ABSTRACT Effective feedback can enhance student learning

but

limited evidence exists on whether nursing students actu- ally use and learn from written feedback. This descriptive survey explored nursing students’ perceptions regarding the amount and type of written feedback required to enhance their learning. In stage one, 362 students completed a 28- item questionnaire regarding feedback experiences and preferences; in stage two, 227 students selected a preferred feedback option for a fi nal topic assignment. Findings re- vealed that many of the students wished to be engaged with the feedback process and believed eff ective written feed- back can and does enhance their learning. However many students also reported learning barriers—including absent, inadequate, ambiguous, inconsistent, and ineff ective feed- back—indicating a signifi cant disconnect between desired and actual feedback. Recommendations include a greater focus on engaging nursing students in the feedback process and evaluating the eff ectiveness of written feedback for indi- vidual students. [J Nurs Educ. 2014;53(1):23-30.]

The relationship between assessment and feedback is complex; both signifi cantly impact student develop-ment in the educational setting and during professional practice (Parboteeah & Anwar, 2009). Feedback is widely ac- knowledged as a vital component in the teaching and learn- ing cycle (Bruno & Santos, 2010; Rae & Cochrane, 2008; Walker, 2009), and written feedback on student assignments plays a crucial role in higher education, including nursing ed- ucation (Koh, 2008). The review by Evans (2013) found that feedback can facilitate students’ development as independent learners who are able to monitor, regulate, and evaluate their own learning, up to and beyond graduation and into profes- sional practice. Despite this importance, evidence regarding student perceptions of feedback is limited (Evans, 2013); in particular, minimal research exists regarding written feedback practices specifi c to nursing education (Parboteeah & Anwar, 2009). The aim of the current study was to examine nursing students’ perceptions regarding the most effective amount and type of written feedback on assignments required to enhance their learning.

LITERATURE REVIEW

The main purpose of written feedback, as cited in the lit- erature, is to improve knowledge, understanding, and future work (Ferguson, 2011; Parboteeah & Anwar, 2009). Accord- ing to Ramsden (2003, p. 187), “it is impossible to overstate the role of effective comments on students’ progress,” and there is strong evidence to show that effective feedback is pivotal to improved student learning (Bruno & Santos, 2010; Ferguson, 2011; Price, Handley, Millar, & O’Donovan, 2010).

Research to date has focused on whether written feedback is of good quality, but there is limited evidence on whether stu- dents actually use the feedback they are provided and whether they learn as a result (Evans, 2013; Giles, Gilbert, & McNeill, 2013; Price et al., 2010). In addition, many lecturers contend that written feedback is not valued by students and that students are most interested in their grade and pay little attention to writ- ten comments (Weaver, 2006; Winter & Dye, 2004), which

Nursing Students’ Perceptions Regarding the Amount and Type of Written Feedback Required to Enhance Their Learning Tracey M. Giles, MNg, RN, GradCert(HDNursing); Sandra Gilbert, MPET, RN, GradDip(HlthCouns); and Liz McNeill, MNg, RN, GradCert(Ed)

Received: May 10, 2013 Accepted: August 22, 2013 Posted Online: December 9, 2013 Ms. Giles and Ms. McNeill are Lecturers in Nursing, School of Nurs-

ing & Midwifery, Flinders University, Adelaide, and Ms. Gilbert is Nurse and Midwife Education Facilitator, Clinical Development, Country Health South Australia Local Health Network, Adelaide, South Australia, Austra- lia.

The authors received support for this study from the Flinders Univer- sity Teaching Quality Network Teaching and Learning Project Fund Seed- ing Grant.

The authors have disclosed no potential confl icts of interest, fi nancial or otherwise.

Address correspondence to Tracey M. Giles, MNg, RN, GradCert(HDNursing), Lecturer in Nursing, School of Nursing & Mid- wifery, Flinders University, GPO Box 2100, Adelaide, SA, Australia, 5001; e-mail: tracey.giles@fl inders.edu.au.

doi:10.3928/01484834-20131209-02

Journal of Nursing Education • Vol. 53, No. 1, 2014 23

STUDENT PERCEPTIONS REGARDING FEEDBACK

leads lecturers to ask whether their efforts are worthwhile (Bai- ley, 2009; Sendziuk, 2010).

