On-line version ISSN 1025-9848
Health SA Gesondheid (Online) vol.18 n.1 Cape Town Oct. 2013
Friddah R. Mathevula; Lunic B. Khoza
Department of Advanced Nursing Science, University of Venda, South Africa
The first session of interaction in the classroom often sets an atmosphere for the entire period of learning. In terms of nurse educator and student nurse neophyte relations, good interaction is essential in helping students to recognise their own responsibilities and to respond positively during the learning process. The purpose of this study was to determine the nurse educators' and student nurse neophytes' perceptions of good interaction in the classroom setting. The study attempted to answer the following specific question: 'What do nurse educators and student nurse neophytes regard as examples of good interaction in the classroom setting?' The accessible population in this study were all student nurse neophytes registered with the University of Venda for the Baccalaureus Curationis, and nurse educators responsible for teaching first-year student nurses in this programme. The study used probability stratified random sampling to obtain two heterogeneous groups of student participants. Forty first-year student nurses were divided into homogenous subsets of 15 male and 25 female students. A random sampling was conducted to arrive at 10 male and 15 female students. The sampling method relating to nurse educators was purposive sampling. Focus groups were used to interview students using individual in-depth interviews to gather data from nurse educators. Coding was used to organise the data collected during the interviews. The study revealed that nurse educators and student nurse neophytes concur that the ethical behaviours influencing good interaction are respect and support, good communication, honesty and openness. Age, gender and cultural background were also factors. The participants further indicated that good interaction has benefits such as improved co-operation levels, the enhancement of learning, the improvement of pass rates, and a reduction in dropout rates. In conclusion, there is a need for nurse educators and student nurses to develop good practices to promote good interaction in the classroom setting.
Die wyse waarop die interaksie tydens die eerste sessie in die klaskamer benader word, bepaal dikwels die atmosfeer vir die res van die leerperiode. Goeie interaksie is dus nodig tussen die verpleegopvoeder en die verpleegnuweling-studente om studente te help om verantwoordelikheid te aanvaar en om positief tydens die leerproses te reageer. Die doel met die studie was om te bepaal wat die persepsies van verpleegopvoeders en verpleegnuwelingstudente is ten opsigte van goeie interaksie in die klaskameropset. Die studie het gepoog om die volgende vraag te beantwoord: 'Wat word deur verpleegopvoeders en verpleegnuweling-studente beskou as voorbeelde van goeie interaksie in die klaskameropset?' Die toeganklike populasie vir die studie was al die verpleegnuweling-studente wat vir die Baccalaureus Curationis aan die Universiteit van Venda geregistreer is, sowel as die verpleegopvoeders wat verantwoordelik is vir die onderrig van die eerstejaar verpleegstudente. Die studie het gebruik gemaak van waarskynlike, ewekansige gestratifieerde steekproeftrekking om twee heterogene groepe studente te trek. Veertig eerstejaarstudente is opgedeel in homogene substelle van 15 manlike en 25 vrouike studente. Die steekproef van die verpleegoopvoeders is met behulp van doelbewuste steekproeftrekking getrek. Fokusgroepe is gebruik om onderhoude te voer met die studente. In-diepte onderhoude is met die verpleegopvoeders gevoer om inligting in te win. Kodifisering is gebruik om die data te organiseer wat tydens die onderhoude ingewin is. Die studie het getoon dat sowel verpleegopvoeders as verpleegnuwelinge saamstem dat respek, ondersteuning, goeie kommunikasie, eerliklheid en openheid etiese gedragspatrone is wat goeie interaksie beïnvloed. Ouderdom, geslag en kulturele agtergrond is ook faktore. Die deelnemers het verder aangedui wat goeie interaksievoordele inhou, soos verbeterde vlakke van samewerking, die verbeterde leerproses, verhoging in slaagsyfers en die afname in uitsakkingsyfers. Opsommenderwyse is daar 'n behoefte aan verpleegopvoeders en verpleegnuweling-studente om goeie praktyke ten opsigte van goeie interaksie in die klaskameropset te ontwikkel.
Improved interaction between the nurse educator and student nurses in the classroom requires a process of identifying learning needs and developing learning skills, particularly for student nurse neophytes (Ellis 2006:157). This process promotes support, improves communication, enhances motivation, boosts the students' self-esteem and helps them to overcome learning problems experienced in the classroom setting (DeYoung 1996:22; Mellish & Brink 1998:72). According to Last and Fulbrook (2003:458), first-year students need a directive and supportive approach to meet their learning needs. This is supported by Jones and Joneson (2007:75) who found, in a study on teacher-student relationships, that the process of a teacher forming a bond with students starts on the first day. This helps them to earn students' respect and promotes a quality learning environment, whilst improving the communication and participation skills of students.
The exposure to a new profession may lead to stress, which can be moderated if support is offered during learning sessions in both the classroom and clinical settings. Nurse educators should establish a pleasant atmosphere by welcoming the student nurse neophytes during this session (Tony 1988:34). According to Ellis (2006:157), a lasting and working classroom relationship should be like a mother-daughter or father-son relationship, where children accept their teacher's authority. This is the position teachers or nurse educators should assume if they want a lasting and successful working relationship to exist in the classroom setting.
