Enhancing Nursing Student Success: A Critical Realist Framework of Modifiable Factors

Ryan, Gemma Sinead (2016). Enhancing Nursing Student Success: A Critical Realist Framework of Modifiable Factors. Archives of Nursing Practice and Care, 2(1) pp. 57–70.

DOI: https://doi.org/10.17352/anpc.000015


There is a range of literature examining the predictors of academic success in nursing including age, entrance qualification and background. However, these are factors that cannot be changed once a student is on a programme of study. However, there is currently little or no literature that focuses only on the modifiable behaviors and environmental factors in achieving good academic success.

This project aimed to explore the modifiable factors that may influence academic performance and develop a framework to guide students and academic staff. A critical realist ‘intensive’ approach employing qualitative methods was used with pre-registration 3rd year nursing students as participants.

Unstructured interviews with use of academic grade documents as a point of reference. Thematic framework analysis enabled comparison on a case-by-case basis.

Eight modifiable student themes were identified: time management, understanding of learning outcomes, focus on the topic and its role in the wider programme, utilization of academic team, peer support, using feedback, life management, and management of stress factors. Four themes for academic staff were found under the headings: encourage, enable, empower and ennoble.

The framework presented provides focus on the factors that can be changed and influenced in order to achieve success. This framework may be used by staff and students to develop guidance documents or in design of teaching and assessment.

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