CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents information important to the at hand study that is within the

understanding of the researchers. The agreement of the information follows the “theme

approach” wherein comparable findings are grouped collectively as to which factor they belong.

RELATED LITERATURE

EDUCATION

Khan (2010) defined education as the knowledge of putting one's potentials to maximum

use. Also, it is one of the most prevailing instruments for plummeting poverty and inequality and

lays an organization for unrelenting economic growth; that is the reason why people continuous

to seek out education from the most influential schools in the region. Education is somehow used

interchangeably with the term learning, in which, however meant as a relatively change in

behaviour that results from experience (Kosslyn, et al. 2005).

Erikson, et. al (2005) pointed and already had identified factors which motivated the

nursing student. But, the easiest way to answer the question is to ask the graduates of the course

and/or the students who are also experiencing the main quandary of this study. Continuing

education can take in any form such as workshops, seminars, home-study or online courses,

conferences, or hands-on training.

 Attending a conference or cultural affair is open to the general public does not give

attendants any type of education credits, and cannot be considered formal training. Mandatory

continuing education is common in certain careers, such as dental and health professions like

nursing. As stated in the law, certain individuals enrolled in the program are mandatory to keep

up with modern developments, thus guaranteeing the best possible course of treatment for

patients.

BACHELOR OF SCIENCE IN NURSING

The BSN Program is a four-year program designed to prepare a professional nurse to

render nursing care to individuals, families, and groups in any setting at any stage of the health-

illness continuum. The curriculum is competency-and problem-based where the basic concepts

in Nursing and the roles and responsibilities the students are expected to assume after graduation

is considered. There are various fields that a registered nurse (the one who graduated the course)

such as in : Institutional Or Hospital Nursing; Community Health Nursing; Private Duty

Nursing; Industrial Or Occupational Nursing; Military Nursing; Flight Nursing Or Aerospace

Nursing; School Nursing; Clinic Nursing; Independent Nursing Practice; Pharmaceutical

Representatives; Nursing Education. The new millennium is in the lead of us. More advances in

the technology and health care make this a new brave world. One of the best course and most

enrolled course is the Nursing Degree. There are a lot of courses in study of each field of

specialization and one of which is the science of Nursing (Nursing, 2009).

19
CURICCULUM

Simply avowed, the curriculum is what students are expected to learn. In the past years,

many psychologists confirmed that curriculum may greatly affect the decision of the students in

continuing their education just like in 2009, Perkins has pointed out that the motivation of

students is often influenced more by what students are expected to study than by the methods

teachers employ in delivering the curriculum. Curriculum designers should take into

consideration such psychological components as the developmental level of the students and the

factors of intrinsic motivation described in the previous themes when they decide what to include

in the curriculum. Science and Technology curricula, including textbooks and the method of

teaching are perceived to be narrow, giving just some information. Thus, the modification of the

curriculum is continually seen as it adapts to its students (Lavonen, et. al 2008).

MOTIVATION

Scientifically speaking, motivation is basically the drive that leads the animal, and also

human is acting in a particular way at a particular time and place (Kosslyn, et. al, 2005). As

stated in the study of Lavonen, et. al (2008), there are been two major contributor of student‟s

motivation towards education. One is the person‟s character and the other is the psychological

state aroused by the learning environment.

20
 Kersten , et. al (2001) has given motivation factors in a student's choice of nursing as a

career been the focus of this study. There was a three-fold purpose: definition of nursing, reasons

for choosing nursing, and who/what influenced their choice.

According to Wagner (2001), motivation controls behaviour, it energises behaviour and

directs it towards some goal. Motivation can modify by experience. And all motivation was

ultimately reducible to two basic and oppose source of energy, the life instinct and the depth

instinct. Motivation is what you want to accomplish a task. As a student, the right motivation can

help you move closer to your goals, keep working on tasks until you succeed, and help you get

started on projects and assignments. The secret to becoming a successful student is staying

motivated.

