Caring and effective teaching behavior of clinical nursing instructors in clinical area as perceived by their students

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  1. Alexander Decker
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    Caring and effective teaching behavior of clinical nursing instructors in clinical area as perceived by their students
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    • 1. Journal of Education and Practice www.iiste.orgISSN 2222-1735 (Paper) ISSN 2222-288X (Online)Vol 3, No 7, 2012 Caring and Effective Teaching Behavior of Clinical Nursing Instructors in Clinical Area as Perceived by Their Students Wafaa G. Ali,Adult Care Department, Faculty of Nursing, Mansoura University, Egypt. Also affiliated to Faculty of Nursing, King Khalid University Corresponding author E- mail; drwafaaali@yahoo.comAbstractNursing is considered to be an applied science. Thus clinical teaching is central to nurse education. The quality of thestudent-teacher interaction in the clinical field can either facilitate or hinder the students integration of theory topractice. It has been postulated that clinical instructors must possess caring behavior and effective clinical teachercharacteristics if they want to facilitate students entry and learning in a multifaceted world of clinical practice. Sothis study done to describe the clinical instructors’ caring and effective clinical teaching behaviors in clinical area asperceived by their students. A convenience sample of 113 nursing students affiliated to faculty of nursing, KingKhalid University, Saudi Arabia was included. Two tools for data collection were used; the first on was developed bythe researcher and it was concerned with measuring the effective teaching characteristics of the clinical nursinginstructors and the second one was the Nursing Student Perceptions of Instructor Caring (NSPIC) which wasconcerned with measuring clinical instructor’s caring behaviors. The participant nursing students has common andunique perspectives on the importance of a clinical instructor demonstrating effective teaching characteristics. Inaddition, caring behaviors demonstrated by clinical instructors were identified and they perceived their clinicalinstructors demonstrated the highest number of caring behaviors from the subscales of respectful sharing andappreciation of life’s meanings. Clinically, the results might be utilized to improve faculty awareness of students’views on their teaching performance. On the other hand, the clinical faculty can be educated and provided withuseful educational tools to assist them in providing effective clinical instructions.Keywords: effective clinical teaching characteristics, caring behavior, clinical teaching in nursing1. IntroductionClinical education, regardless of the profession or setting, is a process that has been studied from both the supervisorand student points of view to determine best practices (Lauber, Toth, Leary, et al, 2003; Laurent &Weidner, 2001).Laurent and Weidner (2001) point out that clinical education is used across many health care professions as a way topractice didactic information in a hands-on environment. Clinical training is considered as essential and veryimportant part of professional nursing education. Since nursing is a discipline based on practice, it needs to becurriculum of education that offers students the opportunity to develop their clinical skills. It comprises about 50% ofthe nursing school curriculum. Recent years have seen international efforts both to support and monitor the clinicaleducation of nursing student and derive more meaningful and sensitive clinical learning indices (Andrew and Roberts,2003).Clinical education plays a crucial role in undergraduate nursing program. Not only does it provide opportunities forstudents to apply the theory learned in the classroom to the real world of clinical nursing, it is also a socializationprocess through which students are inducted into the practices, expectations and real-life work environment of thenursing profession (Lewin, 2007). The aim of clinical education is to develop in the student the professional skillsand knowledge needed in life-long learning and critical thinking, to create self-confidence as a nurse, and to ensurethat the nurse is able to make her own decisions and be independent (Tiwari, Rose, and Chan, 2005). Clinicalteaching is a dynamic process that occurs in a variety of socio-cultural contexts. The quality of the student-teacherinteraction in the clinical field can either facilitate or hinder the students integration of theory to practice. It has beenpostulated that clinical instructors must possess effective clinical teacher characteristics if they want to facilitatestudents entry and learning in a multifaceted world of clinical practice (Papp, Markanken, and Von-Bonsdroff, 2003).Effective characteristic, in the nursing student-clinical instructor relationship, defined as a behavior demonstrated bya clinical instructor and perceived by a nursing student as contributing to a positive learning experience in the 15
    • 2. Journal of Education and Practice www.iiste.orgISSN 2222-1735 (Paper) ISSN 2222-288X (Online)Vol 3, No 7, 2012clinical setting. While effective teaching behaviors defined as those actions and activities transmitted through verbaland non-verbal interactions of the clinical instructor and facilitate student learning in the clinical setting. Nursingstudents spend the majority of their nursing education in the clinical setting with a clinical instructor. Researchstudies and standards for nurse educators supported the importance of the relationship between clinical instructorsand students (Gignac-Caille, & Oermann, 2001; National Council of State Boards of Nursing, 2005; National Leaguefor Nursing. 