Nurse Education Today 34 (2014) 14431449

Contents lists available at ScienceDirect

Nurse Education Today

journal homepage: www.elsevier.com/nedt

Nursing students at a university A study about learning

style preferences
Karin Hallin
Department of Nursing Science, Mid Sweden University, stersund, Sweden

a r t i c l e

i n f o

Article history:
Accepted 3 April 2014
Keywords:
Campuses
Learning preferences
Nursing education
PEPS
Semesters

s u m m a r y
Background: In most adult education, teachers use methods that assume all students learn in the same way. But
knowledge of students' learning style preferences highlights the importance of adequate teaching and learning
adaptation.
Objectives: The aim of the study was to describe and compare nal year nursing students' learning style preferences in two campuses during three semesters. A further aim was to identify differences between learning
style preferences and personal characteristics.
Design: A descriptive cross-sectional study using the Productivity Environmental Preference Survey (PEPS)
questionnaire was conducted at a Swedish rural university. Three semester groups with 263 nursing students
participated in 20122013.
Results: The majority of the students were exible in their learning style preferences and had none or few strong
preferences. Students with strong preferences preferred high structure (75%) and an authority gure present
(40%). About a third were highly auditory, tactile and/or kinesthetic while 8% were highly visual. Few signicant
differences were revealed between the groups of campuses and the groups of semesters or between learning
style preferences and upper secondary school and care experience. There were no signicant differences
between learning style preferences and age and assistant nurse graduation. More women than men were highly
motivated, auditory, tactile and kinesthetic and preferred structure and mobility.
Conclusions: The PEPS questionnaire provides nursing students with self-awareness regarding their strengths
and shortcomings in learning and teachers with a valuable and practical basis for their selection of adapted
individual and group teaching methods. The ndings suggest the need for wide variation and interactive teaching
approaches, conscious didactic actions between cooperating teachers and conscious learning strategies for
nursing students.
2014 Elsevier Ltd. All rights reserved.

Introduction
Adult education assumes that students at universities and colleges
have developed efcient study skills and have acquired appropriate
learning strategies to adapt their learning to the lessons and tutoring
methods used by teachers. But this does not apply to all students. Studies show the importance of teachers' adapting pedagogy and didactics
to students' preferences. When nursing students have studied with
strategies congruent to their learning style preferences they have been
motivated, felt responsibility and achieved high grades (Billings and
Cobb, 1992). Furthermore, nursing students' satisfaction, anxiety and
anger with teaching methods have signicantly been related to
teachers' reections on students' perceptual preferences (O'Hare,

Corresponding author at: Department of Nursing Science, Mid Sweden University,

stersund, SE-831 25, Sweden. Fax: +46 63 1656 26.
E-mail address: karin.hallin@miun.se.

http://dx.doi.org/10.1016/j.nedt.2014.04.001
0260-6917/ 2014 Elsevier Ltd. All rights reserved.

2002). Since earlier research with different questionnaires has shown

that learning styles vary widely between different groups of medical
students (Samarakoon et al., 2013), teaching students (Bostrm,
2011), teaching and nursing students (Bostrm and Hallin, 2013) and
rural and metropolitan nursing students (James et al., 2011), it is of
great interest to nd out if nursing students differ to the same extent
at the end of their education. The question is important as university
teachers, who collaborate within and across disciplines, mostly design
teaching and learning strategies from one year to another without
deeper knowledge about individuals and groups.
Background
Learning style theories assume that all may learn, though in different
ways and at different levels. There are theories and models which focus
on aspects such as talents, sensory modalities, cognitive and/or learning
and thinking processes (Evans and Waring, 2012). Kolb's Learning Style
Model (Kolb and Kolb, 2005), for example, is used for viewing how

