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Student Perceptions of CARING

in Online Baccalaureate Education


KATHLEEN SITZMAN AND DEBRA W O O D A R D LENERS

ARING IS A BROAD TERM THAT ENCOMPASSES MANY MEANINGS.

C
Most definitions of caring include the concept of one person mindfully and
appropriately attending to the spoken and unspoken needs of another. Caring
has long been associated with the nursing profession, initially in the form of
nurses caring for clients, and then extending to nurse educators teaching
nursing students (1-3). Educators convey caring
values through active teacher/student dialogue and modeling, there- ABSTRACT The concept of car-
by perpetuating caring as a core value in nursing (1). • The phe- ing in nursing education is founda-
nomenon of caring in nursing education has been explored within tional. Knowledge development
the context of one-to-one interactions as found in typical classroom regarding caring in face-to-face
settings. There, faculty and students are in close enough proximity classroom settings, effective online
to experience the other's voice, body language, facial expressions, teaching approaches, differences
and shared physical context (1-14). Online interactions are different between online and face-to-face
(15-18), and the question of whether these interactions engender an classroom settings, and supporting
environment of caring is unanswered. This question has become a student success in online settings
concern for nurse educators who have responded to the need for is extensive. However, the question
more widely available nursing education by creating online nursing of whether caring can be effectively
courses and/or programs (18). • Is it possible for nurse instructors conveyed in online nursing class-
to convey and model caring in online classroom environments? room settings remains unan-
Watson discusses this phenomenon: "This non-linear, free-associa- swered. This qualitative study
tion format of hypertext, multimedia, multi-sensory juxtaposition of explored the perceptions of one
pictures and words creates a new form of expression: three-dimetisional, cohort of RN to BSN students

colored, animated symbols for interaction versus an ordered linear textregarding how instructors convey
that is passively read. This new order of human experiences and real- caring in online education. Thir-
ities facing people in the 21st century is a quite different scenario from teen students were emailed sur-
the mindset ofthe middle to late 20th century....On the other hand, the veys consisting of eight open-ended
mind-to-mind, consciousness-to-consciousness connection in the questions; 11 students responded.
world of cyberspace creates a disembodied human-to-human connec- Eight themes emerged from the
tion and, often, an intense personal intimacy with strangers and data: frequent feedback, timeliness,
friends alike but void of an embodied physical relationship" (19, p. reciprocity of caring online, per-
sonal connection and empathy,
201). • It is important to understand how caring is conveyed in online ver-
clarity, multiple contact opportuni-
sus face-to-face classroom settings.This article reports on a qualitative study
ties, second-fiddle worries, and
conducted to clarify those factors that baccalaureate-level nursing students
teacher's commitment to learning.
felt created a caring online environment.

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CARING IN O N L I N E EDUCATION