The attitudes of nurse educators towards the student nurse neophytes affect interaction and the type of relationship established in both the classroom and the clinical setting (Reilly & Oermann 1996:83). This is supported by Vallant (2006:24), who suggests that if the relationship is not positive, it will have a negative impact on learning. A study conducted by Savage and Favret (2006:54) concluded that nurse educators need to exhibit ethical behaviour in order to encourage a positive student-instructor relationship and to create a safe nurturing environment. Therefore, it is important to consider the feelings, behaviour, thoughts, insights, perceptions and attitudes of the subjects in order to capture the meaning of the interaction between the nurse educators and student nurse neophytes in the classroom setting.
According to Mahat (1996:165, 1998:18), poor interpersonal relationships in the classroom are sources of stress between nurse educators and student nurse neophytes. This is supported by the findings of Vallant's study (2006:27) about relationships between student nurses and clinicians, that negative relationships inhibited student learning. In addition to these findings, Scott (2009:216) found that academic and social stress experienced by college freshmen contributed to negative outcomes in classroom settings.
The needs of the student nurse neophytes should be considered at different levels. Good relationships will help them to feel secure, and to learn effectively (Susan 1986:35). According to Craig (1996:285), when teachers are conscious of the need to have an attitude of caring, compassion and love, they will develop greater awareness, depth and spirit. Thus nurse educators and student nurse neophytes have expectations of one another and respond to one another with those expectations in mind. Therefore, it is important that during classroom interactions, student nurse neophytes should not be seen as blank pages waiting to be imprinted by the nurse educator, but should be acknowledged as individuals and encouraged to participate fully.
During the first encounter in the classroom, student nurse neophytes are fully dependent on their educators. The nurse educator should encourage and promote different ways of knowing to empower future nurses to be able to respond in caring ways towards clients. Nurse educators should also encourage students to be creative in finding solutions to their problems. They should also emphasise the value of learning while teaching student nurse neophytes (Leininger & Watson 1990:72). This is supported by Vallant (2006:22) who states that the interactions that take place in classroom have a significant influence on students' learning (Vallant 2006:22).
Student-nurse neophytes are exposed to the first level of learning in the classroom during interaction with nurse educators and should gain perception and appreciation of values in this setting. Students will decide whether they will accept or reject the values presented in subsequent interactions (Nicklin & Kenworthy 1997:206). Values clarification is supported by Dian and Uustal (1993:67), who believe that it offers a process for determining where students stand and explains what is valued. Furthermore, Weiler and Schoonover (2001:32) state that it is important to know what the personal values are that one wants to achieve in life, and to look carefully at them and to establish value priorities. The study conducted by Corcoran (2007:5) concludes that nurse educators should assist students to develop a system of values for nursing.
According to Tony (1988:57), student nurses should assume responsibility for their own learning. The nurse educator-student nurse neophyte interaction is essential in helping students to recognise their own responsibilities and to respond positively in the learning process (Mellish & Brink 1998:58). According to the study by Taylor and Runte (1995:4), professional teachers should provide stimulating, safe and well-managed learning environments in order for students to obtain and maintain acceptable scores and to do whatever it takes to help them to realise their full potential. This is supported by Klopfenstein (2003:41) who says that instructors can empower students to accept responsibility for their own learning and can facilitate the development of students' self-direction skills, whilst giving adequate instructional support to help them have meaningful learning experiences. However, the support that student-nurse neophytes need might be lacking owing to poor relationships or flawed interaction. A trusting relationship between nurse educators and student nurse neophytes is a prerequisite for reducing stress. Similar views are described by Savage and Favret (2006:48) as well as Last and Fulbrook (2003:458) who emphasise the importance of positive relationships in practice and of giving support to student nurses during their education, so that they will feel valued, complete their education and feel ready to face the challenges of modern healthcare. Furthermore, as a result of a study that explored the building of positive student-teacher relationships, Abuja (2010:161) concludes that effective communication and giving feedback to students are very important.
Aggressive teachers who respond inconsistently to students create a negative classroom atmosphere. Other elements of classroom management like the delivery of instruction and direct feedback also influence the creation of a positive learning environment. Nurse educators need to apply ethical behaviour, in order to encourage a positive student-instructor relationship and to create a safe nurturing environment (Savage & Favret 2006:47).
It is widely accepted that the teaching and learning environment established during the initial learning experiences of student nurse neophytes can affect their mental health. As a teacher interacting with student nurses at various levels of their education and training, the researcher observed that student nurse neophytes had problems adjusting to the classroom environment. Some student nurse neophytes appeared to be anxious and tense, sometimes failed to participate in the classroom and failed tests, while some later dropped out of the profession. Some of the literature consulted supported the notion that student nurses experienced stress during their initial experience because of poor teacher-student interaction, peer group pressure, inappropriate teaching strategies and having to adapt to a strange environment (Beck & Srivastava 1991:131; Jones & Joneson 1997:84). This is corroborated by Gupchup, Borego and Konduri (2004:292) who maintain that an unsupportive faculty and excessive study loads are predictors of stress associated with negative outcomes to students' progress.
