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Graduate student perceptions: feeling the passion of caring online.


The concept of caring in nursing education has been addressed with regard to traditional classroom settings. In addition, research on effective online teaching approaches, differences between online and face-to-face classroom settings, and supporting student success in online settings is readily found in published literature. The question of whether caring can be effectively conveyed in online nursing classroom settings remains unanswered. This qualitative study explored graduate nursing student perceptions of caring in online classes. Doctoral and master's nursing students at a research-intensive university were invited to participate in an online survey regarding how instructors may best convey caring online. Survey questions were open-ended. Themes uncovered in the data included empathetic perspective, timeliness of communications, tone of appreciation, being the best I can be, finding a chord of harmony, and feeling the passion of caring online.

Key Words Online Nursing Education--Distance Education--Web-Based Education--Caring Online--Best Practice Approaches to Online Education


TO EXPLICATE BEST PRACTICE APPROACHES to online education, an exploration of caring within online teaching environments is imperative. This qualitative study, which focuses on the perceptions of graduate students, is a replication of a similar study conducted with undergraduate nursing students, completed by the same authors and published in the September/October 2006 issue of Nursing Education Perspectives (1). Both studies were designed to recognize, explore, and understand how students experience caring in online education. In both studies, students responding in writing to six open-ended questions:

* Define caring as it occurs in a student-instructor relationship.

* Is it possible for an instructor to convey a sense of caring in an online classroom setting? If so, how? If not, why not?

* Does presence or absence of caring on the part of the online instructor influence your success in the class? If no, why not? If yes, in what way?

* What factors support the experience of "students feeling cared for" in an online setting?

* What factors do not support the experience of "students feeling cared for" in an online setting?

* What guidance would you offer to instructors who wish to convey a sense of caring to online students?

Review of the Literature Long associated with nursing practice, caring is implicit in quality education (2-5). The concept of caring has numerous meanings, definitions, and associated behaviors. Most definitions include the conceptual notion of one person mindfully and appropriately attending to the spoken and unspoken needs of another. Educators convey caring values through active teacher-student dialogue and modeling, thereby perpetuating caring as a core value in nursing (2).

Caring has been explored in nursing education within the context of one-to-one interactions where participants are able to directly and physically experience the other's voice, body language, facial expressions, and shared physical context, as found in face-to-face classroom settings (2-15). Online interactions lack the direct, physical aspects of face-to-face interactions (16-19), and the question of whether these interactions engender an environment of caring has not been adequately explored. This gap in knowledge is of concern for nurse educators who, in response to the need for more widely accessible nursing education, have created numerous online nursing courses and programs (19).

Studies addressing excellence in nursing and online education cover a variety of topics. Broad categories of research include face-to-face nursing classrooms, student satisfaction with online nursing education, best practices in online educational settings, and student success/satisfaction with online education. Outcomes of this research review are outlined in Table 1.

Ryan and colleagues succinctly point to general differences between online and face-to-face nursing classroom environments. Stating that "transformation to a portable, anywhere, anytime environment can result in loss of familiar landmarks," they call for deliberate "re-thinking" of the two approaches to education (19, p. 77).

Ali and colleagues studied students' perceptions of online learning and formulated a list of implications for faculty aimed at supporting successful online education (20). These implications are summarized in Table 2. Recommendations for a best practice approach to online nursing education include effective communication strategies, quality technical components, and various strategies or approaches to curricula (20-42). These elements are readily seen in the themes uncovered by the authors in this research project with graduate students and in the project that focuses on baccalaureate students (1).

Methodology For this study, the authors replicated the methodology used with baccalaureate students (1). All doctoral and master's students at a Carnegie research-intensive university were invited to participate by a course announcement explaining the purpose of the research. They were provided access to the survey questions, which were posted on an Internet address accessed through the Blackboard online instructional platform. All responses were anonymous. A constant comparative method of analysis uncovered persistent categories of data, which collapsed into themes.

SETTING AND PARTICIPANTS The participants were registered nurses enrolled as master's students (clinical nurse specialist, family nurse practitioner, or nurse educator track) and doctoral students in a PhD in nursing education program. All doctoral coursework was online; master's coursework was either completely online or a hybrid format consisting of on-campus classes with online supplementation. The majority of participants had completed at least two or three years of study and at least four totally online courses.

DATA COLLECTION The survey web address, with consent form, was posted on all online courses available to graduate nursing students at the time of the research. An introductory note explained that students who chose not to participate would not be penalized and that responding to the survey constituted consent to participate. At first, students were given two weeks to access and respond to the survey. A reminder invitation was placed on all online course announcements, and the survey period was extended by two weeks. The Blackboard platform does not allow the researcher to track responses directly to the participant.