According to Webb (2009), it does not matter how many years a person spent in

classrooms, a motivating vision is the common denominator for achievement. A vision that

motivates is the standard constant for success across all social classes and/or lifestyles. He has

given Abraham Lincoln as an example for he was never went to school but he became the

President of the United States of America because he had a vision which motivated him.

Also, Webb (2009) proposed the „Seven Rules of Motivation‟. These are: Set a major

goal, but follow a path; Finish what you start; Socialize with others of similar interest; Learn

how to learn; Harmonize natural talent with interest that motivates; Increase knowledge of

subjects that inspires; Take risk.

21
 Kersten, et al. (2001) pointed out that the most commonly reported reasons for choosing

nursing were: nurturance, emotional needs, employment opportunities, financial benefits, and

interest in science, which will be discussed in the succeeding paragraphs. Remember that we

each learn differently. Thus, education shouldn't be forced to tell the difference and approach

individual needs. If each student is taught the same curriculum, regardless of their skills, desires,

temperament, and abilities; class size is immaterial (except as it grows the power and wealth of

protected education industries and unions), perhaps we may tell the difference.

INTRINSIC FACTOR

According to Microsoft Encarta® (2009), intrinsic is basic and essential: belonging to

something as one of the basic and essential features that make it what it is. In a certain study,

which have focused their study on the motivation of nursing students which have proved that

intrinsic factors have driven the student to learn, to perform, and wish to succeed. Furthermore,

the need for extrinsic factor is also proved to give the students external reward (Nilsson &

Stomberg, 2009).

Intrinsic motivation more simply in terms of what people will do without external

inducement. Activities of these kinds are for no reward unlike interest and enjoyment that

accompanies them which are considered intrinsically motivational. Also, they both have

incorporated a great amount of research on motivational theory interested in a fusion of ways to

design environments that are intrinsically motivating.

22
 Challenges plays a role in intrinsic motivated because people are best motivated when

they are working toward personally meaningful goals whose attainment requires activity at a

continuously optimal or intermediate level of difficulty. In addition, curiosity happens when

something in the physical environment attracts the learner's attention or there is an optimal level

of discrepancy between present knowledge or skills and what these could be if the learner

engaged in some activity.

Thus, affects the intrinsic motivation. Also, control of the basic tendency to want to

control what happens to them affects the attitude of the students in continuing education. In this

course, competitions maybe a great help in motivation the students especially when students feel

satisfaction by comparing their performance favourably to that of others. There is various

activities students feel satisfaction by helping others achieve their goals.

Consequently, Cooperation is also included. In the course, there are also these mental

images of things and situations that are not actually present to stimulate their behaviour,

enriching the fantasy of students. Lastly, recognition is one of the factors in increasing the

motivation of students to continue the course. It happens when the learners feel satisfaction when

others recognize and appreciate their accomplishments.

Motivation of learn

According to a certain literature written by Lavonen, et al. (2008), they have found out

that since 1960, students were interested in taking up Science-related courses, especially males.

23
 As stated in the book of Willingham (2009), it is important for the teachers to consider

the pleasurable experiences for the students to answer a problem. But the learning environment

differs as the persons‟ characteristics. One may enjoy the phenomena in Science while the others

don‟t, thus, affecting the performance of the student.

But one factor, mentioned in the study by Lavonen, et al. (2008), says that the image of

science was altered depending on the students viewed on it. One student may perhaps see that

science is harmful but others see it as beneficial. Some students tend to fit into place in the

activity because of achievement of one goal, like for example, one gained scholarship or fame in

the enrolled course. Some researchers take the argument, claiming that one of the few universal

features of human development is children‟s inclination to engage in social relationships. One of

which is maintain communication and desire to perform some tasks to establish close

relationship with others.

According to Santrock (2008), in line with what has Siegler mentioned, all three

important mechanisms of change are characterized by self-modification, and an important aspect

of this self-modification includes metacognition – that knows about knowing. The student may

have realized that in his stay with the particular course will help him realize more with the

chosen career and thus, decreasing his level of reluctance.

