Much research has been conducted on characteristics that the effective classroom teacher should possess, from both the faculty and student perspective. Yet little research has been carried out regarding faculty and student perceptions of the effective clinical teacher. In the clinical area, the teacher is in a very different position from teachers in most other fields. The learning situation is often one that cannot be repeated, and theclinical learning milieu is not usually controlled specifically for the teaching of the nursing student only.1 If we, as nursing educators, cannot distinguish between effective and noneffective teaching behaviors in the clinical nursing setting, how can we expect to know the way to help students achieve desired goals? It is essential that clinical teachers be able to identify and incorporate effective teaching behaviors and thus, avoid wasteful ineffective behaviors.
The author believed it was imperative to find out what characteristics were regarded as important by students and faculty in relation to effective clinical teachers. The purpose of this study was to identify those characteristics of the clinical teacher believed to be important by students and faculty to see how the two g roups compa red in their perceptions.
Students are part of a new generation who a re concerned with faculty competence and quality of education. In many schools, students are demanding the right to express their ideas and opinions about the competence of individual faculty members.2 Armington et al reported that nursing students marched carrying signs which read: "Educators, Listen to Consumer Ratings" and "Administration, We Want a Piece of the Action, Now."3 By allowing the student an opportunity to help the teacher improve her teaching, the faculty member demonstrates respect for the student and her opinions, and a desire to meet the student's learning needs.4 If nursing educators are to be effective, they need to know which teacher behaviors make differences in achievement of educational goals for their students.
A review of the literature revealed that relatively little research has been conducted in describing the characteristics of the effective clinical teacher. However, several studies have been done regarding the classroom teacher or nursing instructor in general. Findings in several studies suggested that students associate certain teacher behavior with effective instruction. Ryans, in his observation of over 6,000 teachers, identified three distinct patterns of teaching behavior: (1) warm, understanding, friendly versus aloof, egocentric, restricted teacher behavior; (2) responsible, businesslike, systematic versus evading, unplanned, slipshod teacher behavior; and (3) stimulating, imaginative, surgent versus dull, routine teacher behavior.5
Armington et al identified the following four characteristics of effective teachers: (1) exhibits enthusiasm about their work, (2) impresses students as being expert in their field, (3) encourages students to think, and (4) are easily accessible to them.3 In a critical incidents study of effective teaching, Barham found the following behaviors to be exhibited in an effective teacher: an individual who does not let her anxiety influence a situation, who recognizes her limitations, who demonstrates understanding in working with students by being available whenever the student finds herself in a situation that she is unable to handle alone, whose explanations are understandable and who has the ability to stimulate the student to want to learn.6
In another critical incident study done by Jacobson using five university schools of nursing, the data revealed six major critical requirements for the effective teacher of nursing. These were as follows: (1) keeps self available to students; (2) demonstrates own ability as a nurse and teacher; (3) shows skill in interpersonal relationships; (4) demonstrates knowledgeable teaching practices; (5) possesses personal characteristics including honesty, warmth, patience, and calmness; and (6) uses fair evaluation practices.1
Solomon et al reported that gains in comprehension related significantly to teacher energy, flamboyance, and a moderate position on a permissiveness versus control continuum.7 Pohlmann found that instructors must attend to affective aspects of their content areas if they are to be described as effective, which includes motivation and attitude-enhancing facets of teaching.8 Thistlethwaite found that enthusiasm was the characteristic that students observed in the teachers they thought had contributed the most to their desire to learn.9
Mims reported a study done at the College of Nursing and Health, University of Cincinnati, regarding evaluation criteria. The students thought the following teacher behaviors were most important: (1) fairness in making and grading tests, (2) ability to interest students in the subject, (3) systematic organization of subject matter, (4) ability to explain clearly, and (5) availability of the instructor. The least important items were: (l) usefulness of the midterm conference, (2) speech fluency, (3) sense of proportion and humor, (4) sympathetic attitude toward students, and (5) type of textbook used.
A variety of teacher characteristics have been identified in the previously mentioned studies. The investigator will focus on the clinical teacher of nursing and the characteristics believed to make an effective clinical teacher. A foundation for the improvement of clinical teaching in nursing can be established based on the identification of these characteristics.
How do baccalaureate nursing students and faculty compare in their description of characteristics of effective clinical teachers?
Baccalaureate nursing students and faculty will be congruent in their description of the effective clinical teacher.
1. Senior nursing students will have enough experience with a variety of clinical teachers to be able to identify characteristics of the effective clinical teacher.
