Nursing students ’ expectations of the process of writing a bachelor ’ s thesis in Sweden: A qualitative study

While performing various academic work, such as writing a bachelor ’ s thesis


Introduction
In line with contemporary Higher Education (HE) in Europe, Swedish nursing training includes the professional qualification of Bachelor of Science in nursing and registration as a qualified nurse (Swedish Higher Education Act, 1992).In Sweden, since 2007, nursing education requires completion of a bachelor's thesis (BT).An approved BT is worth 15 European Credit Transfer and Accumulation System (ECTS) credits, which is equivalent to ten weeks of full-time studies in the nursing program which, in total, includes 180 ECTS.So, in this context, a BT refers to a written academic student paper, but the task of writing up this paper also forms part of a mandatory course that students enrolled in the nursing program take in the course of studying at university.A BT is graded aligning to the national and European quality descriptors for HE, that formulate three categories of qualifications where students must demonstrate their knowledge and skills: 1) knowledge and understanding, 2) competence and skills and 3) judgement and approach (The Higher Education Ordinance, 1993:100).Thus, BTs are important as they constitute a significant quality indicator of the whole level of bachelor education at universities (Swedish Higher Education Authority, 2017).A BT is also a pedagogical tool in bridging and supporting students' integration of academic, scientific and clinical knowledge and skills (Andre et al., 2016).Indeed, contextualizing the BT in the disciplinary genre of nursing is fundamental in developing preparedness for clinical activities and assessment of nursing outcomes (Jefferies et al., 2018;Regan and Pietrobon, 2010).Lundgren and Robertsson (2013), showed that professional nurses working in health care reported that writing a BT had helped them acquire transferable knowledge and skills of relevance to delivering nursing care.Transferable knowledge and skills, in this context, can be defined as knowledge and skills that can be successfully transferred from a theoretical setting to a clinical setting (Lundgren and Robertsson, 2013).However, BT courses are weighted and balanced differently and vary between countries and universities depending on, e.g.different entry level requirements, policies and local curricula for nursing programs Lahtinen et al., 2014;Roca et al., 2018).An academic student paper carried out within a BT course involves descriptive or investigative research approaches and is most often carried out as a literature review (Hannigan and Burnard, 2001;Mattsson, 2016).In the context of the present study, BTs that involve quality enhancement initiatives or case studies are quite rare, but should students choose to carry out such empirical projects, a local ethics approval is required.Roca et al. (2018) reported that the academic competencies associated with a BT consist of generic and specific skills.The generic competencies include skills in information literacy and synthesizing scientific information, whereas the specific competences include writing skills and engaging in disciplinary communication.Both despite of and due to, the literacy-based methods used in BT-pedagogies, nursing students are often seen as being oriented towards research consumption rather than how to carry out research (Gallart et al., 2015).In the context of the present study, students take obligatory courses in the theory of science and methods and information literacy prior to embarking on the BT.The topics of BTs are freely chosen but with the requirement that they should be of relevance for the major subject of nursing science.An approved bachelor's degree with a BT is required for continued specialization studies in nursing.The BT course includes writing up an academic student paper in collaboration with a fellow student; students are free to choose with whom to work but may in some cases be paired by the course leader.The teaching practices involve five mandatory group supervision sessions when up to eight students participate and are supervised by a teacher allocated to that particular supervision group.Supervision usually follows the structural chronology of the BT, starting with the background description and problem formulation in the BT.The supervisors are teachers who hold at least a master's degree in nursing.An examiner, with at least a doctoral degree, is the main assessor and is involved in providing three formative "check points" during the course.Final grades are set through an examination seminar, where the students defend their BT, with other students acting as opponents.Previous research on supervision shows that students' training in professional literacy during nursing education is insufficient and that students are poorly equipped to use these techniques after graduation (Borglin and Fagerström, 2012;Smith and Caplin, 2012).Moreover, supervision practices of BT are criticized for having a teacher-centered deficit approach to instruction (Elton, 2010;Gratrix and Barrett, 2017;Dysthe, 2002;Whitehead, 2002).Students, having completed an undergraduate academic thesis in different disciplines, describe how they have been overwhelmed by the amount of time and work required to write the work (Çetinkaya and Yılmaz, 2017;Lundgren and Halvarsson, 2009;Krause, 2001).Nursing students have also reported that writing academic exercises does not provide links to their future professional practice (Johansen and Harding, 2013;Whitehead, 2002).Writing a thesis is seen as an academic work preventing the development of skills in and a reflective attitude towards, the clinical practices of nursing (Borglin and Fagerström, 2012;Johansen and Harding, 2013).However, accomplishing a BT has also been reported to have a positive impact on students' self-esteem (Lundgren and Halvarsson, 2009).To be acknowledged in applying knowledge in academic settings can be seen as being rewarded with a "craftsman's diploma" (Lundgren and Halvarsson, 2009).Research has also shown long-term qualifications of writing a BT, such as increased self-awareness and an awareness of patient-needs; indicating that the BT may contribute to developing relevant transferable knowledge and skills (Lundgren and Robertsson, 2013).Previous research describing students' perspectives on the BT has mainly been carried out in retrospect, so we currently lack knowledge of students' expectations of the process of writing a BT.Given that the BT offers students an opportunity to acquire knowledge and skills crucial for the nursing profession, students' expectations of writing a BT has gained surprisingly little attention nationally and internationally.Knowing more about what students expect from such an important part of their undergraduate education can help prepare teachers and supervisors support them in the process of writing a BT and improve their learning experiences.The aim of the present study was to describe students' expectations of the upcoming process of writing a BT in nursing program.This could provide a framework for curricular and policy development based on student participation.Regarding the educational relevance of BT in nursing education, it could also offer a basis for further studies in other contexts and from other and potentially international perspectives.

