Entrepreneurship training: its influences on innovation potentials among nursing students
Article Category: Original article
Publicado en línea: 26 mar 2024
Páginas: 85 - 98
Recibido: 03 abr 2023
Aceptado: 31 ago 2023
DOI: https://doi.org/10.2478/fon-2024-0009
Palabras clave
© 2024 Asmaa Abdel Rahman Abdel Rahman et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
The higher education system is now paying great attention along with professionals from various fields in Egypt, to promote creativity and innovation skills and attitudes among university students in order to be able to face challenges that result from rapid changes in the industry, health care, work environment, globalization, labor market, and climate.1 Nursing students are part of the higher education and health care system. They should be well prepared to encounter increasingly complex problems in health care and services that do not have obvious solutions and require new strategies to face them. Fostering creativity and innovation skills through entrepreneurship training among university nursing students has become a matter of interest nowadays.2
Entrepreneurship refers to the development of something new or the improvement of something already existing, based on identifying needs or opportunities and the proposition of innovative solutions.3 Entrepreneurship training is an international effort to teach specific abilities to better complete the project/idea. Entrepreneurship training has been used as a driving force to improve students’ entrepreneurial potential. It aims to equip nursing students with the relevant knowledge, skills, and attitudes that promote cognitive and motivational outcomes. It helps to create new opportunities and possibilities and consciousness to attempt and complete certain tasks differently.4
Nurses’ innovation ability was defined as the ability to actively seek and develop new methods, technologies, and tools to promote health, prevent diseases, improve the quality of care of patients, and apply innovation to work through teamwork and reasonable support channels.5 Creativity and innovation are critical concepts that have been proven to influence job performance, educational institutions, and organizations.6 Creativity is the process of generating new, unique, useful, and valuable ideas. At the same time, innovation is the adoption of the successful implementation of an idea, service, procedure, process, or behavior that is considered new and useful by the people or adopting organization. Furthermore, entrepreneurs are the people who generally have the responsibility and risks to take ideas/products/services to the market.7
International organizations highlight the importance of strengthening creativity and innovation ability and solving problem competencies among college students.8 In nursing, teaching to encourage creativity and creative problem-solving has been demonstrated to improve nursing students’ success.9 Previous studies show that innovation in nursing could improve health care quality and reduce health care costs,10 and create an organizational atmosphere that eases health care professionals’ stress and reduces their burnout.11 As a result, nursing professionals worldwide have been proactively encouraging nursing students to seek entrepreneurship training for the professional development of nurses in the health work market and improve nursing outcomes.12
The nursing education policy has been shifted in Egypt and emphasizes a more competency-based approach. Various frameworks have described the desirable skills and competencies required by nursing graduates and were identified as the 21st Century skills that incorporate the components of innovation capabilities, which include the ability to think critically and creatively, collaborate and communicate effectively, select and utilize suitable information and communications technologies (ICTs), and use these skills in a self-directed manner.13 Moreover, innovative individuals have been reported as having a high level of creativity and leadership abilities, persistence and task motivation, creative self-efficacy, a propensity to take calculated risks, and a liking for working on ambiguous and complex problems.14
A set of skills and attributes are linked to the innovation process to become a future innovator. These involve the thoughts, associated feelings, and ways of thinking of the innovator expressed in their innovative behavior. The framework of this study was based on assessing the core elements of innovation ability that include skills, behaviors, and thinking modes that can be learned and are required by the innovator student. These skills enable nursing students to work through everyday problems and contribute to hospital and community innovation activities.15
It is important to note that there is a gap in scientific knowledge related to entrepreneurship training among nursing students. Recent literature reviews on entrepreneurship in nursing highlight the shortage of studies on entrepreneurship in nursing education. It is emphasized that there is a need for more studies on entrepreneurship training, particularly on whether and in what specific ways training makes a difference.12 No studies have examined the influence of entrepreneurship training on the innovation skills of nursing students at the faculty of nursing of Ain Shams University (ASU). Therefore, this study aimed to fill this gap.
Tackling the future global health challenges that face the health care system requires innovative and creative approaches from the young nursing generation at universities. In order to produce any innovative product, idea, or service requires the development of nursing students’ abilities and skills to match the needs of the labor market. This aim suggests the need to stimulate nursing students throughout their education and equip them with the opportunities and entrepreneurship training that help them to develop and acquire the appropriate knowledge, skills, and behavior that promote creation and innovation potentials. Furthermore, they should be able to generate original, appropriate, and implementable innovative solutions to complex problems in the health care environment that help to improve the quality of nursing care and nursing outcomes, increase patient satisfaction, reduce costs to health care, and improve access to health care services.
This study aimed to evaluate the influences of entrepreneurship training on the innovation potentials among nursing students through the following: (1) Assessing innovation skills among nursing students before conducting entrepreneurship training; (2) Developing and implementing entrepreneurship training; (3) Evaluating the effect of entrepreneurship training on the innovation potentials of nursing students after conducting the training; and (4) Assessing the level of nursing students in developing innovative projects post implementation of the entrepreneurship training.
The current study hypothesized as follows:
Implementation of entrepreneurship training positively affects nursing students’ innovation potential. Implementation of entrepreneurship training positively affects the level of nursing students in developing innovative projects.
The design of this study was quasi-experimental (one group pretest–posttest design). A quasi-experimental design was done to test whether entrepreneurship training would improve the innovation potential among nursing students. A quasi-experimental design is a non-randomized study design used to evaluate the effect of an intervention. The intervention can be a training program, a policy change, or a medical treatment and it aims to demonstrate causality between an intervention and an outcome. Quasi-experimental studies can use pre-intervention and post-intervention measurements and a non-random selection of participants.16
The study was conducted in the classroom at the Faculty of Nursing and the “iHub” center at ASU in Cairo, Egypt.