1444

K. Hallin / Nurse Education Today 34 (2014) 14431449

students process information, while the Dunn and Dunn Learning Styles
Model (Dunn et al., 2000) views how students acquire information.
Because of its practical usefulness, the Dunns' model is selected for
this study. The model is unique in the sense that it is built on multidimensional and instructional preferences that cover several proportions
of learning and teaching with practical and methodological support in
the research (Dunn and Griggs, 2007; Johansen, 2007). Fifty years of
worldwide research, both quantitative and qualitative, has shown that
it is widely used with children, adolescents and adults, and is very applicable to the education of health professionals (Dunn and Griggs, 1998).
The model consists of the Productivity Environmental Preference
Survey (PEPS) questionnaire, where the mean of the preference is an
individual's strengths and needs in learning new and difcult material
(Dunn and Dunn, 1999). The term learning style denes the way
each learner begins to concentrate on, process and retain new and difcult information (Dunn et al., 1994, p. 12). The model categorizes the
areas that may inuence a person's learning style into elements of the
environment and elements of emotional, sociological, physiological
and perceptual strengths (Dunn and Griggs, 2007). Since the PEPS
covers many preferences and provides information about patterns
through which learning occurs, teachers will have a concrete basis for
pedagogical and didactic choices. At the same time students can work
on their own, providing a basis for lifelong learning.
About 400 doctoral dissertations and more than 500 scientic
articles indicate that the PEPS questionnaire is widely used, at over
130 universities worldwide. But in Western settings and nursing
students few studies on the Dunns' model have been published since
2002. Just one study has focused on Swedish nursing students; a comparative study which conrmed signicant differences in learning
style preferences between groups of teaching and nursing students
(Bostrm and Hallin, 2013).
Because students in higher education are usually heterogeneous in
terms of personal characteristics, it is interesting to use the PEPS questionnaire to investigate learning style preferences in different groups
of nursing students at the same academic level. This study starts with
nal year students, those with great experience of teachers' efforts to
design teaching and learning plans for specic professional aims.
Methods
Aim
The aim of the study was to describe and compare nal year nursing
students' learning style preferences in two campuses during three
semesters. A further aim was to identify differences between learning
style preferences and personal characteristics.

As shown in Table 1, which summarizes the students' characteristics,

most participants were young; 80.6% were 2130 years old and 19.4%
were 3148 years old. Concerning upper secondary school nearly half
(46.4%) had a pre-university program; e.g. natural science, humanities
or social program. Fewer (28.9%) had a vocational program: e.g. health
and care, child and recreational or hotel and tourism program. About a
quarter (24.7%) had a specially designed program for the individual.
Students with an assistant nurse graduation (22.1%) undertook either
a three-year vocational program in upper secondary school or a oneyear course after upper secondary school. The students' care experience
before the nursing education varied: 19.5% had no health care experience, 17.5% had less than one year's experience, while 63.0% had
128 years' care experience (Table 1).
Measurements
Two questionnaires were used; the PEPS for adults to identify learning
style preferences (Dunn et al., 2000) and a questionnaire to identify
personal characteristics. The PEPS consists of 100 questions relating to
20 distinct learning style elements, each with a ve-item Likert-type
scale ranging from 1 (never) to 5 (always). The elements provide students and teachers with information about different areas of preferences:
Environmental preferences: sound, light, temperature, and furniture
design.
Emotional preferences: motivation, responsibility, conformity, persistence, need for externally imposed structure or opportunity to do
things independently.
Sociological preferences: authoritative persons present, variation,
learning alone, in pairs or as a part of a team.
Physiological preferences: perceptual strengths such as auditory,
visual, tactile or kinesthetic, time-of-day energy levels, need for intake
and/or mobility.
Auditory learners prefer hearing material and verbal instructions
related to practical examples while visual learners enjoy reading and
written information, observation, pictures, ashcards and videos. Tactile
learners prefer hands-on-learning and write notes when they are interested, while kinesthetic learners prefer the learning-by-doing approach
and learn best through practical sessions, case studies or computer simulation (Beischel, 2011; Hedin, 2006).
The PEPS is valued for having good reliability and validity (Griggs
et al., 1994). The reliability coefcients for each element typically fall
into the .75 to .88 range (Dunn et al., 1995), and a variety of construct
validity evidence has been revealed in qualied international research
(Dunn et al., 1995; Nelson et al., 1993).
Procedure

Design
A descriptive cross-sectional pilot study was conducted with the
PEPS questionnaire and nursing students in two campuses at a Swedish
rural university during three semesters in 20122013. The study was
part of a larger project involving nursing students and high-delity
patient simulation at the end of education.
Participants and Settings
Convenience sampling was used and a total of 263 nursing students
participated in the study, 209 women and 54 men. The students were
recruited from three semester groups at each of two campuses. The
respondent rate was 88.9%. All students were in their nal semester of
a three-year bachelor of nursing program and studied with the same
curriculum. During nursing education the students had used various
teaching methods, such as lectures, tutorials, computer-based methods,
individual and group works, case studies and practical exercises, but
with a predominance of lectures.

