Exploring the Effect of Problem Based Facilitatory Teaching Approach on Motivation to Learn in Nursing Education: A Quasi-Experimental Study of Nurse Students in Tanzania


 Background: Currently, there has been a progressive shortage of not only the number of frontline healthcare providers but also a decline in the quality of nursing care. Reports about unethical and illegal practices, under standard care and malpractices are not uncommon around the globe. There is a growing concern to rethink the approaches on how nurses are prepared, explore, and test novel approaches for delivering the nursing curricula. This study tested the effect of Problem Based Facilitatory Teaching Approach on motivation to learn among nursing students in Tanzania, higher learning institutions. Methods: A pre-post test controlled quasi-experimental study of purposively selected 401 participants was conducted between February and June 2018. The Auditing Inventory developed by the researcher measured FPBE and Questionnaire titled Motivation to Learn Strategies in Nursing was adopted to measure the motivation to learn, respectively. Statistical Product for Service Solutions software program version 23 was use to perform analysis. Descriptive analysis was performed to analyze sociodemographic. The t-tests were performed to determine mean score differences of the levels of motivation to learn between groups. Regression analysis was performed to determine the association between variables. This study was not a clinical randomized controlled trial and thus it has not been identified in the title and no summary of trial design, methods, results, and conclusion. Results: Findings revealed that 65.8% of the study participants were males. The post-test results on Intrinsic motivation to learn indicated higher mean scores changes (p<0.01). Participants in an intervention group were 1.720 (AOR) times more likely to develop intrinsic motivation to learn than the control group (p<0.05). Moreover, FPBE was less times likely to enhance Extrinsic motivation to learn (AOR = 0.676, p>0.05) and Amotivation (AOR = 0.538, p>0.05) in learning among nurse students respectively respectively. Conclusion: FPBE had a positive effect on the intrinsic motivation to learn than conventional teaching pedagogy. Thus, FPBE has the potential to positively change the spectrum of nursing competency and quality of care. Recommendations were given based on the findings.