A purposive sample of 42 nursing students who participated in the “ASU-innovate” competition from the Faculty of Nursing of ASU during the academic year 2019/2020 and 2020/2021 was included in this study. Inclusion criteria: Male and female nursing students from different classes agreed to participate in the study. Exclusion criteria: Any nursing student who had attended previous training or courses on entrepreneurship, students who were not interested in participating in the study, and nursing students from the technical health institute for nursing were excluded from the study.
Two tools for data collection were used as follows:
This is a self-administered questionnaire used to assess nursing students’ innovation skills. It was developed by researchers in the English language based on the related literature.17–19 It includes the following 4 parts:
Part 1 includes nursing students’ demographic characteristics such as age, gender, class year, and preferred color. Part 2 is concerned with the assessment of innovation skills among nursing students. It is divided into 7 dimensions that include creative/critical thinking (14 items), leadership (8 items), energy (5 items), self-efficacy/self-directed (7 items), risk-taking (4 items), facing challenges (5 items), and teamwork (5 items). This part consists of 48 statements requiring students to rate their skills or give their opinion on a 5-point Likert scale ranging from 1 to 5, where 1 = strongly disagree, 2 = disagree, 3 = do not know (cannot judge), 4 = agree, and 5 = strongly agree. Part 3 assesses the degree of confidence of nursing students in project management and consists of 9 statements. Students’ response to statements is on a 5-point Likert scale ranging from 1 to 5, where 1 = strongly unconfident, 2 = unconfident, 3 = do not know, 4 = confident, and 5 = strongly confident. Part 4 consists of 2 open-ended questions that asks students about their overall opinion regarding the entrepreneurship training and any other comments/ suggestions concerning the acquired skills or training.
The scoring system of part 2 of the nursing students’ innovation skills assessment questionnaire is as follows:
It includes 48 items. The response for each item is on a 5-point Likert scale. The total grade for this part was 240 grades. The students’ scores for every subscale were calculated. The total score of the innovation skills assessment questionnaire was calculated for every student; the mean and standard deviation (SD) of the total score for all students was calculated pre-and post-implementation of the training.
Students were categorized as follows:
48 to <120 categorized as low/weak innovation skills (<50%). 120 to <180 categorized as moderate innovation skills (50% to <75%). ≥180 categorized as high/strong innovation skills (75%–100%).
The scoring system of part 3 of the nursing students’ innovation skills assessment questionnaire is as follows:
It includes 9 items. The response for each item is on a 5-point Likert scale. The total grade for this part was 45 grades. The students’ scores for every subscale were calculated. The total score of the innovation skills assessment questionnaire was calculated for every student; the mean and SD of the total score for all students was calculated pre- and post-implementation of the training.
This tool was developed by the experts in the “iHub center” in the English language after reviewing the related literature.20,21 It was used to evaluate the skill level of nursing students in developing innovative projects based on specific criteria. The tool consisted of 10 items that include the (1) problem definition and market need (nursing students describe the area where people need help, showing the pain, gains, and opportunities for creating gains and relieving pain); (2) approach and value proposition (the students describe the specific key features of the project/idea/product that match the customer’s problems/needs); (3) use of technology (experts evaluate if students use technology in their project, to what extent these technology meet customer’s requirements and add value to the project or service, how much it costs the customer to use, and if it is suitable for the user’s culture); (4) prototype (experts evaluate if prototype present or not, if prototype provides a solution for user needs, ease of use, color, shape, neatness, testing of the product in a thorough manner, novelty, user feedback, and satisfaction); (5) market plan (the students show that marketing activities are within budget, SWOT analysis of the market); (6) benefits and competition (the students show the benefits of their projects for the community or customers and illustrate competitive matrix analysis with other competitors present in the labor market); (7) business model (the students show the unique features of their projects in detail, target customer, key activities of the project, resources, and partners); (8) financial plan (students provide logical numbers for operating expenses which are the day-to-day expenses the project incurs to keep its business operational, capital expenditures which are major purchases the project makes that are designed to be used over the long term, cost of goods sold, net profit for 1 year, cash in, cash out, and investment needed); (9) teamwork (students are evaluated to check if the team functions as a whole with all members contributing, members show what relevant skills each of them have); and (10) pitching (the students are evaluated on their abilities to demonstrate value, business model; while maintaining presentation skills, citation of references, flow of ideas, logical order of speech in pre-determined time).
The scoring system of the innovative projects evaluation tool is as follows:
It includes 10 items. The response for each item is on a scale of 3 levels (low = 1, which means below expectation, moderate = 2–4, means meets expectation, high = 5 means exceeding expectation). The total grade for the tool was 50 grades. The students’ scores for every subscale were calculated. The total score of the innovative projects evaluation tool was calculated for every student. The mean and SD of the total score for all students were calculated post-implementation of the training. Students projects’ levels were categorized as follows:
30–31.5 is categorized as the accepted level of the project. 32.5–36.5 is categorized as a good level. 37.5–41.5 is categorized as a very good level. ≥42.5 is categorized as excellent level.