2. Nursing educators, as clinical teachers, have the opportunity to exhibit their teacher characteristics on a comparable basis in any clinical setting.
3. The nursing faculty will have experience in clinical teaching.
4. Different clinical settings provide comparable opportunity for the nursing student to identify the characteristics of an effective clinical teacher.
Definition of Terms
1. Baccalaureate nursing student - one who is enrolled for the study of nursing in a college or university and will receive a baccalaureate degree in nursing upon graduation.
2. Baccalaureate nursing faculty - all the teachers in a four-year school of nursing located on a university or college campus.
3. Characteristic - a distinguishing trait or quality.
4. Effective - producing a desired effect; impressive.
5. Clinical teacher - one who instructs nursing students in the practice setting.
The major limitation of this study was its reliance on ratings of a small sample from a single institution. For this reason, replication would be needed in other schools before the results could be considered generalizable.
A descriptive research approach was utilized for this study, which assisted the investigator to answer the research question through a data-gathering process. The instrument used for this investigation was a composite of items found in the literature and included twenty characteristics of teachers (Figure 1). These characteristics were to be rated in Section I using the stated rating code. In Section II, the subjects were to choose the five characteristics from the list which they considered most important for a clinical teacher to have and rank them in order of importance.
The sample included 82 senior nursing students and 42 faculty members from East Carolina University School of Nursing, located in Greenville, North Carolina. The nursing students had been supervised by at least six clinical teachers during their nursing education. The tool was administered to the students during ten minutes of a regularly scheduled class period. The investigator gave a brief description of the study before the questionnaire wasadministered and allowed time for questions after the tool had been distributed. A brief explanation of the study was given to the faculty in a faculty meeting and the tool was distributed afterwards.
CLINICAL TEACHER CHARACTERISTICS INSTRUMENT
The process of establishing content validity of the tool was undertaken in a graduate level research course consisting of graduate nursing students and faculty. The content of the instrument was evaluated by this group and revisions made accordingly.
The statistical measures used in Section I included simple frequency, percentages, and Chi Square. Frequency distribution and percentages were used in Section II. A computer was used to tabulate the data and to compute the statistics.
PERCENT DISTRIBUTION OF RESPONSES TO EACH ITEM BY GROUPS
Interpretation of the Data
Through utilization of the collected data, statistical measures were implemented to determine how baccalaureate nursing students and faculty compared in theirdescription of characteristics of effective clinical teachers. Table !gives the percent distribution of responses to each item by group regarding Section I of the instrument. Over 50% of the students marked items 3, 6, 7, 14, and 15 as being of most importance. These items were as follows: shows genuine interest in patients and their care, conveys confidence in and respect for the student, is well informed and able to communicate knowledge to students, encourages students to feel free to ask questions or to ask for help, and is objective and fair in the evaluation of the student. Items 4, 7, and 15 were chosen by 50% or more of the faculty members as being of most importance. These items were as follows: relates underlying theory to nursing practice, is well informed and able to communicate knowledge to students, and is objective and fair in the evaluation of the student. The reader can see that both groups felt that items 7 and 15 were extremely important characteristics of the effective clinical teacher.
The student group felt all of the items were of some importance; therefore, none of these subjects marked an item (e) - of no importance. In regards to the faculty group, two faculty members (4.9%) marked item 5 (displays a sense of humor) as being of no importance. One faculty member (2.4%) marked item 20 (permits freedom of discussion and venting of feelings) as being of no importance.
The investigator horizontally collapsed the instrument's code into two categories, as depicted in Table 2, to further determine which items were felt to be important and those considered to be unimportant by the two groups. Responses A, B, and C were classified into one group labeled important. Responses D and E were classified in a group labeled unimportant. Item 5 (displays a sense of humor) was marked as being the least important of the twenty characteristics listed by both the faculty and student groups. Item 20 (permits freedom of discussion and venting of feelings) was felt to be unimportant by 9.8% of the faculty, but 100% of the students felt this was important. Items 6, 7, 8, 10, 12, 13, 14, 15, and 19 were considered to be important by both groups unanimously.
The 20 characteristics listed on the instrument were then classified into three categories by the investigator. The three categories were: professional competence, relationship with students, and personal attributes. The investigator included items 2, 3, 4, 7, 8, 10, 15, 16, and 17 in the category of professional competence. Items 6, 12, 13, 14, 20, and 21 were categorized as relationship with students and items 5, 9, 11, 18, and 19 were categorized as personal attributes. The percentage responses were again horizontally collapsed into the two categories of important and unimportant. The students ranked relationships with students as first, professional competence as second, and personal attributes as third. The faculty ranked professional competence as first, relationships with students as second, and personal atributes as third. This result revealed a slight discrepancy in the viewpoint of the two groups, yet it was not a significant difference statistically.
