Experiences of role model instructors and nursing students about facilitator factors of role-modeling process: A qualitative research

Abstract

Background:

One of the key strategies in students’ learning is the influence of models on them. Understanding the factors affecting the implementation of role-modeling process in education will help to make greater use of this training strategy. This study aimed to understand the experiences of role model instructors and nursing students about the facilitator factors in the role-modeling process.

Material and Methods:

This qualitative study was carried out by using thematic analysis method and purposeful sampling. Data were collected until saturation by using three focus group discussions (n = 20) and two individual interviews with nursing instructors, as well as six semi-structured face-to-face interviews with role model instructors from five nursing faculties of Tehran universities in 2011.

Results:

Six themes, “effort for humanistic and professional growth of students,” “individual and managerial empowerment of instructor,” “instructor and student's modeling,” “motivation and effort of student,” “strategies governing the education system,” and “appropriate facilities and equipment,” were extracted as the facilitating factors.

Conclusions:

For development of role-modeling process in nursing education, paying attention to personal and environmental factors, especially effort for professional and humanistic growth of nursing students is necessary.

INTRODUCTION

The term “role modeling” was raised for the first time by sociologist Merton in 1950 in a research about socializing medical students; he stated that people compare themselves with a reference group.[1] Role modeling mainly relies on imitation and observation,[2] which is one of the basic contents of social learning theory of Bandura, and according to social learning theory supporters, the most important type of human learning is observational learning.[3]

Model or role model method is a method that is based on the axis of modeling and providing concrete and practical examples. In this method, teacher tries to put appropriate behavior in perspective of the learner practically in order to make necessary conditions for role modeling and imitation for him/her.[4] In the importance of the role of model, it has been said that role of the model in guiding people is like exemplar for education and compass for path; he/she teaches unbeknown to the person and shows necessities.[5]

Modeling and Role-Modeling (MRM) theory was developed by Ericksin, Tomlin, and Swain in 1982. The aim of MRM is helping people for growth, evolution, improvement, and self-actualization. In this theory, modeling is a central content which, in that a person, makes a picture and perception of another person's world with that person's framework, points of view, values, and perspectives. Role modeling needs to have modeling form from the person's at first. MRM theory can be used in teaching in the case that teachers try to perceive their students’ world and design teaching strategies in order to help their growth.[6]

There have been lots of studies about the importance of models’ role in teaching nursing, in a way that role modeling has been introduced as one of the most important functions of nursing teachers and the sign of teaching competence.[7] To be a model is one of the 12 necessary roles of a teacher.[8] Perry stated that models act as a catalyzer for transformation (evolution); while they are teaching, they council, guide, and cause facilitation of others’ promotion.[3]

Other studies have stated “model of being good,” “model of being positive,” and “model of being practicable” as the characteristics of effective clinical teacher.[9,10] Because using special model can be effective in promoting patient-centered approaches,[11] nursing students’ learning forms from communication skills with indirect and empirical modeling of clinical staff and professors,[12] the model supports students’ professional promotion in teaching,[13] and being a model at bedside is a process that promotes patient's world imagination and forms the ability for the nurse to perceive the patients from their perspective.[14] So, nursing teachers are responsible for developing teaching skills to the bedside environment because they not only teach but also are nursing actions’ models.[15]

Moganand Knox's study conducted to recognize and compare characteristics of the “best” and the “worst” clinical teacher from students’ and faculty members’ point of view showed that in both groups of masters and students, “model of being functional” as the characteristic of the best clinical teacher had the highest degree of importance.[16] Clinical environment creates a chance for the students to observe the models, practice and promote skills and abilities of solving the problem, and reflect what they see, hear, and do. The main way that the students promote their professional behaviors related to providing their care is using the models.[2] In Mentorship and Preceptorship, which are two really important useful strategies in clinical education, using model has a key role;[2] mentors are defined as experts who are action models.[18]

