INTRODUCTION:

The clinical component of nursing education is essential in preparing students to be competent and skillful practitioners. Clinical instructors have an important role in the education and in the development of nursing students. Instructor characteristics that have a positive effect on student outcomes must be identified and utilized. Exploration of effective characteristics of clinical instructors provides insight into improvement of educational programs for developing nurses. This study is a partial replication of GignacCaille and Oermann‟s (2001) study which utilized a descriptive approach to determine perceived importance of characteristics of clinical instructors. This chapter contains a description of the methods and procedures that will be used in this study[1].

Positive student perceptions of effective clinical teaching behaviors are the most important influence in learning. “Usually students are in the best position to judge the effectiveness of their clinical instructors” (Fong and McCauley, 1993)[2]. How nursing students perceive their instructors behavior may enhance or deter the learning process of the students. “Effective learning in a clinical setting is influenced, to a great extent, by competent clinical faculty” (Wong and Wong, 1987)[3].

“The purposes of nursing education are to prepare people to become professional practitioners and to ‘assist them to acquire knowledge in the practice of nursing” (King, 1986). Unfortunately clinical instructors are not always experienced or effective in their teaching roles. King also stated “students must be able to be ‘active participants in the [educational] experiences and learn how to think, make decisions, and act consistently and reasonably as members of a profession and of a democratic society”[4].

Over the past four decades numerous studies have focused heavily on the subject of comparing effective and ineffective clinical teaching behaviors (Jacobson, 1966[5]; Kiker 1973[6]; O’Shea and Parsons, 1979[7]; Brown, 1981[8]; Knox and Mogan 1985[9]; Megan and Knox, 1987[10]; Wong and Wong, 1987[3]; Bergman and Gaitskill, 1990[1]; Nehring, 1990[11]; Fong and McCauley, 1993[2]; Sieh and Bell, 1994[12]). The majority of these studies focused on both the faculty and student perceptions of effective and ineffective teaching behaviors.

REVIEW OF LITERATURE:

Numerous studies have focused on varying aspects of clinical teaching in nursing education. All of the literature reviewed involves the evaluation of clinical teaching characteristics or behaviors that are perceived as effective in learning by professional nurses, nursing students and faculty. Study populations found in the literature include education students, nursing students of and graduate programs, nursing faculty as well as graduate and practicing nurses. This literature review will compare and contrast previous research involving the identified variables of interest defined in this study.

Jacobson (1966)[5] conducted one of the early studies, in an attempt to identify effective nursing instructor behaviors as described by nursing students. Jacobson interviewed a sample of 961 undergraduate nursing students from five separate public and private schools in the southern region of the United States. The students involved ranged from freshman to senior level.

Jacobson used a modified Critical incidence technique in group interviews, subjects were asked to provide a description of as many recent effective and ineffective educational incidents as possible in a 80 minute period of time. “The data were analyzed for frequency and percentage and were tested for significance of relationship by use of the chi-square and the Kendall Tau C”. Content analysis and categorization of the incidents was completed by three judges. Of the 1,182 incidents reported, there were 687 effective educational incidents and 495 ineffective identified. Next, the 1,182 educational incidents were grouped into 58 critical requirements. Finally, the educational incidents were categorized into six major behavioral categories of effective clinical teaching behaviors. The six categories are: availability to students, professional competence, interpersonal relations, teaching practices, personal characteristics, and evaluation practices.

The findings from this study revealed, there was no increase in the proportion of negative educational incidents as the faculty to student ratio increased for clinical emergencies. In addition, the effectiveness classification did not increase based on the educational preparation of the faculty. The most relevant finding of this study involves the identification and development of the six major effective clinical teaching behaviors. A majority of the identified behavior categories are pre-dominated throughout the literature reviewed.

Kiker (1973)[6] conducted a exploratory study using a written questionnaire including twelve characteristics, “...each of which had been mentioned as desirable in two or more studies of previously cited evaluations of instructors by students” . A non-random sample of thirty undergraduate junior level education students and thirty-seven junior level nursing students and thirty-six graduate nurses enrolled in education courses, from two Texas Universities were used.

Effective reaching characteristics were grouped into three categories using twelve identified behaviors. The categories included “professional competence, relationships with students, and personal attributes”. Percentage tabulation of the three student samples were conducted for each identified behavior. The study concluded that graduate students rank creativity or personal attributes of their instructors highest (39%) and the undergraduate education students (26.4%) and nursing students (51.3%) maintain professional competence of the instructor highest. The significance of these findings is both undergraduate student ranked professional competence and organizational skills highest and personal attributes lowest.

The graduate students ran ked creativity and stimulation characteristics of the instructor most important (39%). All three sample groups (60%) held similar importance of the characteristic of fair evaluation of the student by the instructor.

