STUDENT PERCEPTIONS OF FACULTY CARING IN ONLINE NURSING EDUCATION: A MIXED-METHODS STUDY

In 2018, a College of Nursing (CON) within a large public university in the southeastern United States adopted a new strategic plan that includes a goal of promoting a vibrant, respectful, and caring environment. This team was interested in how caring is made visible in the CON, particularly in the online learning environment. The primary purpose of this research project was to identify which faculty behaviors effectively demonstrate caring to graduate students in an online learning environment. We selected this population because the didactic content for all of the master’s degree (MSN) and Doctor of Nursing Practice (DNP) concentrations (family, adult-geriatric acute care and psychiatric-mental health nurse practitioner, nursing administration, nurse executive leadership) are provided in an asynchronous online format. A secondary aim was to determine how faculty perceptions compared with students. Finally, we intended to apply this learning in practice by creating professional development tools for faculty who teach nursing students in the online environment.

There is a significant body of literature about online learning, a great deal of which has emerged since the start of the COVID-19 pandemic. The focus of our study on student preferences and perceptions is similar to that of Sitzman and Leners (2006) and the recent findings of Zajac and Lane (2021). However, we found no previous studies that examined faculty perceptions of caring behaviors in comparison to student perceptions.

Background

The phrase “caring is the essence of nursing” has become ubiquitous; conceptually, it may be attributed to Leininger (1984, 1991) whose Culture Care: Diversity and Universality Theory focused on care as a central component of nursing and a characteristic that separates nursing from other health professions. It has also been attributed to Watson, one of the leading nurse caring scientists (Watson, 1988; Clark, et al. 2009). We assert that if caring is nursing’s essence, then caring is essential in online nursing education. Watson (1989) wrote that nursing curricular design should reflect human caring in education and practice. Decades later, in 2017, Sitzman and Watson reflected on the current realities of our digital world and proposed that “establishing and then actively maintaining a firm intent to care is key to creating digital learning environments that convey and sustain caring” (p. 62). We define caring in the online learning context as “intentional communication and actions designed to meet students’ actual and potential needs for human connection, learning, support, and respect” (Jones et al., 2020).

Several nurse researchers have studied online faculty behaviors that signal caring to nursing students. Mastel-Smith, et al. (2015) interviewed faculty with online teaching experience. One of the themes that emerged in this work, online caring presence, was defined by three factors: “student success, affirming, and caring feedback” (p. 149). Mann (2014) conducted a study with nursing students at a Historically Black College and University (HBCU) in the southeastern United States which, in addition to identifying preferred faculty behaviors, found that students believe that a caring environment can be created online, and that an online environment that is caring positively influences student success (p. 35). In a discussion of the online learning environment in nursing education, Bradley et al. (2019) write that “faculty must employee unique methods to model compassionate caring behaviors to students with the ultimate goal being that they perceive these measures as caring actions” (p. 253).

The work of Kathleen Sitzman, a leading nurse researcher in caring and online nursing education, primarily informed our study. In 2006 Sitzman and Leners explored faculty caring behaviors as perceived by undergraduate nursing students and then replicated the study with graduate nursing students (Leners & Sitzman, 2006). In 2010, Sitzman conducted a study asking students to prioritize the previously identified faculty caring behaviors. The instrument that resulted from this work is the Student Perceptions of Online Caring. Internal consistency was validated using Cronbach’s alpha; the result of .8313 exceeds the .70 level that indicates adequate internal consistency (Sitzman, 2019). We used this instrument in the current study, with permission from the author.

Sitzman also explored the nursing faculty perspective on caring in online learning environments to determine if faculty believe that it is possible to demonstrate caring online and identify student behaviors that trigger faculty caring interventions. Using qualitative methods, Sitzman established that nurse educators believe that caring in the online environment is possible, important, and should be cultivated (Sitzman, 2015). Faculty can recognize when students need faculty caring actions and respond with techniques including outreach, connection to academic support, and intentional caring behaviors (Sitzman, 2016).

Zajac and Lane (2021) conducted study that also drew on the previous work of Sitzman and Leners. Instead of using the Student Perceptions of Online Caring instrument as developed by the original researchers, Zajac and Lane used ten open-ended questions modified from the original with permission and developed their own quantitative questions. The respondents in this study ranked characteristics of faculty in online learning. The top three were: “provides timely communication,” “offers academic support,” and “presents an empathetic presence” (p. 71). One unique feature of this study was that it focused on accelerated courses (7 weeks). Since many programs offer accelerated options for students, this helped to fill a gap in the literature on this subset of online learning approaches.