Review of the Literature Studies addressing excellence in nurs- area with familiar surroundings and occurs in a specific time and
ing and online education have covered a variety of topics that relate space. Transformation to a portable, anywhere, anytime environ-
to caring online. These studies fall under several broad categories, ment can result in loss of familiar landmarks" (18, p. 77). They
including caring in face-to-face nursing classrooms, student satis- stated that for optimal effectiveness, it was essential for online edu-
faction with online nursing classrooms, best practices in online cators to deliberately rethink their approaches to teaching.
educational settings, and student success/satisfaction with online ' BEST PRACTICES IN ONLINE EDUCATIONAL SETTINGS
education. Each category is discussed. Currently, accepted best practices for online nursing education
CARING IN FACE-TO-FACE NURSING CLASSROOMS A num- are based on scholarship in the general area of online education.
ber of studies identify traits that are characteristic of caring envi- Best practice guidelines
ronments in traditional nursing classrooms. Miller and colleagues address effective com-
reported that "an essential dimension of the caring interaction is niunication strategies, Timeliness meant that
the faculty's holistic concern for the student, personally and acad- technical components,
emically. Students identify caring teachers as being nonjudgmen- and approaches to cur- the teacher promptly
tal, respectful, patient, available, dependable, flexible, supportive, ricula (20-43).
open, warm, and genuine" (10, p. 129). Simonson (12) reported that Ali and colleagues
and consistently responded
traits of caring teachers include genuinely caring about what hap- (20) studied students'
pens to others, sensitivity to the uniqueness of each student, pro- p;erceptions of online to emails, postings,
moting awareness of self in each student, cultivating acceptance of learning and formulated
differences in others, sharing genuine life/professional experi- recommendations for and phone calls,
ences, and provision of a supportive emotional, sociocultural, and faculty. They can be
spiritual environment. summarized as follows: and also promptly and
Dillon and Stines (6) described a series of caring behaviors and 1) have goals of learning
traits on the part of teachers. These included: honesty, respect, (develop learning out- continually acknowledged
understanding, kindness, and compassion; taking extra time, fol- comes within context of
lowing through, and remembering details; positive reinforcement meaningful activities, work received and
and praise; individualized one-to-one instruction; attentive and create learning experi-
nonjudgmental listening; smiling and exhibiting a sense of humor; ences based on previous grades earned.
sensitivity to students' needs; and positive role modeling. knowledge, employ
OVERALL STUDENT SATISFACTION WITH ONLINE NURSING problem solving, reasoning, and critical thinking strategies, and
CLASSROOMS Ryan and colleagues (17) compared nursing stu- engage in activities that require reflective and active participa-
dent satisfaction with online learning and learning in traditional tion); 2) set conditions of learning (provide a realistic and relevant
settings. In one face-to-face classroom setting, content was covered online classroom environment with opportunities for social inter-
more adequately, with greater interaction and participation due to action and negotiation; employ multiple learning modes; encour-
the immediate availability of verbal and nonverbal communication age independence and autonomy; and support student self-evalu-
and the physical availability of the instructor and classmates. Stu- ation and ownership of the learning process; and 3) provide meth-
dents described the online setting as providing opportunities for ods of instruction (clearly state learning outcomes; use course
independence in learning and assignment completion, fuller par- management tools creatively; and ask students how they prefer to
ticipation of all classmates, learning from classmates as well as the learn, assessing learning styles and designing/redesigning assign-
instructor, and improvement of technical and writing skills. Stu- ments accordingly). They also recommend providing timely feed-
dents also commented that not having to go to the campus for back, returning assignments within a reasonable time period; giv-
class saved time and money. Negative aspects of online learning ing students the opportunity to critique each other's work; recog-
reported by students included feelings of isolation and insuffi- nizing excellent work; appreciating differing perspectives; and
cient interaction and spontaneous discussion. Also of concern for ensuring that technical problems are resolved promptly. Caring
students was lack of clarity regarding how well one was perform- online is not specifically discussed.
ing in the class at any given time.
Ryan and colleagues summarized the general difference Method PERSPECTIVE The data were verbal and subjective in
between online and face-to-face nursing classroom environments as nature, and consisted of written responses to the following open-
follows: "Teaching in the classroom provides a defined physical ended questions:

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C A R I N G IN O N L I N E EDUCATION

• Define caring as it occurs in a student-instructor relationship. meant that starting early in the semester and continuing through-
• Is it possible for an instructor to convey a sense of caring in an out the entire semester, the teacher created postings and email
online classroom setting? If so, how? If not, why not? messages that were respectful, constructive when improvements
• Does presence or absence of caring on the part of the online were needed, and positive and encouraging whenever possible.
instructor influence your success in the class? If no, why not? If The following quotes from respondents illustrate this theme:
yes, in what way? • "/ would suggest that interaction and ongoing feedback is so
• What factors support the experience of "students feeling cared important. I would have just thought this is how online is — you are
for" in an online setting? on your own, no one really cares. There were problems that only the
• What factors do not support the experience of "students feeling instructor that was online with us at least twice or more a week
cared for" in an online setting? picked up on, and offered to help. Letting us know that they were
• What guidance would you offer to instructors who wish to con- there...by actually reading what was posted fby students] and
vey a sense of caring to online students? responding — let the students know that there was someone there
Responses were obtained via email. Aspects of textual analysis that really cared."
and narrative analysis were used to explore the data. • "/ believe that there is definitely a way to convey a sense of car-
SETTING AND PARTICIPANTS The study was conducted at a ing. After only one semester, I have a real affection toward those
state university nursing program. Thirteen students who completed instructors who were making regular contact with me as the student.
their course work online, seldom visiting the main campus, were I would rush to the computer every day hoping for some feedback
sent a survey via email. The students, who ranged in age from 24 about my assignments. Just a 'nice job' or 'good work' made all the
to 48 years, were registered nurses enrolled in an RN to BSN pro- difference in the world when it came to my perceptions of my instruc-
gram. By the time they received the emailed questions, they had tors.... Frequent contact would be my number one suggestion for
completed one full-time online semester of nursing study. instructors to express a caring attitude...."
DATA COLLECTION An introductory note explained that no • "A student does not feel cared for when they continue to be frus-
penalty would be incurred if students chose not to participate in the trated because of a lack of response to their questions. Students feel
study; responding to the survey questions constituted consent. The neglected when we receive no feedback on our assignments and do
students were given four weeks for emailing responses back to the not have a clear understanding as to what we are doing wrong."
researcher. To ensure anonymity, responses were copied, cut, and TIMELINESS Nine respondents discussed the importance of
pasted into randomly numbered Word documents. The original timeliness on the part of the instructor when interacting with online
email transmissions were deleted, leaving no means of matching students. Timeliness meant that the teacher promptly and consis-
responses to respondents. tently responded to emails, postings, and phone calls, and also
DATA REDUCTION AND CODING The data reduction and cod- promptly and continually acknowledged work received and grades
ing process was based on procedures described by Cheek, McKee, earned. The following quotes illustrate this theme:
and Riessman (44-46). The approach included reading and reread- • "Papers should be returned in a timely manner.... They fthe teach-
ing the original written narratives, coding key utterances, reorga- ers] should respond to messages in no later than two working days."
nizing copies of text into themes, and collapsing categories where • "Students rely on technology to submit assignments [sic] they have
needed after further analysis. no sure way of knowing something was received unless the instructor
informs them. Without frequent updates some students may think they
Results Eleven students, two males and nine females, responded are caught up yet may in reality be missing assignments."
to the email surveys. All respondents answered all six questions in • "An instructor can convey a sense of caring by answering ques-
narrative format. Verbatim, untraceable transcripts were made of tions in an appropriate, timely manner; not having weeks go by
all responses. before answering the question, usually by then it doesn't matter any
Eight themes emerged from the data. Results were emailed to more....This instructor fwho demonstrated caring] would always
the original cohort with a request for comments. The responses answer our questions, usually in a day or two."
indicated that the eight themes matched student perceptions. The CARING ONLINE IS RECIPROCAL Eight respondents discussed
themes described below are illustrated with representational quo- the belief that caring online is a reciprocal process that requires
tations from the respondents. commitment to teaching and learning on the part of student and
FREQUENT FEEDBACK Nine of the 11 respondents discussed teacher. Reciprocal caring online meant that to support success,
the importance of frequent feedback in creating an online environ- teachers and students took responsibility for the learning process.
ment of caring between student and instructor. Frequent feedback The following quotes from respondents illustrate this theme:

25 6 Nursing Education Perspectives


C A R I N G IN O N L I N E EDUCATION

• "Caring in a student-instructor relationship begins with trust and course. Clarity also included the practice of providing clear and
respect. A student must trust that the instructor is going to teach the
thorough instructions for completing each assignment and com-
most correct and useful information in the course. The student must municating successfully with peers and the teacher. The following
also show respect to the instructor and realize the knowledge that quotes from respondents illustrate this theme:
he/she has obtained to get to their position. An instructor needs to • "...very helpful to make expectations known at the beginning of
likewise trust that the student has a true desire to learn and respectthe semester...more than anything, clear expectations are helpful."
the opinions that he/she may have. Once these basic traits are con- • "It was very frustrating to have assignments given with poor
veyed, caring can begin to develop. Caring is displayed when both instructions. We did not know when some were due, and exactly
parties truly want to help each other succeed and are doing so in a what we needed to do...I would suggest that the instructor make
selfless manner." sure the assignments are
• "Caring is taking the time to assure that both parties understand self-explanatory...."
what is expected and needed from the other...." • "1) Be clear about Students also
PERSONAL CONNECTION AND EMPATHY Seven respon- your expectations and
dents discussed the importance of personal connection how you will respond to indicated that teachers
between teacher and student, as well as teacher empathy for questions and postings.
student concerns. Necessary aspects of personal connection 2) Be clear about your
and empathy included sensitivity to personal issues, asking
should share
instructions for assign-
how a student was doing periodically throughout the semester, ments and respond
and listening when a student had personal challenges. Stu- quickly if we are not something ahout
dents also indicated that teachers should share something doing it right...Myself
about themselves through a personal introduction at the begin- and several of my themselves through a
ning of the semester. Valuing student experience and acknowl- classmates seriously
edging the challenges of online teaching/learning were also considered quitting the personal introduction
important in establishing a personal connection. The following first couple of weeks
quotes from respondents illustrate this theme: because expectations
• "Caring to me is when Ifeel the instructor is really interested in were not clear and we
at the heginning
me as a student and as a person." were not sure how to
• "It was nice to have a little bit of background on the experi- clarify them." of the semester.
ence of my instructors and likewise, it was nice to hear them MULTIPLE CON-
validate my years of experience as a nurse. The good instructors TACT OPPORTUNtTIES Six respondents discussed the importance
made you feel like your past experiences made you more of an of multiple contact opportunities whereby teachers made themselves
equal rather than a 'student'...." available to students via email, postings, telephone, and in-person
• "Be personal and get to know each student. Make an effort to appointments. Students also discussed the desire to meet with the
communicate with them individually. Do not lose contact with the teacher at the beginning of the semester if possible. The following
students during the semester, give them a call on the phone if you quotes from respondents illustrate this theme:
have not seen a post from them in a while and find out if there are • "/ need to know that if I have a question or a problem, the
any problems that you can help with. Sometimes computers can be instructor will be there to help me, either by a personal phone call or
very unfriendly to the operator and he/she may feel like giving up by email."
or that they are not 'technological' enough to continue with an • "[What supports a student feeling cared for?] Frequent interac-
online program. Convey the experiences you had when you first tion between instructor and student, as well as 'in person' meetings
started teaching online and let them know that they are not the throughout the semester to build rapport."
only person to have trouble familiarizing themselves with online • "For some reason actually meeting the instructor made it easier
programs. Express some leniency during the first week of the semes- to understand her expectations."
ter and help students know where they can go to get help under- COMMITMENT TO LEARNING Four respondents discussed the
standing the 'secrets' of online programs." importance of the teacher demonstrating a commitment to learning,
CLARITY Six respondents discussed the importance of clarity meaning that the teacher participated regularly in online discus-
in conveying a sense of caring online, meaning that the teacher sions and responded to postings in a way that indicated content had
provided thorough information for successful completion of the been read. Inviting student feedback and input and communicating