These findings could indicate undergraduate students are not as confident or secure in their nursing roles as graduate nursing students and prefer organized and structured instructor behaviors. Graduate nursing students have experience and confidence in their clinical roles and seek stimulation and creativity from their instructors.

O’Shea and Parsons (1979)[7] conducted a study of 205 BSN students and 24 faculty to compare effective and ineffective teaching behaviors. A simple two question format was implemented with instructions to write 3-5 identified teaching behaviors that facilitated and or interfered with learning.

Data analysis was completed with tallied keywords and phrases that were normalized and expressed in percentages for each group and then sorted into three broad categories. The three categories identified included: evaluation, instructor assistance and personnel characteristics.

A strong relationship between instructor feedback and learning was identified on the returned questionnaires, 37% Juniors, 79% Seniors, 59% of faculty agreed. Faculty rated the behavior of role modeling five times higher than the students.

This study also identified specific differences in perception of ranked importance in relation to academic standing. Senior nursing students held a higher priority for effective evaluation behaviors over junior level students. This finding could suggest senior level students prefer instructor behaviors that influence student responsibility and independence.

Specific effective behaviors identified by faculty and students involved instructor interactions that provide positive and honest feedback, faculty who are willing to assist the student and faculty availability. The category of professional competence was not identified by the sample within this study and ranked highest by a proportion of undergraduate students in Kiker (1973)[6].

Specific limitations within this study included the deficit of no statistical significance and no demographic information of the sample and a single private institution was used.

Brown (1981)[8] conducted a descriptive study in North Carolina using a sample of eighty two senior nursing students and forty two faculty members to determine if similar perceptions of effective clinical teaching characteristics existed between the two groups. Brown developed the Clinical Teacher Characteristics Instrument (CTCI), which combined “a composite of items found in the Literature and included twenty characteristics of teachers”.

Brown classified the twenty characteristics into three major categories, similar to Kiker (1973)[6] involving professional competence, relationship with students and personal attributes. Brown’s findings using statistical measures of simple frequency, percentages and a chi square analysis resulted in a difference in ranking of importance of teaching characteristics between the two study groups.

The student ranked characteristics involving interpersonal relationships highest, professional competence next and personal attributes lowest. The faculty ranked professional competence highest, relationship with students next and personal attributes last. The findings indicate similarities between the students ranking in Kiker (1973)[6] and the faculty ranking in this study.

METHODOLOGY:

Design

The study will employ a descriptive exploratory design with a self-reporting questionnaire.

Sample

The population is all students enrolled in nursing College of Hail University. The sample for this study will consist of (n = 200) an anticipated convenience sample of 150 nursing students in various levels of their programs and 50 faculty members from the same programs.

Instrument

The instrument used in this study, was adapted from the Clinical Teaching Evaluation instrument. The CTE was developed by Dr. Carolyn Fong at San Francisco State University in San Francisco; CA. Written permission to use the instrument was obtained. This instrument was selected for use in relation to the content it encompassed. The CTE consists of the most prevalent behavior categories (nursing competence, teaching competence and consideration of students) found repeatedly in prior studies involving effective clinical teaching behaviors.

The CTE instrument consists of 25 clinical teaching behaviors which the subjects rated the importance of each behavior using a 5-point Likert - type scale ranging from 5-very important to 1-of no importance.

Additional ranking of important teaching behaviors were then listed in order of importance in section ii. Section ii requests the students to rank the top five most important teaching behaviors listed on the instrument in order of importance. A brief demographic survey of the sample was included to determine student status.

The CTE has three specific categories of behaviors that accumulate the (25) individual behaviors which include: teaching competence (7), nursing competence (9), and consideration of students (9).

CONCEPTUAL FRAMEWORK:

This study is based on Imogene King’s General Systems Framework (1981 retitled 1992). The General Systems Framework incorporates an open system model as well as an interactive systems framework. The General Systems Framework represents the concept of person as an individual entity who interacts within three dynamic open systems. The three open and interacting systems consist of the personal systems, interpersonal systems, and social systems. The personal system involves an individual; the interpersonal system involves two or more individuals interacting together, and the social system represents a formulation of groups of individuals to carry on social activities and goals. Specific concepts are included with each system and aid in further describing each system dimension in the General Systems Framework. The three interacting systems and the concepts of perception and learning will be identified and elaborated on as the conceptual basis of this study.

RESEARCH METHODOLOGY:

Research Design

The study will employ a descriptive exploratory design with a self-reporting questionnaire. Descriptive study designs are useful to gain additional information about characteristics within a particular area of study (Burns and Grove, 2005). No manipulation of variables will be involved. The study will focus on characteristics of effective clinical instructors as perceived by students and faculty.