Methods

This study aimed 1) to describe how graduate nursing students at one large university in the Southeastern part of the United States prioritized faculty behaviors that are perceived as caring in the online learning environment, 2) to identify any significant differences in perceptions related to student demographics and 3) to determine how faculty perception of caring behaviors compared to those of students. Following the study, the intent was to equip faculty members with tools to develop the behaviors that students prioritized as most important to them. The project received the University’s Institutional Review Board (IRB) review and approval prior to implementation.

To gather students’ perceptions of faculty caring behaviors, we sent all graduate nursing students an invitation to participate in an online survey and a focus group. In conducting the online survey, we used an existing instrument, “Student Perceptions of Online Caring,” developed by Sitzman (2010). Student demographic information collected through the survey included gender, age, ethnicity, employment, comfort level with technology, number of online courses taken, and the name of the student’s graduate program and track. Upon completing student surveys and focus groups, and with approval from the survey’s author, we surveyed faculty perceptions of caring behaviors for comparison using the same instrument.

The study team contracted with an outside professional vendor, Core for Applied Research and Evaluation (CARE) to conduct focus groups. We selected this approach for greater confidentiality and to allow students to feel at ease when responding. CARE Researchers conducted two focus groups and two individual interviews to explore students’ experiences in graduate online courses offered by the College of Nursing. Fifteen students responded to the invitation to participate in focus groups (or individual interviews if group attendance was not possible) and provided contact and availability information to the CARE researchers. These volunteers were contacted by email and scheduled to participate in one of three focus groups. All students participating in the focus groups were entered in a drawing for two $100 gift cards as noted in the invitations. The focus groups, conducted through Zoom, were held in June 2019. Only one participant attended the third focus group, so the CARE team conducted an individual interview with that student. The team also conducted an interview with a student who was not available to participate in a scheduled focus group.

Results

We used SAS® (previously known as Statistical Analysis System) for data analysis. Descriptive statistics were calculated to describe, compare, and explore differences in the participant’s demographic data (i.e., age, gender, race/ethnicity, comfort level with technology, number of online courses already taken) that could have a moderating effect on perceived faculty caring behaviors in the online environment. Correlational analyses employing Pearson correlation/Spearman Correlation, and T-tests/Wilcoxin test were used to describe the direction and magnitude (e.g., two-tailed significance at .05 level) of the relationship between study variables. We explored differences in the mean scores of graduate students by program using ANOVA with a 95% confidence interval (CI).

One hundred and forty-one out of 693 students enrolled in the online graduate nursing programs completed the Student Perceptions of Online Caring survey, producing a response rate of 20.34%. Participant demographics are provided in Table 1.

Table 1.

Demographic characteristics of student survey participants

Variables	Frequency	Percent
Gender
Female	121	90.30
Male	13	9.70
Ethnicity
White	106	75.71
Non-White	34	25.29
Age
18–24	3	2.13
25–34	64	45.39
35–44	46	32.62
45–54	20	14.18
55–64	5	3.55
Over 65	1	0.71
Employment
Full time	92	65.71
Part time	39	27.86
Not Employed	7	5.00
Comfort with technology
Somewhat	11	7.86
Neutral	9	6.43
Comfortable	73	52.14
Very Comfortable	45	32.14
Number of Online Courses
1–2	24	17.39
3–4	11	7.97
5–6	18	13.04
More than 6	82	59.42
Program
FNP	43	30.50
AGACNP	28	19.86
PMHNP	28	19.86
Nursing Admin	24	17.02
DNP	16	11.35

Descriptive statistics (means) were used to rank faculty caring behaviors as reported by graduate students and by faculty. The faculty response rate was 37% (28 of 75 responded). Of the 24 caring behaviors evaluated using this survey instrument, the top 3 caring behaviors identified by both students and faculty were: (1) posts clear instructions regarding schedules and due dates; (2) provides a detailed class calendar; (3) responds to postings and emails within 24–48 hours. Eighteen of the 24 statements had some variance between student and faculty perception of their importance. Differences in the ranking of the top 12 caring behaviors as identified by students and faculty are shown in Table 2.

Table 2.