Purpose and research questions
The purpose of this study was to determine nurse educators' and student nurse neophytes' perceptions of good interaction in the classroom setting. The study attempted to answer the following specific question: 'What do nurse educators and student nurse neophytes regard as examples of good interaction in the classroom setting?'
Significance of the study
Nursing education, in particular that offered by nursing colleges and universities, will be improved by promoting the establishment of good relationships between nurse educators and student nurse neophytes in the classroom setting.
Developmental skills of student nurse neophytes will be enhanced; these include communication, critical thinking, problem solving, values clarification, listening and adjusting to the classroom setting.
Study design and methods
The study used a qualitative, descriptive design. Polit and Hungler (2006:172) describe research design as the researcher's overall plan for obtaining answers to the research questions and for testing hypotheses. It spells out strategies adopted by the researcher to develop information that is accurate, objective and interpretable (Thomson 1997:133). In this study the subjects gave the views of nurse educators and student nurse neophytes about what they regard as examples of good interaction in the classroom setting.
Sampling and context of the study
The accessible population in this study were all student nurse neophytes registered with the University of Venda for the Baccalaureus Curationis in Nursing Science and nurse educators responsible for teaching first-year student nurses in this programme. The study focused solely on nurse educator-student nurse neophyte interaction in the classroom setting. Views of senior students and nurse educators were not regarded as being relevant to the study, as they had already developed coping mechanisms with regard to the negative consequences of interaction in the classroom.
According to Burns and Grove (2009:42), sampling involves selecting a group of people, events, behaviour or other elements with which to conduct the study. The study used probability stratified random sampling to obtain two heterogeneous groups of student participants. Probability sampling is the random selection of elements from a population (Polit & Beck 2010:339). Forty first-year student nurses were divided into homogenous subsets of 15 male and 25 female students. A random sampling was conducted as follows: forty cards were numbered from one to forty. The reverse sides of 25 cards were marked yes and 15 were marked no. The box meant for the male students had 10 yes and five no cards. The second box meant for the female students had 15 yes and 10 no cards. Each member of a group was given the chance to choose one card from the box and only those student nurse neophytes who chose numbers marked yes were allowed to be part of the sample, namely 10 male and 15 female students.
Purposive sampling of nurse educators was used. Purposive sampling is performed by choosing a particular case which illustrates some features or processes that are of interest for a particular study (De Vos et al. 2011:230). This approach was used in this study to sample nurse educators, because they represented the total population of nurse educators at the University of Venda. The researcher purposefully chose three nurse educators because they had not been involved in the pilot study and were also judged to be knowledgeable about the topic, as they had experience of teaching student nurse neophytes.
Data collection methods
In this study the researcher used focus groups to interview students, and individual in-depth interviews to gather data from nurse educators. Student nurse neophytes were interviewed in two groups (10 male students in one group and 15 female students in the other) on the same day, but at different times in one of the quiet skills laboratories of the Advanced Nursing Science Department. The second group was requested to wait and relax outside whilst the researcher interviewed the first group. Interviews were tape recorded and field notes were made. Two of the three nurse educators were interviewed on one day and the third on another day in a lecturer's office at the university.
A random selection of student nurse neophytes who were not included in the sample was used in the pilot study. A group of six student nurse neophytes and two nurse educators who were responsible for teaching them were interviewed separately to test the research questions and methodology for reliability and validity. It also aimed at assessing the feasibility of the major study, the time required for completing the interviews and whether the participants could understand the questions. During the pilot study the three central questions were asked. Participants seemed to find it challenging to give detailed information and gave general information related to the research questions. This led the researcher to develop probing questions for the central question, to ensure that participants would provide adequate information.
Data was analysed simultaneously with data collection. Coding and categorisation was generally initiated as soon as data collection began. Coding was used to organise the data collected during the interviews. Themes were derived from the questions asked. The questions generated categories, which provided descriptions of the subcategories. Selected categories were verified through reflection on the data and discussions with the independent expert in the research field, refining the categories and identifying the propositions (Burns & Grove 2009:523).
Confirmability is a criterion for evaluating quality in qualitative data, and refers to the objectivity or neutrality of the data. The supervisor performed a confirmability audit by checking the participants' views quoted by the researcher in the transcripts from the tape recorder.
The researcher in this study exercised great care to maintain the ethical responsibility of protecting and respecting the rights of the student nurse neophytes, nurse educators and the University of Venda (Polit & Hungler 2006:351). The freedom to choose to participate was explained to all participants when their informed consent was obtained, and also on the day of the interviews to ensure that they participated willingly in the study. The researcher advised the participants to ensure that they understood the information and this enabled them to consent freely to participate. The information that was provided included clarifying the purpose of the research study, the method or procedure to be followed in obtaining information, the duration of the study, the nature of the participation expected and the procedure that would be followed for using and publishing the results. The rights of the University of Venda where the research was conducted, were considered by requesting permission from the University Health and Safety Research Ethics Committee to undertake the research, and permission was granted (Polit & Beck 2010:125).
