Review Article

Learning Style Preferences of Undergraduate Nursing

Students: A Systematic Review
Tonderai Washington Shumba Scholastika Ndatinda Iipinge
https://orcid.org/0000-0003-3462-1043 https://orcid.org/0000-0002-9785-6467
Welwitchia Health Training Centre, Welwitchia Health Training Centre,
Namibia Namibia
[email protected] [email protected]

Abstract
This study sought to synthesise evidence from published literature on the
various learning style preferences of undergraduate nursing students and to
determine the extent they can play in promoting academic success in nursing
education of Namibia. A comprehensive literature search was conducted on
electronic databases as a part of the systematic review. Although, kinaesthetic,
visual and auditory learning styles were found to be the most dominant learning
style preferences, most studies (nine) indicated that undergraduate nursing
students have varied learning styles. Studies investigating associations of
certain demographic variables with the learning preferences indicated no
significant association. On the other hand, three studies investigating
association between learning styles and academic performance found a
significant association. Three studies concluded that indeed learning styles
change over time and with academic levels. The more nurse educators in
Namibia are aware of their learning styles and those of their students, the greater
the potential for increased academic performance.

Keywords: learning styles; undergraduate nurse student; Namibia; academic

performance

Background
In the realm of nursing education, learning styles have been at the centre of investigation
for the past decade. The importance of learning styles potentially varies by subject or
profession. Identifying learning style preferences in nursing students has the potential
of helping nursing educators to improve on their teaching styles and to adapt to the
diversity in learning styles (Alharbi et al. 2017). Bangcola (2016) revealed that each

Africa Journal of Nursing and Midwifery https://doi.org/10.25159/2520-5293/5758

https://upjournals.co.za/index.php/AJNM/index ISSN 2520-5293 (Online)
Volume 21 | Number 1 | 2019 | #5758 | 25 pages © Unisa Press 2019
nursing student is most comfortable in a particular learning style which in turn has an
influence on their academic performance.

A number of learning style tools have been used to investigate various learning styles
of undergraduate nursing students. The commonly used learning style scales that have
been found to be valid and reliable and have frequently been used in nursing education
are the VARK Learning Style questionnaire, the Kolb Learning Style Inventory (LSI),
Honey and Mumford’s (2000) learning style questionnaire, the Myers-Briggs Type
Indicator, the Felder-Silverman Learning Style Model, the Perceptual Learning Style
Questionnaire, and the Productivity Environmental Preference Survey (PEPS).

VARK Learning Style Questionnaire

The VARK measures individual learning styles using perceptual preferences (visual,
aural/auditory, read/write, kinaesthetic). Visual learners appreciate symbols, which are
used to categorise information, aural or auditory learners prefer information to be
presented using verbal communication, and are apt to audiotape content presentation,
read/write learners use reading and writing as modes of learning and note taking
supplements the original instruction, whereas kinaesthetic learners use field trips, role
playing, demonstrations, or other activities that provide practice with respect to the
information (Lee, Schull, and Ward-Smith 2016).

Kolb Learning Style Inventory

This scale is an inventory that measures an individual’s learning styles based on four
modes: Concrete Experience (CE) Reflect Observation (RO), Abstract
Conceptualisation (AC) and Active Experimentation (AE) (Gebru, Ghiyasvandian, and
Mohammodi 2015). Kolb LSI characterises individuals into one of the four quadrants
of a learning style type grid, namely converger, diverger, assimilator and
accommodator. Convergers combine AC and AE, have a strong ability to apply an idea
practically and are good at problem-solving and decision-making, divergers combine
CE and RO, look at problems from all perspectives and have a strong imagination and
awareness of meanings and values, assimilators combine RO and AC, and have a strong
ability to create theoretical ideas and plans, and accommodators combine CE and AE,
engage effectively in new experiences and are interested in carrying out plans and
getting the job done (Mitchell, James, and D’Amore 2015).

Honey and Mumford’s Questionnaire

Honey and Mumford use an 80-item questionnaire to assess learning styles based on
five categories: activists (concerned with the here and now, they like to experience by
taking direct action and participation), reflectors (think about things in detail, observe
and evaluate from a range of perspectives before taking action, they appreciate the
opportunity to repeat a learning experience), theorists (like to see how things fit into the
bigger picture, they adopt a logical, systematic and analytical approach to problem-

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solving), and pragmatists (like to see how things work and can be applied to practice,
like to experiment and see the relevance of their work and adopt a practical problem-
solving approach to situations) (Honey and Mumford 2000).

