title: The 'bioscience problem' for nursing students: an integrative review of published evaluations of Year 1 bioscience, and proposed directions for curriculum development.
abstract: BACKGROUND
  The difficulties that nursing students have in learning human biosciences have given cause for concern for over 20 years but the problem remains.
  
  
  OBJECTIVE
  To conduct an integrative review of published primary research into the 'bioscience problem', evaluate their outcomes, and provide a contemporary analysis of potential directions for curriculum planners.
  
  
  METHODS
  A systematic search of electronic databases CINAHL, Medline, British Nursing Index and Google Scholar was conducted for empirical research studies, published between 1990 and 2013, designed to either predict performance of students in bioscience assessments in Year 1 of their studies or identify in-course curriculum delivery issues.
  
  
  RESULTS
  The search generated nineteen papers that met inclusion criteria. Twelve papers involved predictive factors for bioscience attainment and seven surveyed student views on curriculum issues. Four others that surveyed reflections of later-year students or qualified nurses on Year 1 outcomes were also retained for additional context. Prediction based on pre-admission academic achievement was not reliable. Student factors including age at entry, self-efficacy in science, and having appropriate study skills in particular appear to be confounding factors. In-course influences such as teaching strategy or lecturer skills are also inconsistent and likely to represent confounders operating at local, institutional level.
  
  
  CONCLUSIONS
  The integrative review approach enabled analysis of incongruencies between studies that have been a barrier to curriculum development. Sound admissions criteria based on pre-university academic performance show promise in resolving the 'bioscience problem' but will likely be contingent on innovative support early in Year 1 for study skills and the fundamentals of human bioscience, plus attention to local quality assurance for curriculum delivery.
authors.affiliation: School of Nursing and Midwifery, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK. Electronic address: Andy.McVicar@anglia.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: McVicar
authors.affiliation: School of Nursing and Midwifery, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK. Electronic address: Sharon.Andrew@anglia.ac.uk.
authors.forename: Sharon
authors.initials: S
authors.lastname: Andrew
authors.affiliation: Lord Ashcroft International Business School, Anglia Ruskin University, Chelmsford, Essex, UK. Electronic address: Ross.Kemble@anglia.ac.uk.
authors.forename: Ross
authors.initials: R
authors.lastname: Kemble
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001690:Biological Science Disciplines / Q000193:education*; D015986:Confounding Factors, Epidemiologic; D003479:Curriculum; D004508:Education, Nursing, Baccalaureate; D004522:Educational Status; D005181:Faculty, Nursing; D005260:Female; D006801:Humans; D020380:Needs Assessment; D011361:Professional Competence; D012570:School Admission Criteria; D013338:Students, Nursing
keywords: Biological sciences; Bioscience curriculum; Biosciences; Integrative literature review; Nursing education; Nursing students; Pre-registration; Predictive