Data quality is a strategy used by all researchers to produce quality research in order to make their research meaningful. Qualitative researchers avoid using terms such as reliability and validity - instead, terms such as consistency, trustworthiness, dependability, confirmability and auditability are used when referring to validity and reliability (Brink 2004:124). The researcher adopted the contracts of Lincoln and Guba to ensure trustworthiness namely, credibility, transferability, dependability and confirmability.
Credibility was ensured through a number of techniques, including prolonged engagement and member checking. Prolonged engagement with student nurse neophytes and nurse educators during interviews was ensured by spending sufficient time with them during data collection. This assisted the researcher to identify some distortions during the sessions, such as where students wished to dominate the focus group interviews, and to deal with the problem.
Transferability is a criterion for evaluating the quality of qualitative data. It refers to the extent to which the findings from the data can be transferred to other settings or groups in an implementation assessment of the project. The findings of the present study cannot be generalised, since the study focused only on student nurse neophytes and those nurse educators who were responsible for teaching them. Tape-recorded data and word-for-word transcriptions conducted during data collection assist researchers in engaging in future research (Lincoln & Guba 1985:316).
Dependability is a criterion for evaluating quality in qualitative data, referring to the stability of data over time and in other conditions. To ensure dependability, the supervisor examined the process and products of the study. Copies of tapes and transcriptions were made available to the supervisor to confirm the dependability of the research. The data, findings, interpretation and recommendations were also examined by the supervisor to ensure internal cohesion of inquiry (Lincoln & Guba 1985:318).
Results and discussions
Two groups of 25 each consisting of student-nurse neophytes (15 female and 10 male students each) were randomly selected. The third group interviewed consisted of three nurse educators who were purposively selected and interviewed separately. English was used as medium to interview the three groups of participants, because they all understood the language. The students had all passed Grade 12 and were enrolled for the first year of study at the University of Venda and nurse educators all taught at the University.
Categories and subcategories were identified under one theme formulated from the central question of the study. Coding and categorising was generally initiated as soon as data collection began. Similar transcriptions were grouped together.
Perceptions related to ethical behaviour
Respect and support
All participants - male and female students, as well as nurse educators - felt that showing respect was ethical behaviour that enhances good interaction and this was encapsulated in their verbatim responses outlined below:
'I think respect to lecturers can create good interaction between nurse educators and us as students in the classroom.' (Male student nurse, aged 19, first year of the degree programme)
'I agree with him respecting each other's position; a teacher must respect a learner and learner respect a teacher.' (Female student nurse, aged 18, first year of degree programme)
'I have observed in my teaching experience that respect is very important in the classroom and of course [it] depends on student's personality and background and vice versa.' (Female nurse educator A working with nursing neophyte students)
Giving support to and displaying caring both for students and nurse educators, were identified by the three groups as relating to ethical behaviour in the classroom. These subcategories are indicated by the following participant responses:
'As students we need to be given necessary support by our lecturers irrespective of who we are, socially, psychologically and moreover academically in the classroom.' (Female neophyte student nurse, aged 20, first year of degree programme)
'Although we are coming from different backgrounds, I think support should be given to all of us as students without showing any discrimination.' (Female student nurse, aged 19, first year of degree programme)
'When we as lecturers are not ready to give support to our students, we must be quite sure that we are going nowhere with the educational journey with our students, so support is a crucial issue ethically.' (Female nurse educator X working with nursing neophyte students)
Most of the participants were of the opinion that punctuality and time keeping should be included in this subcategory, but it was not supported by some of the female student participants and one nurse educator. However, evidence from literature shows the relevance of being punctual in class (Wax 2008:14) and thus the researcher considers it to be a necessary component of ethical behaviour. Punctuality is a form of courtesy and showing respect for others, be it educators in class or classmates, and people who arrive late and disrupt classes are those who miss information and experience difficulty in keeping up with the work.
Literature consulted agrees that respect is an essential element that influences and enhances teacher-student relationships. Savage and Favret (2006:49) identify respect, confidence and support as attributes that instructors should possess, as these contribute to positive relationships with students. Streitch (2009:44), Takabayashi (2008:17) and Hartjies (2007:280) conclude that positive relationships are based on the trust and mutual respect that are shown during the first week of classroom interaction. Reilly and Oermann (1996:42), Chan (2001:447) and Charles (2002:150) see mutual respect, trust and giving support - including listening attentively - as attributes that are needed to build positive teacher-learner relationships. These views were also cited by Daly (2008:38), who believes that the best teaching begins with what is called the welcoming factor. It is based on building powerful relationships which emanate from showing respect to students and valuing them.
According to the study conducted by Ghias (2009:37), students need a social support system in order to combat stress. Providing support, rewarding competence and promoting self-esteem were regarded as factors that decrease the vulnerability of high-risk students in response to stressful life events (Werner 1990:110). This is supported by Repak (2006:48) who states that building support is required during stressful periods and can be achieved by developing relationships with students.