24
Motivation towards financial benefits

Erickson , et al. (2005) said that good salary is one of the single most reasons of adults

for choosing nursing as their course. Only less than of a third of all respondents who chose

nursing because of these benefits but making a change in people‟s lives is the most top answer in

the survey that they have conducted.

Motivation to help others

Nilsson and Stomberg (2005) found that nursing student was motivated by the desire to

help others and do something useful. Thus, one of the motivational factors of students to

continue their nursing course is their desire to help others despite of the fact that nursing is not

their first choice. One motivational factor is that when a student learned to have a sense of

commitment wherein the student tend to stay in the career although he doesn‟t like it at first but

because of the people that he meet on the career. Nurses should prioritize the basics of nursing

care, such as ambulating patients and bathing them in order to prevent complications and

promote recover. Nurses are working too many hours but still can‟t provide basic care thus they

shall get rid of mandatory overtime and set limits on extended working hours.

Self-Efficacy

In the previous years and also in the study of motivations by Lavonen, et al. (2008), it

was mentioned that an attribution of personal significance or importance to an activity is termed

25
as value-related valences. These are associated with a topic, for example in a career where a

there is a greater chance of helping others, with the feeling of enjoyment and involvement. Thus,

despite reluctance when a person feels that he/she touches life of others may be a motivation

towards the continuation of his vocation

Nilsson and Stomberg (2005) said that in the study of self efficacy, intrinsic motivations

were used congruently with academic identification wherein it foretells meaningful cognitive

engagement. Also extrinsic motivation was found foretell a shallow cognitive engagement in

learning tasks.

Self efficacy may equate the term power, which, in various times was used to define

different terms. In the year 1960s, nurses were called powerless nurses which considered nursing

as a low status in the health care field. Halsam (2007) strongly believed that self efficacy is a

strong belief that individuals are capable of behaving effectively, for instance succeeding at a

demanding work task. Having low self efficacy have low expectations that they can produce the

desired behaviour and consequently they are likely not to attempt it. Efficacy expectations such

as these need not correspond closely to people‟s actual capabilities so that a lot of individuals

may be overwhelmed are self doubt and fail to realize their capabilities.

Larsen and Buss (2008) stated that self efficacy refers to the belief that one can execute a

specific course of action to achieve a goal. Self efficacy and performance mutually influence on

another. Self efficacy leads to better performance then better performance leads to further

increases in self efficacy. It can also be influenced by modelling, by seeing others engage in the

performance with positive results. Self efficacy will also lead to greater effort and persistence on

26
relevant tasks, often resulting in better performance. The stronger the person‟s confidence is in

her ability to perform an action. The more likely it is that she will do so. Enhancing person‟s

feelings of self efficacy is an important component of supporting self management.

People who are high in self efficacy strongly believe that they are capable of behaving

effectively, for instance succeeding at a demanding work fast. People, who are low in self

efficacy, in contrast have low expectations that these can produce the desired behaviour, and

consequently these are likely not to attempt it.

Bandura and colleagues have repeatedly shown that self efficacy predicts positive

outcomes in a wide variety of domains-health, job performance, academic achievements. Self

efficacy can be defined as the event to which people believe they are competent to confront the

challenges in life. Schwarzer has claimed that self efficacy is the single best predictor of

intentions and behaviour change across a wide range of behaviour. If people do not believe that

they can act to produce desired effects, they have little incentive to persevere. Self efficacy

determines whether we try to act at all, how long we persist in the face of difficulty or failure,

and how success or failure at a task affects our future behaviour (Larsen & Buss, 2008).

Our self efficacy beliefs are the result of four types of information: (our past success and

failures); (2) watching others to perform that or similar behaviours (vicarious experience): (3)

verbal persuasion (people talking to us, encouraging or discouraging performance); and (4) how

we feel about the behaviour (emotional reactions). Self efficacy leads to better performance, and

then better performance leads to further increase in self efficacy. People‟s beliefs about what

they can accomplish will influence the goals they select for themselves (Larsen & Buss, 2008).