One strategy that has been recommended to improve the effectiveness of written feedback is to engage students in the feedback process (Evans, 2013; Ferguson, 2011). This could be achieved by inviting students to request the type of feed- back they want or having students identify where they are hav- ing particular diffi culties when they submit work (Sendziuk, 2010).

Few studies have focused on feedback practices from a stu- dent perspective, and research that focuses on written feedback in nursing education is limited (Parboteeah & Anwar, 2009). The ability to write clearly and expertly is a vital skill in nursing education (Giddens & Lobo, 2007; Parboteeah & Anwar, 2009; Wood, Moskovitz, & Valiga, 2011), and a heightened aware- ness of how nursing students use and learn from feedback on their written work could infl uence how lecturers construct and write feedback. These issues warrant further investigation from a nursing education perspective to make educationally sound recommendations to ensure that feedback is effective, is acted upon, and contributes to student learning.

METHOD

A descriptive survey study was undertaken to explore what nursing students consider the most effective amount and type of written feedback on assignments to enhance their learning. The research took place in two distinct stages. For stage 1, a 28-item questionnaire that included six demographic questions, 16 closed-ended questions, and six open-ended questions was constructed following a review of relevant literature. The re- searchers who developed the questionnaire have considerable experience related to teaching and feedback practices. For stage 2, a feedback preference form was constructed to allow students a choice of three feedback options upon submission of their fi nal, summative assignment.

Ethical Considerations Ethical approval for the study was gained from the relevant

university social and behavioral research ethics committee. All participants were aged 18 years or older and were advised that participation was entirely optional. During stage 1 (in-class ques- tionnaire), students who did not wish to participate were given alternate work to complete. That same work was also given to students who chose to participate to ensure equity. During stage 2 (feedback preference form), students were advised that their feed- back choice would not in any way affect their grade or progress in the topic. Students were advised that all results would be pooled prior to analysis to protect the participants’ identities.

Sampling All third-year nursing students enrolled in a fi nal topic at

a major South Australian university and who were present in class on the day the questionnaire was administered (N = 471) were invited to participate in stage 1 of the research. All third- year nursing students in that same topic who submitted the fi nal, summative assignment (n = 440) were invited to participate in stage 2. The total recruitment pool reduced from 471 students in stage 1 to 440 students in stage 2 due to student attrition over the semester period. The Figure depicts the recruitment strat- egy used in the study.

Data Collection Stage 1: In-Class Questionnaire. Students who attended the

week 2 tutorials were given a letter of introduction by their class lecturer and were invited to complete the questionnaire, which took approximately 15 minutes.

Stage 2: Feedback Preference Form. The assignment cover sheet for the fi nal, summative assignment was modifi ed to allow a choice of three written feedback preferences. Students could choose to receive (a) their grade only, (b) their grade and the mark- ing rubric completed only, or (c) their grade, the marking rubric completed, and feedback written throughout the assignment. Stu- dents were advised that choosing a feedback preference was op- tional and that if they chose not to participate, the default would be the third option, which was the current standard practice.

Data Analysis Analysis of the quantitative data was undertaken using IBM

SPSS® (version 19) software. The desired minimum sample size

Figure. Recruitment strategy used in the current study.

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GILES, GILBERT, & MCNEILL

was determined to be 172 (Bu- chner, Erdfelder, Faul, & Lang, 2012). Descriptive statistical analysis was used to calculate frequencies, mean values, and range. Thematic analysis was undertaken of the qualitative data to identify themes, es- sences, or patterns within the responses to open-ended ques- tions within the questionnaire (Liamputtong, 2010).

RESULTS

Demographic Findings A total of 362 of a pos-

sible 471 participants com- pleted the stage 1 question- naire (response rate = 77%). Participant age ranged from 19 to 62 years, with a mean age of 27.2 years (SD � 7.6 years), and 84% of par- ticipants were female. Just more than half (55%) of the participants listed English as their fi rst language, and 38% had previously studied at a university. A total of 227 of the 440 students who submitted the fi nal topic assessment selected a feedback option during stage 2 (response rate = 52%).

The study results presented throughout the following sec- tions are from stage 1 (in-class questionnaire) unless they are specifi cally stated from stage 2.

Do Students Want and Need Written Feedback on All Written Assignments?