To determine if there was a significant difference in the two groups' responses to each item, a Chi Square test was done and the results are indicated in Table 3. The investigator used p<.05 as classification for justifying a significant difference in the responses. Items 4, 8, 11, and 20 were regarded as significantly different between the groups. The majority of the student group (54.9%) ranked item 4 (relates underlying theory to nursing practice) as being very important. Yet, the majority of the faculty group (54.8%) felt that this item was of most importance. There was a significant difference (p<.005) in the response according to the code, yet both groups indicated the item was important. Item 8 (supervises and helps new experiences without taking over) was significant at p<.05. The item was regarded as more important by the students than the faculty. The students also indicated that Item 11 (is self -con trolled, cooperative, and patient) was more important (p<.005) according to the code than the faculty did. The faculty responded to item 20 (permits freedom of discussion and venting of feelings) as being less important than the student group (p<.05).
In Section II of the instrument, the subjects were to choose the five most important characteristics and rank them in order of importance. Table 4 indicates the frequency of each item that was ranked and the missing cases. One can observe that over 50% of the student group ranked item 6 (conveys confidence in and respect for the student) as one of the five most important characteristics of an effective clinical teacher. More than 50% of the faculty group ranked item 4 (relates underlying theory to nursing practice) and item 7 (is well informed and able to communicate knowledge to students) as being among the five most important characteristics of the effective clinical teacher. Items 6, 15, 3, 10, and 12, were responded to the greatest number of times (the top five in descending order) by the student group. The faculty group's most frequent responses were to items 4, 7, 10, 15, and 17 (top five in descending order). Items 10 and 15 were ranked by both groups in the top five frequencies. These characteristics were: provides useful feedback on student progress and is objective and fair in the evaluation of the student.
PERCENTAGE OF RESPONSES BY GROUPS USING HORIZONTALLY COLLAPSED CODE
LEVEL OF SIGNIFICANCE BETWEEN GROUPS* RESPONSES ON EACH ITEM
Through analysis of the data, the investigator must reject the hypothesis that nursing faculty and students are congruent in their description of the effective clinical teacher. The results indicated that baccalaureate students in nursing regarded the instructor's relationships with students as more important than professional competence. An inverse relationship was indicated by the faculty group. The data also revealed there was a significant difference between the groups on four of the items on the instrument as previously discussed. These items included: relates underlying theory to nursing practice; supervises and helps in new experiences without taking over; is self-controlled, cooperative, and patient; and permits freedom of discussion and venting of feelings. While both groups considered these characteristics as important, there were differences in the degree of importance they held for certain items. The items that both groups ranked among the top five characteristics of an effective clinical teacher were: provides useful feedback on student progress and is objective and fair in the evaluation of the student. The faculty and student groups differed in their responses for the remaining three characteristics they considered most important.
FREQUENCY OF RESPONSES TO SECTION Il ITEMS
The data findings yielded many implications that are applicable to clinical nursing teachers, nursing students, and nursing education administrators. The results indicated that baccalaureate nursing students regarded the instructor's relationships with students as more important than professional competence. Kiker reported this same finding in a study conducted in 1972. 10 This finding has strongimplications for nursing educators to seek to develop a greater interest in the student and his or her problems. The researcher suggests that administration in schools of nursing should encourage seminars and workshops regarding interpersonal relationships and teacher-student relationships as part of their professional development program for faculty. The student must also be involved in this process. The author recommends that students attempt to keep the lines of communication open with their instructor and express their feelings openly. Students should also participate in seminars designed toenhance thecommunication process and interpersonal relationships.
The faculty felt that relating underlying theory to nursing practice was more important than students did. Are we as nursing educators applying theory to practice in the classroom and clinical setting? Implications from this finding demand that nursing educators must face up to their responsibilities. One must realize in order to be an effective practitioner, the individual must be able to apply theory to practice. The difficulty that many students have with the State Board Exam may have a relationship to this finding. The clinical teacher must be constantly aware of relating theory to practice. The researcher recommends that administration constantly remind faculty of the reciprocal relationship between theory and practice and allow time for the faculty member to engage in research and attend classes so that theoretical knowledge can be increased. Emphasis should be placed on the teacher-practitioner role to facilitate application of theoretical knowledge in clinical practice. It is essential for the nursing student to internalize the importance of applying theory to practice for provision of optimum health care to the consumer.