The tools were evaluated in terms of face and content validity by a panel of 5 experts (2 professors, 2 assistant professors, and 1 lecturer) from the Faculty of Nursing and Entrepreneurship Department at the Faculty of Commerce of ASU. The experts reviewed the tools for clarity, relevance, comprehensiveness, simplicity, and applicability. No modifications were done. After verification of the validity of the questionnaires by experts, the reliability of the tools was tested. The reliability was achieved via Cronbach’s alpha; it was 0.715 for the nursing students’ innovation skills assessment questionnaire and 0.872 for the innovative projects evaluation tool.
A pilot study was conducted on 10% (4) of students to test the study’s applicability, the clarity of the designed questionnaires, and the time needed to fill in the tool. No modifications were done to the tool used. Students of the pilot study were included in the study’s subjects.
The research approval was obtained from the faculty of Nursing Research Ethics Committee before initiating the study. The researcher clarified the goals and aim of the study to students included in the study. Oral consent was obtained from students to ensure willingness to engage in the study. The researchers maintained the anonymity and confidentiality of the subjects’ data. Students were informed that they were allowed to withdraw from the study at any time without penalty.
Fieldwork included 3 phases: preparatory, implementation, and evaluation.
This phase involved extensive reviewing of the recent related literature to develop tools for data collection.
The training program’s content was designed by the “I Hub” center team, which specializes in entrepreneurship science. It was developed in the English language. It includes topics about problem statements, design thinking, business model, empathy plan, team canvas, marketing plans, financial plans, fundraising, pitching, and essential skills such as presenting the idea and making a good presentation.
The content of the entrepreneurship training program was revised for content validity by a group of 3 senior experts (2 assistant professors and 1 professor) in entrepreneurship at the “iHub” center. A final modification was done based on the opinion of the experts.
This phase was started by informing nursing students about the aim and nature of the study, as well as taking their approval to participate in the study prior to data collection.
The students’ telephone numbers were obtained for the first time to facilitate communication and to contact them during the evaluation phase to complete the data collection process.
The innovation skills assessment questionnaire was distributed to nursing students to assess their innovation skills before being involved in entrepreneurship training. It took about 15–20 min to be filled in by students. This session was conducted in the classroom at the faculty of nursing.
Teaching sessions of the entrepreneurship training were conducted for all students enrolled in the ASU competition from all ASU faculties.
Data collection process was conducted during the morning hours in the classroom at the Faculty of Nursing, while the face-to-face training sessions were conducted during the afternoon time from 4 to 8 pm in the “iHub” center at ASU, starting from February 2020 till the first week of March 2020. After that, and due to the Coronavirus Disease 2019 (COVID-19) pandemic, the training sessions were completed by online teaching through the Zoom application till April 2020 during the academic year 2019/2020.
The entrepreneurship training sessions were entirely conducted over 12 weeks by online teaching through the Zoom application during the academic year 2020/2021 from February 2021 to April 2021 at different times.
The training consisted of 10 theoretical sessions over 10 weeks. Each session continued for 2 h. Only one topic was explained during each session.
Another 10 practical sessions over the same 10 weeks were held, which include hands-on skills, during which the students apply what they learned on their projects/ideas that are suggested by each student at the time of application for the competition. During the practical sessions, the trainers encourage students to use creative thinking tools such as brainstorming and paired comparison to stimulate divergent and convergent thinking skills.
The nursing students included in the study in both years were divided into 19 groups. They participated in 19 projects during the training. Each group contains 2–5 students, either from the Faculty of Nursing or other faculties, based on the nature of the project.
The last 2 weeks of training are used to evaluate nursing students’ projects by a diverse panel of field experts. The students are asked to present the final project at the end of the training period in front of their colleagues and the judiciary committee.
Post implementation of the entrepreneurship training, the nursing students’ innovation skills assessment questionnaire was re-filled in again by students through an online Google form designed by one of the researchers. The judiciary committee filled the innovative project evaluation tool, which includes experienced faculty members from different disciplines such as medicine, engineering, and nursing. The number of judges in the committee ranged from 5 to 8 members. They evaluate each project’s level based on the criteria in the project evaluation tool. The average of the 8 experts’ degrees was calculated for each criterion for every student, and the average of the final degree was also calculated. The effect of entrepreneurship training on students’ innovation potentials was evaluated by comparing the results pre- and post-implementation of the training using the same data collection tool.
In addition, the team at the “iHub” center designed an online questionnaire to assess the quality of online lectures by getting feedback from participants. The questionnaire asked students to rate their opinion about the lecture content, lecturers, and the online zoom application on a 3-point Likert scale, where 1 = disagree, 2 = somewhat agree, and 3 = agree. Also, the iHub team made an announcement before each online lecture to ensure that the lecture timings are suitable for students. The trainers kept an eye on the participants throughout the training, providing feedback on their work and allowing them to practice pitching in front of them several times to improve their final pitch. Moreover, they encouraged students to engage in online discussion with the lecturers during the online lectures.
The collected data were tabulated and analyzed using the statistical package for social science (SPSS) version 20 (SPSS Inc., Chicago, IL, USA). Quantitative data were described as mean and SD, and Paired t-test was used for comparing quantitative variables between groups. Qualitative data were presented as frequencies (n) and percentages (%). Internal consistency and reliability (Cronbach’s alpha) were measured for the tools. The significance of the observed difference was considered statistically significant if the
As for the demographic characteristics of the study subjects, Table 1 clarifies that the mean age of the studied subjects was 21.8 ± 1.6 and fell in the age group between 19 years and 24 years. Three-quarters (76.2%) of the students were females. More than half of the students (59.5%) were in the internship year and approximately one-quarter of them (23.8%) were in the second year. Nearly two-fifths (38.1%) of students preferred the color black, 21.4% and 21.4% preferred white and blue, respectively, while only 7.1% of them preferred green.