Methods
The study employed an explorative, qualitative approach with a single, written open-ended question design (Polit and Beck, 2020), inviting students to reflect in writing on their expectations of the upcoming BT.

Settings
This study was conducted at a nursing studies university located in Stockholm, the capital city of Sweden.During the period of this study, 2013-2016, an annual average of nurses graduating from the university was 114.Mean age among the students in the nursing program was 23-25 years and 10% of them were male.

Participants and data collection
All students studying the 5th of total 6 semesters of the nursing program were eligible to participate.The data of the study was collected over four consecutive years, 2013-2016, once per class and student.After an introductory lesson on the upcoming BT course, held by a course leader for students, the first author (AH) entered the class and presented the study.To facilitate freedom in their responses (Polit and Beck, 2020), the students were asked to give written answers to one open-ended question.The question asked was, "What are your expectations about the process of upcoming BT ?".The time spent on answering varied from 2 to 20 min.Students who chose to answer the open-ended question ranged from 7 to 31 on each occasion.A total of 93 written answers were collected during the study period.

Data analysis
A method of qualitative content analysis was chosen, based on careful reading of the textual accounts.Organization, interpretation and abstraction of data was performed stepwise (Elo and Kyngäs 2008).For ethical and readability reasons, the whole of the material was transcribed to a digital text document as a first step.The second step involved an open coding of words and phrases linked to the research aim.This phase was performed by two of the authors (AH, MW).Thirdly, subcategories were derived by a process of back-and-forth grouping of the codes, based on their differences and similarities.Building on the initial interpretations, the abstraction phase involved development of categories.Categories were developed by collapsing the subcategories according to their belongingness to a certain category of topic (Elo and Kyngäs, 2008).According to Elo and Kyngäs (2008), the scope and type of data influence the level of abstraction of the analysis.To obtain optimal descriptive names for the resulting generic categories, these were labelled and re-labelled during the analysis process.Furthermore, the interpretation and abstraction phases included validation in terms of discussions between all of the authors (Sandelowski, 1998).An example of the process of coding, interpretation and abstraction is shown in Table 1.

Research ethics
This study was carried out in accordance with the Swedish Research Council's (2017), guidelines for good research practice, stating that participants must be provided with clear information and ensured confidentiality in participation.All students received information in class, describing the study's purpose and its organization.Furthermore, the students were provided both oral and written information on the voluntary nature of participation as well as their right to withdraw at any stage without consequences.It was voluntary for the students to write their names and e-mail addresses in connection with their answers, to facilitate eventual further inquiry, however, no data were added secondary to the collections.To keep the data collection strictly anonymous and protect the integrity of those involved, the students were not asked to provide any demographic information.Even though topic of this research is not regarded as sensitive, all students had access to the students' health unit connected to the university.A coding sheet was created to ensure the confidentiality of the written consents and the answers.The original materials were kept separate in a locked safe and a password protected computer program, accessible to the first author (AH) only.In accordance to the Swedish code of archival storage, the original hand-written accounts will be destroyed 10 years from publication.The study was approved by the Swedish Ethical Review Authority (Dn.2017/639-31/5).