All information was given both in written and verbal form by

teachers, and data were collected when the students were in the classroom. It took the students about 40 min to complete the two questionnaires. Those who were not present were informed individually and
were invited to submit the answered forms to the current teacher.
After data collection and result analysis the participants were e-mailed
a copy of the outcomes of the PEPS supplemented by a manual on
how the results should be interpreted. Although they were in the nal
stage of their education, they should be able to use the results in further
studies.
Data Analysis
The responses of the PEPS were computer processed to obtain scores
for each individual on each subscale. The individual prole showed an
average for each question on a 60-point scale and marked each student's
values as low (average 2040), exible (average 4160) and high (average 6180). These values were calculated at the individual level and

K. Hallin / Nurse Education Today 34 (2014) 14431449

1445

Table 1
Personal characteristics of 263 nursing students at two campuses during three semesters.
Variable

Gender
Age

Upper secondary school

Assistant nurse graduation

Female
Male
2122 Mean = 26,84
2324 Median = 25,0
2526 St. dev. = 5,27
2730 Range = 28 (2148)
3148
Pre-university program
Vocational program
Individual program
Yes
No

Care experience
0
b1 year
1b3 years
3b5 years
5 (maximum 28 years)

Two campuses

Three semesters including six

courses

Total

Comparisons between

Campus
A

Campus
B

Spring
2012

n = 263
%

Campuses

Semesters

n = 125 %

n = 138 %

n = 78 %

n = 72 %

n = 113 %

74.4
25.6
25.6
19.2
16.8
19.2
19.2
45.6
31.2
23.2
24.8
75.2
n = 124 %
14.5
21.8
34.7
15.3
13.7

84.1
15.9
12.3
26.8
19.6
21.7
19.6
47.1
26.8
26.1
19.6
80.4
n = 138 %
23.9
13.8
31.1
10.9
20.3

78.2
21.8
21.8
25.6
11.5
20.5
20.5
50.0
28.2
21.8
19.2
80.8
n = 78 %
24.4
14.1
34.6
11.5
15.4

84.7
15.3
9.7
27.8
22.2
20.8
19.4
43.1
34.7
22.2
23.6
76.4
n = 72 %
15.3
20.8
31.9
8.3
23.6

77.0
23.0
22.1
18.6
20.35
20.35
18.6
46.0
25.7
28.3
23.0
77.0
n = 112 %
18.8
17.8
32.1
17.0
14.3

79.5
20.5
18.6
23.2
18.3
20.5
19.4
46.4
28.9
24.7
22.1
77.9
n = 262 %
19.5
17.5
32.8
13.0
17.2

2 (1) = 3.75,
P = 0.053 n.s.
MannWhitney
U-test 7919.5
Z = 1.150
P = 0.250 n.s

2 (2) = 1.719
P = 0.423 n.s
KruskalWallis test
2 (2) = 1.238
P = 0.538 n.s.

2 (2) = 0.690,
P = 0.708 n.s.

2 (4) = 2.706
P = 0.608 n.s.

2 (1) = 1.046
P = 0.307 n.s
MannWhitney
U-test 8364.00
Z = 0.315
P = 0.753 n.s

2 (2) = 0.523
P = 0.770 n.s.
KruskalWallis test
2 (2) = 0.776
P = 0.678 n.s.

Autumn
2012

Spring
2013

(HSFR, 2002). There was no relationship of dependency between the

researcher and the participants.

used for the inferential statistics. For further processing Statistical

Package for Social Sciences (SPSS Inc., Chicago, IL, USA), version 21 for
Windows was used and the level of signicance was dened as
P b 0.05 (two-tailed).
Descriptive statistics were used to characterize the study sample and
inferential statistics to test similarities and differences between groups.
Students' learning style preferences were determined individually and
cumulatively per university, campus and semester. The Pearson Chisquare test was used to compare nominal data. The MannWhitney Utest and KruskalWallis test were used to compare ordinal, interval
and ratio data.

Results
Comparison of students' personal characteristics between the
groups of campuses and semesters showed no signicant differences
(Table 1). Therefore, regarding personal characteristics, the student
groups will in further comparisons be treated as one group.
Learning Style Preferences of Final Year Nursing Students
Table 2 shows distributions of low, exible and high-preference
scores for each of the PEPS subscales for 263 nursing students. As can
be seen, most subscale scores fell essentially between 41 and 60, the
exible region of no strong preferences. Three students were exible
in all of the 20 elements, and 260 students had two or more preferences.

Ethical Considerations
The Ethics Committee at the university approved the study (dnr:
2012/499). The students gave their informed consent and were assured
a condential process according to the principles of research ethics
Table 2
Distribution of low, exible, and high-preference scores for 263 nursing students.
Elementsa

Low
Scale 2040

Noise level
Light
Temperature
Design
Motivation
Persistent
Responsibility
Structure
Alonepeers
Authority gure
Several ways
Auditory
Visual
Tactile
Kinesthetic
Intake
Morning
Late morning
Afternoon
Mobility

Prefers quiet
Prefers dim
Prefers cool
Prefers informal
Low
Low
Low
Does not prefer
Prefers alone
Does not want present
Does not prefer
Does not prefer
Does not prefer
Does not prefer
Does not prefer
Does not prefer
Does not prefer
Does not prefer
Does not prefer
Does not prefer

Items with Likert scales: 1 (never) to 5 (always).