DATA REDUCTION AND CODING The data were downloaded from the survey site and analyzed by the authors. The analysis process included reading and rereading the original written responses, coding key utterances, identifying categories of consistent concepts found, then collapsing the categories into themes.

Results An overall response rate of 79 percent was achieved (39 out of 49 total possible participants). Data were not separated by track or level of student, but treated as one population cohort of graduate nursing students. The sample consisted of 36 women and three men.

Six themes emerged from the data, one of which appeared to be an overarching theme that contained elements from the others. All themes are described and illustrated with quotations from the respondents.

EMPATHETIC PERSPECTIVE The majority of respondents defined online caring with respect to the concept of empathy. The word empathetic and connotations of empathy were repeatedly observed in the responses. The notion of empathy involved "looking at the other person's perspective and demonstrating concern over their well being." Even though the online educational experience is not face to face, elements of intuitive interaction were also identified within the definition of online caring and referred to as inherent in an empathetic approach to online education. Students stated that online caring involved "being in tune with the thoughts and feelings of others" and faculty ability to "sense [student] overload" from a distance.

TIMELINESS OF COMMUNICATION Students clearly desired prompt responses from faculty as often as possible. High frequency, constant availability, and immediacy of interaction were very important to feeling cared for online. Even so, two of the 39 participants in the study stated directly that they were not supportive of online education in general; they consistently communicated that no online interaction could in any way mirror quality interactions in face-to-face classroom settings.

Frequent constructive feedback, personal email interactions, synchronous online chats, and course discussion forums were all mentioned as important communication tools that should be used every week. The higher the frequency of use, the greater the students felt "cared for" by faculty. Only one student explored the degree to which it is realistic to expect faculty availability 24/7 for responses to all students needs. She wrote, "One faculty member modeled taking care of oneself by sharing that she would not be online on the weekend because she used this time for rest and refreshment. I felt she was modeling permission to care for oneself and believe this is a very caring behavior." Timeliness of online communications also meant letting the students know if and when faculty would not be available.

TONE OF APPRECIATION Graduate students wrote of the great desire for affirmation and encouragement from faculty in order to "know" that they are cared for. Students stated that a "tone of appreciation," communicated through the instructor's choice of words and punctuation in online feedback, was imperative. This tone of appreciation was noted to be of great significance for student morale; students wrote that they had dropped online courses when they did not receive the necessary degree of positive encouragement and support from faculty.

A tone of appreciation and support was also seen as necessary from the course peer group. One student wrote, "I would throw in the towel if there was not support from the instructor or my classmates." The fact that "reading between the lines" can alter the meaning of the written word was observed in many of the responses. To convey caring, faculty were encouraged to choose their words and craft their narrative, online responses very carefully and thoughtfully.

BEING THE BEST I CAN BE The degree to which caring is implicated in student success was readily apparent in responses such as, "If faculty doesn't care, why should I?"; "Caring encourages me to do the best I can", "Presence of caring makes me a winner or at least I feel like one." Online caring was a significant motivator for graduate student behavior: "I go the extra distance for the people I feel care about me" and "Online faculty caring helps me be the best I can be." Such responses convey the significance of caring and the apparently strong impact it has on the student's degree of success in the academic experience: "Caring is active to me--like passion; it keeps me coming back for more."

FINDING A CHORD OF HARMONY A pervasive theme focused on the student's need for faculty to get to know them on a personal level, even if the interaction was never face to face. Students spoke frequently about their need for faculty to "understand them as people, and not just computer entries," and for faculty to also share who they were personally. Instructors were encouraged to "zone in on tidbits of information to remember about each individual student," and "share [something] about yourself--if you like gardening and I like gardening, we have something in common." One student stated that "finding a chord of harmony" between faculty and students requires vulnerability on the part of both parties and allows each to "be visible to the other"--clearly a necessary element when interacting online with a caring approach.

Feeling the Passion of Caring Online Respondents articulated in many ways that they could feel, and appreciated, "the passion of caring online" from some faculty. The passion of caring has elements of an overarching theme in that it captures and draws together all the other themes uncovered in the data. Students wrote of the degree to which a caring affect can be "generated," "picked up on," "focused on," and "anticipated." They spoke of it as highly conducive to quality online academic experiences.

Affective behaviors, such as sensitivity, openness, warmth, responsiveness, reaffirming, and patience, as well as being genuine, supportive, insightful, thought provoking, and inspiring were all used to describe caring online faculty. Although a common concern about online education has been the lack of a personal touch or communicating personal passion for educating students, it is curious that in an online format, an educator's "passion for teaching and interaction with students" is readily conveyed to students. Clearly, online interactions can communicate a degree of affective behavior. Caring is perceived through attention to quality and relational interactions between students and faculty.