According to Barak and Wilhelem (2005:544), nursing has been perceived as a caring profession since the era of Florence Nightingale and is associated with the dynamics of relationships. This should be practised by nurse educators in their dealings with student nurse neophytes who are being prepared to care for patients. Langley (2009:11) identified the need for creating safe and caring classrooms that focus on encouraging learning and realising the potential of learners.
Good communication was also viewed by all the participants as an aspect to be considered in the classroom. Furthermore, using an official common language or a language that is understood both by students and nurse educators, was also perceived as an important aspect of ethical interaction. These subcategories were encapsulated in the following verbatim responses:
'Good communication skills can bring good fruits in the class room irrespective of gender and age, so our teachers must have these skills.' (Male student nurse, aged 20)
' It becomes a challenge in a big classroom where some of our students cannot communicate well, especially in English.' (Female nurse educator X working with nursing neophyte students)
'Using [an] official language which is known by all individuals can also be regarded as a good characteristic of ethical behaviour; our teachers should stick to that.' (Female student nurse, aged 18)
Gordon (2009:29) states that teachers need to have good communication skills and verbal presentation abilities for them to become effective in making connections with students. Similar views are supported by Hershman (2009:22) who concludes that friendliness, kindness, mutual respect and good communication are some of the important aspects of creating a positive classroom environment. This is also supported by Brophy-Herb et al. (2007:134) who state that a positive classroom climate mediates the relationship between teachers and learners. The use of language that students can master and understand was also recommended by Wedin (2009:145) and Dembele (2006:66), who state that this overcomes obstacles to efficient learning and improves the quality of education.
Honesty and openness
One participant from the male student group felt that being honest and open was critical to ethical behaviour. Honesty was supported by other participants, whilst they did not consider openness to be a component of ethical behaviour. The following contradictory verbatim responses were made by participants:
'Being honest and open can contribute much to ethical behaviour, maybe my fellow students can also comment.' (Female student nurse, aged 17)
'I am not quite certain whether to be honest and open can be regarded as a good characteristic of ethical behaviour, but let me give other students chance to state their views.' (Female student nurse, aged 18)
'I prefer to teach honest students in my class, for it is ethically recommended that a nurse should have this characteristic.' (Female nurse educator X working with nursing neophyte students)
'When our educators show honesty and openness to us in class, this can contribute much as a good example of ethical behaviour.' (Male student nurse, aged 20)
Literature supports the idea of honesty being an important component of ethical behaviour. Indeed, it is included in the universal principles and accepted as fundamental to ethical conduct (Searle & Pera 1995:141; Mellish & Paton 2009:123). Veracity is regarded as one of the most important ethical principles next to honesty and sincerity. The researcher considers honesty to be a good characteristic, because both nurse educators and students should possess these attributes to be able to establish a positive learning environment:
Age, gender and cultural background
The male students were of the opinion that age, gender and cultural background influenced ethical behaviour. On the other hand, the female students and two nurse educators thought that whilst socialisation was a component of good ethical behaviour, age and gender did not influence good ethical interaction. However, one nurse educator disagreed with this view, and emphasised the issue of personality as contributing much to one's behaviour. The participants' verbatim responses are quoted hereunder:
'Gender and age can also be an issue here; culturally, males feel they are heroes and need to be respected and if a person is older ... his word should be final.' (Female student nurse, aged 18)
'[...]A person's conduct can relate to his background.' (Female nurse educator X working with nursing neophyte students)
'I think age and gender cannot contribute to ethical behaviour, but cultural background maybe, for example how a person was orientated contributes much to one's moral or ethical behaviour. With orientation I am referring to how one was brought up.' (Female nurse educator X working with nursing neophyte students)
Listening actively was perceived as another indicator of ethical behaviour by all three groups of participants and was encapsulated as follows:
'Listening actively, according to me, is a good characteristic as related to ethical behaviour in the classroom for both parties; students should listen very well when we teach.' (Female nurse educator X working with nursing neophyte students)
'Everyone's opinion must be taken into consideration by our lecturers, even though there is difference in age or sex.' (Male student nurse, aged 18)
'Nurse-educators should learn to listen attentively to us, even if they are experienced in teaching, for sometimes they can miss very important information [coming] from students.' (Male student nurse, aged 20)
'When you happen to do [sic] a mistake they do not have a room for that nor listen to you as a student.' (Female student nurse, aged 17)
The importance of cultural background is supported by literature as contributing to effective learning and encouraging active student engagement (Dembele 2006:66). According to Langley (2009:11) and Kelly (2009:123), considering cultural differences is very important in the building of positive relationships.
Listening is supported in literature as being a motivational strategy and a prerequisite to student learning, and is critical to student-teacher relationships (Kelly 2009:123). According to Cotton (2001:10) paying attention to students' interests, problems and accomplishments during interaction, both in and out of the classroom is needed to motivate students. Similar views are stated by Catlin and Mensah (2009:92) who conclude that productive classrooms result from teachers who truly listen to their students and show them respect, give them what they need, understand their needs, value their feedback during classroom activities and support their ideas. Active listening is a critical issue and thus the researcher recognises its importance in the classroom.