The student group regarded the following items as more important than the faculty group: supervises and helps in new experiences without taking over; is selfcontrolled, cooperative, and patient; and permits freedom of discussion and venting of feelings. The clinical teacher often does not allow the student time to carry out a procedure without taking over. Each learner learns at a different pace and this must be considered by the teacher. It is frustrating for the learner to be unable to accomplish the task he or she sets out to do. This data implies that the student regards completing the task as important. The researcher recommends that clinical teachers examine their teaching strategies and note whether they are allowing an appropriate length of time for the learner to complete his task. Implications for administration include considering if faculty need additional information on teaching strategies and encouraging periodic faculty evaluations by qualified supervisors.
The personal attributes of being selfcontrolled, cooperative and patient were considered important characteristics for the clinical teacher to have by the student group. The clinical area is often stressproducing for the student since he or she is dealing with human lives. The instructor can inhibit learning by producing fear and anxiety within the student. Clinical students need a facilitator of learning who can assist the learner to accomplish desired goals. The student group also felt they needed freedom of discussion and venting of feelings. Again, this relates to the stresses and anxieties the student encounters in the clinical setting. The researcher suggests that clinical teachers in nursing should examine their personal attributes and teaching methods and modify these to meet the learner's needs. Students must also examine their attitudes and behavior. There must be a common understanding and mutual respect between the student and clinical teacher.
Two characteristics were ranked among the five most important characteristics by both groups. These characteristics included: provides useful feedback on student progress and is objective and fair in the evaluation of the student. Mutual acknowledgment of the importance of these characteristics signifies their imperativeness in the teaching-learning environment. The other top three characteristics ranked by students included: conveys confidence in and respect for the student, shows genuine interest in patients and their care, and is realistic in expectations of students. Again, these characteristics relate to the importance students regard interpersonal relationships. The clinical teacher must display confidence in the student's work and demonstrate respect for the student as an individual. It is also important to set realistic expectations for each student. An implication for students would again be honest and open communication with their instructor. It is difficult for the clinical teacher to set realistic expectations for the student without the student expressing his or her learning needs and objectives. Clinical nursing teachers must not only be concerned with student-teacher relationships, but also be concerned with relationships with patients. The clinical teacher serves as a role model for students. As a role model, one must establish therapeutic relationships with patients and demonstrate an understanding of human behavior and the communication process.
The characteristics ranked most important by the faculty group related to professional competence. It is the educator's professional responsibility to keep abreast of current knowledge and practices in nursing and education. The clinical teacher must demonstrate professional competence to meet the needs of the consumer of nursing education. The characteristics indicated as important by the student group must be considered as the teacher seeks to improve.
Recommendations for Further Study
On the basis of findings from this investigation, it is recommended that:
1. This study be replicated in other schools of nursing and other regions of the United States to test the perceptions of students and faculty in regards to clinical teacher characteristics and to rule out the possibility of regional differences.
2. A follow-up study be done to explore further reasons for differences in the characteristics regarded as important for clinical teachers to possess.
3. The list of clinical teacher characteristics regarded as important by students and clinical teachers be utilized for evaluation of clinical teaching effectiveness.
The following study has been conducted to discover the characteristics of an effective clinical teacher as described by faculty and students in a selected baccalaureate school of nursing. Through determination of these characteristics, clinical teachers can improve their teaching methodology and provide a more effective learning environment for the learner. The identification of these characteristics also has implications for graduate nursing education, as clinical teachers are being prepared in this arena to enter the teaching environment. Administrators should consider utilization of these characteristics for teacher evaluation purposes. Nursing educators must attempt to bridge the gap between what educators and students perceive as characteristics of the effective clinical teacher. The ultimate goal to be achieved from identification of effective clinical teacher characteristics, as determined in this study, is improvement in clinical teaching.
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CLINICAL TEACHER CHARACTERISTICS INSTRUMENT
PERCENT DISTRIBUTION OF RESPONSES TO EACH ITEM BY GROUPS
PERCENTAGE OF RESPONSES BY GROUPS USING HORIZONTALLY COLLAPSED CODE
LEVEL OF SIGNIFICANCE BETWEEN GROUPS* RESPONSES ON EACH ITEM
FREQUENCY OF RESPONSES TO SECTION Il ITEMS