Almost all students had received written feedback on a pre- vious assignment (99.2%) and had read this feedback (97.5%); most students believed that written feedback helps them to learn (83.7%) and that they need to receive written feedback on all writ- ten assignments to learn effectively (79.8%) (Table 1). A higher percentage of students who had previously studied biomedical– nursing (92.3%) and humanities (89.2%) indicated that feedback enhances their learning, compared with students who had previ- ously studied science (75%). Of note, 89% of students indicated they had changed what they did in their next assignment based on written feedback, but only 74.3% stated they used feedback sug- gestions to improve their work and just more than half (52.2%) indicated they would like to be able to request the type of feed- back they receive on assignments (Table 1).

During stage 2, when asked to select a feedback preference, the majority of students (72%) selected option 3, which was the maximum amount of feedback possible; just more than one quarter (26.4%) selected option 2 (the grade plus marking ru- bric); and only 3 students (1.3%) requested their grade only and no written feedback at all.

When Don’t Students Want Feedback? Students were asked the open-ended question “Which types

of assignments would you NOT want written feedback on?” A compilation of qualitative responses to this question is presented in Table 2. The most common responses were examinations/ quizzes that required specifi c answers, multiple choice or true- or-false questions, and summative or fi nal assignments.

Do Students Understand Feedback Written on Their Essays?

When asked whether there were always suggestions for im- provement written on their essay, 56.1% of participants answered no and 16% were unsure. Just more than one third (37.6%) re- ported that written feedback was not always legible to them, and 15.7% were unsure. Only 30.7% of students reported that it is always clear from the feedback what they did well and why, and 36.7% said it was always clear from written feedback what they needed to improve and why (Table 1). The following comments from students further demonstrate this ambiguity:

• [A comment] like “nearly there” on its own is no help. • Comments such as “good” over & over. Why is it “good?”

To me “good” is not encouraging. • Confl icting critique—“you did this well but you could

have done this”—I didn’t do it well then, did I?

Do Students Use Written Feedback to Inform and Guide Subsequent Essay Writing?

Most of the students reported making changes to future as- signments based on previous feedback (89%) and using sugges-

TABLE 1

Responses to Questions Requiring a Yes/No/Unsure Response (N = 362)

Survey Question Yes, n (%) No, n (%) Unsure, n (%)

Have you ever had feedback written on your assignment at this university?

359 (99.2) 3 (0.8) 0 (0)

If yes, did you read the feedback? 353 (97.5) 4 (1.1) 5 (1.4)

Do you think written comments on your assignment helps you to learn?

303 (83.7) 11 (3) 48 (13.3)

Do you think you need to receive feedback on all written assignments to learn eff ectively?

289 (79.8) 39 (10.8) 34 (9.4)

Did you change what you did in your next assignment based on that feedback?

322 (89) 24 (6.6) 16 (4.4)

Do you use suggestions for how to improve your work the next time you write an assignment?

269 (74.3) 24 (6.6) 69 (19.1)

Would you like to be able to request the type of feedback you want on assignments?

189 (52.2) 63 (17.4) 110 (30.4)

Are there always suggestions written on your assignment for how you could improve it?

101 (27.9) 203 (56.1) 58 (16)

Is written feedback always legible to you? 169 (46.7) 136 (37.6) 57 (15.7)

Is it always clear from the feedback what you did well and why? 111 (30.7) 179 (49.4) 72 (19.9)

Is it always clear from the feedback what you needed to improve and why?

133 (36.7) 160 (44.2) 69 (19.1)

Journal of Nursing Education • Vol. 53, No. 1, 2014 25

STUDENT PERCEPTIONS REGARDING FEEDBACK

tions for how to improve their work in subsequent submissions (74.3%). Some students reported making improvements to as- signment structure and referencing; for example, one student stat- ed, “I applied information to future essays, usually referencing and structure comments helped me with future essays.” Another student stated, “I had a problem in structure [and] logical fl ow in assignments, feedback helped me improve [my] writing skills.”

Other students wrote about changes they had made to the content of subsequent assignments. One student said, “If I have another assignment or the same topic, like evidence, I will fol- low the tutor’s advice—e.g., choosing better framework—and work through more deeply.” Another student said, “I received a comment that some of the work I did on an assignment was too descriptive and not analytical enough. I tried to keep this in mind for future assignments.”