Myers-Briggs Type Indicator

This scale is designed for group administration and determines learning styles on four
dichotomies: extraversion/introversion (you prefer to focus on the outer world or on
your own inner world), intuition/sensing (prefer to focus on the basic information you
take in or prefer to interpret and add meaning), thinking/feeling (when making decisions
you prefer to first look at logic and consistency or first look at the people and special
circumstances), and perception/judgement (in dealing with the outside world, you prefer
to get things decided or you prefer to stay open to new information and options) (The
Myers and Briggs Foundation 2018).

Felder-Silverman Learning Style Model

This model consists of a 44-item self-report questionnaire focusing on four dimensions:
input (visual: pictures, diagrams, graphs, demonstrations, or auditory-words, sounds),
perception (sensory (external): sights, sounds, physical sensations, or intuitive
(internal): possibilities, insights, hunches), processing (actively: through engagement in
physical activity or discussion, or reflectively: through introspection), and
understanding (sequentially: in continual steps, or globally: in large jumps, holistically)
(Felder and Silverman 1988).

Perceptual Learning Style Questionnaire

This questionnaire assesses the preferences of student learning styles based on their
perceptions utilising 30 self-report statements rated on a five-point Likert scale. The 30
items are distributed equally among the learning style preferences: five items each for
statements regarding visual, auditory, kinaesthetic, and tactile preferences, and two
social aspects of learning: group and individual preferences. The learning style
categories with the most points determine an individual’s preference for those categories
(Bangcola 2016).

Productivity Environmental Preference Survey (PEPS) questionnaire

This is a learning style questionnaire that consists of 100 questions identifying 20
learning style elements. The elements include environmental preferences (sound, light,
temperature and furniture design), emotional preferences (motivation, conformity, and
persistence), social preferences (authoritative persons present, variation, learning alone,
in pairs or as a team), and physiological preferences (perceptual strengths such as
auditory, visual tactile or kinaesthetic, time-of-day energy levels, need for intake or
mobility) (Hallin 2014).

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Notwithstanding a number of investigations on learning styles, there is a paucity of
literature on how learning styles contribute to academic success in nursing students
(Bangcola 2016). The authors observed that nursing educators in Namibia are not
conscious of their students’ learning styles. Educators often have a tendency to focus
solely on instruction, rather than considering learning styles. To the best knowledge of
the authors there is no evidence in literature of the preferred learning style of
undergraduate nursing students in Namibia and how it contributes to their academic
success. Further, it is unknown what role learning styles can play in promoting academic
success in Namibia. This study aims to synthesise evidence from published literature on
the various learning styles or preferences of undergraduate nursing students and the
potential role they can play in promoting academic success in nursing education of
Namibia.

Methods
A systematic review of literature was undertaken on the learning style preferences of
undergraduate nursing students for the past 10 years (2007 to 2017). In this study, all
English-speaking countries worldwide were included. The search was conducted in
January 2018.

Research Questions
To what extent can published literature provide evidence on the various learning style
preferences of undergraduate nursing students? Further, what role can learning styles
play in promoting academic success in nursing education of Namibia?

The objectives of the study were to identify the most prevalent learning style preferences
of undergraduate students and to determine the role that learning styles play in their
academic success.

Identification of Relevant Studies

Using the key phrase “learning style preference” to answer the research question, a
search was made in English for all peer-reviewed literature in the following electronic
bibliographic databases: Google scholar, Pubmed, EBSCOhost (MEDLINE,
PsychINFO, Academic search, Education source, Health source), Sage Publications,
Science Direct, and Web of Science. Relevant websites were also checked for articles
and the reference lists of all included studies were screened to select studies.

Initially the key search phrase was limited to “learning style preference” to obtain a
sense of the volume of literature. This initial search was limited to Google Scholar and
Pubmed to determine the appropriateness and sensitivity of the key search phrase.

4
Secondly, to narrow down the search and include the relevant articles, an extensive
search was conducted with other databases (EBSCOhost, Sage Publications, Science
Direct, and Web of Science) utilising the following search words and phrases: “learning
style AND preference AND undergraduate nursing students”.

Two independent research personnel, researcher 1 (TS) and researcher 2 (SI) reviewed
the retrieved articles. The review and selection process was guided by PICO (Cooke,
Smith, and Booth 2012), as shown in Table 1, to screen out studies that did not focus on
the research questions. Only articles written in English were included and articles
without an abstract were excluded, as the procedure for selecting articles primarily
involved reviewing the abstracts. Letters to the editor and short editorials were also
excluded.

Where a full article was not available, the main author of the article was contacted to
obtain a reprint of the full article as abstracts may not capture the full scope of an article
(Badger et al. 2000). Detailed arbitration was followed with each step (Cleaver and
Nixon 2014) and the results of this process are shown in Figure 1.