Demographic characteristics of the study subjects (
| Students’ characteristics | No. | % |
|---|---|---|
| 21.8 ± 1.6 | Min–max (19–24) | |
| Male | 10 | 23.8 |
| Female | 32 | 76.2 |
| First | 1 | 2.4 |
| Second | 10 | 23.8 |
| Third | 1 | 2.4 |
| Fourth | 5 | 11.9 |
| Internship | 25 | 59.5 |
| White | 9 | 21.4 |
| Black | 16 | 38.1 |
| Green | 3 | 7.1 |
| Blue | 9 | 21.4 |
| Red | 5 | 12.0 |
| Yellow | 0 | 0.0 |
+
A high effect of the entrepreneurship training was observed on the creative thinking skills and energy skills of nursing students in all items of Table 2, with statistically significant differences between mean scores pre- and post-implementation of the training (
Differences between mean scores of nursing students’ skills related to creative thinking and energy pre- and post-implementation of entrepreneurship training.
| Items | Pre | Post | Mean difference | ||||
|---|---|---|---|---|---|---|---|
| Mean | SD | Mean | SD | Mean | SD | ||
| I would like my lessons to involve lots of different creative activities. | 2.2 | 0.7 | 4.4 | 0.9 | 2.2 | 0.2 | 0.000* |
| I prefer lessons that involve different activities rather than just sitting at my desk. | 2.2 | 0.6 | 4.5 | 0.7 | 2.3 | 0.1 | 0.000* |
| I feel proud when I’ve designed something myself and made it. | 2.7 | 0.5 | 4.7 | 0.6 | 2.0 | 0.1 | 0.000* |
| I like doing things that are very practical. | 3.8 | 0.6 | 4.5 | 0.6 | 0.7 | 0.0 | 0.000* |
| The subjects at faculty give me the freedom to express my own ideas. | 1.3 | 0.5 | 3.2 | 1.2 | 1.9 | 0.7 | 0.000* |
| The subjects I’m studying at faculty require my imagination/creative thinking. | 1.6 | 0.6 | 3.5 | 1.0 | 1.9 | 0.4 | 0.000* |
| I can come up with something new that will benefit others. | 1.9 | 0.7 | 4.2 | 0.7 | 2.3 | 0.0 | 0.000* |
| I like to develop new strategies for helping ideas become realities. | 1.5 | 0.6 | 4.0 | 0.9 | 2.5 | 0.3 | 0.000* |
| I enjoy being asked to come up with new ideas and solutions for problems. | 1.7 | 0.8 | 4.5 | 0.6 | 2.8 | −0.2 | 0.000* |
| I frequently introduce new ideas to improve the situations. | 1.6 | 0.8 | 4.1 | 0.8 | 2.5 | 0.0 | 0.000* |
| I use trial and error for problem solving. | 1.6 | 0.5 | 4.3 | 0.8 | 2.7 | 0.3 | 0.000* |
| I ask “Why?” and “Why not?” and “What if?” with a purpose. | 1.6 | 0.6 | 4.4 | 0.7 | 2.8 | 0.1 | 0.000* |
| I show inventiveness in using resources. | 1.6 | 0.6 | 3.9 | 1.0 | 2.3 | 0.4 | 0.000* |
| I search out new working methods, techniques, or instruments. | 1.7 | 0.6 | 4.2 | 0.7 | 2.5 | 0.1 | 0.000* |
| It is energizing when you are given rewards for good work. | 4.5 | 0.6 | 4.5 | 0.7 | 0.0 | 0.1 | 1.000 |
| I feel really motivated when I produce something that no one else has. | 4.3 | 0.7 | 4.8 | 0.4 | 0.5 | −0.3 | 0.001* |
| I feel really enthusiastic about my chosen subjects. | 2.0 | 0.7 | 3.6 | 1.2 | 1.6 | 0.5 | 0.000* |
| I really push myself to achieve good grades. | 2.8 | 0.7 | 4.5 | 0.6 | 1.7 | −0.1 | 0.000* |
| I like to do something that has a purpose or goal. | 3.1 | 0.6 | 4.6 | 0.6 | 1.5 | 0.0 | 0.000* |
SD, standard deviation.
Table 3 shows that there were statistically significant differences in the mean scores of nursing students’ skills related to facing challenges and leadership abilities before and after entrepreneurship training implementation, with
Differences between mean scores of nursing students’ skills related to facing challenges and leadership pre- and post-implementation of entrepreneurship training.