Flexible
Scale 4160

High
Scale 6180

2
16
29
20
5
1
29
0
11
3
37
10
42
12
2
23
41
48
38
6

0.8
6.1
11.0
7.6
1.9
0.4
11.0
0.0
4.2
1.1
14.1
3.8
16.0
4.6
0.8
8.7
15.6
18.2
14.4
2.3

211
227
200
192
215
175
209
68
76
154
216
169
200
170
188
184
174
158
149
199

80.2
86.3
76.0
73.0
81.7
66.5
79.5
25.9
28.9
58.6
82.1
64.3
76.0
64.6
71.5
70.0
66.2
60.1
56.7
75.7

Prefers sound
Prefers bright
Prefers warm
Prefers formal
High
High
High
Prefers
Prefers with peers
Wants present
Prefers variety
Prefers
Prefers
Prefers
Prefers
Prefers
Prefers
Prefers
Prefers
Prefers

Total
n

50
20
34
51
43
87
25
195
176
106
10
84
21
81
73
56
48
57
76
58

19.0
7.6
12.9
19.4
16.3
33.1
9.5
74.1
66.9
40.3
3.8
31.9
8.0
30.8
27.7
21.3
18.2
21.7
28.9
22.0

263
263
263
263
263
263
263
263
263
263
263
263
263
263
263
263
263
263
263
263

1446

K. Hallin / Nurse Education Today 34 (2014) 14431449

Table 3
Signicant differences in the distribution of low, exible and high-preference scores for nursing students of two campuses.
Elementsa

Low
Does not prefer
Scale 2040
Campus

Tactile
a
b

Flexible
Scale 4160

High
Prefers
Scale 6180

Campus

A%
7.2

B%
2.2

A%
68.0

Campus
A n = 125 B n = 138

Comparisons between Campus A and Campus B

Total n
263

MannWhitney U-test
6842.5; Z = 2.913; P = 0.004b

Campus
B%
61.6

A%
24.8

B%
36.2

Items with Likert scales: 1 (never) to 5 (always).

Differences signicant at P b 0.01.

There were some nursing students with scores below 40 and above
60 on each of the learning style elements, indicating they would avoid
or benet from special accommodations to their learning style preferences. Regarding the environmental elements, more students preferred
a sound and formal furniture design to a quiet and informal design. All
the students preferred structure but three-quarters showed a high preference. Two-thirds highly preferred working with peers while some
(4%) preferred working alone; 40% highly preferred to have an authority
gure present while 1.1% did not. Additionally, about 31% highly preferred the auditory and/or the tactile, 28% the kinesthetic, 22% the mobility while 8% highly preferred the visual. Further, 33% rated high
persistent, 16% high motivation and 9% high responsibility. For the
other preferences, the differences between the numbers of students
who had no or high preferences were less distinctive (Table 2).
Comparison of Learning Style Preferences Between Groups of two Campuses
and Three Semesters
In relation to the students' learning style preferences, there were few
signicant differences between the groups. Comparing the two campus
groups, there was one distinctive preference (Table 3); more students at
campus B were highly tactile (P = .004). Comparing the three semester
groups, there were two distinctive preferences (Table 4): most auditory
students were in the group of autumn 2012 (P = .004), most visual students were in the group of spring 2012 (P = .028) and less visual students were in the group of 2013. Those three differences appeared to
be more group-afliated than related to changes in time and place.
Learning Style Preferences Compared to Personal Characteristics
No signicant differences were found between the elements of PEPS,
the students' age and assistant nurse graduation (Table 5). Concerning
upper secondary school, signicantly more of those who had undertaken a vocational program were auditory (P b .045) and preferred sound
(P b .040), while more of those who undertook a special program for
the individual were visual (P b .049). Concerning care experiences,
there were signicantly more students in three of ve groups who
preferred the visual (P b .047), but without any clear connection to

