Trends The quantification of practice competency is central to nursing education (Raines, 2009).

Nursing education programs have focused attention on developing compe- tency statements and theories (Raines, 2009)

Issues

Problematizing Competencies are the subset of outcomes that nursing students need to function at the desired level(Hseih & Hsu, 2009) .

Nurse educators must effectively prepare students for a nursing career in today's high-tech health care environment (Klein, 2006).--(Hseih & Hsu, 2013) Over the last 5 years, increasing focus on the need to better prepare nursing graduates for the realities of the practice environment has centered on patient safety and quality topics (Sullivan, Hirst & Cronenwett, 2009).

But less attention has been given to learning approches that might have an impact in the competency of nursing students. With continuing demands on and changes in health care organizations, students' nursing practice experiences are more isolated and often fragmented, and as a result, outcome of the experience is less predictable (Raines, 2009).

Limited information is available for factors that are associated with performance of nursing students(Hseih & Hsu, 2013).

Objectives

Learning approach

Competency

Objectives to address the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continu- ously improve the quality and safety of the health care systems in which they work (Sullivan, Hirst & Cronenwett, 2009).

Learning approach

Competency

A theory of learning is presented that accentuates the interaction between the person and the situation (Biggs, 1987). Students approaches to learning describe whether they engage in learning environment with learning matters (Spencer in Tural & Akdeniz, 2008)

Heavy workloads could have the unintended consequence of discouraging positive attitudes towards learning and encouraging surface approaches (Tural & Akdeniz, 2008). It is important therefore to take into account the fact that higher education requires a higher quality of teaching as well as learning (Pimparyon, et al., 2000)---(Tural & Akdeniz, 2008).

Competencies are characteristics that drive performance in a given job, role, or function (Raven & Stephenson in Raines, 2009 ). Benner (1984) has defined nurse competency as the ability to perform or act with desirable outcomes under the varied circumstances of the real world.-(Raines, 2009) To be competent, one needs to be able to interpret the context of the nursing situation and have a repertoire of possible actions to take and have learned how to enact the possible actions. Competency is more than just clinical skill or theoretical knowing; it is the crossroads of knowing, doing, and being that is nursing care (Raines, 2009). Competency is a dynamic process that grows through experience and the extent of an individual's motivation to learn and adapt (Raven & Stephenson in Raines, 2009)

The use of deep approach increased from the third year to the fourth year. It can be thought that the student teachers consciousness of responsibility rises during the fourth year(Tural & Akdeniz, 2008).

Competency focuses on an individual's ability to perform activities related to work, life skills, or learning (Anema and McCoy, 2010).--- (Hseih & Hsu, 2013)

Developing teaching and learning strategies to cater for the diversity of students backgrounds is made more complex by the flexibility of the study modes and levels of participation they choose to undertake. This is exacerbated by the fact that many fulltime students spend significantly less time on-campus than in the past as they balance work and study (Burton, Taylor, Dowling & Lawrence, 2009). Students are under pressure to succeed and universities continue to recognise the need to increase retention rates (Burton, Taylor, Dowling & Lawrence, 2009). University administrators and academics need to better understand how such factors might impact student learning to determine how best to cater for todays diverse student cohorts and maximise students chances of academic success (Burton, Taylor, Dowling & Lawrence, 2009) .

The National Council of State Boards of Nursing (2005) describes competency as the ability to apply knowledge and interpersonal, decision making, and psychomotor skills to nursing practice roles.-- (Hseih & Hsu, 2013) Lejonqvist et al. (2012) demonstrated that clinical competence in practice is encountering, knowing, performing, maturing and improving (Hseih & Hsu, 2013).

Clinical competence is an ongoing process, rather than a state and manifests itself in an ontological and a contextual dimension (Hseih & Hsu, 2013).

In an era where many universities offer students more flexibility than ever before, it is imperative that they become acquainted with their own learning approaches and understand how to study effectively so they can manage that flexibility and make informed choices (Burton, Taylor, Dowling & Lawrence, 2009). Approaches to learning reflect the individual differences in strategies used to achieve a particular learning task (Diseth, 2003).-----(Burton, Taylor, Dowling & Lawrence, 2009). A Deep approach involves finding meaning in what is being studied to maximise understanding. A Surface approach involves investing little time in the academic task and memorising information with rote-learning. A Strategic approach involves being guided by the assessment criteria and enhancing self-esteem through competition (Burton, Taylor, Dowling & Lawrence, 2009). The SAL paradigm argues that high achievement can be predicted by a Deep approach, either alone or in combination with a Strategic approach (Diseth, 2003; Diseth, Pallesen, Hovland, & Larsen, 2006).--- (Burton, Taylor, Dowling & Lawrence, 2009).