Table 1: PICO for systematic review – learning style preferences of undergraduate

nursing students

PICO elements Description of PICO concept

Population – The review included:
characteristics of the • original peer reviewed research article that describes learning
patient/population/ style preferences of undergraduate nursing students enrolled
condition or disease in a four-year programme;
of interest • article published between 2007 and 2017; and
• all types of study design (e.g. qualitative, quantitative, mixed
methods).
Intervention – Description and understanding of undergraduate nursing students
phenomenon of learning style preferences. The learning style scales and words
interest used to describe the learning style preferences.
Context Geographical – global. Only articles written in English. Learning
style preferences of first to fourth year nursing student measured
using any type of learning style scale.
Outcome of interest Published concepts. The description of research methods,
to the reviewer purposes, outcomes, implications for practice and
recommendations for future research.
Source: Adapted from Cooke, Smith, and Booth (2012).

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 Pubmed, EBSCOhost (MEDLINE, PsychINFO, Academic
search, Education source, Health source), Sage Publications,
Science Direct, and Web of Science
(n = 3554)

Abstract kept for further Full text kept Irrelevant articles

evaluation of full text for further
excluded
(n = 38) evaluation
(n = 38) (n = 3516)

Included studies
(n = 18)
Studies duplicated and not
meeting inclusion criteria
excluded
(n = 20)

No document added

18 original studies finally

included

Source: Adapted from Moher et al. (2009)

Figure 1: Flow chart for the selection of the articles

6
Methodological Qualitative Rigour
The two independent reviewers utilised the Critical Appraisal Skills Programme
(CASP) (Arksey and O’Malley 2005) to assess methodological qualitative rigour of the
18 included articles (see Table 2). The CASP is used to appraise a systematic review
attempting to answer the following three broad issues: Are the results of the study valid?
What are the results? Will the results help locally? The CASP consists of 10 questions
to help reflect on these issues. The first two questions allow for quick screening, and a
“yes” answer to both questions allows one to proceed with the remaining questions
(Critical Appraisal Skills Programme 2018). There is a degree of overlap in the
questions, requesting to answer “yes”, “no” or “cannot tell”. This checklist does not
come with a scoring system and thus this study adapted a scoring system by M’kumbuzi
and Myezwa (2016). Table 2 depicts the performance of the 18 included articles on the
10 CASP questions.

Table 2: Outcomes of CASP questions

6. What are the overall results of the review?

2. Did the authors look for the right type of

4. Did the reviewers’ authors do enough to

1. Did the review address a clearly focused

3. Do you think all the important relevant

assess the quality of the included studies?

10. Are the benefits worth the harms and

8. Can the results be applied to the local
5. If the results of the review have been
combined, was it reasonable to do so?

9. Were all the important outcomes

7. How precise are the results?
studies were included?

population?

considered?
question?
Response

papers?
Author

costs?
Total
AlKhasawneh

Yes

6
Cannot tell

√
No

7
 D’Amore, James, Bangcola Alharbi et al. Author
and Mitchell

Response
Yes No Cannot tell Yes No Cannot tell Yes

1. Did the review address a clearly focused

√ √ √ question?
2. Did the authors look for the right type of
√ √ √ papers?

3. Do you think all the important relevant

√ √ √ studies were included?

8
4. Did the reviewers’ authors do enough to
√ √ √ assess the quality of the included studies?
5. If the results of the review have been
√ √ √ combined, was it reasonable to do so?
√ √ √ 6. What are the overall results of the review?

√ √ √ 7. How precise are the results?

8. Can the results be applied to the local

√ √ population?
9. Were all the important outcomes
√ √ √ considered?
10. Are the benefits worth the harms and
√ √ √ costs?
9 6 9 Total
 Fleming, El-Gilany and Author
Mckee, and Abusaad
Huntley-Moore

Response
No Cannot tell Yes No Cannot tell Yes No Cannot tell

1. Did the review address a clearly focused

√ √ question?
2. Did the authors look for the right type of
√ √ papers?

3. Do you think all the important relevant

√ √ studies were included?

9
4. Did the reviewers’ authors do enough to
√ √ assess the quality of the included studies?
5. If the results of the review have been
√ √ combined, was it reasonable to do so?
√ √ 6. What are the overall results of the review?

√ √ 7. How precise are the results?

8. Can the results be applied to the local

√ √ population?
9. Were all the important outcomes
√ √ considered?
10. Are the benefits worth the harms and
√ √ costs?
7 8 Total
 Ibrahim and Hallin Gebru, Author
Hussein Ghiyasvandian, and
Mohammodi

No Cannot tell Yes No Cannot tell Yes Response

Yes

√ √ √ 1. Did the review address a clearly focused

question?
√ √ √ 2. Did the authors look for the right type of
papers?

