-3.88)	<.001*	2.91 (2.10-4.04)	<.001**
Sometimes	11.54 (6.80-19.59)	<.001*	12.57 (7.33-21.56)	<.001**
Often/Always	21.41 (8.58-53.42)	<.001*	20.18 (8.03-50.73)	<.001**

No competing interests reported.

What Makes Nursing Students Satisfied with Their Academic Advising and Counseling Services: A Cross-sectional Study

Status:

Version 1

Abstract

Introduction

Methods

Study design

Settings and sampling

Data Collection

Instruments

Statistical Analysis

Ethical Considerations

Results

Discussion

Conclusion and recommendations

Declarations

References

Tables

Additional Declarations

Status:

Version 1