Comparison of the early development of the professional values for nursing students in the traditional program and the second‐degree program: a longitudinal study

Abstract Aim This study aims to compare the early development of professional value between the students in the traditional programme (BSN) and those in the accelerated BSN (ABSN) programmes. Design A longitudinal design was conducted. Methods Data were collected from three schools of nursing during one academic year. A total of 117 BSN students and 101 ABSN students completed the survey of demographic information and the Nurses’ Professional Values Scale–Revised questionnaires. All data were analysed by IBM SPSS‐Statistics 22. Results Results showed that, in the beginning of the first professional nursing course, both students in the BSN and the ABSN programmes reported similar level of professional values. However, after one academic year, the changes in the professional value varied both between these two programmes and among the three different nursing schools. The increased professional value in school A represented the possibility for students to improve during their first‐year professional nursing programme. As educators, we should redesign our teaching strategies according to the different conditions of students in each programme.


| INTRODUC TI ON
Nurses are the largest group in the healthcare system. Although lots of strategies have been implied, nursing shortage is still a worldwide challenge in the healthcare system, especially during the pandemic of the COVID-19 recently (Spurlock, 2020). In order to increase the manpower, four nursing schools started the accelerated BSN (ABSN) programmes at 2016 by the assignment from the Ministry of Education, Taiwan, ROC. One more school joined this programme at 2018.
The students in the ABSN programmes are expected to reach similar nursing professionalism outcomes at graduation as students those in the BSN programme, although various differences are known to exist, such as stress (Kowitlawakul et al., 2013) and curriculum plan (Payne & Mullen, 2014).
The baccalaureate education in nursing includes the development of the professional values and value-based behaviours. The values can be taught, modified and promoted directly or indirectly through the education (Leners et al., 2006). Will the students in the BSN and the ABSN programmes develop similar professional value, which has been identified as the core of the professional nursing behaviours?

| BACKG ROU N D
Most of the studies explored the professional values of student nurses used cross-sectional study with comparisons in different academic year (Shafakhah et al., 2018), across the academic years (Caldwell & Katie, 2016), types of educational programme (Fisher, 2014;Martin et al., 2003), geographic location (Bang et al., 2011) and cultures (Alfred et al., 2013;Alkaya et al., 2018).
However, inconsistent results were found. For example, when compared with the status at entry, a significant increase in professional value was found at present (Kantek et al., 2017;Lin et al., 2010), at graduation (Fisher, 2014;Leners et al., 2006) or after completed an ethics course (Knecht et al., 2019). Nevertheless, some studies demonstrated no significant difference of the professional value between students' entry and exit (Posluszny & Hawley, 2017) or at different school years (Caldwell & Katie, 2016).
In regard to the types of programmes, some studies found that the BSN students had higher professional values than the students with the associate degree in nursing (Fisher, 2014;Martin et al., 2003). Conversely, some studies showed that the BSN students reported less professional values than the students in the diploma and the ABSN programmes (Feller et al., 2019). There were also studies demonstrated no statistical difference was observed in the overall nursing values between the traditional and the accelerated graduating senior BSN students (Astorino, 2006), or among nursing students, new graduates and seasoned nursing profession (LeDuc & Kotzer, 2009). One study observed that the student in the ABSN reported a higher professional value than the students with associated degree (Feller et al., 2019). Nevertheless, nurses reported a lowest professional value when compared with the student nurses (Poorchangizi et al., 2019b), clinical nurses and nursing instructors (Bijani et al., 2019).
Professional value in nursing students was significantly different between six regions throughout the Iran (Poorchangizi et al., 2019b).
In regard to the issue of culture, students from US and Taiwan reported a similar high levels of the overall professional value, but they weighed differently on certain individual items (Alfred et al., 2013).
All these diverse results indicate the necessity of further exploration, especially among different programmes.
Students of the ABSN in Taiwan firmly believed that the choice of nursing profession was the right direction for a brighter future and they looked positively at the problems they faced and sought solutions during their first year in the ABSN programme (Yang et al., 2019). Will these characters affect their process of professionalism? Therefore, we included the first-year students in the ABSN programme and the second-year students in the BSN programme, who just started their initial learning phase of nursing profession as the samples for the present study. The purpose of this study was to compare the early development of professional value between the ABSN programme and the BSN programme within three schools during one academic year.

| Research design and setting
This is a prospective, multi-site, longitudinal study. Data were collected from three nursing schools from August 2017 to July 2018.
Participants were contacted twice for data collection during an academic year. Three of the five schools providing both the ABSN programme and BSN programme agreed the research groups to contact with their students in each programme.