Procedure

Three preliminary steps were involved in the development of this study

Step 1-Adaptation of the CTE instrument

Step 2-Approval of Human Research Review Committee

Step 3-Approval of Dean, HODs and Class coordinator’s

Step 1, adaptation of the CTE instrument included changing the five letters on the Likert type scale to numbers 1-5 for ease in the statistical analysis. A demographic survey of the sample was added to the CTE, which provided sample information concerning sex and clarification of student status.

Step 2, involved obtaining permission from the Human Research Review. The Human Research Review Committee received copies of the CTE instrument along with specific documentation explaining the research purpose and protocol.

Step 3, involves approval of (i) Dean, College of Nursing, University of Hail, Kingdom of Saudi Arabia, (ii) HODs of respective departments, College of Nursing, University of Hail, Kingdom of Saudi Arabia and (iii) Class coordinator’s of College of Nursing, University of Hail, Kingdom of Saudi Arabia.

DATA ANALYSIS AND INTERPRETATION:

The purpose of this study was to com pare perceptions of effective clinical reaching behaviors held by both students and faculty of College of Nursing, University of Hail, Kingdom of Saudi Arabia . The independent variable of clinical teaching behaviors w ere compared with the dependent variables of students and faculty perceptions. The specific research questions studied involved identification of the most effective clinical teaching behaviors perceived by the two study samples and subsequently revealing similarities and differences in the student and faculty perceptions.

The data analysis for this study will be conducted using the statistical package for the social sciences(SPSS).data from the CTE instrument involved ranked item scores of the 25 clinical teaching behaviors’ obtained from the student samples, the data were analyzed using descriptive statistics. The initial rank ordering of the clinical teaching behaviors will be based on the median responses; the final rank order of perceived effectiveness will be determined by using the statistical mean for each clinical teaching behavior. A Mann Whitney-u analysis was the statistical method to identify significant differences in the mean item responses from the student and faculty responses. An alpha level of 0.05 was set to determine the significance for analysis of the statistical data.

Table 1. 10 most effective Clinical Teaching Behaviours ranked by students of College of Nursing, University of Hail (n=150)

Behaviour	Students Mean Item Rank	Standard Deviation
Demonstrates skills	4.67	0.87
Interest in Patient care	4.45	1.14
Objective and fair	4.32	0.99
Technical skill	4.20	0.79
Credits students	4.10	1.19
Professional responsibilities	4.34	0.95
Constructive evaluation	4.41	1.09
Helps without talking over	3.97	1.00
Relates theory	3.93	0.75
Clinical assignments	3.81	0.88

Table 2. 10 most effective Clinical Teaching Behaviours ranked by faculty of College of Nursing, University of Hail (n=50)

Behaviour	Students Mean Item Rank	Standard Deviation
Demonstrates skills	4.51	0.46
Interest in Patient care	4.86	0.61
Objective and fair	4.93	0.65
Technical skill	4.54	0.63
Credits students	4.29	0.69
Professional responsibilities	4.39	0.69
Constructive evaluation	4.41	0.71
Helps without talking over	4.19	0.64
Relates theory	4.29	0.64
Clinical assignments	4.24	0.70

Table 3. Identified Behaviours with similarities in Ranking (n=200)

Behaviour	Mean Item Rank
Behaviour	Student	Faculty	z	p
Demonstrates skills	28.53	27.76	-0.19	0.86
Admits limitations	27.64	28.49	-0.31	0.79
Relates theory	29.05	27.49	-0.34	0.75
Reviews	29.37	27.34	-0.54	0.62
Clinical assignments	25.80	28.75	-0.50	0.60
Technical skills	30.00	27.25	-0.54	0.62
Additional resources	26.50	28.89	-0.71	0.54
Professional responsibilities	25.98	29.05	-0.74	0.46
Helps without talking over	25.29	29.30	-0.99	0.34
Credits students	24.31	29.80	-1.40	0.19
Sense of humor	23.69	30.10	-1.52	0.16
Shows interest	23.85	30.00	-1.45	0.16
Shows recognition	23.92	29.99	-1.35	0.17
Respects confidentiality	23.65	30.10	-1.50	0.15
Constructive evaluation	22.92	30.45	-1.80	0.08
Flexibility	22.76	30.55	-1.89	0.07

Table 4. Identified Behaviours with a significant difference in Ranking (n=200)