√ √ 3. Do you think all the important relevant

studies were included?

10
√ √ √ 4. Did the reviewers’ authors do enough to
assess the quality of the included studies?
√ √ √ 5. If the results of the review have been
combined, was it reasonable to do so?

Source: Adapted from M’kumbuzi and Myezwa (2016).

√ √ √ 6. What are the overall results of the review?

√ √ √ 7. How precise are the results?

√ √ 8. Can the results be applied to the local

population?
√ √ √ 9. Were all the important outcomes
considered?
√ √ √ 10. Are the benefits worth the harms and
costs?
8 9 8 Total
Charting the Data
A “data charting form” using an Excel spreadsheet was utilised to review the final
selected 18 original research articles. The second author did a blind verification of a
random sample of 20 per cent (4) of the articles to check the quality of the categorisation
of the charting process. Inconsistencies in the charting process were resolved through
discussion.

Initially, the following categories of information for each study were recorded: year of
publication, geographical distribution, academic year of study, learning style scale,
study design, and sample size. Secondly, a conventional content analysis (Namey et al.
2008) was undertaken to analyse the purposes, outcomes, implications and areas for
future research. This process involved reviewing the articles and highlighting text that
appeared to describe these four areas. These data were extracted verbatim for coding
and the final codes (themes) were examined, followed by a tabulation of frequencies of
each theme.

Results
The initial search yielded 3 554 articles of which 3 516 did not meet the inclusion
criteria and 38 were retained for review. A final 18 full-text articles were included for
review. Based on the performance of the 18 included articles on the 10 CASP questions,
it was difficult to tell if the results are applicable to the local population because none
of the studies were conducted in Namibia, or anywhere else in Africa (Question 8).
However, all the articles were considered to be valuable (Question 10).

Table 3 charts the narrative description of the studies following these categories of
information: year of publication, geographical distribution, academic year of study,
learning style scale, study design, and sample size.

Year of Publication
All articles were published from January 2010 to October 2017. The results showed that
over this period there was a small, but increasing interest in investigating the learning
style preferences of undergraduate nursing students.

Demographical Location
The majority of the studies were conducted in the Middle East (six), with the balance in
Australia (four), Asia (three), Europe (two), South America (two), and North America
(one). It was observed that no articles published in Africa were found in any of the
database searches.

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Population and Sample
Half of the studies (nine) included a population of all nursing undergraduate academic
levels (year 1–4). Five studies focused only on first-year students, one study on second-
year students only, and one study on final-year students only. Two studies compared the
learning styles preferences of first-year and final-year students. The sample sizes ranged
from 56–345 with most studies (13) utilising a sample size above 100.

Research Design
The majority of the studies (12) employed a cross-sectional descriptive design, one
study utilised prospective correlational study and another study used a longitudinal,
descriptive comparative design.

Learning Style Scale

The commonly used learning style scales were the VARK Learning Style questionnaire
(seven studies) and the Kolb LSI (six studies). Two studies utilised Honey and
Mumford’s (2000) learning style questionnaire. The Myers-Briggs Type Indicator, the
Felder-Silverman Learning Style Model, the Perceptual Learning Style Questionnaire,
and the Productivity Environmental Preference Survey (PEPS) questionnaire were
utilised once.

Table 3: Narrative description of the studies

Description Number List of articles ( by authors)

of
articles
Year of 2007 1 Rassool and Rawaf 2007
publication
2011 4 Fleming, Mckee, and Huntley-Moore 2011;
James, D’Amore, and Thomas 2011; Koch et
al. 2011; Li et al. 2011,
2013 2 AlKhasawneh 2013; El-Gilany and Abusaad
2012
2014 1 Hallin 2014
2015 4 D’Amore, James, and Mitchell 2012; Gebru,
Ghiyasvandian, and Mohammodi 2015;
Mitchell, James, and D’Amore 2015;
Shinnick and Woo 2015
2016 4 Bangcola 2016; Ibrahim and Hussein 2016;
Lee, Schull, and Ward-Smith 2016; Nair and
Lee 2016
2017 2 Alharbi et al. 2017; Stirling, Wadha, and
Alquraini 2017
Geographic Middle East 6 Alharbi et al. 2017; AlKhasawneh 2013; El-
location Gilany and Abusaad 2012; Gebru,