Motivating nurse students to learn while they are at school has been observed to bring hope in producing graduates who will be able to address societal health needs and create contemporary society's awareness of the current educational systems, management of nursing education systems, and blend well with the advanced science and technology (17). It is an essential component to ensure competent graduates who can exhibit safe, ethical and legal practice and is a critical issue in the nursing education grounds (14, 16,18). Duiker (10) found out student's motivation in education is often driven by two questions "Can I do this task?"(Beliefs on one's capabilities, belief about factors which cause success and belief about one's low in uence on success) moreover, "Why am I doing this task?" (Task valuesinterestingness, importance, utility, goal orientation). Gattinger (15) embraces that, the choice and volition regulate students with autonomous motivation. Autonomously motivated students to study in a self-empowered or self-directed manner. Intrinsic motivation is the highest level of autonomous motivation. Students with intrinsic motivation study because studying in itself is enjoyable or interesting. However, also more identi ed forms of extrinsic motivation are considered to be autonomous (20).
These students will have an extrinsic reason for studying, but that reason integrates with their fundamental goals and needs. For example, a psychology student may voluntarily choose to invest effort in a statistics course, even if s/he does not nd this enjoyable because this course will help him or her achieve a major life goal: becoming a psychologist (21). In other words, tasks that are interesting or relevant can elicit autonomous motivation. Regarding goal orientations, the assumption is that autonomous motivation has close links with mastery goal orientation.
Researchers describe controlled motivation, on the other hand, is regulated by internal or external pressure. Students with introjected motivation run by internal pressures such as shame or guilt. Students with external motivation are keeping pace by external contingencies, such as demands of others, the threat of punishment, or extrinsic rewards. The concept of introjected motivation closely aligns with having a performance goal orientation, whereas the idea of extrinsic motivation is assumed to have positive associations with instrumental motivation/high utility value in an FPBL environment (14,22,23). In addition to autonomous and controlled motivation, motivation is distinguished. Amotivation is written off as the relative absence of motivation. It is a state in which students lack an intention to act and a sense of personal causation. Amotivation can occur when the task or activity is not valued when students do not feel competent to do a task, or when they believe acting will not lead to the desired outcome (17).
The curricula in nursing institutions are challenged to motivate nursing students to acquire appropriate skills that will allow them to offer high-quality care to patients/clients (11). Challenges are still on enhancing student's intrinsic motivation (to know), intrinsic motivation (toward accomplishment), and intrinsic motivation (to experience motivation) rather than extrinsic motivation (Identi ed), extrinsic motivation (Introjected), extrinsic motivation (External regulation) and decrease Amotivation. A lack of motivation for nurses will not only burn them but may also have destructive effects on the health of society and result in a waste of time and money. It is inevitable however for faculty members, managers and consultants to take a look at employing FPBE teaching pedagogy in nursing programs in order to enhance motivation to nursing students.
A global strategic direction 2016-2020 is to strengthen nursing and midwifery education. It has begun involving various stakeholders (expertise) and empowering educational system organs. They include academicians, policy-makers, government chief nursing, and midwifery o cers, professional associations, educational institutions, individual nurses and midwives, non-governmental organizations, students and civil society to solve the noted education discrepancies (24). The emphasis also has been on the adoption and utilization of competency-based curricula in various educational systems.
Tanzania is among Sub-Saharan African countries, which has adopted competency-based curricula.
However, no evidence shows how Health Science Colleges/Universities have changed to cater to new demands (4) However, no matter what happens, educators continue being challenged to motivate and prepare students for the future they cannot predict, and if they do not prepare them to be life-longer learners, they are doing them as dependent nurse professionals. Tutors and lecturers, still focus on developing course contents along with traditional instructional-based pedagogies with the hope that, learners will be motivated and develop the intended knowledge and skills automatically (25).
Educators nd themselves utilize instructional teaching methods (traditional) more often because it is cheap, easy to implement, can cover an extensive course content at once and suitable for a large group of students (17). Professional schools subsequently are still having a di cult time in assisting their students to be motivated to learn in program modules (14). Likewise, students are trained in such a way they associate teaching and learning as the process, which involves preparing for a test or earning a grade (26). However, competency-based curricula aligned with facilitation in the problem-based environment (FPBE), has been seen to be a robust educational solution (27). PBL is a teaching pedagogy that uses real-world problems as the motivator of student's self-directed learning process and makes students break the culture of academic silence within the classroom and outside the classroom (28).
Problem-based learning (PBL) pedagogy is rooting in a constructivist instructional approach (learnercentered). It began in the early 1760s at the medical schools at McMaster University in Canada whereby in the 1970s, the University of New Mexico with support from McMaster set a program and showed effectively working for students to be lifelong learners (29). Its aims were to motivate and help students construct an extensive and exible knowledge base, develop effective problem-solving skills, become an effective collaborator, develop competences in their learning process.
Its emphasis is on academic motivation and knowledge construction rather than knowledge transmission. It motivates and makes students be a source of knowledge and skills. It advocates the philosophical and psychological concepts which assets students not taken like a blank slate (tabula rasa). They can build up new knowledge from their existing one (zonal of proximal development) while scaffolding being the support to help them achieve their signi cant developmental potentials (30).
Students in the problem-based environment demonstrate more enthusiasm and interest in the subject matter. It was seen to be a useful instructional alternative to conventional teaching pedagogy as many medical education students, could not see the relevance of rst-year course materials like Anatomy and physiology to their future profession (32). Under FPBE pedagogy, the delivery of teaching materials is done by projecting questions or problems and let students discover the solutions on their own which are then the entire class (20).
Students are given opportunities to explore, investigate, analyze, synthesize, and carry out experiments and eventually reach their conclusions. The instructor's roles are just to facilitate, direct, guide, and assist students to be motivated to learn. The instructor poses questions to the entire class and students in teams work together to discuss and reach an agreement on their answers, which then they share in the class (19,33). The teaching and learning environments are set to favor the implementation of facilitation in the problem-based environment. Its assessment process was through an observational checklist or scoring rubric according to the educational psychology, and philosophical criteria set out by the teacher, peer scoring, self-evaluation, portfolios, and critical incidents or anecdotal (34).
In the face of pons from the use of PBL pedagogy in delivering course content among students, it is argued that instructors are hesitant to try this method, as it requires additional planning. They often feel as if they are diminishing their professional reputation. They see themselves not doing their job especially when students are working together and actively discussing the materials instead of busily taking notes (35,36). They nd themselves switch into lecture-based instructional pedagogies, as they are always ready-made and prescribed by the state or professional bodies and they need no extra preparation before teaching (37).
What is lacking; is understanding to what extent can new teaching methods like FPBE pedagogy be an alternative and effective teaching pedagogy in improving learning motivation to nursing students in solving real-world problems, (27). Available ndings do not adequately show clearly whether course instructors are actively implementing facilitation in problem-based environment pedagogy as a means to motivate students to learn. There is a scarcity of locally nursing scholarly literature, on the subject in Tanzania. Likewise, little has been done to demonstrate the means through which Tanzanian nursing training institutions are actively implementing new instruction pedagogies (4).
The current study aimed at determining the effect of FPBE teaching pedagogy on motivation to learn among undergraduate nurse students in higher Tanzanian training institutions. It was guided by speci c objectives including determining the effect of FPBE pedagogy on the level of intrinsic motivation, extrinsic motivation, and Amotivation to learn among undergraduate nurse students in higher learning institutions within Dodoma city. The null hypothesis was used to determine the effect of the independent variable over the outcome variable, which stated: "there was no signi cant difference in the levels of motivation to learn between nurse students under FPBE and their counterparts in the NFPBE in a higher learning institution, Tanzania."