Benner (1984) puts forth the idea that competence is a progressive experience that she calibrates in five distinct stages from Novice to Expert (Hseih & Hsu, 2013). Competencies are based upon a behavior theory and its focus on producing specific desired behaviors (Albanese et al., 2008).-- (Hseih & Hsu, 2013).

competence requires an up to date knowledge base and is manifested by demonstrating the ability to achieve desired outcomes through the performance of defined skills (LaDuke, 2002)-- (Hseih & Hsu, 2013)

In addition, learning outcomes provide an opportunity for graduates to acquire the knowledge and skills (Mohayidin et al., 2008).--- Hseih & Hsu, 2013

In contrast, low achievement can be predicted by a Surface approach to learning (Biggs, 1999; Diseth, 2003). Indeed, the Surface learning approach has consistently been found to negatively correlate with academic success (Boyle, Duffy, & Dunleavy, 2003; Diseth, 2003).--- (Burton, Taylor, Dowling & Lawrence, 2009). Previous research has shown that mature-age students favour the Deep approach (Duff et al., 2004; Gijbels, Van de Watering, Dochy, & Van den Bossche, 2005) and school leavers prefer the Surface approach (Richardson & Newby, 2006). Matureage students tend to be more successful academically than school leavers (McKenzie & Gow, 2004).----Previous research has shown that mature-age students favour the Deep approach (Duff et al., 2004; Gijbels, Van de Watering, Dochy, & Van den Bossche, 2005) and school leavers prefer the Surface approach (Richardson & Newby, 2006). Matureage students tend to be more successful academically than school leavers (McKenzie & Gow, 2004).------(Burton, Taylor, Dowling & Lawrence, 2009).

Learning outcomes are commonly expressed in terms of competences or skills and competence (Adam, 2004). Compe- tency focuses on an individual's ability to perform activities related to work, life skills, or learning (Anema and McCoy, 2010). -- Hseih & Hsu, 2013

he National Council of State Boards of Nursing (2005) describes competency as the ability to apply knowledge and interpersonal, decision making, and psychomotor skills to nursing practice roles. Hseih & Hsu, 2013

The expected negative relationship between Emotional Stability and the Surface approach was also found.---(Burton, Taylor, Dowling & Lawrence, 2009).

Educating students for nursing practice is challenging. Nurse educa- tors must effectively prepare students for a nursing career in today's high-tech health care environment (Klein, 2006). -- Hseih & Hsu, 2013

They support the view that educators should encourage all students, including those learning online and via distance education, to develop an active interest in, and engagement with, the subject material. This teaching approach will help to enhance students conceptual understanding, a key component of the Deep learning approach, and establish the extent to which teachers can help students adapt to their flexible learning environments, Limited information is available for understand course requirements, and factors that are associated with achieve success.----- (Burton, Taylor, performance of nursing students. --Dowling & Lawrence, 2009). Hseih & Hsu, 2013 Assessing the competence of nursing students is critical to identifying areas Education systems aim to enable for professional development and students not just to acquire knowledge educational needs while ensuring that but also to become capable, con- fident competencies are put to use for quality and enthusiastic learners (Artelt, care (Marshburn et al., 2009).--- Hseih Baumert, McElvany & Peschar, 2000). & Hsu, 2013

Studies investigating how students actually regulate learning and use appropriate strategies have found particularly strong associations between approaches to learning and performance. Less direct but easier to measure student attitudes and behaviours associated with selfregulated learning, such as their motivation and tendency to use certain strategies, are also associated with performance, albeit generally less strongly (Artelt, Baumert, McElvany & Peschar, 2000). A particularly depressing finding is that most students in most undergraduate courses become increasingly surface and decreasingly deep in their orientation to learning (Biggs, 1987; Gow & Kember 1990; Watkins & Hattie, 1985).

Clinical competence is an ongoing process, rather than a state and manifests itself in an ontological and a contextual dimension. Hseih & Hsu, 2013

Benner (1984) puts forth the idea that competence is a progressive experience that she calibrates in ve distinct stages from Novice to Expert. --- Hseih & Hsu, 2013

In addition, the identication of factors which impact on students' progression, performance and completion is instrumental in the planning and development of preregistration programs to ensure Teaching and evaluation methods affect best outcomes for both the institution students' study approaches (Hayes, and the student (Pitt et al., 2012).-Sanders & Healey, 2010). Hseih & Hsu, 2013

The use of any particular study approach depends on the nature of the activity required of the student. Most students are capable of using any of the approaches for a particular activity, even while demonstrating a preference for another approach (Hayes, Sanders & Healey, 2010).