The impact of positive interaction in the classroom
Participants felt that learning would be enhanced, and the failure rate and attrition rate would be reduced, if positive interaction were evident during classes. Participants in this study also believed that co-operation between the two parties in the learning setting was beneficial. Furthermore they felt that students would adapt to new situations and cope well in the classroom and in clinical settings if good relationships existed between them and their educators. These subcategories of opinions are encapsulated in the following verbatim responses:
'I also support that good relationships motivate us to learn, we are not bored by the educator or subject.' (Male student nurse, aged 20)
'We learn more if things are going smoothly in class between us and our nurse educators. (Female student nurse, aged 21)
'Students must be free to ask questions and talk to us educators; this promotes learning and increases pass rates.' (Female nurse educator X working with nursing neophyte students)
'I also will like to add that no students will fail and drop out if there is good relationship with the lecturers.' (Female student nurse, aged 21)
'As an educator, I've observed that the level of co-operation between the two parties can improve.' (Female nurse educator X working with nursing neophyte students)
'Yes, good relationship with our lectures ... has good impact because people will be able to work hand in hand [with one another].' (Male student nurse, aged 19)
Both the educators and students nurse neophytes realised the need for improving communication, encouraging mutual respect and engaging in classroom dialogue. The student participants felt strongly that good interaction in the classroom would reduce the number of dropouts, because nurse educators would identify students at risk and suggest remedial activities to minimise the failure rate. The nurse educator participants indicated that students should be allowed to raise their concerns and feelings about the subject matter, the teaching and learning environment and teacher behaviour. Some of the literature consulted also reflected similar findings.
Schuster (1996:21) and Killen (1998:72) reflect the experiences of a nursing instructor who encouraged quality teacher-student relationships and support by allowing students to air their concerns and feelings. This resulted in the students wishing to progress in their studies. According to De Souza (2000:29), creating a harmonious and meaningful environment can contribute to the development of students' creativity and promote learning. Similar views were supported by Leitao and Waugh (2007:32) who state that teacher-student relationships influence students' ability to adjust to their studies and do well. Lombardo (2004:218) concludes that positive relationships are necessary for effective teaching and learning to take place. Furthermore the pass rate of students improves when they have co-operative and supportive relationships with their advisors, coordinators and teachers. As an educator, the researcher has experienced the excellent impact that positive relationships have on students' learning experience. Therefore she agrees with the participants that positive interaction promotes learning, and reduces student failure and dropout rate.
The study was conducted at the University of Venda, Department of Advanced Nursing Science among student nurse neophytes and the nurse educators who were responsible for teaching them as participants, therefore the findings could not be generalised for the entire University and for other universities.
The study focused solely on the perceptions of nurse educators and student nurse neophytes with regard to what they regard as examples of good interaction in the classroom; therefore, the perceived examples of poor interaction were not included in this study as it was discussed in another context.
Participants viewed the creation of a positive and harmonious environment in the classroom and the promotion of good student nurse-nurse educator relationships to be conducive to learning and reduced both the failure rate and the attrition rate. Therefore, the good influence of these positive factors should be reinforced in order to improve nurse educator-student nurse neophyte relationships. The subcategories of positive factors were valued by participants and supported by literature. The findings of the research indicated that improved levels of co-operation had a positive impact on pass rates, the enhancement of learning and the reduction of failures and dropouts.
The study recommends that nurse educators and student nurses should display behaviours that could contribute to the desirable outcomes, including for instance good communication, listening, honesty, openness and cooperation The subcategories identified in this study are considered by the researcher to be important, because they can help to improve student motivation, create a positive learning atmosphere and help students to succeed in their studies.
The findings in this study indicate the need for nurse educators and student nurses to develop good practices to promote good interaction in the classroom setting. Respect, support, caring, good communication, using a common language, active listening, socialisation, kindness and acceptance were identified as examples of ethical behaviour in this study. Improving student relationships with nurse educators is important and has long lasting and positive implications for students' academic and social development.
'We, the authors declare that we have no financial or personal relationship(s) which may have inappropriately influenced us in writing this paper.'
F.M. (University of Venda) literature review, collected and analysed data; L.B. (University of Venda) refined the data analysis and conceptualised the text.