the quantity of experience. Concerning gender, there were a lot of

signicant differences. The rank average showed relatively more
women than men scored motivation highly (P b .005) and preferred
high structure (P b .004), auditory (P b .008), tactile (P b .027) and kinesthetic (P b .010) methods. Likewise, relatively more women than men
preferred intake (P b .002) and mobility (P b .011). However, the results
should be viewed with some caution as there were fewer men in relation
to the number of women.
Discussion
The aim of the study was to describe and compare nal year nursing
students' learning style preferences in two campuses during three semesters. A further aim was to identify differences between learning
style preferences and personal characteristics. As there were no signicant differences between the groups of semesters and campuses
concerning the students' personal characteristics, the discussion will
be based on the view of 263 students.
Due to the difculties educators have in satisfying students' desire
for different learning environments, such as dim and bright light, quiet
and sound, formal and informal design, food or beverage intake and
time of day, those aspects are left out of the discussion. However,
when students become aware of their proles they have the opportunity to customize appropriate elements, especially in home environments.
The results showed individual variations for all the elements.
Relatively few scored does not prefer more scored prefer but
most of the students were exible persons who had no or few strong
preferences. Those students who clearly marked what they preferred or
did not prefer had taken a position on special accommodations that facilitate or impede their learning. With or without support, they strive to
attain knowledge and skills in the easiest and quickest way. But the
stronger the preferences are, the more important it is for teachers to
provide compatible instruction strategies (Griggs et al., 1994).
More troubling is the large number of exible students. The concept
of exibility is generally consistent with multimodal nursing and medical students using the VARK test, a questionnaire quite similar to the
PEPS questionnaire regarding visual, aural, reading/writing and kinesthetic sensory modalities (AIKhasawneh, 2013; James et al., 2011;

Table 4
Signicant differences in the distribution of low, exible and high-preference scores for nursing students of three semesters.
Elementsa

Auditory
Visual
a
b
c

Low does not prefer

Scale 2040

Flexible
Scale 4160

High prefers
Scale 6180

Total

Comparisons between three semester groups

Spring
2012
%

Autumn
2012
%

Spring
2013
%

Spring 2012
Autumn 2012
Spring 2013
%

Spring
2012
%

Autumn
2012
%

Spring
2013
%

Spring n = 78
Autumn n = 72
Spring n = 113
Total n

KruskalWallis test

6.4
14.1

4.2
11.1

1.8
20.4

67.9; 51.4; 69.9

71.8; 81.9; 75.2

25.6
14.1

44.4
6.9

28.3
4.4

263
263

2 (2) = 10.858, P = 0.004b

2 (2) = 7.186, P = 0.028c

Items with Likert scales: 1 (never) to 5 (always).

Differences signicant at P b 0.01.
Differences signicant at P b 0.05.

K. Hallin / Nurse Education Today 34 (2014) 14431449

1447

Table 5
Signicant differences between 263 nursing students' learning style preferences and their personal characteristics.
Elementsa
Low 2040
Flexible 2160
High 6180

Noise level
Light
Temperature
Design
Motivation
Persistent
Responsibility
Structure
Alonepeers
Authority gure
Several ways
Auditory
Visual
Tactile
Kinesthetic
Intake
Morning
Late morning
Afternoon
Mobility
a
b
c

Upper secondary school

1. Pre-university program
n = 76
2. Individual program
n = 122
3. Vocational program
n = 65

Assistant
nurse
graduation
Yes n = 205
No n = 58

Care experience
a: 0 year n = 51
b: b1 year n = 46
c: 1 b 3 years n = 86
d: 3 b 5 years n = 34
e: 528 years n = 45

KruskalWallis test
P-value

KruskalWallis test
P-value

MannWhitney U-test
P-value

KruskalWallis test
P-value

.178
.699
.627
.270
.233
.914
.496
.131
.985
.615
.050
.740
.653
.094
.528
.904
.119
.738
.238
.216

.040b in group 3 prefer sound

.620
.316
.911
.465
.533
.737
.863
.248
.434
.574
.045b in group 3 prefer
.049b in group 2 prefer
.085
.136
.081
.587
.789
.708
.251

.520
.554
.978
.920
.305
.965
.745
.712
.339
.137
.741
.389
.451
.535
.267
.181
.423
.611
.133
.109

.389
.623
.557
.395
.903
.626
.199
.246
.355
.839
.812
.171
.047b in b,c,e prefer
.997
.854
.214
.454
.964
.631
.873

Gender
Women (W) n = 209
Men (M) n = 54

Age
2122 n
2324 n
2526 n
2730 n
3148 n

MannWhitney U-test
P-value
.404
.059
.663
.714
.005c W were
.151
.213
.004c W prefer
.458
.249
.233
.008c W prefer
.733
.027b W prefer
.010b W prefer
.002c W prefer
.305
.071
.104
.011b W prefer

= 49
= 61
= 48
= 54
= 51

Items with Likert scales: 1 (never) to 5 (always). more.