12
Description Number List of articles ( by authors)
of
articles
Ghiyasvandian, and Mohammodi 2015;
Ibrahim and Hussein 2016; Stirling, Wadha,
and Alquraini 2017
Australia 4 D’Amore, James, and Mitchell 2012; James,
D’Amore, and Thomas 2011; Koch et al.
2011; Mitchell, James, and D’Amore 2015
Europe 2 Fleming, Mckee, and Huntley-Moore 2011;
Hallin 2014
North America 1 Lee, Schull, and Ward-Smith 2016
South America 2 Rassool and Rawaf 2007; Shinnick and Woo
2015
Asia 3 Bangcola 2016; Li et al. 2011; Nair and Lee
2016
Africa 0
Population All academic 9 Alharbi et al. 2017; AlKhasawneh 2013; El-
levels(year 1–4) Gilany and Abusaad 2012; Gebru,
Ghiyasvandian, and Mohammodi 2015;
Ibrahim and Hussein 2016; Li et al. 2011;
Nair and Lee 2016; Rassool and Rawaf 2007;
Shinnick and Woo 2015
1 years 5 D’Amore, James, and Mitchell 2012; James,
D’Amore, and Thomas 2011; Koch et al.
2011; Lee, Schull, and Ward-Smith 2016;
Mitchell, James, and D’Amore 2015
2nd year 1 Bangcola 2016
3rd year 0
4th year 1 Hallin 2014
Mixed (1st and 2 Fleming, Mckee, and Huntley-Moore 2011;
4th year) Stirling, Wadha, and Alquraini 2017
Sample Fewer than 100 5 Alharbi, et al.2017; Fleming, Mckee, and
size Huntley-Moore 2011; Koch et al. 2011; Lee,
Schull, and Ward-Smith 2016
100–200 4 AlKhasawneh 2013; Rassool and Rawaf
2007; Shinnick and Woo 2015; Stirling,
Wadha, and Alquraini 2017
200–300 4 El-Gilany and Abusaad 2012; Gebru,
Ghiyasvandian, and Mohammodi 2015;
Hallin 2014; Ibrahim and Hussein 2016
300+ 5 Bangcola 2016; D’Amore, James, and
Mitchell 2012; James, D’Amore, and Thomas
2011; Li et al. 2011; Nair and Lee 2016
Research Cross-sectional 12 Alharbi et al. 2017; D’Amore, James, and
design descriptive Mitchell 2012; El-Gilany and Abusaad 2012;,
Gebru, Ghiyasvandian, and Mohammodi
2015; Hallin 2014; Ibrahim and Hussein

13
 Description Number List of articles ( by authors)
of
articles
2016; James, D’Amore, and Thomas 2011;
Lee, Schull, and Ward-Smith 2016; Li et al.
2011; Nair and Lee 2016; Rassool and Rawaf
2007; Stirling, Wadha, and Alquraini 2017
Prospective 1 Koch et al. 2011
correlational
Descriptive 1 Bangcola 2016
correlational
Cross-sectional 2 Fleming, Mckee, and Huntley-Moore 2011;
longitudinal Mitchell, James, and D’Amore 2015
Cross-sectional 2 AlKhasawneh 2013; Shinnick and Woo 2015
comparative
Learning VARK 7 AlKhasawneh 2013; Ibrahim and Hussein
style scale Learning Style 2016; James, D’Amore, and Thomas 2011;
questionnaire Koch et al. 2011; Lee, Schull, and Ward-
Smith 2016; Mitchell, James, and D’Amore
2015; Stirling, Wadha, and Alquraini 2017
Kolb LSI 6 D’Amore, James, and Mitchell 2012; El-
Gilany and Abusaad 2012; Gebru,
Ghiyasvandian, and Mohammodi 2015;
Mitchell, James, and D’Amore 2015; Nair and
Lee 2016; Shinnick and Woo 2015
Felder- 1 Alharbi et al. 2017
Silverman
Learning Style
Model
Honey and 2 Fleming, Mckee, and Huntley-Moore 2011;
Mumford scale Rassool and Rawaf 2007
Myers-Briggs 1 Li et al. 2011
Type Indicator
Perceptual 1 Bangcola 2016
Learning Style
Questionnaire
Productivity 1 Hallin 2014
Environmental
Preference
Survey (PEPS)
questionnaire

One study (Mitchell, James, and D’Amore 2015) used a combination of two scales.
Other studies by El-Gilany and Abusaad (2012), Koch et al. (2011), and Shinnick and
Woo (2015) combined one learning style scale with a questionnaire.

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Purposes, Outcomes and Implications of Studies
Table 4 presents the different purposes that the studies investigated, the outcomes and
implications of the studies.

Purposes
Five main purposes were explored by the studies. The majority of studies explored more
than one purpose. Ten of the studies aimed at identifying learning style preferences,
while eight investigated associations of certain demographic variables with the learning
preferences. The association between learning styles and academic performance was
investigated by six studies, while four examined changes in students’ learning styles
over time. Noteworthy is that one study analysed the link between learning preference
and language proficiency.