Several students reported that any changes made to subse- quent assignments based on feedback depended on the person marking their work, indicating that inconsistent feedback is problematic. One student indicated, “[It] actually depends on the lecturers, some ask for things that others do not want.” An- other student indicated, “the format and how to reference be- cause I was referencing wrong [for the] fi rst 2 years of [univer- sity] until one tutor pointed it out.”

One student provided a clear example of how she believed written feedback had enhanced her learning: “I had 11/30 in my fi rst paper and I was asked to explain in detail how I understand the issue without concentrating too much on the references. I did that in my next paper and I had 22/30.”

Qualitative responses regarding changes made to subse- quent assignments based on written feedback were grouped

into four broad categories under the following headings: referencing, structure and format, grammar or English, and content and critique. Table 3 presents the overall percentage of students who made changes based on written feedback, as well as the background of students who made changes in each category. Of note, students who had previously studied at a university were less likely than students with no previous university experience to make changes to subsequent assign- ments across all four categories. This suggests that students with more university experience were less likely to use feed- back to enhance their writing. Students who listed English as a second language (ESL) were less likely to make changes to their referencing, structure and format, and content and cri- tique than were students with English as the primary language. However, students with ESL were much more likely to make changes to grammar or English than were those with English as the primary language (Table 3).

Feedback That Hinders Student Learning Students were asked the open-ended question, “What kind

of written feedback or comments do you think hinders (pre- vents) your learning (e.g., too much critique, can’t read hand- writing, etc)?” Feedback that hindered student learning is sum- marized in Table 4. The two most common responses were “too much critique” (43.9%) and “cannot read marker’s handwrit- ing” (38.2%). One student wrote, “too much critique is bad for confi dence levels. Superfi cial positive feedback provides no insight. A combination is necessary.”

Approximately one third of the participants (31.2%) also claimed their potential learning was hindered when not enough detail is provided about what they did well and what areas needed improvement. One student wrote that learning was hindered by “feedback that does not explain what I did wrong or how to fi x it. Mere identifi cation of an error is not enough for me to improve on it.”

Just more than one quarter of students (27.7%) wrote that unclear comments and confusing statements make it diffi cult to know how to improve future essays. One student summarized this particular frustration succinctly: “It is hard to improve your next paper when lecturers simply put ticks all over the page.”

Fifteen students (4%) reported that their learning could be signifi cantly hampered when unnecessarily harsh or negative comments are written on their essays. For example, one student wrote, “Sometimes I understand if our paper is [expletive] but at least be a little encouraging.” Another wrote, “[I] don’t like to see my essays torn apart by the marker. [It] makes me think they are too critical and unfair…[and it] discredits their mark.”

Some students shared that an overfocus on spelling, gram- mar, and punctuation, rather than content, frustrates them. One student wrote, “Sometimes feedback [I receive] is not about the content but only about the structure, referencing, punctuation, grammar, which is not helpful.” Other participants wrote that too much feedback can also hamper their learning; for example, “I think when you received a lot of feedback often it can make you feel overwhelmed and down-hearted, especially when you feel you did a good job.”

Several students reported that they had experienced situa- tions where feedback written on their assignment did not match

TABLE 2

When Students Do Not Want Written Feedback on Assignments (N = 26)

Type of Assessment n (%)a

Examinations, tests, or quizzes with specifi c answers, multiple choice, true-or-false answers

10 (38.5)

Summative or fi nal assignments 4 (15.4)

Minor assignments 3 (11.5)

Journals, refl ective writing 2 (7.7)

For particular topics (i.e., research and sociology) 2 (7.7)

Assignments that do not allow resubmission 1 (3.8)

Easy assignments 1 (3.8)

Every type of assignment 1 (3.8)

High-distinction assignments 1 (3.8)

Tutor has given verbal feedback or checked draft work prior to submission

1 (3.8)

When requirements or rubric are clear 1 (3.8)

When I know the essay is fl awed or poor work 1 (3.8)

a As some students wrote more than one answer, total sums greater than 26.

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GILES, GILBERT, & MCNEILL

the grade awarded. The con- fusion this may create is evi- dent from the following com- ments from students:

• I feel confused if I re- ceived a good grade but only received [negative] feed- back. But comments at [the] end of assignment state the paper was good.

• Comments don’t match grade (e.g., com- ments are really positive, then [the] grade is a Pass?).