Differences signicant at P b 0.05.
Differences signicant at P b 0.01.

Samarakoon et al., 2013). Unfortunately, while educators may believe

that exible and multimodal students can easily adapt their learning regardless of teaching methods, this is not the case. Students in such middle range adapt to teaching methods without any special requirements
as long they are interested in the topic. When not interested, they learn
supercially and engage only their short-term memory (Dunn and
Griggs, 2007). Thus, moderately interested exible students need to
have two, three or four elements involved in learning before they are
satised (AIKhasawneh, 2013). It follows that the more exible students are, the more important it is for teachers to arouse interest and
motivation in ongoing activities and set limits and rules for suitable
working. Based on the fact that just 16% of the students were highly motivated and 9% highly responsible the teachers' biggest challenge lies in
satisfying and inuencing those students' internal motivation. When
the driving force comes from the inside (internal motivation), learners
enjoy challenges and try different ways to deal with the challenges.
But the opposite effect occurs when the driving force comes from the
outside (external motivation) for example, in order to impress someone or receive a prize. Learners experience stress when confronted with
teaching methods that are difcult to cope with (Hedin, 2006).
The results showed that even nal year nursing students preferred
high structure and having an authority gure present. Of course, all students, regardless of educational level, need clear goals and academic
conditions where they know what is expected of them. However,
when university students are at the end of their education and soon to
be autonomous registered nurses, it is surprising that so many greatly
desire the closeness and backing of authority gures. This is probably
not what university teachers expect. One plausible explanation may
be that as nursing is governed by laws and regulations and life and
death situations, students want to receive immediate conrmation in
thinking and acting with regard to patient safety. In addition, twothirds preferred working with peers to a high degree, which should
reduce their need for teachers, but apparently not enough.
The most thought-provoking result was the 8% who preferred visuals highly and the high proportion of unvisuals (16%). The extent

to which the students took advantage of the literature is not known,

but no one can waive reading and self studies. An interesting thought
connected to the majority of the young students comes from the results
of Pettigrew et al. (2011), who found that older nursing students spent
more time per week studying than younger students. That is something
on which teachers have to reect.
Just about a third of the students highly preferred auditory, tactile,
and/or kinesthetic methods. Those students were in the nal stage of
a three-year nursing program and had a predominance of lecture experiences from all the aforementioned teaching and learning methods, but
overall it is evident that students have found that those methods more
or less t like a glove. According to Dale (1969), who 45 years ago concluded, the number of lectures should be reduced in favor of increasing
other teaching methods. Dale found that after two weeks people remember 10% of what they read, 20% of what they hear, 30% of what is
demonstrated but 90% of what is said and done in combination. This
indicates and conrms the importance of using seminars, case studies
and scenario-based learning. Nevertheless, it is remarkable that it has
taken decades for the knowledge to make deeper impact at higher
education institutions.
In order to meet individual needs in groups and keep their interest for
a period of several hours, teachers should use multimodal interactive approaches that change format every 4050 min. According to Pettigrew
et al. (2011), even university students' minds will start wandering after
40 min of a lecture. Thus, most lectures in the end of nursing education
should be replaced by strategies that promote interaction and participation, critical reections and feedback (cf. West et al., 2012). If the curriculum clearly outlines that the literature and case studies are discussed in
workshops it should encourage even unvisuals to read and be prepared.
Unique individual characteristics appeared in the results which have
repercussions on leadership in lecture halls. So, even if a group is large,
students need teachers who have the ability to choose methods that energize and trigger each to work toward set goals. Besides clarifying the
goals, directives and guidelines, teachers need to possess the competence to expand methodological repertoires to present subjects in an