27
EXTRINSIC FACTOR

Extrinsic motivation refers to motivation that comes from outside an individual; these

motivating factors are external, or outside, rewards such as money or grades. These rewards

provide satisfaction and pleasure that the task itself may not provide.

An extrinsically motivated person will work on a task even when they have little interest

in it because of the anticipated satisfaction they will get from some reward. The rewards can be

something as minor as a smiley face to something major like fame or fortune. For example, an

extrinsically motivated person who dislikes math may work hard on a math equation because

wants the reward for completing it. In the case of a student, the reward would be a good grade on

an assignment or in the class.

Extrinsic motivation does not mean, however, that a person will not get any pleasure

from working on or completing a task. It just means that the pleasure they anticipate from some

external reward will continue to be a motivator even when the task to be done holds little or no

interest. An extrinsically motivated student, for example, may dislike an assignment, may find it

boring, or may have no interest in the subject, but the possibility of a good grade will be enough

to keep the student motivated in order for him or her to put forth the effort to do well on a task.

28
Family Support System

Common definitions to help the reader describe the meaning of a family is that a family is

a social unit made up of people related to each other by blood, by birth, or by marriage. Some

other definition is that it is a social unit made up of people who support each other in one or

several ways or whose members identify with each other in a supportive way (O‟Donell et al.,

2007).

Many children during this time face problems that may serve as a barrier for the students

to get educated compared with students who lives in higher-income areas (Santrock, 2008). This

particular factor, as stated by Lavonen et al. (2008) includes the role models found among family

members. Moreover, the value systems of the whole society influence the occupational choice of

the student.

Parents play a very significant role in the adolescent development Family provides

gradual approximations of a desired behaviour which also equates the term shaping. They also

provide the primary need of each individual; it may be the emotional, financial, and social needs

of the individual (O‟Donell et al., 2007).

According to Santrock (2008), Family, especially parents play an important role as

managers of children‟s opportunities, as monitor of their behaviour and social arrangers. Also,

parents may influence the continuation and achievement in a child‟s academic performance. In

addition, he found out that the presence of a positive family atmosphere can promote

29
individuality and connectedness which is important with identity involvement. In general,

Santrock (2008) indicates that the identity formation is enhanced by family relationships which

encourages individuals to develop their point of view.

As primary arrangers, family has also the role to regular one‟s emotion when he or she

faces a „stress‟ (sometimes referred to as storms). With this emotional regulation, the family may

help the student control the level of cognition of a student, thus, increasing the like hood to

perform well academically (O‟Donell et al., 2007). However, negative family atmosphere may

lead children to confusion and foreclosure (Santrock, 2008).

In sequence with this, many parents see their children negatively, thus children become

more rebellious it may be with the use of drugs or poorly perform in the school (Santrock 2008).

On the other hand, some families (also ethnicities) tend to follow closely knit families with

extensive kin networks. This is one reason why families tend to follow the career path of their

relatives. One instance is when a family is greatly involved with medical field; expect that all the

family members are also engaged with the same field (Santrock, 2008).

Peer and Mentors’ Influence

According to the literature review, the continuation and career selection of students, in

general, reflect the educational and/or training system of the youth. They have argued that school

science and the mentors as well, to the highest degree influence the occupational choice even

though they don‟t unavoidably mean it. For instance, a student is having difficulty on a particular

30
topic but by the encouragement and advice of the mentor, the learner continues and, more often,

studies tough. Popular children are often disliked by their peers. They are frequently nominated

as best friends that being hated. In line with this domain, children who are friends tend to be

similar to each other (Santrock 2008).

One good motivation is the mentor support, supportiveness of the teacher. According to

O‟Donnell, et al. (2007), the greater the teacher supports the student the greater chance for the

student to engage more in learning. This primary fits the description Peer and Mentor support.