On the other hand, after that, Robinson introduced scholarship as one of the main qualifications of a clinical teacher and stated that scholarship function of clinical teachers is done through being a model for the students.[19] Karimi Moonaghi mentioned that nursing teachers believe that in clinical education, teaching in the method of being a model is the most effective and correct method for transformation of experiences and professional attitudes to students.[20] Lack of models can lead to increase of stress and dissatisfaction among nurses.[14]

So, considering the importance of role modeling in nursing education, knowing the facilitating factors in every environment can be effective in implementation of this successful educational strategy. On the other hand, there is no study giving the explanations of facilitators of role model process in Iran. Thus, the present study was done with the aim of finding “perception of nursing model teachers and nursing students’ experiences about role-modeling process facilitators.”

MATERIALS AND METHODS

The present study was done with a qualitative approach and with the method of thematic analysis from November 2010 to August 2011. Thematic analysis is a qualitative research method that emphasizes on searching themes and contents related to the question of the study. In this kind of study, the main source of information is interview and having in-depth talk with the participants through the questions designed to get explanation of their life experiences. In other words, researchers can perceive participants’ world by conducting deep interview and discovering their experiences.[21]

Participants had been chosen by using purposive sampling and according to the following criteria:

1. Students of the last semesters of BA, MA, and PhD of nursing from five nursing colleges of medical science universities of Tehran.

2. Nursing teachers who were introduced by these students as model.

Exclusion criterion was the students or teachers not willing to continue discussion.

The students were asked to participate in individual interviews or focus group discussions. Names of the volunteers and their phone numbers were documented and they were invited to participate in individual interview or focus group discussions. Data were collected through focus group discussions and face-to-face semi-structured interviews until data saturation occurred. There were two meetings of focus group discussions with BA students and one meeting with MA students, with the presence of six, eight, and six people, respectively. Every meeting lasted from 80 to 120 min and questions were asked openly and according to the aims of the study. Meetings were conducted by using verbal and non-verbal communication skills by two researchers. There were two individual interviews with nursing PhD students and six nursing teachers, which lasted between 20 and 120 min.

The average age of the students was 26.5 ± 6.25 years, and of them, 55.8% had BA degree and 56.7% were women. Also, six nursing teachers of age 45 ± 2.9 years participated in individual interviews and had work experience of 24 ± 6.7 years, of whom four people had PhD in nursing education and two people had MA in nursing.

The main question from the professors was, “explain your experiences about facilitating factors of achieving your considered educational approaches.” And questions from the students included: “explain your experience in education period with model teachers.” Another question was “what factors led to accept this professor (professors) as a model?”. These questions were designed to guide interviews. The interviews process continued based on participants’ responses.

Exploratory questions such as “please explain more” or “what did you mean by this word?” encouraged the participants to discuss and helped to obtain deeper information. After every meeting, conversations, after being recorded on MP3, were written on a paper word by word as soon as possible. Focus group discussions caused more interactions between researcher and participants.[22] Since there were no new data from the last interview and no new class had been formed, collecting information was stopped.

Data analysis

Although there is no clear agreement among researchers about the way of thematic analysis, nowadays, it is used widely. According to the opinion of Braun and Clarke, simultaneous collection and analysis of data had been done in line with the research aim during six stages: 1. researcher becoming familiar with the data, 2. producing the initial codes from the data, 3. searching to find themes by reviewing different extracted codes from the last phase, 4. reviewing the themes and comparison of them again with the data in order to be sure about their accuracy, 5. defining and naming of the themes, and 6. preparing the final report.[20]

All the interviews and discussions of focus group discussions were recorded and copied, and the text of the interview was read line by line several times by the researchers and 1200 statements or important phrases or meaningful units were extracted. These units were in the form of classes. Conceptual and abstract naming of every class was done according to the characteristic of meaningful units inside every class. Comparing the initial classes was done many times and finally six themes were extracted.

Data rigor

In order to assess credibility of data, two nursing students of PhD who were participants in this study were used as member check. Long-term involvement (about 9 months) with the subject of the study helped to test validity and distribution of participants’ choice from five nursing colleges and transferability of most of the data. In order to assess confirmability and dependability of data, five faculty members who were out of the study and were familiar with qualitative researches were asked to comment on the correctness of the data (faculty members’ check and external check), and then researchers discussed about their opinions concerning data analysis and fixed the bugs.