Outcomes
Although, kinaesthetic, visual and auditory preferences were found to be the most
dominant learning style preferences, most studies (nine) indicated that undergraduate
nursing students have varied learning styles.

The seven studies investigating associations of certain demographic variables with the
learning preferences indicated no significant association. On the other hand, the three
studies investigating the association between learning styles and academic performance
found a significant association. Three studies concluded that indeed learning styles
change over time and with academic levels.

Implications of the Studies

Several implications for practice for each outcome are indicated in Table 4. For
example, Bangcola (2016) urged teachers to be cognisant of the efficacy of more
learning styles that allow students to achieve optimal learning.

Table 4: Purposes, outcomes and implications of practice

Purpose No of Outcomes No of Implications for practice

identified studies studies
Identifying 10 Most Kinaes- 5 “‘Examine the effectiveness of
learning styles preferred thetic teaching strategies in continuing
learning mode education programs that
style Visual and 5 incorporated the predominant
auditory learning styles of course
Reflector 2 participants” (Gebru,
Diverger 3 Ghiyasvandian, and Mohammodi
and 2015).
assimila- “Because most students are
tor kinaesthetic there is need for
Abstract 1 more hands on with laboratory
work, demonstrations,

15
Purpose No of Outcomes No of Implications for practice
identified studies studies
conceptu- simulations, videos, etc. Low
alisation scores with aural means that
traditional method of teaching
with lectures in not receptive and
preferred by modern students”
(James, D’Amore, and Thomas
2011).
“Employing more practically
based modules in curricula is
important” (Koch et al. 2011)
“The converger learning style has
a positive implication for their
education and post-employment
continuing nursing education.
Encourage colleges to adopt self-
directed learning policies” (El-
Gilany and Abusaad 2012)
Multimodal: Nursing 9 “Teachers at nursing program
students have varied should use more than one
learning styles teaching modality to be able to
make their students satisfied with
their learning experience”
(AlKhasawneh 2013).
“Teachers should be aware that
efficacy with more learning styles
will allow students to achieve the
optimal learning environment”
(Bangcola 2016).
“There is need for a wide
variation and interactive teaching
approaches, conscious didactic
actions between cooperating
teachers and conscious learning
strategies for nursing students.
Teachers should reflect on their
learning style before planning
courses” (Hallin 2014).
“It is important that students
utilise all learning styles, as
opposed to solely relying on one,
as this will help the students to be
better and more adaptable life-
long learners. Therefore, it is
important for their learning that
students are motivated to develop
all learning styles” (Mitchell,
James, and D’Amore 2015).
“Particular skills need to be
learned and maximised thus a
balanced profile is not ideal for
specialised professions like
nursing” (Shinnick and Woo

16
Purpose No of Outcomes No of Implications for practice
identified studies studies
2015).
Associations 8 Significant association 1 “There is need to emphasize the
of certain was identified between importance of knowing student
demographic certain demographic learning styles, and completing
variables with variables with the the learning style profile at the
the learning learning preferences start of a course” (Bangcola
preferences 2016).
No significant 7 “Nursing educators need to deal
association was with student differences in order
identified between to offer support services and
certain demographic educational strategies for student
variables with the learning needs and to match
learning preferences individual differences. Using a
learning style approach can
empower staff development to
create an optimal environment
that ensures retention” (Li et al.
2011).
Association 4 Significant relationship 3 “A mismatch between teaching
between between learning styles style and the learning styles of
learning styles and performance students has been found to have
and academic No significant 1 serious consequences (students
performance relationship between tend to be uninterested, do poorly
learning styles and on tests, become discouraged
performance about the course, and may
conclude that they are no good at
the subject and give up).
Understanding the learning style
preferences of students can
enhance learning for those who
are under-performing in their
academic studies. Those who are
‘at risk’ may be provided with
individual tutorials where tailor-
made supplementary learning
programmes can be devised and
initiated” (Rassool and Rawaf
2007).
“Nurse educators need to
acknowledge the diversity of
learning styles among students
and develop curricula that support
a balanced teaching approach that
promotes flexibility in the
acquisition and application of
knowledge” (Fleming, Mckee,
and Huntley-Moore 2011).
“Learning style has an effect on
course presentation preference.
Inclusion of student learning
preference may influence the
development of critical thinking