For most children, being popular with their peers is a strong motivator. The focus of their

peer relations is on being linked by classmates and being included in games in lunchroom

conversations. However, the term „peer pressures‟ is a widely used term to define the struggle of

an individual to go along with his peers. Harry Stack Sullivan argued that friends are also

important in shaping the adolescents (Santrock 2008). This can further explain why adolescents

tend to follow the course where their best friends are enrolled, because they want to go along

with them.

Students benefit when the teacher provide atonement, supportiveness and gentle

discipline. As the society grows more, teachers‟ knowledge about their students grows in

importance. This contributes to a high relationship. As a student finds a great caring relationship

outside the house, individuals develop relationship-specific beliefs with each specific interaction

such as one‟s teacher. Teachers may have different teaching styles to provide cognitive and

emotional support in the issues on one‟s life (O‟Donell et al., 2007).

31
 As described by Santrock, (2008) mentors (teachers) are great factors in motivating

students for them to go on with their education. In agreement with this as he settled in his study,

students who are not encouraged to practice long hours are implausible to be converted into

experts in a particular area.

Without knowing, teachers may have a direct influence on a student academic

performance. Say for instance, a student is already giving up with his course, a mentor may

advise to her student. This is somehow associated to the direct instruction approach. The

undeviating instruction approach, a structured, teacher – centred loom that is characterized by the

teacher‟s control, mastery of skills, high outlook, maximum time spent on learning tasks, and

efforts to keep negative effect to a minimum (Santrock, 2008). Thus, a student may experience a

motivational event wherein he still decides to continue the academic task, the continuation of the

course.

Allowance

Allowance is the money given to child by parents: a small sum of money paid regularly

by parents to a child so that the child can make his or her own purchases. (Encarta® World

English Dictionary, North American Edition 2009). According to O‟Donell et al. (2007), a

reward is given in return for the other person‟s service or achievement. In this case, the reward

specified to student in recompense for progressing the nursing education is money. With this, the

student are emotionally continues with interest. According to the same psychologist, the

32
psychological mechanism that makes students sensitive to rewards is the release of dopamine

which triggers the behavioural activation system. Thus, the students increase their positive

attitude towards the continuation of Nursing Education because they are expecting special

privileges such as an increase in allowance. In short, extrinsic increase in rewards encourage

approach behaviour because they indicator that personal add is impending.

This may be considered as an incentive. An incentive is an experience that attracts one in the

direction of a particular course of action.

In psychology, addition in allowance is considered to be a positive reinforcement

effective for he studies to continue their education. However, it may also be a form of a

punishment if the students fail to continue the course (O‟Donell et al., 2007).

Increase in allowance may be a form of reward. The first line of research generally

focuses in behaviourism. This theory is built on the basic principle that behaviour that is

rewarded tends to be repeated than that of the punished behaviour (O‟Donell et al., 2007).

Relationship with the opposite sex

As described by O‟Donell et al. (2007), in a book, they have said that “Relationships are

the soil in which the social development grows”. In addition, an individual or particularly, a

student‟s past relationship dictates the quality of his social development. It is the reason of

trusting or mistrusting a person, just like what is mentioned on Erik Erikson‟s Psychosocial

Development Theory.

33
 With this, parties may have the same likeness; they tend to follow in which course the

other party is enrolled believing that both of them will have the same career path. Relatedness is

the term defining the same idea of relationship, wherein it is the sense of being close to one

person and it entails feeling of special and importance to the other party. Sometimes, it is

referred to as intimacy. For these reason, relatedness is an especially good predictor of student‟s

course engagement. Individuals spend considerable time either dating or thinking about romantic

relationships (Santrock 2008).

Job Opportunities in Nursing

Recently, the increase in the demand for nurses in the international community brought

about an extraordinary increase in the number of nursing students, this past decade (Erickson, et

al., 2005). The number of nursing students rose to the extent of overtaking 50% of a University‟s

population. The top Philippine Universities even saw professionals going back to school just to

take up nursing (Palaypay & Padilla, 2009).