Comparison of Student and Faculty Ranking of Online Caring Behaviors (Top 12)

Online Caring Behavior	Student Ranking	Faculty Ranking	More important to:
Writes out and posts clear instructions regarding schedules and due dates	1	1	No difference
Provides a detailed class calendar that includes all due dates or postings, papers, and projects	2	2	No difference
Responds to postings and emails within 24–48 hours	3	3	No difference
Writes out and posts clear instructions regarding acceptable length/quality of required online communications	4	6	Students
Provides a discussion board thread dedicated to student questions and concerns only	5	11	Students
Demonstrates respect for the learning process by exhibiting excellence in creating/presenting online content	6	5	Faculty
When responding to student work, refers to specifics so that students know their work has been thoroughly read	7	8	Students
Expresses the belief that students will be successful in the online setting	8	9	Students
Provides supportive/corrective guidance to individual students via personal email or telephone rather than in any public venue i.e. chat or postings	9	10	Students
Verbalizes enthusiasm for learning	10	4	Faculty
Recounts challenges experienced in the online classroom setting and shares remedies that have worked for self and other students.	11	15	Students
Writes out and posts clear instructions regarding acceptable social behavior in the online classroom.	12	7	Faculty

Note: Items with greatest difference are noted in bold

Focusing on the behaviors that respondents ranked as the top 12, we noted that while the top 3 behaviors were the same for both groups, faculty placed a higher priority and value on writing out clear instructions regarding behavior in the online classroom (ranked 7 by faculty and 12 by students) and verbalizing enthusiasm for learning (ranked 4 by faculty and 10 by students). This suggests that students want quality teaching with clear instructions, but they were less concerned about being reminded that learning is important, and they don’t feel that instructions about online social behavior are as important as faculty do. The study team surmised that this difference is because each individual student perceives their own online behavior as appropriate, but faculty see and need to manage all online behaviors, including those that may not be entirely benign. The use of class discussion boards to address student concerns was ranked 5 by students and 11 by faculty, indicating the importance to students of having a place where their questions could be addressed. In all the other areas, there was general consistency in the rankings of the faculty caring behaviors by students and faculty.

Although the sample size was small and limited a single site, we did note some significant variations in student responses related to demographics, particularly race and gender. Female students rated their comfort level with technology higher than male students (P=.049). Black students worked full time more (P =.028) and took fewer online courses (P =.034) than White students.

There was a significant difference in the perceived importance of one faculty caring behavior between Black and White students, with Black students ranking “mindfully addresses student challenges as they become evident” more important than White students (P = .047). Significant gender differences were found in three statements. Male students placed less importance on the instructor 1) posting clear instructions regarding schedules and due dates (P = 0.020), 2) stating acceptable length for assignments/communications (P =.006), and 3) providing a detailed calendar with all due dates (P = .001).

We also conducted a thematic analysis of student responses to an open-ended question asking them to identify any other behaviors perceived as caring that were not already listed. The results affirmed the faculty caring behaviors listed in the survey instrument and produced a list of additional caring behaviors desired by the students: (1) keeping the deadlines consistent throughout the course; (2) answering student questions patiently, directly, and respectfully; (3) making online lectures interesting and engaging by including examples, explanations, and personal perspectives; (4) providing constructive feedback without shaming; and (5) maintaining technical competency.

Focus group interviews provided examples of faculty behaviors which students perceived as caring and non-caring. Students felt that faculty cared about them when faculty made themselves available; consistently provided encouragement and support through announcements, emails, and weekly videos; always started feedback with something positive; assured students that they would be successful despite competing demands from major life events; recognized that “life happens” and adjusted deadlines as needed; “just picked up the phone and called”; and made themselves available for real-time meetings through web conferencing or in person. One student explained that “students always want to hear positive things” because “most of us have so much else going on that the last thing you need is negativity—and it can help lesson anxiety.” Another simply stated, “a little kindness goes a long way.”

Examples of non-caring behaviors included: saying “it is in the syllabus” or “find it on YouTube,” or pointing out that other students in the class were able to find the information themselves in response to questions; telling students when they struggled with a particular assignment or class “perhaps this is not the program for you”; and scheduling tests or having major assignments due on religious holidays. Students also clarified their expectations for making online lectures more engaging. They emphasized that faculty should avoid reading PowerPoint slides and instead speak to them as if they were in class. They also wanted faculty to share their experiences and thoughts on the content and ensure that written materials do not contain typos and errors.