| Samples
The inclusion criteria of samples were the first-year ABSN students or the second year BSN students since they took the same first professional nursing course in this specific academic year, and those who agreed to receive data collection twice during study period.
Before the research started, we obtained the permission from the IRB (201701656B0) and from each school first. Then, we contacted with the class leaders in each programme and arranged meeting schedules with the whole classes. We explained the purpose of the study and issues of voluntary participation. Once subjects agreed and signed the informed consents during that meeting, questionnaires were distributed to them immediately. Researcher waited and collected questionnaires after the students completed. A total of 101 students in the ABSN programme and 117 students in the BSN programme completed and returned their questionnaires during the study period. A power of 0.89 was achieved by this data set.

| Demographic data of subjects
The collected demographic data included age, gender, religion, marriage status, types of educational programmes and pre-ABSN educational programme.

| Statistical analysis
All data were handled by the IBM SPSS-Statistics 22. The descriptive statistics were conducted to describe the characteristics of each variable. Paired t test, t test and ANOVA were performed to verify the expected relationships among variables. A p value <.05 was set as significant.

| Characteristics of the samples
Subjects in the BSN programme within three sites were characterized as female, no specific religion, unmarried and unemployed (Table 1). Subjects in the ABSN programme have similar characteristics, except age. When all subjects were grouped as the BSN and the ABSN, t test showed that subjects in the ABSN programme were significantly older than subjects in the BSN programme (27.57 vs. 20.83, t = 17.53, p < .001). Nevertheless, comparison of age for subjects in the BSN programme within three schools showed no differences among them (F = 2.017, p > .05). Similar results were also found for the subjects in the ABSN programme (F = 0.29, p > .05).

| NPVS-R
The results of the total score and each subscale of the NPVS-R for the BSN and the ABSN in each semester were shown in Table 2. For the BSN group, the mean of total scale of the NPVS-R in the first semester was 110.64 ± 11.91 whereas the mean of total scale of the NPVS-R in the second semester was 108.48 ± 16.38. The range of mean in each subscale of NPVS-R during research period was 3.86-4.48. Meanwhile, similar relationship was found in the second semester.

| Comparison of the professional value between the ABSN and the BSN programmes
For the subjects in the BSN programme, the results of paired t test showed that the total scale, and professionalism and justice subscales had reached the statistical significance of 0.05. It indicated a significant higher score in the total scale, professionalism and justice subscales in the first semester for the subjects in the BSN group. For the ABSN group, the results of paired t test showed a significant higher score in the total scale, professionalism and trust subscales in the first semester for subjects in the ABSN group (Table 2). 4.3.2 | Self-comparison between the first and the second semesters for each programme in three schools For BSN programme, self-comparison between the first and the second semesters for each school showed a significantly different change in the total scale and subscales (p < .05; Table 2). Justice subscale was the only one that showed a change across these comparisons. However, a decreased score was observed in the school A and B, and an increased score existed in the school C.
For the subjects in the ABSN programme, the significantly difference only existed in one subscale of the NPVS-R in the school A and C. In addition, a significantly higher score was reported in the first semester than that in the second semester for trust and professionalism subscales respectively (p < .05).

| Comparison of the ABSN programme and the BSN programme among three schools in each semester
Comparison of the BSN programme among three schools showed that no significant differences of the total scale and all subscales of the NPVS-R existed at the first and the second semesters respectively (p > .05; Table 3). The comparison of the ABSN programme showed that, at the first semester, all subscales and the total scale of the NPVS-R reached the statistical significance of 0.05.
It indicated that the subjects in the school A reported a lower score than the school B and C in general. In the second semester, only the subjects in the school A reported significantly a lower activism than the subjects in the school B (p = .04; Table 4).

| Comparison between the BSN programme and the ABSN programme at the same semester in the same school
Results of t tests showed that the only significant differences of the NPVS-R were existed in the second semester in the School A (p < .05; Table 4) and the school B (p < .05; Table 4). In the school A, the subjects in the ABSN programme reported higher scores in the total scale, and professionalism and trust subscales of the NPVS-R than these in the BSN programme. In the school B, the subjects in the ABSN programme reported lower scores in the total scale, and caring and trust subscales of the NPVS-R than the subjects in the BSN programme.