The quantity of high school students who have decided to take up nursing increased. As

stated by Limlingan (2007) on his article, due to the increased demand of nurses abroad, Nursing

is one of the courses preferred by the incoming college students here in the Philippines.

Moreover, based from Commission on Higher Education, for the period of 1998 – 2007, the

27,833 number of enrolees recorded in the Academic Year (A.Y.) 2000-2001 rose to a record

high of 453, 896 in Academic Year 2006-2007 with an annual average growth of 62 %. The

34
number graduates exhibited an increasing trend for the period 2000-2005, with 140.5% increased

in the number of graduates in A.Y.2004-2005. (Palaypay & Padilla, 2009).

With an increased in the number of nurses being hired abroad and being employed in

different countries, nursing has been a demand career choice which resulted in the mushrooming

of nursing schools. As cited by Palaypay and Padilla (2009), there is a significant rise in the

number of nursing colleges from 190 in A.Y. 1998 -1999 to 465 in A.Y. 2006-2007. However,

do these students who are taking up nursing really want Nursing as their personal career choice

or is it because they are persuaded because of the opportunity that awaits them? Do they still

manage to finish the course?

Some age motivated in taking up the Nursing course for them to go to abroad but some

may see nursing to be less glamour (Braten & Olaussen , 2007) for example some are engaged in

the community health service. However, it is more important for them the view of increase

employment abroad. With this, they also have the greater chance to go abroad.

RELATED STUDIES

Erickson, et al. (2005) pointed out that despite that nearly half of the respondents did not

choose nursing studies as their first choice in a study conducted in Sweden, the respondents were

motivated by the desire to help others and to do something useful. The study result also showed

that teachers' involvement, organization of the program, contents in the studies associated to the

35
profession, life situation and friendship, were more commonly used as extrinsic motivators and

as explanation to the motivation score than was intrinsic factors such as attitude to the study.

In addition, the American Association of the Colleges of Pharmacy revealed that the main

reason why their students stay in the course is that the students feel the development of various

programs in their profession. Thus, considering the stay and finishing the program, as the result

reveals, will be a good decision. Thus, less focus to variables such as workplace setting, degree,

financial support, age, and number of years in practice was observed. Hence, continuous

professional development (CPD) may be able to guide and educate pharmacists with CE program

selection in the future. These two studies may suggest that various factors may affect the

decision of the students (in any colleges) depending on selected motivational factors.

SIMILARITIES AND DIFFERENCES OF THE PRESENT STUDY

WITH THE PREVIOUS STUDIES

This study is similar with that of the study conducted by Erickson, et al. (2005) and the

American Association of the Colleges of Pharmacy (2006) in two main points. One is that this

study also aims to know the motivational factors of their citizens in continuing the nursing

course while considering them as reluctant in choosing the course; and the second point is that of

the pre-identified motivational factors.

However, we may have considered the pre-identified motivational factors yet the

researchers are to consider the setting, answering the question, “Are these motivational factors

applicable in the Philippines?”

36
 One point to consider is the attitude of the respondents. The main difference is that this

study also aims to know the respondents‟ level of reluctance, prior taking up the course and after

enrolling and having clinical experience. This also aims to include the selected factors of the

Filipino students in taking up the course.

In the year 2007, Braten, I. and Olaussen, B. has studied the motivational development of

Norwegian nursing students over the college years. Like in the study by Lavonen et al (2008),

the researchers added some motivational factors that were seen in the pilot study conducted.

These factors were added to the previous proposed motivational factors by Erickson, J.I. et al.

The difference of this study to the study conducted by the aforementioned researchers is that the

study focuses on the motivation to learn by the Norwegian students than becoming a nurse. The

study by Braten I. and Olaussen B. is to investigate few theory-driven and long-term studies of

motivational development in nursing education.

37