2002; and Wade, 2003).Nursing students learn from the behaviors, knowledge, experience and skills of their clinical instructors. Successfuldevelopment of nursing students into a professional role as caring nurses is increasingly believed to be dependent onthe quality of the clinical learning environment (Hofler, 2008; Jenkins, 2006; Laitinen-Vaananen, Talvitie, & Luukka,2007; McBrien, 2006; and Clark, 2006). Conversely, perceptions of unfair treatment by nursing faculty leads tostudent nurses voicing their concerns, leaving a program or conforming to the situation to avoid being failed(Thomas, 2003). According to Thomas (2003), some nurses still harbor negative feelings of unfair faculty treatmenteven after 10-20 years. In summary, effective teaching has been described as encompassing the traits of teachingability, professional competence, evaluations of students, interpersonal relationship, and personality traits.Measurement of effective teaching has been accomplished through students and faculty evaluation. Evaluation ofclinical demonstrators behavior in the clinical settings plays an important role in the effective clinical teachingprocess for both students who is seeking knowledge and competent, and also for the demonstrator who is seekingcompetence and doing good job. So, evaluation and assessment of clinical demonstrators behaviors in the clinicalarea by their students is an important issue in nursing education.The National Council of State Boards of Nursing (2005) recommended that improvements were needed withinnursing education and nursing student-clinical instructor relationships. Caring behaviors of clinical instructors haveemerged as an important component of the nursing student-clinical instructor relationship (Wade, 2003; Waterman,2007; Wilkes, 2006; Cook, & Cullen, 2003; and Griffiths, & Tagliareni, 2001). Caring behaviors, in the context ofthe nursing student-clinical instructor relationships was defined as those verbal and non-verbal caring actions basedon caring theory, demonstrated by the clinical instructor and perceived by the student nurses to facilitate studentlearning of professional role development, a caring attitude, clinical confidence, clinical competence andinterpersonal caring interactions (Laitinen-Vaananen, Talvitie, & Luukka, 2007; Thomas, 2003; Griffiths, &Tagliareni, 2001; McGregor, 2007; McManemy, 2002; and Sutherland, Hamilton, & Goodman, 2007).Caring in nursing practice, as well as nursing education, is certainly not a new concept. Although inherent in nursingsince the days of Florence Nightingale, for several decades, nurse scholars have begun to rigorously study and debatethe notion of caring. Nurse scholars have considered such issues as how to define and measure caring, if caring is ascience, and how to teach caring (Cook & Cullen, 2003). According to Beck (2001), the revolution ―called forenhancing caring practices by means of faculty-student and faculty-faculty relationships. As a result, students wouldlearn caring through faculty modeling of caring behaviors and experiencing caring among their interactions withfaculty and other students. Early research conducted on caring behaviors of nursing faculty was qualitative in nature.Subsequent quantitative research conducted on caring behaviors of nursing faculty used instruments non specific tocaring theory. Wade (2006) developed the NSPIC based on Dr. Jean Watson‟s descriptors of instructor caringbehaviors reflecting the 10 carative factors embedded in Watson‟s theory of human caring.Research supported the presence of an effective caring clinical instructor may influence student nurses outcomes(Laitinen-Vaananen, Talvitie, & Luukka, 2007; Thomas, 2003; Griffiths, & Tagliareni, 2001; McGregor, 2007;McManemy, 2002; and Sutherland, Hamilton, & Goodman, 2007). Wade (2006) found that when clinical instructorsare perceived as caring, nursing students develop caring abilities. Duffy (2009) believes the development of caringnurses stems from nursing programs based on caring theory. Cook (2005) found the uncaring behaviors demonstratedby clinical faculty raised the levels of anxiety in student nurses. Clinical instructors should be aware of anxietyamong nursing students and the impact of high anxiety levels on learning and skill performance.Finally from the previous review of literatures, there are two major areas of research on student-instructorrelationships have emerged as important to the clinical education of nursing students. One area is related to nursingstudent and faculty perceptions of clinical instructor characteristics considered effective or ineffective. The secondand more recent area is related to caring behaviors of clinical instructors. So this study was done to describe thecaring and effective teaching behavior of clinical instructors in clinical area as perceived by their students. 16
    • 3. Journal of Education and Practice www.iiste.orgISSN 2222-1735 (Paper) ISSN 2222-288X (Online)Vol 3, No 7, 20122. Methodology2.1 Aim of the studyWas to describe the caring and effective teaching behaviors of clinical instructors in clinical area as perceived bytheir student2.2 SubjectsA convenience sample of 113 students affiliated to faculty of nursing, King Khalid University, Saudi Arabia, wasincluded in the study. They were selected from four different levels, 26.54% from 4th level, and 26.54% from 5thlevel, 23.03% from 6th, and 23.89% from 7th level. Student’s number in each level represents the majority ofstudents enrolled in this level. Inclusion criteria include nursing student affiliated to faculty of nursing, King KhalidUniversity, had hospital clinical training experience and willing to participate in the study. The study sampleexcluded the first three academic levels because they don’t have hospital training experience to assess caring andeffective clinical teaching behaviors of clinical instructors in clinical area.2.3 DesignA descriptive quantitative research design was used to explore student nurses perceptions about clinical instruction2.4 Tool of data collectionThe data were collected by using two self-administered questionnaire sheet. The first questionnaire sheet wasdeveloped by the researcher, guided by literature review (Nahas, Nour, and Al-Nobani, 1999; Wolf, Bender, Beitz,Wieland, and Vito, 2004; Beitz, and Wieland, 2005; Whitehead, 1997; and Reeve, 1994.). It was concerned withmeasuring the effective teaching characteristics of the clinical nursing instructors and included 46 items. The 46items were grouped into 5 categories, interpersonal relationship (10 items), personality traits (5 items), teachingpractice (14 items), knowledge and experience (8 items), and evaluation procedure (9 items). The responses ofparticipants were measured on a five point Likert scale that ranged from most important (5) to not important (1). Testretest reliability was estimated it was 87% where, p
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