Study Design and Approach
The study was a pre-post test quasi-experimental with a controlled study of random allocated learning institutions (to either be in an intervention or control group) through a simple random sampling technique by lottery method, which was done by the research assistants. The researcher blinded the study participants and research assistants about their allocation to either the intervention or the control group prior to the study. Pieces of paper labeled "institution one and institution two", were then folded into a box and shacked by the research assistant. Then the rst pick of papers after opening it was assigned to an intervention and the second to the control group. The study participants were purposively selected 401(interventional group = 134 and control group = 267) by the researcher and research assistants.
The participants were undergraduate nurse students from selected government and private-owned higher learning institutions in Tanzania. This population was among the greatest expected workforce in the nursing profession who could work in various health facilities to render health service among people. If they would graduate competently under proper and excellent academic preparation, it would help to improve the quality of health services to the society at a low cost. The quantitative research approach was employed to determine the extent FBPE could improve levels of motivation to learn among nurse students.
The study included undergraduate nurse students, who were admitted and registered directly from higher education and stay in/out the campus in the respective Universities as per the semester schedule. Moreover, nurse students, who were not repeating the year of studies or transferred in from other Universities or upgrading, students who had a regular attendance of classes and those who gave a written informed consent (willingness to join the study) prior to the commencement of the study. Matching of the study participants by their social demographic and academic characteristics was also done to ensure the similarities.
The sample size was determined by using ndings of Shahin et al., (38), who did a study on the critical thinking and self-directed learning as an outcome of facilitation in a problem-based environment among nurse students. The study found that there was a statistically signi cant difference in mean scores for SD 16.44 in an intervention group (A) and SD 14.45 in the control group (B). A WinPepi Software program (sample size calculator) version 11.65 was used to calculate the minimum sample of this study. Effect size (d = 4.5) of demonstrating a statistically signi cant difference between mean values of the before and after the intervention, was set at a 95% con dence interval. A signi cance level was set at 5% (p < 0.05) with the power of 80%. The ratio of sample size was B: A = 1:2.

Study Location
The study was done between February and June 2018 in the two major Universities within Dodoma administrative region and currently the Capital city, Central zone of Tanzania. The pre-post written test was used to collect and compare data before and after an intervention. The interventional group learned the prepared research content by using FPBE pedagogy whereas their counterpart (control group) learned by using the conventional-based instructional method.