• Getting told very little except “good work” but still only getting 80%. Where did the other 20% go? Inconsistent feedback

among markers and feedback the student believes to be in- correct were also reported to hinder student learning. In relation to generic feedback summaries that some lectur- ers provide to all students, one student recommended that lec- turers should “personalize it. Many times, friends and I receive identical feedback and different grades, it’s lazy, no comments would be better.”

Feedback That Enhances Student Learning The majority of students (79.6%) reported that a mixture of

positive and negative or critical feedback best enhances their learning, whereas 9.9% preferred only positive feedback, 8.8% preferred only negative or critical feedback, and 1.7% were un- sure of their preference. Qualitative responses regarding feed- back that enhanced student learning were analyzed and grouped under common headings (Table 5). A total of 310 participants answered the open-ended question, “What kind of feedback helps your learning?” The most frequent response (47.7%) was that lecturers should write specifi c comments on the assignment about how it could have been improved. Almost half of the participants (40.3%) also wrote that feedback should contain a mixture of positive and negative or critical comments to high- light what students did well, what was done incorrectly, and what could have been improved.

DISCUSSION

There was widespread agreement among nursing students in the current study that feedback is important for their learn- ing and that most assignments should include written feedback. This fi nding is similar to other research fi ndings that assessment feedback is valued by students when the feedback they receive is of useful quality and quantity (Ferguson, 2011; Parboteeah & Anwar, 2009). However, this fi nding contradicts the view held by many lecturers or teachers that the majority of students are not interested in feedback (Sendziuk, 2010; Weaver, 2006),

and it further highlights the disconnect between lecturers’ and students’ perceptions of written feedback (Evans, 2013). The contribution of effective feedback to student learning is too im- portant to assume that students and lecturers are on the same page (Carless, 2006). Future research is needed to educate both lecturers and students on how to give and receive effective feed- back (Evans, 2013).

Findings from our study are consistent with research that recommends that written feedback, to be effective, needs to be timely, appropriately detailed, focused on acknowledging suc- cesses, and understood and used by students, as well as guid- ing students toward further improvement (Evans, 2013; Li & Barnard, 2011; Sendziuk, 2010). The current study’s fi ndings are also similar to those of Ferguson (2011), indicating that the most effective feedback occurs when the link between assess- ment criteria and the feedback is clear and the feedback is indi- vidualized to the students’ specifi c piece of work.

Uniquely, the current study found that many nursing stu- dents wanted to and did request the type of written feedback on their assignments and expressed appreciation for being asked their preferences. The strong personal connection that students may have with feedback has been identifi ed in a number of studies (Carless, 2006; Parboteeah & Anwar, 2009; Sendziuk, 2010) and could explain the high number of students in the cur- rent requesting the maximum available feedback. The authors agree that student engagement is essential to increase the likeli- hood of the feedback being effective (Evans, 2013; Sendziuk, 2010). However it is not inevitable that students will read and pay attention to feedback even when they have a say in the pro- cess (Evans, 2013). Further research is needed to determine un- der what circumstances increased student engagement leads to feedback being understood and incorporated into future work and, in turn, to improved learning outcomes.

TABLE 3

Responses to Open-Ended Question “If You Have Made Changes to Subsequent Essays Based on Feedback, What Changes Did You Make?”

Students Who Make Changes in the Following Categories (%)a

Student Background Referencing Structure/

Format Grammar/

English Critique/ Content

All students who responded to this question (n = 318)

61 53 13 39

Students who have previously studied at university (n = 138)

33 36 42 39

Students who have not previously studied at university (n = 224)

67 64 58 61

Students with English as the primary language (n = 198)

57 59 29 61

Students with English as a second language (n = 164)

43 41 71 39

a As some students answered in more than one category, totals may sum greater than 100%.

Journal of Nursing Education • Vol. 53, No. 1, 2014 27

STUDENT PERCEPTIONS REGARDING FEEDBACK

Similar to previous research, the majority of students in our study indicated that a mixture of positive and negative or critical feedback best enhances their learning (Evans, 2013). A small number of students in our study said they preferred only positive feedback, but it was not clear whether they thought this would improve their subsequent work. Sendziuk (2010) found that students want recognition of their time and effort even if it does not equate to high-quality work. Boehler et al. (2006) and Ferguson (2011) suggested that including positive comments with constructive feedback may increase student satisfaction with feedback. However, it is important to consider that satis- faction is not a reliable indicator of quality or effectiveness of feedback. Boehler et al. (2006) found that satisfaction ratings increased when feedback contained praise or compliments, but learning and performance did not improve unless feedback was specifi c about how to improve.