Results
The results consist of three generic categories and five subcategories.An overview of the resulting categories is shown in Table 2.The five sub-categories are presented in text under each generic category.Authentic accounts are provided with numerical codes.
Over and above the categorized results, typical of nearly all the answers were the short expressions of mixed feelings about the upcoming process of the BT.One recurring expression about the task of BT was that it will be: "A delight mingled with terror".

Gaining professional knowledge and competence
For the students, writing the BT would increase and deepen their knowledge about important issues regarding nursing care.The answers revealed that with the BT, the students hoped they would gain valuable knowledge which they would use in their professional practice in health care: "I hope to take the knowledge from my bachelor's thesis with me out into practice as a clinical RN (Registered Nurse) to be able to make use of that knowledge" (Student 59).
Choosing a topic was emphasized as important by several students.An inspiring topic would be one's own choice and related to the field of professional nursing.Students who had not yet come up with a topic that would interest them explained it to be a frustrating and frightening situation where they felt lost.
Others noted that they had already chosen a topic they would write about and now they would be able to "dig into it".Several students explained that the topic would give them insights into areas of nursing that had not been covered during training.Furthermore, some students had chosen topics related to their wish to work with a specific patient group.As one student wrote: "I want to plunge into one topic that I am very interested to work with in the future, within women's health" (Student 81).
Some of the students said they considered embarking on a research career in the future and the BT could be a gateway to the scientific discipline of nursing.For example: "I expect this to be an opportunity to gain deeper knowledge in nursing and to understand the academic field (of nursing) once and for all" (Student 82).
Yet others said they expected that writing a BT would be a matter of personal growth and development.Another opinion expressed in the answers was that the BT would not be of any advantage for future working practices as an RN.In some of these answers it was explained that nursing care is clinical and practical whereas the BT is purely an academic task for those aspiring to become researchers.A few of the students expressed the opinion that writing a BT is merely a prerequisite for completing the nursing education: "I have no specific expectations about this task of writing a BT.I see it as an obligatory part of the program, to get my nursing license and start working" (Student 17).

Planning and organizing the work
In their answers, several students commented on the novelty of writing a BT as something they had not experienced hitherto in their education.The students considered the steps that would outline the BT work timely and requiring a structured approach: "I think it's going to take a lot of time to write.I think it's important to start early… it's going be a lot of work that won't just involve writing, such as booking and finding interviewees, preparing questionnaires and so forth" (Student 75).
Some of the students were confused, not knowing how to go about tackling the BT, as expressed in the following: "My thoughts are somewhat rambling and most of it swirls around: what is there to write, how do you write, what facts are there, how will we be able to pull it all together?"(Student 70).
As the students would have supervision, they reflected on their expectations in relation to receiving comments from a supervisor.Consequences of failing or receiving erroneous instruction would be devastating, as one student put it: "I'm also worried that my supervisor may mislead me about the examiner, about being forced to redo major parts of the work" (Student 82).
Students in this study would write their BT with a fellow student, in some cases allocated to them and thus without any experience of previous collaboration.The students preferred having a peer with similar interests and ambitions.One student wrote: "I think it's good for me to write together with somebody, because then somebody besides just me is expecting me to perform.But it can also be harder since we have to compromise around the study's direction and aim" (Student 89).
Some students commented on the group-work model of supervision at the university.Group supervision sessions with up to 8 peer students and a supervisor would be a source of support when facing problems like "writer's block" (Student 39).Other students expected that the preparing practices of reading and commenting others' BTs would considerably increase their workload during the course.

Taking stock of personal resources
Nearly all the students included accounts of doubts and beliefs regarding their personal capabilities and motivation in relation to the upcoming ten-week course of writing a BT.The students ascribed their doubts and beliefs to their endurance of and coping with, the scope and complex demands of the work.One student wrote: "… My expectations are mixed.On the one hand I'm very nervous, it seems really complicated and difficult and I doubt my own ability to pull it all together.Afraid of becoming a burden to my writing colleague.On the other hand, sometimes I feel like it will probably be incredibly useful for me even though it's scary.It feels like a big thing …" (Student 71).
Furthermore, the students wrote short comments about their motivation, such as: "This will be a test of my self-discipline" (Student 89).
"… Exciting to be allowed to take own responsibility for the work" (Student 11).
"I want to have something of a challenge rather than something safe and easy" (Student 9).Some of the students anticipated facing difficulties in independently writing and creating a text according to the requirements of scientific and academic standards, expressing that the demands for the degree would put whole of the graduation at risk.One student stated: "Panic -will I be able to write and pass this"?(Student 2).On the other hand, those students who mentioned having previous experiences of academic essay writing, were assured of their abilities yet acknowledged the large scope of the work: "I've written a bachelor's thesis before so I know I can do it, but I also know what a tough process I have ahead of me" (Student 91).
Only few of the students commented on the fact that their BT would be subjected to appraisal for grading and wrote that they would prepare for "sufficient" or "good" grades.