One area of interest for the team was whether students expect faculty to be available on weekends. Demographic data showed that 94% of the students in this sample are working either full or part time, and our assumption is that many are completing schoolwork on the weekends. The response from students was that 24–48 hours is a reasonable response time, but that responses outside of working hours are appreciated. These student comments are representative of this feedback:

• “I do not think they should be required to be available evenings or weekends, but it really means so much when they are.”

• “Weekend responses may be warranted [on the ‘Questions about the course’ discussion board] depending on an assignment.”

• “I think that a relatively quick response (1 or 2 weekdays) and a direct answer to any questions is the most appreciated.”

Discussion

Although online learning approaches have been around for a long time, they have increased in popularity and necessity due to the pandemic (Griffiths, 2020). Studies have documented the emotional and psychological challenges of Covid-19 on graduate students’ teaching and learning needs, including an increased need for graduate students to have greater connection with others for emotional support (Harlan, Rosenzweig, & Hoffman, 2021; Kee, 2021). This increased need for emotional support during the Pandemic further underscores the value of consistent caring faculty behaviors in an online learning environment, where authentic human connections can be especially challenged without in-person contact (Kee, 2021).

This project focused on evaluating humanistic aspects of teaching, particularly graduate students’ perception of faculty caring behaviors in the online environment, and secondarily compared student and faculty perceptions. The behaviors that our respondents (both students and faculty) prioritized as the top three were the same as the top three identified by student respondents in Sitzman’s 2010 study (n = 122 Bachelor of Science in Nursing (BSN) students from 5 different universities). In the rest of the top 10 caring behaviors ranked by students there were only slight differences in order, thus confirming the importance of these faculty caring behaviors for online learning over time. In our study, we noted differences in student perceptions of caring related to race and gender, and identified additional caring behaviors desired by online students in today’s more technologically advanced and media rich environment. As online learning environments are enhanced with more technology, students expect faculty to maintain technical competency to keep online courses free of major glitches and communicate effectively and compassionately through emerging communication platforms such as Zoom.

Although we conducted this study in the context of nursing graduate programs, the results might apply to other online educational contexts as caring is a human value and need. In distance education literature, the Community of Inquiry framework identifies the elements of the educational experience as social presence, teaching presence, and cognitive presence (Garrison et al., 2000). We connected the social and teaching presence from the Community of Inquiry framework with the central behavior of nursing (caring) to blend distance education and nursing perspectives for a broader understanding of the importance of caring in online education in nursing and other disciplines (Jones et al., 2020).

This study team recommends further research: within the CON, a study of undergraduate nursing student perceptions; at the University level, to explore how online faculty behaviors are prioritized by students in other disciplines; and outside of the University, at schools or colleges of nursing in other geographic areas. More research is needed to study differences in student perceptions of online faculty caring based on gender and race. This study’s primary limitations were that it was limited to graduate nursing students only and that it was a single-site study.

We were able to meet our final goal of promoting faculty development on this topic by disseminating findings at the CON and at the university. We created a toolkit “Faculty Caring Behaviors in Online Learning Environments” that was distributed to CON faculty and is now part of new faculty orientation. The toolkit includes detailed guidance for both the design and delivery phases of teaching. For example, based on student feedback about weekend availability, we included guidance for faculty about specifying their weekend availability in their course instructions. One faculty member at the CON now includes this statement: “I do check email and Blackboard once on the weekends, but not on University holidays. Practicing self-care and being “offline” sometimes is an important practice for nurses. I’ve provided my cell phone number so if there is an urgent personal issue that I need to be aware of, you can text me and I’ll call you back.”

We sponsored a workshop for CON faculty featuring a virtual discussion with Dr. Sitzman and presented our findings and recommendations to faculty from other academic departments through the University’s Center for Teaching Excellence (CTE), both in person and virtually.

Conclusion

Students’ need for increased emotional support during the COVID-19 pandemic reinforces the value of consistent faculty caring behaviors in an online learning environment. This research, which was conducted pre-pandemic, helped faculty gain a better understanding of online behaviors that are perceived as caring by graduate nursing students, and the subsequent faculty development opportunities helped to prepare faculty for the unforeseen event of a global pandemic. Since caring is central to nursing, and is a core value of the CON, it was important to be able to quantify not only graduate students’ perceptions of faculty caring, but also the differences among student groups, and between student and faculty perspectives. With this information, and with the provided tools, faculty can be more intentional about incorporating caring behaviors when designing and delivering courses in the online learning environment.