Feedback effectiveness is more complex than the pro- vision of quality feedback. Factors such as students’ self- esteem and learning preferences can impact feedback effec- tiveness (Rowe & Wood, 2008). Several studies have linked the effect of written feedback to student self-esteem and motivation (Carless, 2006; Evans, 2013; Parboteeah & An- war, 2009; Rowe & Wood, 2008; Sendziuk, 2010). Sendziuk (2010) concluded that students invest themselves emotional- ly in the feedback process, which can infl uence their sense of self-worth, particularly when they believe they have received unnecessarily harsh or negative feedback. Further, Carless (2006) suggested that feedback received by students engages their ego, which can distract them from the potential learning benefi ts of feedback. Similarly, students in our study indi- cated that too much critique and insuffi cient detail of what they did well can impact their attitudes and self-esteem and hinder future learning.

Our study did not corre- late the quality of students’ work with their feedback preference; however, the default for assignments re- ceiving a fail grade was to provide detailed feedback. This is in line with the study by Ferguson (2011), who recommended that weaker standards of work should re- ceive more feedback to assist students to identify and fi ll gaps in their knowledge and also to justify the grade. Al- though the default feedback option in the current study did this, it also raised ques- tions regarding effi cient and effective feedback practices. Detailed feedback on low- quality papers is time con- suming to write and likely to contain more critique than praise. For feedback to be ef-

fective in this instance, lecturers must be discerning about the amount and type of feedback that will be effective without hav- ing a detrimental effect on students’ self-esteem and motivation and, in turn, their future learning.

Even when effective feedback is provided, many students are unable to act on that feedback due to various issues, such as their understanding of what the feedback means, their intellectual ma- turity, content knowledge, and their past experiences with feed- back (Evans, 2013). Findings from the current study suggest that past experience can affect student feedback preferences and their use of feedback. An interesting fi nding was that students in the current study with more university experience were less likely to use feedback to enhance their writing. Possible explanations for this are that students with more university experience believe they do not need as much feedback, they may not have found previous feedback useful, or previous perceptions of feedback may have led to what Evans (2013, p. 95) calls resistance to correction.

It is signifi cant that the majority of students in the current study reported there were not always suggestions written on their essay for how it could be improved. There could be several explanations for this, including that students did not receive ap- propriate feedback, they did not understand how the feedback could enhance their learning, or the feedback was not legible. Legibility has been cited as a signifi cant issue in previous re- search (Ferguson, 2011; Parboteeah & Anwar, 2009). Many universities, including the one in the current study, have moved to online marking, which should address legibility issues. How- ever, the authors of the current study agree with Bailey and Garner (2010), who cautioned that institutional measures such as standardized feedback forms and use of online mechanisms that enable cut-and-paste and mix-and-match comments may exacerbate problems of ineffectual feedback. Indeed, several students in the current study commented on feedback not being

TABLE 4

Feedback That Hinders Student Learning (N = 314)

Type of Feedback n (%)a

Too much critique or overwhelmed by negative comments 138 (43.9)

Cannot read marker’s handwriting or the feedback is illegible 120 (38.2)

Not enough detail provided 98 (31.2)

Comments are unclear 87 (27.7)

Comments are unnecessarily harsh or negative 15 (4.8)

Overfocus on grammar, spelling, or punctuation rather than content 9 (2.9)

Too much feedback or comments written all over essay are overwhelming 8 (2.5)

Feedback not relevant to the essay being marked 6 (1.9)

The feedback does not match the grade (positive feedback and low grade) 6 (1.9)

Student does not agree with feedback or believes the feedback is incorrect 4 (1.3)

Generic feedback sheets are provided to all students 3 (1)

Inconsistent feedback between markers 3 (1)

a As some students wrote more than one suggestion, totals may sum greater than 100%.

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GILES, GILBERT, & MCNEILL

individualized and expressed dissatisfaction with standard- ized feedback. Therefore, al- though increased use of tech- nology can address legibility issues, feedback still needs to be individualized to enhance student learning.