Data Collection Process
No kind of harm (be physical, emotional, social, spiritual, cultural or economic) occurred to the study participants throughout the study. Before the commencement of data collection, written informed consents were obtained from the study respondents that helped the research to be assured about their willingness to participate in this study. To ensure privacy and con dentiality, all the study participants gathered in a room that was offered by the deans of the respective learning institution and given brief instructions on how to ll the questionnaires. Then, the researcher and research assistants distributed copies of questionnaires among the study participants and supervise the process of lling them throughout data collection. All participants answered the same questions before and after an intervention. Any point that needed clari cations, the researcher or assistants responded accordingly. Anonymity was ensured by excluding the study participants' names from the data collection instruments.

Data Collection Tools
The instrument used for data collection was a structured Questionnaire titled Academic Motivation Scale (AMS-HS 28): adapted from AMS -College Version 1993 and validated by Haugan et al., (39). The tool was used for assessing levels of intrinsic motivation (towards knowledge, accomplishments, and stimulation), extrinsic (introjected and identi ed regulation), and amotivation among undergraduate nurse students. It had 28 items with 140 scores on a 5-point point Likert scale. Scale 1 = does not correspond at all, 2 = correspond a little, 3 = corresponds moderately, 4 = corresponds a lot and 5 = corresponds exactly. Part A of the instrument elicited information about demographic data (e.g. age, sex, education level of the student, accommodation status, etc.). Part B elicited information about levels of motivation to learn adopted by students in their learning processes. This part covered three aspects (Intrinsic motivation, extrinsic motivation, and Amotivation to learn).
Intrinsic motivation was assessed by using a twelve (12) 5-point Likert (≥ 6 scores were de ned as intrinsically motivated) scale items, extrinsic motivation twelve (12) items (≥ 6 scores were de ned as extrinsically motivated), and Amotivation to learn 4 items (≥ 2 scores were de ned as intrinsically motivated). The overall motivation to learn among the study participants was then computed that had a cut-off point in this study was set at 70 scores from 140 total scores of the scale items. The study participant, who scored ≥ 70 of the scale items, was de ned as motivated to learn otherwise not.

Development and Classroom Tryouts of the Research Teaching Guidelines
Auditing inventory (AI), developed by the researcher, was used to collect experts' and students' opinions of the developed research teaching materials after each classroom tryouts before the actual eld testing. The developed material was tried out in the classroom for three phases (phases 0, 1, and 2) (40). Phase 0 was the development phase while phases 1 and 2 were for classroom tryouts. The third version was subjected to the eld-testing. Classroom tryouts for phases 1 and 2 were done in one sampled health training institution, which was different from health training institutions where the study was conducted. All classroom tryouts involved 10 nurse students, researcher, 2 research assistants, 1 curriculum development expert, 1 over ve years experienced nurse tutor in teaching leadership and management content.
Experts and student's opinions of one classroom tryout led to the development and re nement of the next version. Auditing inventory covered a number of aspects including the relevance of the content, content organization, organization of learning experiences, timing, dosage, frequency, and evaluation strategies. The topics were drawn from the Leadership and Management course, which was found within the undergraduate curriculum for Bachelor Degrees in Nursing Program. The researcher developed the illstructured scenario on con ict resolution strategies at a working area with assistance from the curriculum development expert and nurse tutor who had over 5 years of teaching experience in nursing courses.
The evaluation process of the developed research teaching material was done formative and summative basing on the experts' and students' opinions. All observations from experts and students were only used to assure the acceptability, feasibility, and practicality of the research teaching and learning material before actual eld implementation.

Validation and Reliability of the Research Instruments
All research tools were shared with experts and senior colleagues for their review, inputs, and opinions to ascertain their validity before classroom tryouts (done in phase 0). Modi cations were effected to ensure that only the recommended content and items were administered among the study participants.