| Items | Pre | Post | Mean difference | ||||
|---|---|---|---|---|---|---|---|
| Mean | SD | Mean | SD | Mean | SD | ||
| Persist towards achieving long-term goals, even after experiencing setbacks. | 1.9 | 0.7 | 4.2 | 0.7 | 2.3 | 0.0 | 0.000* |
| Respond effectively to unexpected challenges that arise when working on projects. | 1.6 | 0.7 | 4.0 | 0.7 | 2.4 | 0.0 | 0.000* |
| Pursue a goal even after someone has told me it will be difficult to achieve. | 1.5 | 0.7 | 4.1 | 0.8 | 2.6 | 0.1 | 0.000* |
| I find interests in facing challenges and difficulties to achieve goals. | 1.7 | 0.8 | 4.1 | 0.7 | 2.4 | −0.1 | 0.000* |
| Challenge a classmate’s suggestions for how to solve a problem. | 1.8 | 0.7 | 4.0 | 0.8 | 2.2 | 0.1 | 0.000* |
| I really like being leader of a group. | 1.8 | 0.7 | 4.0 | 0.9 | 2.2 | 0.2 | 0.000* |
| Project work gives me the chance to take a leading role in the group. | 3.2 | 1.1 | 4.3 | 0.6 | 1.1 | −0.5 | 0.000* |
| When working in a group I do my best to persuade the others to take up my ideas. | 2.0 | 0.8 | 4.2 | 0.9 | 2.2 | 0.1 | 0.000* |
| I am often chosen to be the team leader or captain of my team. | 3.2 | 1.2 | 4.0 | 0.8 | 0.8 | −0.4 | 0.001* |
| My friends follow my suggestions when they can’t make up their minds. | 2.1 | 0.8 | 4.1 | 0.7 | 2.0 | −0.1 | 0.000* |
| Working as part of a group with people who have different skill sets from my own. | 2.2 | 0.8 | 4.5 | 0.7 | 2.3 | −0.1 | 0.000* |
| Working on a team with people whom I am meeting for the first time. | 1.9 | 0.8 | 4.1 | 1.0 | 2.2 | 0.2 | 0.000* |
| Explaining my rationale for making a decision to others. | 1.8 | 0.8 | 4.0 | 1.0 | 2.2 | 0.2 | 0.000* |
SD, standard deviation.
Table 4 revealed statistically significant differences between the mean scores of nursing students’ skills pre- and post-implementation of entrepreneurship training in terms of self-efficacy skills, risk propensity, and teamwork skills, with
Differences between mean scores of nursing students’ skills related to facing self-efficacy, risk propensity, and teamwork pre- and post-implementation of entrepreneurship training.
| Items | Pre | Post | Mean difference | ||||
|---|---|---|---|---|---|---|---|
| Mean | SD | Mean | SD | Mean | SD | ||
| I like to pursue my interests outside college where I feel more in control. | 2.9 | 0.6 | 4.4 | 0.8 | 1.5 | 0.2 | 0.000* |
| Once I start something, I like to finish it. | 3.0 | 0.7 | 4.4 | 0.8 | 1.4 | 0.1 | 0.000* |
| I would join a club/interest group independently of my friends if it was something I really wanted to do. | 2.5 | 0.6 | 4.5 | 0.6 | 2.0 | 0.0 | 0.000* |
| Communicate your ideas using media other than a written paper (e.g., posters, video, blogs, etc.) | 1.8 | 0.7 | 4.1 | 0.9 | 2.3 | 0.2 | 0.000* |
| Answer questions in front of an audience. | 2.0 | 0.8 | 4.1 | 0.7 | 2.1 | −0.1 | 0.000* |
| I like to experiment with different approaches to completing the same task. | 2.4 | 0.6 | 4.1 | 0.8 | 1.7 | 0.2 | 0.000* |
| I go beyond expectations in the assignment, task, or job description without being asked. | 1.7 | 0.7 | 4.1 | 0.8 | 2.4 | 0.1 | 0.000* |
| When I make choices, I want to be as sure as possible what the future consequences will be for me. | 1.5 | 0.6 | 3.8 | 0.8 | 2.3 | 0.2 | 0.000* |
| I feel I can overcome problems. | 1.7 | 0.7 | 3.9 | 0.8 | 2.2 | 0.1 | 0.000* |
| I take the risk to participate in activities without fear of not getting good grades at college. | 1.5 | 0.6 | 3.5 | 1.1 | 2.0 | 0.5 | 0.000* |
| I take an acceptable level of risk to support new ideas. | 1.5 | 0.5 | 3.9 | 0.8 | 2.4 | 0.3 | 0.000* |
| I’m attentive when others are speaking and respond effectively to others’ comments during the conversation. | 1.7 | 0.8 | 4.1 | 0.7 | 2.4 | −0.1 | 0.000* |
| I identify sources of conflict between oneself and others, and take steps to overcome disharmony. | 1.6 | 0.7 | 4.3 | 0.6 | 2.7 | −0.1 | 0.000* |
| Try to build relationships with other people/organization to share timely information and experience. | 1.5 | 0.6 | 4.2 | 0.8 | 2.7 | 0.2 | 0.000* |
| I provide constructive feedback, cooperation, coaching, or help to team colleagues. | 2.0 | 0.8 | 4.4 | 0.7 | 2.4 | −0.1 | 0.000* |
| Persist in my relationship after the task is finished. | 2.0 | 0.9 | 4.1 | 0.9 | 2.1 | 0.0 | 0.000* |
SD, standard deviation.
According to Table 5, the “creativity” category is seen to have the highest rank with a mean of (58.3 + 7.0), which reflects the ability of nursing students to generate and produce creative ideas and work post-entrepreneurship training with a
Differences between mean scores of nursing students’ total innovation skills pre- and post-implementation of entrepreneurship training.
| Items | Pre | Post | Max score | Mean percentage | |||
|---|---|---|---|---|---|---|---|
| Mean | SD | Mean | SD | ||||
| Creativity | 27.0 | 2.7 | 58.3 | 7.0 | 70.0 | 83.2 | 0.000* |
| Leadership | 18.2 | 2.4 | 33.1 | 4.3 | 40.0 | 82.7 | 0.000* |
| Energy (Motivation) | 16.8 | 1.5 | 22.0 | 2.2 | 25.0 | 88.0 | 0.000* |
| Self-efficacy | 16.1 | 1.6 | 29.7 | 3.9 | 35.0 | 84.8 | 0.000* |
| Risk-propensity | 6.2 | 1.6 | 15.1 | 2.8 | 20.0 | 75.5 | 0.000* |
| Facing challenges | 8.5 | 2.0 | 20.4 | 3.0 | 25.0 | 81.6 | 0.000* |
| Teamwork | 8.7 | 1.8 | 21.1 | 2.6 | 25.0 | 84.4 | 0.000* |
| 101.4 | 7.4 | 199.9 | 21.9 | 240.0 | 83.2 | 0.000* | |
SD, standard deviation.