Ethical considerations

This study was observed and confirmed by the ethics committee of Baqiyatallah Medical Sciences University and Behavioral Sciences Research Center. All the participants were informed of the method and the aim of the study, and they participated voluntarily. They were told that they could withdraw from the interview at any time they wanted. In addition, they were ensured that their identity would be kept secret in research reports. Informed consent form was filled by the volunteers.

RESULTS

Themes showed facilitator dimensions of role-modeling process in nursing students’ education. Six themes had been extracted: “teacher's effort for student's humanistic and professional growth,” “teacher's personal and management abilities,” “teacher and students’ model accepting,” “student's effort and motivation,” “strategies governing the education system,” and “appropriate equipment and facilities.” Findings are provided for the respective theme and its data.

Teacher's effort for student's humanistic and professional growth

Model teachers facilitated emotional growth by effective interactions. Effective interactions had been done through loving others, communication based on respect, open and interactive communication, eloquent and passionate speech, sense of humor, holistic support of the student, promoting self-esteem (with instilling sense of being valued and interaction based on student's perception). For example, one participant expressed:

“My model teacher, at the end of a tiring work day, while he/she is tired, communicates with humor and respect. He/she comes to the class full of energy and enthusiasm.” (Focus group discussion 1)

Another student said

“He creates attraction in the class by his sense of humor. If you answer to the question, which has been stated incorrectly, he does not humiliate the student. He tries to maintain student's honor.” (Focus group discussion 3)

Model teachers had special personality characteristics. These characteristics included: connecting to the source of divine power, adherence to practical ethics (it means having honesty, sincerity, sobriety, good temper, patience, regulation, criticism, work commitment, dedication, decisiveness and seriousness in work, humility, endurance and sustainability, flexibility, happiness), and adherence to religion as through them, students had gained spiritual growth grounds. Here is an experience of a student about the effect of spiritual development of the model teacher on himself/herself:

“For example, at the beginning of the class, he/she said a Hadith or prayer; in the class, he/she pointed to spiritual dimension of the discussion; for example, he/she said God created the veins in this form. Well, it has not been said like this in English references and resources. It shows that he/she has a spiritual dimension in himself/herself. This belief in heaven and other personal characteristics of this professor such as sobriety, regulation, humility, etc. were model for me.” (PhD student 1)

Other strategies of nursing model teacher were comprehensive and consistent advice, creating insight and critical thinking, and in more complete words, management of students’ thinking. These strategies were among the facilitator factors of students’ intellectual growth. One of the participants said:

“I believe that if I engage and lead student's thought, I am going to be successful in teaching. I ask him/her why you think like this, I ask him/her to criticize class discussion, and wherever and whenever it is needed I guide him/her.” (Teacher 3)

Teachers’ effort to facilitate emotional, spiritual, and intellectual growth is expressed in the growth of nursing students’ different humanistic dimensions. But model teachers did not consider nursing students’ growth as only limited to humanistic different dimensions’ growth, but they considered nursing students’ professional growth in achieving professional independence, social-professional commitment, and professional organizational interactions [Figure 1]. One participant expressed:

Figure 1.

Teacher's effort for student's humanistic and professional growth

“He/she treated respectfully the treatment team members and patients in the ward during training and he/she had good interaction, he/she asked the staff to cooperate with us and he/she believed that if we take care of the patient perfectly, we have fulfilled our professional independence and our commitments, and he/she started himself/herself and came to help in taking care.” (PhD student 2)

And another one said:

“It was clear in the model teachers that they like nursing students’ humanistic dimensions to be grown, and on the other hand, they like in a way that nursing needs and it is professionally necessary, to get great and to be grown.” (Focus group discussion 3)