Competencies are the subset of outcomes that nursing students need to function at the desired level. Hseih & Hsu, 2013

An outcomes-based approach to nursing competence shifts the emphasis from he responsiveness of study approach to what perfor- mances the individual curricular influences suggests that should possess, and what a person has examining students' study approaches been taught and trained to do, to how might be helpful in curricular that person is expected to perform, now assessment (Hayes, Sanders & Healey, and in the future (Harrison and Mitchell, 2010). 2006) -- Hseih & Hsu, 2013 . The approaches to learning paradigm is one of the most widely used frameworks for understanding how students go about learning in higher education (Ramburuth & Mladenovic, 2004; Tight, 2003) and it is specifically concerned with discovering why some students learn better than others (Marton & Booth, 1997, p.16). -(Byrne, Flood, Willis, 2009)

Competent, lifelong learners generally have the capacity to respond exibly to changing circumstances (Bath and Smith, 2009), have access to information, use information in the proper place, and attempt to learn how to learn besides being creative and critical thinkers (Uzunboylu and Hursen, 2011).--- Hseih & Hsu, 2013

Students demonstrating a high level of understanding typically adopted what became known as a deep approach to learning, while students with a low level of understanding used what was described as a surface approach -(Byrne, Flood, Willis, 2009)

Students who had 5-year AD/ADN, with high interest in nursing, extracurricular activity experience, and played an active role in classroom discussions and asked questions had greater caring competency compared with those graduated from nursing school, with neutral interest in nursing, no extracurric- ular activity experience, and never played an active role in classroom discussions and asked questions. --Hseih & Hsu, 2013

In this study, students with high interest in nursing had signi- cantly greater nursing competency (ethics and In a later study, Ramsden (1979) accountability, general clinical skills, identified a third approach to learning and lifelong learning competency) than which he called a strategic approach. -- those with neutral interest in nursing-(Byrne, Flood, Willis, 2009) Hseih & Hsu, 2013 A deep approach to learning is characterized by a personal commitment to learning and an interest in the subject.-- (Byrne, Flood, Willis, 2009) Therefore, students with higher interest in nursing as a profession tend to make better progress in improving general clinical skills and lifelong learning capacities.-- Hseih & Hsu, 2013

Students adopting this approach set out with the intention of understanding the material, they interact critically with the arguments put forward, relate them to their prior knowledge and experience, and evaluate the extent to which conclusions are justified by the evidence presented (Biggs, 2003; Prosser & Trigwell, 1999; Ramsden, 2003)-- (Byrne, Flood, Willis, 2009)

The result supports the ndings of Whitehead (2006) which suggest that improvement in language skills could lead to improve- ment in critical thinking. --- Hseih & Hsu, 2013

incompetent individuals displayed a tendency to overestimate their abilities, while the burden of expertise is the consis- tent tendency to underestimate In contrast, a surface approach is and criticize one's own performance characterized by a lack of personal (Rudy et al., 2001; Lind et al., 2002; engagement in the learning process Edwards et al., 2003). --- Hseih & Hsu, (Byrne, Flood, Willis, 2009) 2013 There was a signicant positive correlation between critical thinking competency and school location, type of Ramsden (2003) contends that the nursing program, nursing license, and approach to learning is one of the most interest in nursing, while nursing influential concepts to have emerged competency had a negative correlation from research into teaching and with academic class rank, and grades of learning in higher education. -- (Byrne, basic science and nursing biomedical Flood, Willis, 2009) science. --- Hseih & Hsu, 2013

Students learning approaches are not intrinsic characteristics of students, but rather they are dynamic and are likely non existence of re- lationship between to change depending on how students critical thinking performance and GPAs perceive the learning task (Lucas & of either nursing courses or science Mladenovic, 2004; Ramsden, 1987). --- courses (Berger, 1984; Thompson and (Byrne, Flood, Willis, 2009) Rebeschi, 1999). --- Hseih & Hsu, 2013 Today's healthcare graduates must not only possess the technical skills study of Sharma (1997) They found necessary to practice but must also be procient in other competencies that that students favored a surface over a deep approach. They also impact on their professional practice reported a significant negative (Rowe et al.,2012). A competencyrelationship between the surface based assessment approach is to meet approach and academic the de- mand for a complex workforce, performance, but no relationship so it is essential to identify factors which for the deep approach-- (Byrne, have the greatest impact on student Flood, Willis, 2009) performance.--- Hseih & Hsu, 2013 He reported that age was positively related to a preference for a deep approach among students and that females were more likely to adopt a surface approach than males.

A further point of interest from the results is that, within the surface approach, the Irish students report significantly lower levels of lack of purpose in their study. This may be attributable to their greater independence in learning, but it is more likely to be due to the fact that a substantial percentage of the Irish students (57%) have already decided to major in accounting, while only 9% of the U.S.

Others

Connection

Reason

the identification of factors which impact on students' progression, performance and completion is instrumental in the planning and development of Learning outcomes are preregistration programs to commonly expressed in terms ensure best outcomes for of competences or skills and both the institution and the competence (Adam, 2004).-----student (Pitt et al., 2012) --(Hseih & Hsu, 2013) (Hseih & Hsu, 2013).