Table 6 shows that all nursing students (100%) had a low innovation potential pre-implementation of entrepreneurship training. While there was 85.7% and 14.4% of them who got high and moderate scores in innovation skills post-implementation of entrepreneurship training, respectively. This confirms the study’s hypothesis and the positive effect of entrepreneurship training on the innovation skills of nursing students.
Frequency and percentage distribution of total level of nursing students’ innovation skills pre- and post-implementation of entrepreneurship training (
| Level of innovation skills | Pre | Post | ||
|---|---|---|---|---|
| No | % | No | % | |
| Low (<50%) | 42 | 100 | 0 | 0.0 |
| Moderate (50% to <75%) | 0 | 0.0 | 6 | 14.4 |
| High (75%–100%) | 0 | 0.0 | 36 | 85.7 |
It is observed in Table 7 that entrepreneurship training had a great effect on nursing students’ confidence level in managing projects, with statistically significant differences between means of pre- and post-assessments in all items of project management, with
Differences between mean scores of nursing students’ skills related to confidence in projects management pre- and post-implementation of entrepreneurship training.
| Items | Pre | Post | Mean difference | ||||
|---|---|---|---|---|---|---|---|
| Mean | SD | Mean | SD | Mean | SD | ||
| I trust in my abilities to start a project by myself and run it in the future. | 1.4 | 0.5 | 4.2 | 0.8 | 2.8 | 0.3 | 0.000* |
| I trust to develop my idea/project. | 1.4 | 0.5 | 4.2 | 0.8 | 2.8 | 0.3 | 0.000* |
| Determine the user’s needs and market the product/service. | 1.4 | 0.5 | 4.0 | 0.9 | 2.6 | 0.4 | 0.000* |
| I search myself for competitors in the labor market. | 1.2 | 0.4 | 3.8 | 0.8 | 2.6 | 0.4 | 0.000* |
| I know how to present my ideas and service to the community. | 1.4 | 0.5 | 4.0 | 0.6 | 2.6 | 0.1 | 0.000* |
| Able to find ‘methods’ to market ideas/ services. | 1.4 | 0.5 | 3.8 | 0.8 | 2.4 | 0.3 | 0.000* |
| Able to design a financial budget for my project/service. | 1.1 | 0.3 | 3.7 | 0.8 | 2.6 | 0.5 | 0.000* |
| Able to manage the project. | 1.0 | 0.2 | 4.0 | 0.7 | 3.0 | 0.5 | 0.000* |
| Able to identify the strengths/weaknesses of the project. | 1.4 | 0.5 | 4.2 | 0.6 | 2.8 | 0.1 | 0.000* |
| 11.7 | 2.0 | 36.0 | 4.6 | 24.3 | 2.6 | 0.006* | |
SD, standard deviation.
Table 8 shows that nursing students were more skillful in teamwork and pitching skills, with a mean score of 5.0 + 0.1 and 5.0 + 0.1, respectively. At the same time, the lowest mean score they achieved was related to a financial plan, prototype, and business model, with mean scores of 2.8 + 0.8, 3.0 + 1.4, and 3.1 + 0.8, respectively.
Mean scores of nursing students’ innovative projects post-implementation of entrepreneurship training.
| Items | Mean | SD | Rank |
|---|---|---|---|
| Problem definition/market need | 4.3 | 1.0 | 4 |
| Approach and value proposition | 4.4 | 1.0 | 3 |
| Using of technology | 3.2 | 1.3 | 7 |
| Prototype | 3.0 | 1.4 | 9 |
| Market analysis | 3.8 | 1.0 | 6 |
| Benefits and competition | 4.3 | 1.0 | 4 |
| Business model | 3.1 | 0.8 | 8 |
| Financial plan | 2.8 | 0.8 | 10 |
| Teamwork | 5.0 | 0.1 | 1 |
| Pitching | 5.0 | 0.1 | 1 |
| 38.7 | 3.8 |
Table 9 illustrates that 38.1% of nursing students got a very good level, 28.6% had an excellent level, and 33.3% had a good level in developing projects post-implementation of entrepreneurship training, which supports the second hypothesis of the study.
Frequency and percentage distribution of total level of nursing students’ innovative projects post-implementation of entrepreneurship training.
| Innovative projects assessment categories | No | % |
|---|---|---|
| Good | 14 | 33.3 |
| Very good | 16 | 38.1 |
| Excellent | 12 | 28.6 |
Entrepreneurship is now supported worldwide, because an increase in entrepreneurship positively influences the world economy. Implementing entrepreneurship education and training for nursing students can enable them to develop innovative nursing activities, practices, products, services, and sustainable companies, engage in social development, and focus on the health and needs of patients and communities.3
The present study reveals that the mean age of the studied subjects was 21.8 ± 1.6, and they fall in the age group between 19 years and 24 years. Approximately three-quarters of nursing students were female, and most of them were in their internship year at the faculty of nursing. This result may be because students join the faculty of nursing after secondary school at age 18 years or 19 years and complete the 5 years of study at the faculty when they are around 23 years or 24 years old. Nursing has been a female job for decades, and male students are being accepted recently at faculties of nursing in Egypt. This result was agreed by Liu et al.,22 who stated that the average age of the participants was 21.3 ± 0.47 years, and almost all of them (98%) were female nursing students. El-Demerdash et al.23 found that more than half of the nursing students under study were more than 21 years old, with a mean age of 21.85 ± 1.8. Additionally, the highest percentages of them were female and single.