Being able to read feed- back and being able to un- derstand and learn from it are two different things. The majority of students in the current study reported that it was not always clear what they did well and why or what they needed to improve and why. This study also found that unclear or am- biguous statements, as well as lack of congruence among comments, assessment cri- teria, and grades, frustrated students and hindered their learning. Previous research has found that students are often unable to decode writ- ten feedback and their un- derstanding of assessment criteria often differs from the teacher’s (Carless, 2006; Evans, 2013). Not understanding the academic discourse that underpins feedback language and as- sessment criteria often prevents students using feedback to en- hance future work (Bailey & Garner, 2010; Sendziuk, 2010). A strong argument exists for using simple vocabulary and expres- sions that are familiar to students to maximize understanding and usefulness of written feedback. Feedback that focuses on assisting students to understand what they needed to improve and why it would signifi cantly enhance their learning. Address- ing issues of continued misunderstandings is therefore crucial to improve feedback practices.

A recent literature review of 460 studies concluded that there is limited consensus regarding the feedback practices that are most effective, particularly the ideal volume and type of feedback (Evans, 2013). Comments by many students in the current study about the (misguided) emphasis placed on spell- ing, grammar, and punctuation rather than on content suggests that some students do not fi nd this kind of feedback useful for their learning. Sheen, Wright, and Moldawa (2009) con- tended that corrective feedback is unfocused and has limited pedagogical value. Providing quality feedback takes time and effort; therefore, it is important to invest this time when it will have the most impact (Wood et al., 2011). The current study asked students when they would not want written feedback on assessments. The mixed responses from this question once again stress the importance of engaging students in the feed- back process and of individualizing feedback to student needs and preferences (Evans, 2013).

LIMITATIONS

This study was limited to one cohort of nursing students in a single university setting and relied on cross-sectional, self- reported data. However, the large sample size and high response rate mean fi ndings are applicable to similar settings. In stage 2 of the study, some students may not have seen the modifi ed as- signment cover sheet, and some may have chosen not to use it. It is therefore not possible to determine a true response rate. Al- though fi ndings did not reach statistical signifi cance, they have considerable educational signifi cance and contribute important insights into nursing student preferences around feedback and potential impact on learning.

CONCLUSION

This study examined nursing students’ perceptions regarding the type and amount of feedback required to enhance their learning and adds to the emerging body of literature focused on improving feedback practices. The study found that many students wish to be engaged with the feedback process and believe that effective writ- ten feedback on assignments can and does enhance their learning. However, many students also reported that past experiences, such as absent, inadequate, ambiguous, inconsistent, and ineffective feedback, hindered their learning, indicating a signifi cant discon- nect between desired and actual feedback for these students.

Future practice and research needs to focus on engaging both lecturers and students in the feedback process, providing

TABLE 5

Type of Feedback That Helps Students Learn (N = 310)

Feedback That Enhances Student Learning n (%)a

Write specifi c suggestions for how the essay could have been improved 148 (47.7)

Balanced feedback—what they did well, what was incorrect, improvements 125 (40.3)

Positive feedback only—what the student did well or correctly 36 (11.6)

Be constructive 30 (9.7)

In depth and detailed 27 (8.7)

Be encouraging 16 (5.2)

Critical feedback only (i.e., what the student did incorrectly or poorly) 15 (4.8)

Clear and easy to understand 14 (4.5)

Needs to be relevant to the essay being marked 8 (2.6)

Any feedback helps students learn 7 (2.3)

Short and concise or precise 6 (1.9)

Related to essay content rather than structure and referencing 6 (1.9)

In person/verbal 3 (1)

Format, referencing, and grammar corrections 2 (0.6)

Use a detailed rubric 1 (0.3)

Timely—before the next essay is due 1 (0.3)

a As some students wrote more than one suggestion, totals may sum greater than 100%.

Journal of Nursing Education • Vol. 53, No. 1, 2014 29

STUDENT PERCEPTIONS REGARDING FEEDBACK

opportunities for students to use written, individualized feed- back to produce improved work, and evaluating subsequent work to determine whether the feedback was effective for in- dividual students. For this to occur, it is crucial to educate both lecturers and students about effective feedback practices to en- sure teaching and learning resources are used in the most ef- fi cient manner possible and that feedback contributes to student learning.

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