Discussion
The main finding of this study was that the nursing students expected to gain professional knowledge and competence through the process of writing a BT.Although, this may be a first-hand view of students reflecting on a new task within their education, it was prominent.Students, who enter a vocational program in HE may have a holistic view of their future profession and expect the program to be closely aligned to this (Glerean et al., 2017).Furthermore, students can state personal, social and academic goals with an education (Edberg and Lilja Andersson, 2015;Entwistle, 2009).In this study, only a few of the answers referred to the BT as a personal, self-developing endeavor.
In one of the few existing studies examining nursing students' expectations regarding writing a BT, this endeavor was mainly looked on with motivation and interest (Lundgren and Halvarsson, 2009).However, the same study also observed that a minority of the students anticipated the BT to be a "nightmare" -a perception that was closely linked to the demands of the process of academic writing.Interestingly, with a few students, the negative conception prevailed even after the BT had been completed and approved (Lundgren and Halvarsson, 2009).Adding to this research, the results of the present study suggest that most nursing students viewed the BT as an integral part of their education.The nursing students in this study wish to express care problems in a scientific way.However, the prospect of writing seems to elicit mixed emotions within students.These results may be partly explained by the students being aware that the BT represents an important foundation of the comprehensive nursing program and to their bachelor grade.
Further confirming the theory of the BT as being a means of gaining knowledge for their professional life (Lundgren and Robertsson, 2013;Tuomi-Gröhn and Engeström, 2003), the students in this study stressed the importance of being able to choose their own topic of study independently.
The view of the BT process as useful was defended in two ways.Firstly, "digging into" an interesting and important topic was explained as motivating.Secondly, to write about a certain topic would be a source of knowledge for future work.Similarly, in an overview of 491 Swedish BTs, the major topics chosen by students covered knowledge in nursing management and experiences of illness, thus pinpointing relevant topics for generalist nurse professionals (Silen and Johansson, 2016).An ultimate goal in all vocational programs at HE is that students are able to deploy the knowledge acquired in new situations and roles (European Higher Education Area (EHEA), 1999; Tuomi-Gröhn and Engeström, 2003).There has been a debate about the usability of the BT as a potential bridge to working practices and Lundgren and Robertsson (2013) showed that the process fosters development of knowledge and skills that are generalizable and transferable.In promoting transferable knowledge, innovative initiatives for participatory, interprofessional and community BT-projects are increasingly being developed (Dall--Hansen and Odegaard, 2019;de Jong et al., 2018).
To develop a scholarly approach and skills in evidence-based methodologies, students need to practice data organization, i.e. techniques of information literacy and appraisal of research studies (Herrström et al., 2020;Smith and Caplin, 2012).The second resulting category in our study showed that planning and organizing the BT was looked forward to with confusion and distress.According to Entwistle (2009), planning a project may serve as an implicit and personal "learning contract" to be shaped by the individual student in relation to their understanding of the learning commitment.However, the task was new to main part of the students creating mixed emotions of not knowing how to proceed.Inexperienced students may hold a rather linear view of how to approach academic writing tasks (Lavelle et al., 2013).Moreover, to the complexity adds that unlike the disciplinary communication involved in writing care plans, academic writing is a genre of its own (Gimenez, 2008).To develop a personal academic "voice" requires effort from both students and supervisors (Negretti, 2012;Read et al., 2001).Whilst some of the students in our study were confident from the outset and already had started planning, others stated their unsureness.Common to these reflections was that the process of BT would entail coping with a considerable workload.As shown in previous studies, lack of experience in organization and time management of academic writing demands are boundaries for learning and even to start with the task (Çetinkaya and Yılmaz, 2017).This study confirms that managing time is an issue and students reflected on the steps they needed to take to succeed with the task, as well as their need of support.
The students in our study expressed worries about not understanding given instructions.They also worried about receiving conflicting advice from supervisors and examiners.Indeed, inconsistency in supervision and feedback are among the most frustrating experiences of HE students (Tuvesson and Borglin, 2014).The present study suggests that the students expected their supervision to be functional.This is an important observation since supervision ideally supports students to maintain the skills embedded in the BT for future use (Lundgren and Robertsson, 2013).According to studies, students expect to receive expert advice on how to interpret subject matter content rather than on methodological aspects (Derounian, 2011;Henricson et al., 2018).Supervision is also a relational matter and unfortunately, expectations from supervisors and students seldom fully match what they experience (Derounian, 2011;Gratrix and Barrett, 2017;Vehviläinen, 2009).
Research on collaborative BT writing is scarce.Samara (2006) found that group supervision empowers graduate students' skills in supervising peers.Our study indicates that students expect to co-work with a known peer with similar levels of ambition.Cooperation with peers entail students being prepared to compromise on important features of the work.Even though the students in this study thought their learning needs would be satisfied by supervisor and peers, it is not uncommon that HE institutions offer additional writing support (Miller et al., 2018).Opponents to this view argue that external supervision may lead to fragmentation of the academic writing processes, decontextualizing the work from its disciplinary context (McCune, 2004).This, in turn, may decrease students' sense of ownership about the BT and the process of academic maturation in writing (Lavelle et al., 2013).
This study suggests that there is a need to clarify the role and purpose of BT in nursing education.Students, who are on the threshold of becoming nurse professionals, expect the BT to cater for their professional knowledge and competence needs (Haigh and Kilmartin, 1999).Beal (2012) propose collaborative processes between HE -faculty and health care professionals regarding BT projects.This in turn, may have a powerful outcome for nurses' role in work-place knowledge practices and lifelong learning.Further studies are needed to test initiatives for how students can gain knowledge and competency through the process of writing a BT in nursing education.