Facilitation in a Problem-Based Environment Sessions (Intervention)
This part served as an actual implementation phase, which involved the followings; Introduction and Group Formulation this part was covered in the rst day of the study for introducing the FPBE and familiarizes students with the researcher and research assistants. The researcher introduced the FPBE process and shared the expected terminal behavior throughout the FPBE classes. Students were then randomly assigned to the learning groups (8 students) per each whereby they were asked to appoint a leader and record keeper between himself and herself. This part took approximately 30 minutes.
Problem Presentation, Solving, and Discussions the researcher and research assistant before its commencement to avoid groups going off track reviewed objective of each session. Each group was asked to seat in the round so that they could maintain eye contact and facilitate the easy ow of discussions. Thereafter, each group was given the developed scenario on Con ict Resolution at the working place and allows the students to start addressing it. Participants were guided and facilitated by the researcher and research assistants to solve the problem, listing what they knew, what they did not know, what they needed to know and establish the issues to learn.
Students were guided to clarify, rank, and assign learning tasks to each member of the group. They were then guided to identify and suggest the reasoned available resources needed to solve the presented problem and continue solving it. This part took approximately 60 to 120 minutes based on the institution schedules. Then, students were given one week to address the problem until the next scheduled time because there would always-learning issues to be explored about the problem. As part of the closure, the researcher and research assistants required either students to communicate by mobile texts, orally or writings through email whenever they need any help or clari cations. In the next meeting, presentations of the solved problems were done per each followed by discussions and sharing of real-world scenarios, which re ected their experiences in real life. Misconceptions and other myths got a chance to be cleared and participants have to gain new knowledge and skills about how to address con ict in working areas once they occur.
Group Facilitations this study used two forms of facilitating the groups including researcher and research assistant facilitation and group leaders' facilitation. Group leaders were sometimes used to facilitate groups because the classes were so large. They were brie y instructed to act as facilitators on how to monitor and control the learning process in their groups. They were given the roles of moving from one group to another, ask probing questions, and give encouraging words, which in turn could help to serve students who would nearly drop or withdraw from the study.
Assessments after completing the FPBE classroom sessions, the researcher, assistant researchers and students, evaluated the lesson objectives by providing inputs, students learning behaviors, advantages and disadvantages of group interactions and the bene ts of learning through FPBE. Peer assessment was the main method used to assess the learning process among participants. The posttest to assess end line levels of motivation to learn was then administered to the participated students to ascertain the effect of FPBE.

Data Analysis
Descriptive and Inferential statistical analyses were performed in this study. All the statistical analysis was performed using the Statistical Product for Service Solutions (SPSS) version 23. The study ndings were presented in tables. Descriptive statistics by the means of chi-square and cross-tabulation statistical tests were performed to determine the relationship between categorical variables and ndings were presented in frequencies, percentages, mean scores, and standard deviation (SD). Paired-sample and independent samples t-tests were performed to compare the mean scores differences among the study participants within and between groups whereby to mean (M), standard deviation (SD) and p-value were used to present the ndings in tables. Inferential statistical analyses were performed through regression analysis to determine the association between variables. The ndings were presented in tables by odds ratio (OR), adjusted odds ratio (AOR), p-value that was set at ≤ 0.05 to be statistically signi cant at 95% con dence interval (CI).

Results
Demographic characteristics of the study participants Table 1 shows the distributions of the study participants' gender, age, marital status, and accommodation status. It was observed that 65.8% of the participants were males and 34.2% females.. 73.6% of the participants have age ranging between 25 to 29 years and it was a dominating age group in this study. In addition to that, 92.5% of them were singles against those who were married. 69.3% of the participants lived on campus. No statistically signi cant difference in their gender, age, and marital status distributions between groups (p > 0.05). A signi cant difference was observed in the accommodation status of the participants between the two groups (p < 0.01). Other important participants' characteristics (interest, reasons, satisfaction, learning bene ts, and learning di culties), which could in uence motivation to learn (n = 401) As shown in Table 2, 73.8% of the participants were interested in the nursing profession and its programs while 52.4% of them had chosen the nursing profession, as their rst "own choice" and 20.9% due to parent's/peer pressure. Moreover, 75.3% of the participants were satis ed with nursing courses being taught to them whereas, 84.0% of them agreed that the teaching and learning practices were of a bene t to their learning processes. However, 30.7% of the participants reported experiencing some di culties in comprehending course contents due to its complexity, limited time (25.9%) and di culties in accessing learning materials (20.0%). Some ndings differed between groups as it is shown in the table.    (Table 3).