17
 Purpose No of Outcomes No of Implications for practice
identified studies studies
skills” (Lee, Schull, and Ward-
Smith 2016).
“The need for nursing educators
to have an awareness of the
different learning styles, so that
they can remediate their teaching
strategies to match the learning
styles prevailing in the classroom
to improve quality of education
and in turn promote academic
success” (Nair and Lee 2016).
Examine 3 Learning styles change 3 “Need to investigate all fresh
changes in over time entry students as the cohort of
students’ students are continuously
learning styles changing” (James, D’Amore, and
over time Thomas 2011).
“There is need for educators to
continue to assess information
processing styles throughout the
degree programme to plan
specific educational experiences
aimed at developing a balanced
learner” (Mitchell, James, and
D’Amore 2015).
“Each academic level has its own
properties and learning
preferences which the lecturer
should consider while teaching”
(Ibrahim and Hussein 2016).
“The reduction in balanced
learners over the years
necessitates careful consideration
in the planning and delivery of
second and third year curriculum,
by considering providing more
experiences in abstract
conceptualisation and active
experimentation to promote
balanced learners” (Mitchell,
James, and D’Amore 2015).
Link between 1 Students who spoke 1 “Effect of rural and non-English
learning English had high mean speaking poses a challenge to
preference values compared to educators to embrace diversity in
and language those who are non- students and accommodate
proficiency English speaking different planning and
assessments with learning styles”
(James, D’Amore, and Thomas
2011).
Total studies 25 40
Note: The total articles of this study are 18. However, some of the articles explored
more than one purpose and had more than one outcome.

18
Recommendations for Future Research
Table 5 depicts the recommendations for future research that the studies suggested.

Table 5: Recommendations for future research

Authors Future research

Alkhasawneh Assess whether multiple-mode learners learn better than others.
Correlate learning preference with student grades on different
classes (clinical and theoretical).
Assess trends in changing learning style and academic level.
Alharbi et al. Identify whether matching of student learning preferences and
educator learning styles is more or less effective in improving
teaching learning strategies and learning skills.
Bangcola Use alternative approaches to study the different learning styles
of students, such as a qualitative study focusing in depth on only
one or two learning styles, such as the kinaesthetic or tactile or
auditory learning styles, so frequently found in nursing.
Since the ability to process information quickly and efficiently is
vital to learning, conduct a study focusing only on concept
attainment using the cognitive style.
D’Amore, James, and Investigate significance in correlating student learning styles to
Mitchell teaching styles.
Fleming, Mckee, and Conduct further research to determine the influence of these
Huntley-Moore factors on the learning experiences and changing learning styles
across the academic period of students: the use of a variety of
learning styles according to the subject being studied (Sutcliffe
1993), the course design, the assessment strategy utilised
(Rassool and Rawaf 2007), the influences of socialisation and
education during one’s nursing career (Ramprogus 1988), and
also possibly the developmental growth process (Kolb 1984).
Gebru, Ghiyasvandian, Conduct action research that would apply specific techniques to
and Mohammodi target diverse perspectives, communication with faculty and
peers, asking questions in class, class discussions, perceived
difficulty of course work, and preparation for class.
Conduct research on the persistence between gender groups,
which was another serious issue in this finding.
Hallin Determine trends in learning styles with new students
particularly those from technologically advanced homes.
Combine learning style questionnaires and compare results.
Triangulate quantitative and qualitative studies of learning
styles.
James, D’Amore, and Investigate changes with learning styles over the degree
Thomas programme as a result of awareness.
Adopt multimodal learning styles and evaluate their effect on
student learning.
Investigate correlation of learning styles and learning outcomes
with their effect on retention rates of commencing students.

19
 Authors Future research
Koch et al. Investigate reasons why the kinaesthetic mode is a high
predictor of academic performance.
Investigate why the VARK mean scores change with improved
English proficiency.
Investigate whether mean scores change when the VARK
questionnaire is administered in vernacular languages.
Lee, Schull, and Ward- Conduct more research to better understand the relationship
Smith between learning outcomes, learning preferences, and teaching
pedagogies.
Rassool and Rawaf Identify in nursing education if any particular teaching style, or a
variety of teaching styles, is more or less effective for learners
with a diversity of learning styles.
Explore the role of learning style preferences in the application
of theory to clinical practice.
Shinnick and Woo Determine the impact of learning style preferences in areas such
as skills attainment, clinical judgement and patient safety.
Stirling, Wadha, and Assess different modes of learning and nursing student success.
Alquraini

Discussion
Given the increasing interest in investigating the learning style preferences of
undergraduate nursing students, this review did not find any conducted in Africa. The
authors assume that there are numerous studies going on in Africa, but that they are
possibly not documented in peer-reviewed journals. Fleming, Mckee, and Huntley-
Moore (2011) argued that knowledge and practise in nursing profession are not static,
but ever-changing. Nurse educators are encouraged to upgrade their delivery of
instruction to match the student abilities and learning styles (Bangcola 2016). To this
end, there is a need for more funding for investigating learning style preferences of
undergraduate nursing students that could be shared with the wider community,
ensuring the evolution and growth of nursing education. Further, nursing educators need
to document their studies in peer-reviewed journals regarding the learning styles of
undergraduate nursing students.