Behaviour	Mean Item Rank
Behaviour	Student	Faculty	z	p
Organizes experience	19.78	32.04	-2.80	0.007*
Interest in patient care	21.65	31.11	-2.64	0.010*
Confidence	20.83	31.54	-2.51	0.01*
Objective and fair	21.72	31.10	-2.38	0.02*
Well prepared	21.19	31.35	-2.35	0.03*
Worthwhile conference	21.60	31.15	-2.19	0.03*
Allows expression	22.19	30.82	-2.02	0.04*
Practice before evaluation	22.15	30.89	-2.08	0.04*
Utilizes resources	22.09	30.93	-2.04	0.04*

* =P<0.05

DISCUSSION:

This study, as did Kiker (1973), Brown (1981), Mogan and Knox (1985), O’Shea and Parsons (1987), Knox and Mogan (1987), Bergman and Gaitsldll (1990), Nehring (1990) and Sieh and Bell (1994) identified important or effective clinical teaching behaviors as perceived by nursing students and faculty. An additional objective of this study was to identify similarities and differences of students and faculty perceptions of effective clinical teaching behaviors. The General Systems Framework by King was implemented to guide this study. The concepts and interrelating relationships involved in Kings System framework has provided consistent interpretation of the variables involved within this particular study.

Fig 1. Relationship among study variables and concepts included in King’s conceptual framework

The following discussion will compare and contrast prior study findings in context with the results of this study, based on the objectives of study. The study findings are the result of ranked mean item scores based on the percentage response of the 25 item CTE instrument and the results of a Mann Whitney U test conducted from the students and faculty sample data.

CONCLUSION:

The foundation of this study is based on the enhancement of nursing education and the identification of effective clinical teaching behaviors as perceived by nursing students and faculty. When the most effective clinical reaching behaviors are identified and implemented effectively by clinical instructors, nursing education will benefit by effective learned outcomes achieved by students and faculty. Time, money and educational energy can be conserved if the most effective learning interactions are identified, implemented and evaluated.

RECOMMENDATION:

Recommend to further research the perceptions of students in relation to the lack of consist research involving this population. Replication of this study is strongly recommended with a larger sample involving nursing students and faculty. Consideration of a longitudinal research study involving changing perceptions of effective clinical teaching behaviors, based on academic student level and or post graduation of sample subjects. Earlier studies such as Knox and Mogan and Kiker identify similar results concerning effective reaching behaviors which are identified at differing nursing educational and practicing levels.

Further recommendation is suggested to investigate and define the clinical teaching behavior predominately found in the previous literature of being a good role model. Strongly suggest continued use of the CTE instrument with permission, by nurse researchers and faculty members to enhance the ability to evaluate perceptions of effective clinical reaching behaviors.

REFERENCES:

1. Bergman, K., and Gaitskill, T, (1990). Faculty and student perceptions of effective clinical teacher: an extension study. Tournai of Professional Nursing. 6. 33-44.

2. Fong, C. M., and McCauley, G., T. (1993). Measuring the nursing, teaching, and interpersonal effectiveness of clinical instructors. Tournai of Nursing Education. 32. 325-328.

3. Wong, J., and Wong, S. (1987). Towards effective clinical teaching in nursing. Tournai of Advanced Nursing. 12.505-513.

4. King, I. (1981). A theory for nursing: Systems, concepts, process. Albany, NY: Publishers Inc.

5. Jacobson, D. M. (1966). Effective and ineffective behavior of teachers of nursing as determined by their students. Nursing Research. 15. 218-224.

6. Kiker, M. (1973). Characteristics of the effective teacher. Nursing Outlook. 21. 721-723.

7. O’Shea, H. S. and Parsons, M., K. (1979). Clinical instruction: effective a n d ineffective teacher behaviors. Nursing Outlook. 411-415.

8. Brown, S. (1981). Faculty and students’ perceptions of effective clinical teachers. Tournai of Nursing Education. 20. 4-15.

9. Knox J., and Mogan, J. (1985). Important clinical teacher behaviors as perceived by university nursing faculty, students and graduates. Journal of Advanced Nursing. 10. 25-30.

10. Mogan, J., and Knox, J. (1987). Characteristics of “best” and “worst” clinical teachers as perceived by university faculty and students. Tournai of Advanced Nursing. 12. 331-337.

11. Nehring, V. (1990). Nursing clinical teacher effectiveness inventory: a replication study of the characteristics of ‘best’ and ‘worst’ clinical teachers as perceived by nursing faculty and students. Tournai of Advanced Nursing. 15, 934-940.

12. Sieh, L., and BeU, S. K. (1994). Perceptions of effective clinical teachers in associate degree programs. Tournai of Nursing Education. 33. 389-394.

Received on 26.03.2016 Modified on 25.04.2016

Int. J. Adv. Nur. Management. 2016; 4(3): 235-240.

DOI: 10.5958/2454-2652.2016.00052.4