Teacher's management and personal abilities

Model teachers had special abilities such as high scientific and professional merit, long-term work experience (research, clinical, and teaching), good family background (cultured family that allows them to pursue and continue their education, acceptance and cooperation of their spouses of their job and their education place, even in a foreign country), forming apparent and attractive norms for the students, creativity and innovation, management experience and its ability, and being charismatic in his/her organization. These abilities attract the student, cause increase of influence power, and strengthen the role-modeling process. For example, one of the teachers expressed:

“It's about 25 years that I am in nursing profession. It's about 20 years that I have clinical work experience in surgical department of urology units, ICU, CCU and almost all the units of hospital. I was always at the bedside until 4-5 years ago and now I go to training with the students.” (Teacher 7)

Another teacher said:

“I had been selected as the best researcher in Razi Festival” (Teacher 3)

One student expressed in focus group discussion thus:

“My professor did his/her work completely scientific and dominant.” (Focus group discussion 3)

Model acceptance of teacher and student

Model teachers expressed that they followed their models, and also that they were training future models and their models were effective on their future professions. On the other hand, students said that their models were their ideals in all the areas and following them was their own priority. For example; one participant said:

“If my student did not bring the assignment on time, I do not insult him/her. My model teacher was also like this; if the student had problem, he/she accepted the assignment after the deadline, he/she showed the problem and said to the student to correct and to bring.” (PhD student 1)

Another one expressed:

“Students call me; up to now, 40 students have called me and asked what should they do. I spend much time to help them, may be if the professor… did not do the same for me easily and without any mint, I did not do this for others, I turned off my phone and I said that I have to get to my own work.” (Focus group discussion 3)

Student's effort and motivation

In the role-modeling process, existence of motivation and, consequently, student's effort is very important, in a way that motivation has been expressed as the factor of accompanying with model teacher, interest, role model communication, and effectiveness of model teacher's activity. One of the teachers expressed:

“Persistence, consistency, students’ interest and the motivation that they have could be very helpful in determining their learning activities and success for achieving educational objectives.” (Teacher 3)

Another one said:

“Many people do not come to us at all, because you know, it's another way. It's a way that the students themselves should have learning motivations and they should like and accept and take step.” (Teacher 2)

Strategies governing the education system

Strategies governing the education system concerning attunement with educational goals of model teachers, being free in framing educational policies, authorities’ protection for bringing necessary changes, and assistance for establishing in-service training were among the factors that helped model teachers in achieving their goals. For example, one participant said:

“In MA and PhD level, the teacher can do many works. Actually the system does not intervene a lot, for example, educational system, evaluation system, the observations that the education managers have. For example; we are supposed to set final exam; final exam has got 3-4 scores, if you want to do something else for the midterm, at the most 1.4 scores, you are limited. But it is not like this in MA and PhD level, even you can evaluate yourself 100% and it helps me in achieving my educational goals.” (Teacher 3)

Appropriate facilities and equipment

Providing necessary facilities for performing educational strategies, such as appropriate space, educational facilities, and existing facilities in clinical environment (during training) were among the facilitator factors of achieving model teachers’ approaches. One participant expressed:

“In education process, many factors are effective; person's scientific ability, …, environmental equipment, social equipment, economical equipment, all of them can be effective positively or negatively.” (Teacher 6)

Another one said:

“Financial support is among the simplest things in accessing educational approaches of the teacher at bedside. For example, how much is the glove? It means that when I’m teaching the students that after every suction you should change your gloves, the unit does not give me gloves, what can I say to them? They say that the problem is the funding.” (Teacher 5)

DISCUSSION

Results of this study showed that nursing model teachers and nursing students had experienced several facilitator factors. Model teachers, students, and environmental factors, every one of them, in its turn, were effective in facilitating role-modeling process.