Abuja, S.E., 2010, 'Building positive student-teacher relationship', viewed on 11 January 2010, from http://:www.leadershipeditors.com/ns/index.php?option=com-content&view=article&id [ Links ]
Barak, L.O. & Wilhelem, D., 2005, 'Novices in clinical practice settings. Student nurses' stories of learning the practice of nursing', Nurse Education Today 25, 455-464. http://dx.doi.org/10.1016/j.nedt.2005.04.006, PMid:16005116 [ Links ]
Beck, D.L. & Srivastava, R., 1991, 'Perceived level and sources of stress in Baccalaureate Nursing students', Journal of Nursing Education 30(3)131-138. [ Links ]
Brink, H.L., 2004, Fundamentals of research methodology for health care professionals, 4th edn., Juta & company Ltd., Cape Town. [ Links ]
Brophy-Herb, H.E., Lee, R.E., Nievar, M.A. & Stollak, G., 2007, 'Preschoolers' social Competence, Relations to family characteristics, teacher behaviours and classroom climate', Journal of Applied Developmental Psychology 28(2),134-148. http://dx.doi.org/10.1016/j.appdev.2006.12.004 [ Links ]
Burns, N. & Grove, S.K., 2009, The Practice of nursing research. Appraisal, synthesis and generation of evidence, 6th edn., Elsevier Saunders, USA. [ Links ]
Catlin, J.N. & Mensah, F.M., 2009, Creating an equitable classroom through establishing respect, Ohio State University, Nation foundation. [ Links ]
Chan, D.S.K., 2001, 'Combining qualitative and quantitative methods in assessing hospital learning environments', International Journal of Nursing Studies 38, 447-459. http://dx.doi.org/10.1016/S0020-7489(00)00082-1 [ Links ]
Charles, B., 2002, Some factors influencing the use of simultaneous interpreting as an alternative to parallel-medium teaching in tertiary education, Darwin University, Australia. [ Links ]
Corcoran, S., 2007, 'The Value of values in nursing', Journal of scholarship 7(3), 5-9. [ Links ]
Cotton, K., 2001, 'Improving student attitude and behaviour, Longmont, Colorado, Loma Linda Elementary Northeast Junior High School', School Improvement Research Series, 3, 10-16. [ Links ]
Craig, R.P., 1996, 'Student-teacher relationship, A Buddhist perspective', Clearing House Journal 69(5), 285-286. [ Links ]
Daly, T., 2008, 'Seven days to a perfect classroom', in Middle school Ideas, viewed on 07 September 2009, from http://wiki.fms.k12.nm.us/groups/middleschoolteachingideas [ Links ]
De Souza, D., 2000, 'Teacher and student perceptions of creativity in the classroom environment: Roeper Review Articles', viewed on 01 April 2000, from http://www.accessmylibrary.com/article-1G-62684709/teacher-and-student-perceptions [ Links ]
De Vos, A.S., Strydom, H., Fouche, C.B. & Delport, C.S.L., 2011, Research at grass roots for the social sciences and human service professions, 4th edn., Van Schaik Publishers, Pretoria. [ Links ]
Dembele, P.R., 2006, Teacher-learner relationship in the management of discipline in public high schools, Tshwane University of South Africa, Pretoria. [ Links ]
De Young, S., 1996, Teaching nursing, 2nd edn., Cummings Publishing Company Inc., Addison, Wesley. PMCid:2143488 [ Links ]
Dian, B. & Uustal, H., 1993, Palliative care nursing, Quality care to the end of life, 2nd edn., Spring Publisher Company, New York. PMid:8112161 [ Links ]
Ellis, D.M., 2006, 'Exploring men's perceived educational experiences in a baccalaureus program', Journal of Nursing Education 45(12), 154-157. [ Links ]
Ghias, S., 2009, 'Health and Science psychological effect of stress ground report', BiAnnual National Journal 24(1), 224-229. [ Links ]
Gordon, T., 2009, Teacher-learner relationship, The Missing Link, Teacher Effectiveness Training, Solana Beach, California. [ Links ]
Gupchup, G.V., Borrego, M.E. & Konduri, N., 2004, 'The Impact of student life stress on health related quality of life amongst doctor of pharmacy students', College Student Journal 38(2), 292-302. [ Links ]
Hartjies, E., 2007, Respect in the classroom is a two way street, Teachers at Risk, Reading Council, Toronto. [ Links ]
Hershman, D., 2009, Inspiring teachers, Classroom leadership styles - empowering educators, Inspiring Teachers Publishing, Inc., Canada. [ Links ]
Jones, V.F. & Joneson, M.C., 1997, Positive teacher-student relationship, Allyn and Bacon Inc., Boston. [ Links ]
Kelly, M., 2009, 'Active listening for the classroom, An important motivational strategy', in About.com, viewed on 07 Sept 2009, from http://712educators.about.com/cs/activelistening/a/activelistening.htm [ Links ]
Killen, C., 1998, 'Creating positive interpersonal relationships in the classroom', Journal for Effective Teaching Strategies 3, 70-73. [ Links ]
Klopfenstein, B.J., 2003, Empowering learners, Strategies for fostering self directed learning and implications for online learning, Department of Elementary Education, Edmonton, Alberta. PMCid:2173678 [ Links ]