Kinaesthetic, visual and auditory learning styles were found to be the most preferred
learning styles, suggesting the need for more hands-on laboratory work, demonstrations,
simulations, videos, etc. Understanding the predominant learning style has the potential
to guide the development of the curriculum and teaching strategies (Gebru,
Ghiyasvandian, and Mohammodi 2015). However, other studies recorded low scores
with aural learning styles, indicating that the traditional method of teaching with
PowerPoint presentations and lectures is not preferred by modern students (James,
D’Amore, and Thomas 2011). Although the kinaesthetic, visual and auditory learning
styles were found to be the most preferred learning styles, most students had more than

20
one (multimodal) preferred learning style. Educators are encouraged to reflect on their
learning style before preparing their lessons (Hallin 2014). However, the authors take
cognisance of the fact that some nurse educators might not be aware of the various
learning styles that exist. There is a potential for those who are aware of their learning
style to be biased towards their preferred learning style resulting in an unbalanced
learning environment. Moreover, both learners and educators are encouraged to have an
awareness of the available learning styles at the beginning of the course to stimulate a
balanced learning environment and to enable learners to grow in learning as they can
draw from each learning style (D’Amore, James, and Mitchell 2012).

Noteworthy is that almost all the studies in this review, investigating the association of
learning styles with demographic characteristics, found no association. In order to
embrace student diversity, educators need to tailor support services and educational
strategies for student learning needs (Li et al. 2011). On the other hand, one study
(Bangcola 2016) revealed an association between learning styles with demographic
characteristics, indicating the need to profile student learning styles at each academic
year level. Thus a greater emphasis should be placed on profiling student learning styles
at each academic year to ensure academic success. James, D’Amore, and Thomas
(2011) observed that cohorts of nursing students are changing and therefore there is a
need to profile all fresh entry students. This will allow for individual tutorials to be
tailor-made for students who are having challenges in grasping concepts.

The reviews also found that there is an association between a learning style and
academic performance. A study of Australian nursing students revealed that a strong
kinaesthetic mode was a predictor of academic success (Koch et al. 2011). Similarly, a
study in China on nursing students affirmed that academic success is significantly
related to learning style (Yi et al. 2014). However, Rassool and Rawaf (2007) stated that
a mismatch between the student and educator learning style can hamper success as
students lose interest in the subject, do poorly on tests or exams, and might give up as
they conclude that they are no good at the subject. Importantly, educators should note
that each academic year has new courses and presents different challenges. Thus each
academic level curriculum should be aligned to the student learning styles as learning
style preferences change over time.

Critical to nursing education is language proficiency. Evidence has shown that there is
a link between a learning preference and language proficiency. James, D’Amore, and
Thomas (2011) found that students who spoke English had high mean values compared
to those who are non-English speaking. Thus, nursing educators in Namibia may need
to embrace the diversity of English proficiency for students who are school-leavers or
mature entry, from rural and urban backgrounds and from English and non-English
speaking backgrounds.

The researchers premised the selection of systematic review as a choice of methodology

based on the fact that they synthesise knowledge that is essential to advance practice
21
and research through consolidation of evidence. Systematic reviews are aimed at
informing nursing education, programmes, and policy, and providing direction to future
research priorities. Systematic reviews can be utilised to answer a range of research
questions and to reveal research gaps. Evidence indicates that they can also help enhance
knowledge of research methods and improve research productivity.

Limitations
Although multiple electronic databases were searched, the search could have been more
comprehensive had social science databases been included. Further, including only
English articles could have excluded important articles. Future searches could
potentially include social science databases and articles in a variety of languages.

Conclusion
Despite some studies indicating that the most preferred learning styles of undergraduate
nursing students are primarily kinaesthetic, visual or auditory learning styles, the
majority concluded that they are multimodal learning styles. Nurse educators need to
embrace diversity in student backgrounds and demographic characteristics to foster an
environment conducive to learning. The current study revealed that there is a significant
association between learning style preferences and academic performance and thus it is
critical to investigate student learning style preferences to ensure improved curriculum
development and teaching methods aimed at increasing academic success. The more
educators in Namibia are aware of learning style, their own learning styles and the
learning styles of their students, the greater the prospects are for increased student
academic performance. Several recommendations for future research were identified (as
shown in Table 5).

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