| Characteristics of the samples
The only significant difference of demographic characteristics was that the subjects in the 'ABSN' programme were significantly older than the subjects in the 'BSN' programme. This fits the fact that the subjects in the ABSN programme need to obtain their first bachelor degree; then, they are qualified to enter this new ASBSN programme.
Some students in the ABSN worked as part-time, even full-time, while they were studying this new nursing programme, it might indicate the independent needs and financial burden of these students as found in other countries (Kowitlawakul et al., 2013;Meyer et al., 2006). From the disciplines of their previous BS programme, most of them were in social sciences which was similar to the subjects in USA (Meyer et al., 2006). Compared with the nursing profession, the occupations related to these social sciences have been recognized as a career with limited vacancy and lower salary in general.
These might be the reasons for them to enter this new ABSN programme, even though additional 3-year studies are required.

| Comparison of all subjects between the ABSN programme and the BSN programmes at the same semester
Various types of results were reported for the NPVS-R in literature.
Although culture had been identified as a factor associated with the professional value (Alfred et al., 2013;Alkaya et al., 2018), different results existed even though the data were collected from the same country. For example, our data (106.38 ~ 112.44) were greater than 99.10 ± 15.6 (Lin et al., 2016) and 104.27 ± 16.81 (Alfred et al., 2013) that were collected in Taiwan. It might be associated with the promotion of social status and salary of nurses during last decade in Taiwan.
Further exploration is needed.
Meanwhile, the subjects in both the BSN programme and the ABSN programmes reported a similar level of the professional value when they began their learning of professional nursing. In the western literature, students in the ABSN programme were recognized as highly independent and motivated (Penprase & Koczara, 2009).

Self-comparison between the first and the second semesters for each programme in three schools
The self-comparisons in the BSN programme, except in the school C, reported higher values in certain subscales and the total scale in the NPVS-R in the 1st semester even though our follow-up was one semester only. Similar trend was found in one subscale of the NPVS-R in the ABSN programme in school A and C. Contradictory results were found in literatures that the professional values increased with time (Fisher, 2014;Kantek et al., 2017;Leners et al., 2006;Lin et al., 2010). As mentioned previously, learning professional nursing might increase their stress and understanding of reality in nursing care. Therefore, they reported a lower value and passion to be a nurse. Will faculties and learning environment be the reasons?
Further exploration is needed.
The subjects in the school B, both the BSN pram and the ABSN programme, reported a similar level of the NPVS-R. Literature did find that there was no difference during school year (Caldwell & Katie, 2016;Poorchangizi et al., 2019a;Posluszny & Hawley, 2017).
The school B is a private school, and the same group of faculties taught these two programmes. Thus, faculties might be a reason related to the perceived levels of changes in the professional value.

Comparison of each programme among three schools in each semester
Present study showed that no significant differences existed in the NPVS-R for the BSN subjects in three schools at the first and the second semesters respectively. It might be associated with the facts that the Ministry of Education in Taiwan

Comparison between the BSN programme and the ABSN programme at the same semester in the same school
Our study showed that, in school A, subjects in the ABSN programme reported a higher level of professional value then subjects in the BSN programme. It was supported by literature (Feller et al., 2019).
Contradictory result was found in school B. However, for school C, a similar level of the professional value was reported and fitted the literature (Astorino, 2006

| Limitations and suggestions for further study
The limitation of the present study was that these results cannot be generalized into the whole nursing programmes during the whole academic years because it only collected one class of subjects from 3/5 nursing schools and during one academic year. Larger sample sizes and longer duration of follow-up are strongly suggested for further study. Thus, we can get a whole picture of the development of the professional value for students both in the BSN programme and the ABSN programme that have never been explored yet. Improving the professional value was possible from our findings with 1-year follow-up. Redesign teaching strategies to fit the characters of the students in the ABSN programme was strongly suggested. These might promote the development of the professional value and help the students in this new programme reach the ultimate goals of learning in nursing profession.

| CON CLUS IONS
New type of the nursing educational programme was implemented in Taiwan recently. Students in the BSN and the ABSN programmes were purposely sampling and recruited during one academic year.
The returned questionnaires showed the various patterns of changes in the professional value in each comparison with types of programmes and schools of nursing. Also, the increased professional value in the school A showed the possibility of improvement during the first learning of professional nursing. As educators, we must redesign our teaching strategies according to the different conditions of the students in each programme.

ACK N OWLED G EM ENT
This study was funded by MOST 107-2511-H-182-011 and CMRPD1B0181.

CO N FLI C T O F I NTE R E S T
The authors declare that they have no competing interests.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the corresponding author upon reasonable request.