Amotivation to Learn
The study ndings in Table 3   Chi-square test and cross-tabulation were done to determine the relationship between categorical variables under study. It was found that FPBE teaching pedagogy and the reasons which made students join the nursing program were signi cantly related to the intrinsic motivation of the undergraduate nurse students to learn (X 2 = 7.041 a , p < 0.01) and (X 2 = 9.903 a , p < 0.05) respectively. Other variables that did not show a statistically signi cant relationship with intrinsic motivation as shown in Table 4. The effect of FPBE on intrinsic motivation, among undergraduate nurse students between FPBE and NFPBE groups Binary and multinomial logistic regression was done to determine the extent to which FPBE and the reasons that made nurse students join nursing programs had in motivating them to learn. Findings in Table 5 below indicate that participants in an intervention group were 1.720 (AOR) times more likely to be motivated to learn against participants in the control counterparts (p < 0.05, CI: 1.122, 2.635). However, the reasons that made nurse students join nursing programs had no in uence on motivating students to learn when adjusted to other variables (p > 0.05). Factors related to and the effect of FPBE on Extrinsic motivation, among undergraduate nurse students between FPBE and NFPBE groups Extrinsic motivation furthermore, was another variable studied under the learning motivation. A chisquare test and cross-tabulation were performed to test the relationship between categorical variables. Findings in Table 6 below show that FPBE teaching pedagogy was related to extrinsic learning motivation of the undergraduate nurse students (X 2 = 9.876 a , p < 0.01) and accommodation status of students likewise showed to be related to their extrinsic motivation to learn (X 2 = 11.421 a, p < 0.01). Other variables did not show signi cant relationships under this aspect as shown in the table. The effect of FPBE on Extrinsic motivation, among undergraduate nurse students between FPBE and NFPBE groups As shown in Table 7 below, a univariate and binary logistic regression was performed. Participants who were exposed to FPBE pedagogy were 0.676 (AOR) times less likely to be extrinsically motivated to learn than participants who were exposed to conventional teaching methods (p > 0.05, CI: 0.405, 1.129). On the other hand, participants who were living on the campus were 0.591 (AOR) times less likely to be extrinsically motivated than the participants who were living out campus (p > 0.05, CI: 0.349, 1.002). Chi-square and cross-tabulation tests were employed to nd out the relationship between variables.  The effect of FPBE on Amotivation, among undergraduate nurse students between FPBE and NFPBE groups A univariate and binary logistic regression was performed to determine the association between FPBE teaching pedagogy and the state in which, nurse students were demotivated to learn. Table 9 below signpost that, participants who were exposed to FPBE teaching pedagogy were 0.538 (AOR) times less likely to experience amotivation to learn than their counterpart participants in the control group (p > 0.05, CI: 0.283, 1.022).

Discussions Of The Study Findings
Socio-demographic characteristics of the study participants The current study noticed many male students (65.8%) joined the nursing programs as their rst choice compared to females. These are discussed in this study to be one of the successes the nursing profession is earning in its revolution as compared to the past where female nurse students were many. However, these ndings do not line up with those found by Kusumawaty, Kumara, Emilia & Haryanti (41) and Sabzevari, Abbaszade & Borhani (42), which showed that majority of females selected to join nursing as their rst priority.
The variation above could be contributed to the day to day awareness creation about nursing programs and its career paths through various Media, advanced roles of nursing and the need for more quali ed nurses' professionals. It is worth to observe both females and males selecting nursing as their pathway to advance their educational careers, for the sake of serving the community, as they were prepared for the patients' care responsibilities. On the other hand, it was worth too to observe a great number of men joining the nursing profession as this would clear out the belief which has existed for a long time that nursing was for females.