Based on this study’s findings, more than half of the students were in their internship year. This is because internship year students are less busy studying and attending lectures than other students who are still in the different academic years and follow a regular schedule of lectures and training. It allows internship-year students to participate in various activities and attend entrepreneurship training. This result is in line with Ali et al.,24 who revealed that about half of the study participants were nursing interns, and the rest were new graduates.
One of the noticeable findings of this study was that nearly two-fifths of students prefer the color black. This is because nursing students learn how to detect, discover, prevent, and manage risks during their study in the faculty. Also, according to the 6 hats of thinking, the black color means that students are logically and critically thinking, cautious when doing things, and able to identify dangerous, illegal suggestions or risks that should be avoided or things that do not fit their resources, strategy, values, and ethics. The result of the study showed that less than one-quarter of students preferred the white and blue colors, respectively. The white color means that students focus on what information, data, and facts they already have, what information is missing, and how they will get it to be put forward objectively. The blue color may interpret that they can organize their thinking and control the process by finding other definitions of the problems and market needs; they may suggest the next step, being able to find new ideas or solutions and they usually ask about the conclusion, or decision.
In addition, it was noticed that only a few students preferred the green color. The green color may suggest that those students are creative thinkers, energetic, able to generate new ideas and alternatives, and have new approaches to doing things. They can modify and improve suggested ideas and overcome some difficulties. There may be more need for the green hat thinker students. According to Debono,25 creativity is a matter of skill, talent, or personality. So, the Faculty of Nursing can make more efforts to develop the skill of creativity among nursing students until they can reach a competent level. None of the students preferred the yellow color, which may be attributed to the fact that they need help in figuring out how to make things happen or the immediate benefits of their idea/service. They need to search for that or test their idea, service, or prototype to ensure a positive view of what they are doing. So, it is logical that no one prefers that color, at least at the beginning of the training, because they need to be certain about the future.
Regarding creativity skills, there were statistically significant differences between the mean scores of nursing students’ skills pre- and post-implementation of entrepreneurship training. This may be because the entrepreneurship training included different activities, tools, and instructions that teach students how to be critical and creative thinkers in doing things and generating creative ideas. In addition, nursing students feel that they are doing something different from others or something that others cannot do, which increases the level of self-esteem of students and the feeling of being important. It also gives them the confidence to be more creative and encourages them to participate in projects and bring up solutions and suggestions for problems in the health care system, which is useful and valuable for patients and community. This result agrees with that of Liu et al.,26 who mentioned that nursing students’ creative thinking ability scores improved after participating in teaching creative intervention programs.
Moreover, nursing students expressed that they like lessons that involve a lot of different activities rather than being passive listeners or just seeing the slides during lectures. The finding of this study may be due to the nature of the nursing profession, which includes a lot of activities and practical hours which require students to be actively involved in patient care, and they want to be involved in more practical hours that help to increase their confidence and experience in doing things. They became more curious after entrepreneurship training and liked to understand and learn in-depth. This finding is because entrepreneurship lectures and training have involved theoretical concepts such as design thinking and practical sessions that require students to think critically and deeply before they do anything to reach the desired outcomes of their projects.
This result is supported by Ehtyar and Baser,27 who stated that students prefer to learn how to do different practical things that could be applied through more practical lessons, seminars, and projects. This approach will help them to be more creative. In addition, the students want teachers to use different methods in teaching, because university education limits their creativity due to the standard teaching methods, and there is too much theory. However, there is no practice training and most subjects depend on memorization, preventing them from thinking. Students suggest that entrepreneurship courses allow them to disseminate their ideas and enhance their creativity. Some students said there was no system to make them think differently, and they needed to take some lessons related to creativity.
Concerning energy or motivation, the result shows statistically significant differences between the mean scores of nursing students’ skills pre- and post-implementation entrepreneurship training. This result may be due to nursing students’ feeling that they are participating in solving health care problems or improving the existing services, which results in positive change and adds value to society. It also motivates students to achieve good grades and continue to come up with ideas that meet the needs and solve patients’ health problems. In addition, the trainers used methods to motivate students during training, such as peer-to-peer evaluation during sessions and determining a financial award for the first 3 winning projects. This result was similar to that of Olugbola,28 who reported that the entrepreneurial readiness of students can be influenced by motivation, opportunity identification, and availability of resources. His study showed that students who participated in entrepreneurship training were highly motivated and were more likely to set up new businesses and innovations.
Concerning facing challenges and difficulties, the results clarify that there were statistically significant differences between the mean score of nursing students’ skills pre- and post-implementation of entrepreneurship training. This result may be because nursing students ensure the value and benefits of their projects for patients and the community, and they know that achieving long-term goals will take time. If they fail once, they will continue working on their ideas and projects to refine them until they have a chance to reach the market. In addition, the nursing students met experts and professionals during the training course who had their startups after several failures. Now, they achieved success in the labor market and provide advice to other entrepreneurs who are still in their initial stage of small businesses and projects. All these factors helped improve skills and power nursing students in facing challenges. This result is similar to Neergard,29 who found that an entrepreneurship camp had a role as an experiential learning intervention that encourages and supports nursing students in acting entrepreneurially. They become empowered and willing to face challenges and problems and innovate within complex ambiguous problems to overcome them.