Summary and Conclusions The themes uncovered by seeking the graduate student's voice to explain what online caring is all about--empathetic perspective, timeliness of communications, tone of appreciation, being the best I can be, finding a chord of harmony, and feeling the passion of caring online--support findings in related studies that look at best practice approaches to online education (7,18,20). Indeed, the data support a convergence of the concepts of caring and best practice in online nursing education. It may he that the best way to create a caring online environment is to increase faculty awareness about specific approaches and the degree to which interpersonal caring moments (43) are communicated directly or indirectly online. The researchers were struck by the extent to which respondents sought, experienced, and appreciated faculty actions, affect, and intuitive behavior that reflected caring, albeit from a distance.

Intentional caring on the part of the teacher improves nursing student outcomes in face-to-face settings through enhanced learning, enhanced student self-esteem, perceived competency, retention, and program completion (3,8,9,11,44). The data reported from this research study are consistent with these outcomes.

The high degree to which caring motivates graduate student success deserves a closer look in future research. For example, the statement, "I go the extra distance for the people I feel care about me" suggests that the student is "performing" for external rewards of praise, instead of being motivated toward personal goals of lifelong learning. It would be prudent to explore ways of encouraging students to internalize the locus of control, motivating them by means of caring interactions and words that are chosen carefully and thoughtfully. If manifestations of caring support quality educational experiences for online nursing students, clarifying how best to support caring would be a benefit for students and teachers.

Two participants in the study were very clear about their view that that learning online was not comparable in any way to the traditional classroom setting. The degree to which these students were outliers in the cohort was difficult to determine due to the fact that the rest of cohort did not express these concerns. Many of the students had clearly self-selected the online format for their course work.

In future studies, participants who self-select online course work may need to be compared separately to those who do not have a choice in course or program format. Negative student responses to online education yield a different sort of data. Therefore, it may be advisable to approach data collection from a different perspective, asking participants to describe "non-caring" student-faculty online interactions.

Continued exploration of caring within online teaching environments is necessary to discover similarities and differences in caring as conveyed in online versus face-to-face classrooms. Best practice approaches to deliberately create caring teaching environments for online nursing students are important for high quality online education. Increased numbers of online programs address access and choice issues for nursing students. However, expanding knowledge about caring-focused online learning experiences will serve to promote quality nursing education.


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Debra Woodard Leners, PhD, RN, CNE, CPNP, is professor and doctoral program coordinator at the University of Northern Colorado, Greeley. Kathleen Sitzman, RN, MS, a doctoral student at the University of Northern Colorado, Greeley, is an assistant professor of nursing, Weber State University, Ogden, Utah. For more information, contact Ms. Sitzman at
Table 1. Caring in Face-to-Face Nursing Classrooms


* Honesty, respect, understanding, kindness, and compassion

* Taking extra time, following through, and remembering details

* Positive reinforcement and praise

* Individualized one-to-one instruction

* Attentive and non-judgmental listening

* Smiling and exhibiting a sense of humor

* Sensitivity to students' needs

* Positive role modeling


* Faculty's holistic concern for the student, personally and

* Faculty being nonjudgmental, respectful

* Faculty affect of being open, warm, and genuine


* Genuinely caring about what happens to others

* Sensitivity to the uniqueness of each student

* Promoting awareness of self in each student

* Cultivating acceptance of differences in others

* Sharing genuine life/professional experiences

* Provision of a supportive emotional, sociocultural, and
spiritual environment

Table 2. Best Practice in Online Education


* Develop learning outcomes within context of meaningful activities

* Create learning experiences based on previous knowledge

* Employ problem solving, reasoning, and critical thinking strategies
and engage in activities that require reflective and active


* Realistic and relevant online classroom environment

* Many opportunities for social interaction and negotiation

* Employ multiple learning modes

* Encourage independence and autonomy

* Support student self-evaluation and ownership of the learning


* Clearly state learning outcomes

* Use course management tools creatively

* Ask students how they prefer to learn

* Assess learning styles of the students and design/redesign
assignments accordingly

* Provide timely feedback, returning assignments within a
reasonable time period

* Give students the opportunity to critique each other

* Recognize excellent work

* Appreciate differing perspectives

* Ensure that technical problems are resolved promptly
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Author:Leners, Debra Woodard; Sitzman, Kathleen
Publication:Nursing Education Perspectives
Date:Nov 1, 2006
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