1448

K. Hallin / Nurse Education Today 34 (2014) 14431449

efcient manner (Augustsson and Bostrm, 2012). Depending on the

students, the context and the situated activity, there are four didactic
areas that teachers have to consider initially: What should be taught
and why, how and to whom should it be taught? (Johansen, 2007). As
early as 20 years ago, Billings and Cobb (1992) reported nursing students who, congruent to their learning style preferences, studied with
interactive strategies and clear instructions and became motivated,
felt responsibility and achieved high grades.
Only three differences were found in learning style preferences between the two campuses and the three semesters. Likewise there
were no differences in learning style preferences related to different
groups of age and assistant nurse graduation. Overall the differences appeared to be more group-afliated than to do with changes to the time
and place. Nevertheless, comparing gender, there were a lot of surprisingly signicant ndings; comparatively more women than men were
highly motivated, auditory, tactile and kinesthetic and preferred structure and mobility. Since some of those results are contrary to the results
of the VARK test, where no relationships to gender were found (James
et al., 2011), nursing teachers should take into account possible differences in men's and women's study approaches. Anyway, the degree to
which previous education has inuenced the outcome of the present
study is not known, although signicantly more auditory students undertook a vocational program in upper secondary school, and signicantly more visual students undertook a special individual program.
That calls for more research on whether various upper secondary school
programs affect nursing students' learning styles.
Study Limitations
The central strengths of this study were the results generated from a
well proven questionnaire with high reliability and validity that is easily
applicable to nursing education (Dunn et al., 1995; LaMothe et al., 1991;
Nelson et al., 1993). The response rate was high (88.9%), and data were
selected from two campuses and a number of students at the same level
of education.
There were some weaknesses that limit the ability to generalize. The
study was conducted at a single rural university with nal semester
nursing students, and as with all surveys, the results should be seen as
snapshots. A multi-method design with students from several universities and education levels would have strengthened the results. However, the intention was to perform a pilot study and generate a basis for
further research.
Implications
The PEPS questionnaire gives both students and teachers good information about individual and group-related learning style preferences.
Since learning styles tend to change over time, teachers need to investigate groups on a recurrent basis, but the frequency required can be
discussed. James et al. (2011) suggests surveying each year, but according to the results of the present study two tests would be enough in a
three-year period. Therefore, if teachers estimate a student group
based on the results of the most recent survey, they will be able to
plan for two or three semester courses ahead.
To achieve success it is of utmost importance that teachers who
meet and guide the same student groups set aside time to discuss not
only the students' but their own learning style preferences before they
jointly decide content, didactic, pedagogy and behavioral strategies. As
students' and teachers' learning styles may differ, teachers should be
aware of their own preferences and answer the PEPS questionnaire too.
Implicitly, higher education requires students to select learning tools
that suit and improve them best. On the other hand, high-quality teaching is affected by a lot of factors that inuence deep learning and students' internal motivation (Hedin, 2006). A good start is to provide
structure with clear goals complemented by motivational expectations,
and thereafter make use of critical friends to determine the kind of

varying interactive pedagogical and didactic methods required as well

as opportunities for communication, collaboration and self-regulation.
Further Studies
To get an idea of whether there are trends in the new nursing students' learning styles, for example in relation to those who have
grown up in a technological home and in different school environments,
further studies are needed. It is also interesting to ask about university
students' family circumstances and the degree to which nursing students work alongside full-time studies. Another interesting approach
would be to combine the PEPS with additional learning style questionnaires, e.g. the questionnaire used in Kolb's Learning Style Model and
the VAK test. Triangulated quantitative and qualitative studies are needed, too. At the university where the study was conducted, the results of
this pilot study will be important for further pedagogical development
in a high-delity patient-simulation project.
Conclusions
Nursing students and nursing educators strive to adapt learning and
teaching methods, but they usually do so without mapping. The PEPS
questionnaire is a multidimensional and instructional tool in order to
investigate students' learning styles preferences.
The results showed that there were more or less heterogeneous
results with regard to what nal year nursing students preferred and
did not prefer. However, the majority were exible, and if not interested
in the topic, they are the learners who largely call for teachers' support
and motivation-enhancing guidance. Holistically there are complex circumstances that characterize teachers' leadership and students' learning,
but these are not impossible to handle for skilled teachers and for students who know their needs. Based on the results, most tuition should
be varying and interactive, discussed and conrmed between teachers
and students and between cooperating teachers.
The few differences in students' learning style preferences between
three semester groups during a 1.5-year period indicated that two
learning style tests should be enough over three years of nursing education. In such a range students could work on their own as a basis for
long-term learning.
The PEPS questionnaire provides a good basis for learning and teaching in colleges and universities. As there are few studies involving nursing students and the PEPS questionnaire, the results will be helpful as a
reference for further surveys at rural and metropolitan universities
regionally, nationally, and internationally.
Acknowledgments
This study was conducted as a part of fund from Mid Sweden University. Grateful thanks to all nursing students who agreed to participate in
the study.
References
AIKhasawneh, E., 2013. Using VARK to assess changes in learning preferences of nursing
students at a public university in Jordan: implications for teaching. Nurse Educ. Today
33 (12), 15461549.
Augustsson, G., Bostrm, L., 2012. A theoretical framework about leadership perspectives
and leadership styles in the didactic room. Int. J. Hum. Resour. Stud. 2 (4), 166186.
Beischel, K.P., 2011. Variables affecting learning in a simulation experience: a mixed
methods study. West. J. Nurs. Res. 35 (2), 226247.
Billings, D.M., Cobb, K.L., 1992. Effects of learning style preferences, attitudes, and GPA on
learner achievement using computer-assisted interactive videodisc instruction.
J. Comput.-Based Instr. 19 (1), 1216.
Bostrm, L., 2011. How do teacher students for compulsory school learn compared to
music teacher students in Sweden? A comparative study of two different student
teacher groups in Sweden. Qual. High. Educ. 8, 158179.
Bostrm, L., Hallin, K., 2013. Learning style differences between nursing and teaching students in Sweden: a comparative study. Int. J. High. Educ. 2 (1), 2234.
Dale, E., 1969. Audio-Visual Methods in Teaching, 3rd ed. Holt Rinehart Winston, New
York.