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C A R I N G IN O N L I N E EDUCATION

concern about student success was also discussed. In addition, online education. The results of the current study suggest that
sharing tips for learning success and ensuring that online content engaging in best practices for nursing and online education may
was accurate and up to date was important. The following quotes be one effective way to convey caring to online nursing students.
from respondents illustrate this theme: Frequent feedback, timeliness, personal connection and empa-
thy, clarity, and multiple contact opportunities are all themes
• "Caring.. .would just be basically conveying a sense of concern for
how a student is getting along in the class and how their grade is identified in this study that validate findings in related studies.
coming along. Are the students' personal objectives being met? Do For example, Ali and colleagues (20), Dillon and Stines (6), and
Ryan and colleagues (17) point to a convergence ofthe concepts
theyfeel like they need any additional resources from the instructor to
help them digest the material better?" of caring and best practice in online nursing education. It may
• "The instructor can be that one of the best ways for a teacher to support a caring
show they care by respond- environment online is to mindfully engage in the best practices
Clarity included the ing to the online discus- described by researchers for online education and nursing edu-
sions [sic] their thoughts cation in general.
practice of providing and feelings...one of the It has been found that intentional caring on the part of the
instructors would always teacher improves nursing student outcomes in face-to-face settings
clear and thorough comment on our postings. I in the way of enhanced learning, enhanced student self-esteem,
knew that they had read it perceived competency, retention, and program completion
instructions for and was [sic] involved in (2,7,8,10,47,48). If caring online supports similar outcomes in
the class." online nursing students, clarifying how best to support caring
completing each SECOND-FIDDLE online would benefit students, teachers, and educational knowl-
WORRIES Four respon- edge development.
assignment and dents discussed second- Themes found in this study not previously addressed by oth-
fiddle worries, indicating ers include the reciprocity of caring online, second-fiddle wor-
communicating that they were concerned ries, and the importance of the teacher's commitment to learn-
about being less important ing. Further study regarding the impact of these three concerns
successfully with to the teacher than stu- on supporting an environment of caring online is warranted.
dents in face-to-face Indeed, continued exploration of caring in online teaching envi-
peers and the teacher classroom settings. The ronments could provide a template for nurse faculty who wish to
following quotes from deliberately create caring online teaching environments for
respondents illustrate this theme: nursing students.
• "Since online was set up for people to be able to access at their Challenges and opportunities are inherent in online teaching
leisure, it also sets up that doubt feeling. You often wonder if you environments. Clarifying how best to use the online teaching
dare ask questions, did you understand right, are you learning environment as a vehicle for effectively modeling and conveying
what you should. The fact that you maybe have people in your caring will help empower nurse educators and nursing students to
class that don't care, just going through the motions and then you move forward into the technology of the 21st century. At the same
have an instructor that you are just an online class, and that their time, these efforts will help perpetuate and preserve one of the
regular students take first spot can make you feel like who cares." profession's oldest, most enduring, and cherished values. ( ^ ^
• "This is the first time experiencing online classes for me, I have
paid the same tuition as other students who go to class, I should About the Authors Kathleen Sitzman, MS, RN, is an assistant
receive at least the same support and care from the instructor...[In professor of nursing, Weber State University, Ogden, Utah. She is a
one uncaring teacher's class] I felt like we were not a priority, that doctoral student at the University of Northern Colorado, Creeley,
we were just a class that she put on the back burner and would where Debra Woodard Leners, PhD, RN, CNE, CPNP, is professor
deal with us when she had to." and doctoral progrqtm coordinator. For more information, contact
Ms. Sitzman at ksitzman@weber.edu.
Discussion and Implication Despite a lack of research specifi-
cally directed toward caring in online education, five of the eight Key Words Best Practices in Online Education - Caring - Distance
themes identified in this study had been discussed in previous Education - Online Nursing Education -Web-Based Education
studies aimed at exploring support for excellence in nursing and

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