Study limitations
The study site had one of the most diverse local population in the UK. It attracted an atypical nursing student population
because of its location. There are, therefore, inevitable difficulties in extrapolating the findings to the wider population of
nursing students. Although the overall response rate was reasonable, the repeat response rate for the three time points was
low, which means that there were limits to the trend analysis which could be undertaken. A further limitation of this survey
design was the dependence on self reporting without the triangulation of results with a knowledge test. The combining of
ethnic groups [34] limits the inferences which can be made about any cultural group. While it was interesting and potentially
useful to have a very diverse population from which to draw, this also resulted in certain challenges relating to the
interpretation of the study findings. The rapid advances in technology mean that, for future use, the survey instrument will
need further validation, and refinement, and must be reconsidered in the context of the competencies expected of a newly
registered nurse at a given point in time.