K. Hallin / Nurse Education Today 34 (2014) 14431449

Dunn, R., Dunn, K., 1999. The Complete Guide to the Learning Style in Service System.
Allyn & Bacon, Boston.
Dunn, R., Dunn, K., Perrin, J., 1994. Teaching Young Children Through Their Individual
Learning Style. Allyn & Bacon, Boston, MA.
Dunn, R., Dunn, K., Price, G.E., 2000. Productivity Environmental Preference Survey. Price
System, Lawrence, KS.
Dunn, R., Griggs, S., 1998. Learning Styles and the Nursing Profession. NLN Press, New
York.
Dunn, R., Griggs, S.A., 2007. Synthesis of the Dunn and Dunn Learning Style Model: Who,
What, When, Where, and So What? Center for the Study of Learning and Teaching
Styles. St. John's University, New York.
Dunn, R., Griggs, S.A., Olson, J., Gorman, B., Beasley, M., 1995. A meta analytic validation of
the Dunn and Dunn Learning Style Model. J. Educ. Res. 88 (6), 353364.
Evans, C., Waring, M., 2012. Application of styles in educational instruction and assessment. In: Zhang, L.F., Sternberg, R.J., Rayner, S. (Eds.), The Handbook of Intellectual
Styles. Springer, New York, pp. 297330.
Griggs, D., Griggs, S., Dunn, R., Ingham, J., 1994. Accommodating nursing students' diverse
learning styles. Nurse Educ. 19 (6), 4145.
Hedin, A., 2006. Lrande p hg niv. Ider frn studenter, lrare och pedagogisk
forskning som std fr utveckling av universitetsundervisning. Avdelningen fr
universitetspedagogisk utveckling, Uppsala Universitet (Learning at the high level.
Ideas from students, teachers and educational research to support the development
of university education. Division of University Educational Development, Uppsala
University).
HSFR, 2002. Forskningsetiska principer inom humanistisk-samhllsvetenskaplig
forskning. Vetenskapsrdet (Research ethical principles in the humanities and social
sciences. Research Council). Elanders Gotab, Stockholm.

1449

James, S., D'Amore, A., Thomas, T., 2011. Learning preferences of rst year nursing and
midwifery students: utilising VARK. Nurse Educ. Today 31, 417423.
Johansen, G., 2007. Didactic and the selection of content as points of departure for studying the quality of teaching and learning. Qual. High. Educ. 13 (3), 249261.
Kolb, A., Kolb, D., 2005. Learning styles and learning spaces: enhancing experiential learning in higher education. Acad. Manag. Learn. Educ. 4 (2), 193212.
LaMothe, J., Billings, D.M., Belcher, A., Cobb, K., Nice, A., Richardson, V., 1991. Reliability
and validity of the productivity environmental preference survey (PEPS). Nurse
Educ. 16 (4), 3035.
Nelson, B., Dunn, R., Griggs, S.A., Primavera, L., Fitzpatrick, M., Bacilios, Z., Miller, R., 1993.
Effects of learning style intervention on college students' retention and achievement.
J. Coll. Stud. Dev. 34 (5), 364369.
O'Hare, L., 2002. Effects of traditional versus learning style presentations of course content
in adult health nursing on achievement and attitudes of baccalaureate nursing
students. St John's University, New York (Doctoral dissertation).
Pettigrew, A., Dienger, M., O'Brien King, M., 2011. Nursing students today: who are they
and what are their learning preferences? J. Prof. Nurs. 27 (4), 227236.
Samarakoon, L., Fernando, T., Rodrigo, C., Rajapakse, S., 2013. Learning styles and
approaches to learning among medical undergraduates and postgraduates. BMC
Med. Educ. 13 (42), 16.
West, C., Usher, K., Delaney, J., 2012. Unfolding case studies in pre-registration nursing
education: lessons learned. Nurse Educ. Today 32 (5), 576580.