Langley, D.J., 2009, 'Student challenging behaviour and its impact on classroom culture, An investigation into how challenging behaviour can affect the learning culture in New Zealand primary schools', Journal of College Student Development 50(6), 677-678. [ Links ]
Last, L. & Fulbrook, P., 2003, 'Why do student nurses leave? Suggestions from a Delphi study', Nurse Education Today 5(6), 241-458. [ Links ]
Leininger, M. & Watson, J., 1990, Teaching caring within the context of health, Imperative in Education, New York. PMCid:1014166 [ Links ]
Leitao, N. & Waugh, R.F., 2007, Students' views of teacher-student relationship in primary school, Edith Cowan University, Perth Western, Australia. [ Links ]
Lincoln, Y.S. & Guba, E.G., 1985, Naturalistic inquiry, Sage Publications, London. [ Links ]
Lombardo, J.B., 2004, 'Relationship Count. Transitioning ESOL students into community college takes collaboration and personalized services', Focus on Basics, Connecting Research and Practice 6(D), 218-220. [ Links ]
Mahat, G., 1996, 'Stress and coping, Junior Baccalaureate Students in clinical settings', Journal of Nursing Education 35(4), 159-165. [ Links ]
Mahat, G., 1998, 'Stress and coping, Junior Baccalaureate Students in clinical settings', Nursing Forum Journal 22(1), 11-19. http://dx.doi.org/10.1111/j.1744-6198.1998.tb00976.x [ Links ]
Maki, M., 2009, 'Student-teacher relationship, Key to co-operative classrooms', School Psychology Review 37(3), 18-24. [ Links ]
Mellish, J.M., & Brink, H.I.L., 1998, Teaching the practice of nursing, 4th edn., Butterworth, Durban. PMid:9604650 [ Links ]
Mellish, J.M. & Paton, F., 2009, An introduction to ethos of nursing, A text for basic student nurses, 2nd edn., Heinemann, Sandton. [ Links ]
Nicklin, P. & Kenworthy, N., 1997, Nursing practice education, A reflective approach, 2nd edn., Freeman & Company, New York. PMCid:179744 [ Links ]
Polit, D.F. & Beck, C.T., 2010, Essential of nursing research, Appraising evidence for nursing practice, 8th edn., Lippincott Williams & Wilkins, Kluwer. PMCid:2903691 [ Links ]
Polit, D.F. & Hungler, B.P., 2006, Essentials of nursing research, methods, appraisal and utilization, 7th edn., JB Lippincott Company, Philadelphia. [ Links ]
Powell, J., 2009, Teacher-student interaction, An evaluation of an English First Language classroom, Trinity College, London. [ Links ]
Reilly, D.E. & Oermann, M.H., 1996, Clinical teaching in nursing education, 2nd edn., National League of Nursing, New York. [ Links ]
Repak, N., 2006, Emotional fatigue, Coping with academic pressure, Ben Gurion University, Boston. [ Links ]
Savage, J.S. & Favret, J.O., 2006, 'Nursing students' perceptions of ethical behaviour in undergraduate nursing faculty', Nursing Education in Practice 6(1), 46-49. http://dx.doi.org/10.1016/j.nepr.2005.08.002, PMid:19040855 [ Links ]
Schuster, C.A., 1996, 'Student nurses can be good nurses', Geriatric Nursing 17(47), 18-25. [ Links ]
Scott, E., 2009, 'Stress in college, Common causes of stress in college', Health Promotion International Journal 2(16), 215-232. [ Links ]
Searle, C. & Pera, S.A., 1995, Professional practice, A southern African nursing perspective, 3rd edn., Butterworth publishers (Pty) Ltd., Durban. [ Links ]
Streich, M., 2009, 'Classroom management tips, Mutual respect and professionalism begins with a successful year', in BrokenHeartedGirl.com, viewed 22 January 2009, from http://www.brokenheartedgirl.com [ Links ]
Susan, M.H., 1986, Teaching clinical nursing, 2nd edn., Churchill Livingstone, Edinburg London Melbourne & New York. [ Links ]
Takabayashi, R., 2008, Successful education begins with positive relationship between teacher and students, Honolulu Advertiser, California. [ Links ]
Taylor, G. & Runte, R., 1995, Introduction to thinking about teaching, Harcourt Brace, Toronto. [ Links ]
Thomson, S., 1997, Nurse teachers as researchers, A Reflective Approach, 2nd edn., Arnold, London. [ Links ]
Tony, H., 1988, Learning to teach with problem based learning, University of Otago, New Zealand. [ Links ]
Vallant, S., 2006, 'The relationship between student nurses and nurse clinician, Impact on student learning', Nursing Praxis in New Zealand 22(3), 23-33. PMid:17375485 [ Links ]
Wax, D.M., 2008, 'Punctuality counts', in Lifehack, viewed on 28 May 2008, from http://www.lifehack.org/articles/productivity/punctuality-counts.html [ Links ]
Wedin, A., 2009, 'Classroom Interaction, Potential or problem? The case of Karangwe. International', Journal of Educational Development 30, 30-35. [ Links ]
Werner, E.E., 1990, Vulnerability of high risk students, Response to stressful life events, Cambridge University Press, New York. [ Links ]
Zhong, M., 2006, 'Classroom organisation, From teachers to students, Student-Centred Learning', A Personal Journal 9, 57-61. [ Links ]
PO Box 643
Letaba 0870, South Africa
Received: 17 Apr. 2012
Accepted: 03 Oct. 2012
Published: 03 June 2013