Humanistic tendency of model teachers is cleared in the theme of “teacher's effort for humanistic dimensions growth or human nurturing.” Humanistic tendency is rooted in progressivism philosophy and child-oriented movement in training. In this tendency, not only cognitive dimension but also the learner totally is attended.[23] Nowadays, nursing education is moving from focusing on behavioral outcomes toward focusing on human nurturing.[24] Islamic teachings show that this divine school gives deep attention to all the dimensions of human beings, such as physical and mental, material and spiritual, intellectual, emotional and social, and it gives special attention to training in all these dimensions.[25] According to the results obtained, model teachers’ strategies and approaches were in line with three dimensions, i.e. emotional, spiritual, and intellectual, and model teachers’ concern and effort was in line with human nurturing and training different dimensions of human existence. Also, in the study of Holt-Waldo, human-centered education was the main concern of the teachers.[26] In the study of Wright, commitment to the learners’ growth and creating friendly relationship with the learners that included interaction between teacher and student has been introduced as model teachers’ characteristics.[27] Also, the study of Balmer et al. counted attention to empowerment as the factor of role modeling.[28] In MRM theory, appearance of role-modeling process in education is subject to recognition and perception of student's growth needs and teachers’ effort for promoting students’ growth.[6]

According to the opinion of Belinsky and Tataronis, models teach professional attitude, behaviors, and thinking, and positive role modeling facilitates promotion of beliefs and learner's performance.[3] Also, other studies point to the effect of model on creating positive attitude and professional values and professional promotion.[3,10,29]

In this study, facilitating professional growth was one among nursing teachers’ approaches. So, by propelling student toward professional growth and growth of human dimensions, it has attended to the comprehensive growth of the student and helps in facilitating role-modeling process.

Robinson states five main abilities of nursing teachers as follows: 1. clinical and teaching competence, 2. interpersonal and interprofessional relationship and communications, 3. assessment and evaluation, 4. leading and management, and 5. scholarship and professional promotion.[19] According to the findings, these competences existed in model teachers. In other words, competence of model teachers is confirmed for being a teacher. These personal and management abilities attracted the student toward the model teacher for being a model and facilitated role-modeling process.

In this study, model acceptance of the students and model teachers had been recognized as another facilitating factor of role-modeling process. Also, in the phenomenological study of Perry, one of the approaches of model nurses which made them a competent model was their role modeling.[3]

Nazari mentioned that a strong, disciplined, and questioning student, who is interested in having knowledge of higher scientific level, causes increase of teacher's scientific and practical activity and also his/her ability. Also, alignment of care-treatment goals of the units with teachers’ educational goals can have positive effect on teachers’ competence.[30] In this study, students’ effort and motivation helped in performing role-modeling strategy in education. Role-modeling process needs mutual interaction of teacher and student. It requires on one hand, teacher's effort for comprehensive growth of abilities and his/her model acceptance and on the other hand, student's effort and motivation and his/her model acceptance.

Also, the participating teachers in this study considered the strategies governing educational system helping them to achieve their approaches. If there are more governing strategies, in line with teachers’ educational strategies, students’ affection and model acceptance are more; this finding shows the effect of educational conditions and necessity of educational planners’ and managers’ attention to design educational strategies. Jouybari in his/her study considered inadequacy of clinical equipment of units for education and following bad practices that govern clinical environment as among the clinical environment problems that cause nursing teachers’ weakness in clinical education.[31] These points show the necessity of the nursing educational mangers and teachers of this field paying attention in order to choose a clinical environment with appropriate equipment and teachers’ assistance for making model teachers’ educational goals practicable. Also, Ramezani's study points to the effect of some factors related to physical environment on teacher's efficiency,[32] which is in line with the findings of this study.

Considering the findings of this study, it is suggested to the educational managers that for facilitating role-modeling process, in addition to attending to appropriate equipment, they should facilitate simultaneous human and professional growth of nursing students for achieving model teachers’ goals.

CONCLUSION

Perceiving the facilitating factors of role-modeling process helps in using this strategy in nursing education and promotion of nursing education quality. The main goal of role-modeling process facilitator was model teachers’ effort for comprehensive growth of the student (nursing students’ professional and humanistic dimensions growth).

Nursing officials and education managers can use the findings of this study for training teachers of the nursing colleges. It is recommended to present the results of this study to the novice teachers who, by using them, can be successful models in the future for the nursing students.