Intrinsic Motivation in Learning among Undergraduate Nurse Students
Motivation has always been the central issue in nursing education and even been referred to as the most complex and challenging issue, facing educators, and students today. Various teaching modalities are tested in different settings and programs to help motivate students to learn on their own with minimal support from educators. It has been observed in the current study that FPBE teaching pedagogy had a positive in uence on intrinsic learning motivation among undergraduate nurse students. Students would demonstrate the ability to know what to learn, accomplish the learning activities and experience stimulation to learn more and more. Participants in an intervention group demonstrated highly learning the motivation for the pleasure as they felt teamwork and being occupied with learning tasks to be of importance in their academic life.
These ndings match with those found by Gaber et al.,(14), which revealed problem-based learning could enhance learning force within a student, which in uenced and directed behavior and willingness to put efforts, into achieving a goal or reward by decreasing their tension caused by their needs. Based on these facts, the researcher observed that FPBE teaching pedagogy could positively make nurse students, to become intrinsically motivated to learn and thus, become autonomous learners. This tells nursing educators that, when developing nursing curricula, course contents and other teaching and learning materials should make usage of FPBE teaching pedagogy in order to make nurse students are intrinsically motivated to learn.

Extrinsic Motivation in Learning among Undergraduate Nurse Students
This is an aspect that de nes the ways students are motivated to learn through the in uence of external stimuli such as environments, peer pressures, punishments, rewards just to mention a few. Undergraduate nurse students who were exposed to FPBE teaching pedagogy in this study nevertheless were fewer times likely to be extrinsically motivated to their learning process when compared to the participants who were under conventional teaching pedagogies. Nurse students demonstrated a motivation to learn without being in uenced by external stimuli.
The status of extrinsic motivation was also observed among nurse students who were living on campus who were noted to be fewer times likely to develop the extrinsic motivation to learn, as compared to those who were living outside the campus. Burse students in the control group were learning for being identi ed or recognized by others that they were able to know and solve issues. They demonstrated a highly motivated to learn by adopting the values or attitudes they were impressed to in order to be accepted by others in their learning process. Moreover, nurse students in the control group were highly motivated to learn due to the institutional regulations, principles, order, or rules Amotivation to Learn among Undergraduate Nurse Students This aspect measured the level to which nurse students were discouraged to learn by the teaching pedagogy, which was used in this study when controlled with other factors. It was found that participants who were exposed to FPBE teaching pedagogy demonstrated to be less demotivated in their learning processes, as compared to those in conventional teaching pedagogies. This has been discussed in this study to be attributed to the new teaching modality in the nature of FPBE with its associated setups.
These ndings are not new as they link with those found by Khamoushi et al., (26), which revealed low academic achievements of undergraduate nurse students, to be attributed to the type of teaching pedagogies that educators used. The more the didactic teaching methods were used, the more students were demotivated to their learning process when compared to the usage of constructive teaching pedagogies. They then concluded that there was a necessity to respond appropriately in order to improve student's academic achievements.

Conclusions
This study builds on and extends the earlier research on the effects of FPBE on teaching and learning processes. It based on social constructivism, which believed in collaborative learning among undergraduate nurse students with reference to the development of motivation to learn. A well-developed and structured FPBE strategy have shown to be useful and feasible in the Tanzanian perspective in in uencing intrinsic motivation to learn among nursing students in Tanzania. The success of FPBE was attributed to the provision of an opportunity for student's interactions and the fact that students were able to view the learning pathway in the motivation to learn. This was done through the vantage point of problem identi cation; they were able to propose learning issues, practice knowledge research and sharing, and then revisit the scenario to solve particular real problems.
The ndings do throw light that FPBE teaching and learning pedagogy can positively in uence the levels of intrinsic motivation to learn among students. Thus, the move to adopt facilitation in a problem-based environment teaching pedagogy in Tanzania is worth considering and needs to be continued. The elements of the FPBE, which were used in the current study, have the potential contributions to the development of competent graduate nurses. The quantitative ndings of the current study, cannot offer any obvious and strong evidence of sustained development of motivation through conventional teaching methods.

Limitation Of The Study
During the implementation phase of this study, group leaders were trained to act as facilitators. This would affect their full participation in solving the presented problems and even make their colleagues not to take into serious their learning roles.

Contributions To The Literature
Profession associations as welfare organs may be enlightened about the need to incorporate Facilitation in a Problem-Based Environment (FPBE) into reproductive health educational curricula.
Findings from this study give light to educational program developers about conditions under which curricula innovations in the nature of FPBE can work in this case.
Findings constitute a vital knowledge necessary for instructors on how to design and implement curricula basing on FPBE Researchers will also use the results as baseline data for further interventional studies or projects in the nature of FPBE