Concerning leadership skills, the results show statistically significant differences between the mean scores of nursing students pre- and post-implementation of entrepreneurship training. These results may be attributed to the fact that students had practiced leadership skills during the training period while working in groups to complete the required tasks and had to take different roles within the group based on instructions from their trainers. So they had to practice how to be the leader of the group. These leadership skills allowed each student to deal with classmates with different personality traits and skills, and they knew they were competing each other. Everyone has his/her skills and knowledge that benefit the project. Sometimes, students also had to deal with other colleagues who joined the project team from different faculties and specialties during the training period. During the leadership role, students distributed tasks to group members, defined the objectives that should be achieved, and directed the group about how to achieve them.
This result is similar to Koyuncuoglu,30 who stated that the mean score of potential leadership perception of university students was above moderate (3.64 ± 0.83). In addition, he found that there is an effect of university students’ potential leadership perceptions on their innovation skills. It is statistically significant where
Concerning self-efficacy skills, the results reveal statistically significant differences between the mean scores of nursing students’ skills pre- and post-implementation of entrepreneurship training. This is because nursing students had been equipped with the knowledge and concepts that made them think creatively during the training and enabled them to implement different methods to do the same work. In addition, they worked in groups, which allowed them to learn from each other, increased their confidence and potential in communication and presentation skills, and empowered them to face their colleagues and assessors successfully. A few students reported in the open-ended questions that their self-abilities were enhanced, and they would continue to do more things that are useful for patients until they develop their own business, because if they did not believe in their self-efficacy, their performance and efforts would weaken. This result agreed with Jahani et al.,32 who reported a significant difference between the mean score of self-efficacy belief of nurses in the intervention group before and after entrepreneurship education. However, the results are in contrast to a study conducted by Farsi et al.,33 who showed that self-efficacy did not show a significant difference after training (29.54 ± 4.59) in comparison to the score obtained before intervention (29.19 ± 5.00).
The mean score of risk propensity skills was improved post-implementation of the training and was statistically significant. This finding may be due to the encouragement of students during training by their coaches to continue to achieve their goals even if they fail and not to be so cautious, because it can easily kill creative ideas and stop the progress. They also learned the scientific methods of problem-solving techniques, which enhanced their confidence in facing expected risks. This result is similar to Chell and Athayde,19 who attributed the lower score for risk propensity to the lack of formal teaching mechanisms that should include seeking sensation, avoiding risk, taking calculated risks, and taking steps to reduce those risks.
The findings of the present study revealed that there was an improvement in the total mean scores of nursing students’ innovation skills pre- and post-implementation of entrepreneurship training (101 + 7.4, 199.9 + 21.9, respectively), and this confirms that the findings of the present study’s support the first hypothesis, because the result is statistically significant. This result is similar to Gao et al., 15who stated that the total score of the innovation ability of the nurses increased significantly (
On the contrary, the results of the present study illustrate that all nursing students had a low level of innovation potential pre-implementation of entrepreneurship training. However, it was improved to a high and moderate level for all students post-implementation of the training. This finding may be due to knowledge and skills acquired during the entrepreneurship training that enhanced innovative awareness, innovative potential, and attitude. In addition, it helped them to foster creative skills that enabled the student to generate ideas and use the acquired knowledge to produce innovative products or services. This result was supported by Wei,34 who mentioned that entrepreneurship education provides comprehensive learning management for student entrepreneurs, helping them to establish correct values and cognitive systems, enhance their perceptions of innovation, and continuously integrate and accumulate new knowledge to shape their innovative ability and personality.
Based on the evaluation of the judiciary committee, this study reveals that two-thirds of students achieved very good and excellent levels in their abilities to produce innovative projects related to the nursing field. This finding confirms the second hypothesis that entrepreneurship training positively affects the level of nursing students in developing innovative projects. This finding is also supported by Liu et al.,22 who stated that the mean scores for innovation products of nursing students ranged between 83 and 96 out of a possible 100, indicating a medium-high level of innovation. A total of 48 out of 98 students had scores greater than 91, indicating a high level of innovation.
In order to meet the current and unexpected challenges presented by the speed of information and technology available, it is important to educate and train motivated and competent nursing students on creativity, innovation, and entrepreneurship by adapting educational methodology, scheduling time for brainstorming among teams and solving problems together, and providing financial resources and emotional support to meet the current need for innovative nursing talent for the development of healthcare services.
Developing a formal entrepreneurship program to teach nursing students entrepreneurship and innovation or integrate entrepreneurship education into nursing curriculum and practice.
Adopting the creative ideas of nursing students and sending them for training on entrepreneurship.
Provide resources that help produce innovative products and research and reward the best projects and research.
Further research is needed to study the effect of entrepreneurship training on the innovation ability of nursing students with a large sample size.
The present study’s findings showed how skills acquired in entrepreneurship education are associated with innovative awareness, innovative products, and innovative personality. By the end of this entrepreneurship training, the nursing students in this study were able to produce 19 ideas, projects, and prototypes, which is considered to be the central goal of entrepreneurship education.
Moreover, some of these projects have commercial use in the market, which may end up as business overtime and provide social and economic development for faculty, universities, and the public.
Entrepreneurship education provides knowledge and skills and may also change nursing students’ attitudes and behaviors, which could improve healthcare services.
The participants of this study were from one faculty only, which limits the generalization of the findings to all nursing students population. A small sample size limits the applicability of the results to all nursing students. Most of the students who participated in the study were in the internship year and female; this could limit the generalization of the findings. Future studies may include more male students from different classes in the faculty.