Limitations
The data were collected between 2013 and 2016.However, as few previous studies have investigated students' expectations of writing a BT prior to engaging in it, the data are still highly relevant.Moreover, the educational context where the data were collected is largely unchanged, which increases the trustworthiness of the results.The nature of the data, including ambivalent and many single-word expressions and feelings, a mutual exclusivity of categories, as proposed by qualitative content analysts, could not be obtained (Graneheim and Lundman, 2004).Interpretations of the data were repeatedly discussed and calibrated in the research group in different phases of the analysis to ensure trustworthiness of the results (Guba, 1981).In the consecutive collection of data, a decrease in participation was observed.A structural change that may have contributed to this drop was the university's implementation of group supervision of BTs in the second year of data collection.However, in respect of dependability (Guba, 1981), the students accounts were found stable and consistent throughout the 93 answers independently of collection year.We collected no demographic data, which can be seen as a weakness.However, settings in Swedish HE in general and nursing education in particular, are relatively similar across universities.For instance, in 2016 most students completing a bachelor's degree at HE was under 26 years of age, as was the case in our study setting (The Swedish Higher Education Authority, 2017).Our study describes students' expectations of BT in Swedish context; however, transferability of results can be justified for any nursing education involving writing projects and assignments usually considered as high-stakes examinations.

Conclusions
The students' expectations of the BT comprised present and future knowledge, competencies, writing skills and abilities.The expected qualities embedded in writing a BT as presented here implies that writing up a BT can promote students' transfer from university to clinical practice in the nursing profession.If nurses' roles are to be extended towards development work, evidence-based nursing and a knowledge practices approach, more research is needed on how the process of the BT can promote these developments.Further research would yield valuable information on how to support students' learning processes to bring about a match between academic criteria for the BT and students' interpretations of disciplinary relevant knowledge.The students' prior expectations indicate a diversity of valid needs that would not be easily identified through conventional post-course feedback.The results presented here emphasize the need to invite students to reflect on their expectations of the upcoming process of writing a BT.By making these expectations visible, teachers working in health care education will be better prepared to support students in this endeavor.So, the implications of the results presented here are twofold.Firstly, in a university context, educators need to take this into account in designing and planning courses that involve scientific writing in nursing.Taking students' expectations into account in developing curricula allows not only increased student-participation but also invites reflection on how to successfully integrate qualities of potential professional relevance into the academic task of writing up a BT.Secondly, given the potential of BT found in this study in transferring knowledge and skills, the research presented here may be of relevance to nursing education in other, international settings where opportunities for harnessing the potential of a BT could be further explored.

Table 1
Example of the coding, interpretation and abstraction process.

Table 2
Presentation of the identified sub-and generic categories.