Journal of Nursing Education

Major Article 

Nursing Student Experiences with Face-to-Face Learning

Barbara J. Gruendemann, PhD, RN, CNOR, FAAN

Abstract

Face-to-face learning has been the mainstay of nursing student learning. Despite moves to online learning, face-to-face learning persists. This study focuses on how nursing students experience face-to-face learning and why it not only survives, but thrives. This study was anchored in a hermeneutic phenomenological approach, with Gadamerian concepts and van Manen’s lifeworlds as frameworks to understand students’ experiences of face-to-face learning. Patterns and themes were extracted from audiore-corded face-to-face interviews. Participants confirmed that face-to-face learning continues to be valued as a strong methodology in nursing education. Their experiences focused on humanism, the importance of “presence,” physical proximity, classroom as “the real thing,” immediacy of feedback, and learning and knowing by human connections and interaction. The study findings were a rich source for understanding how nursing students process learning experiences. Increased understanding of the meaning and essence of face-to-face learning is essential as we decide how nursing content will be taught.

Abstract

Face-to-face learning has been the mainstay of nursing student learning. Despite moves to online learning, face-to-face learning persists. This study focuses on how nursing students experience face-to-face learning and why it not only survives, but thrives. This study was anchored in a hermeneutic phenomenological approach, with Gadamerian concepts and van Manen’s lifeworlds as frameworks to understand students’ experiences of face-to-face learning. Patterns and themes were extracted from audiore-corded face-to-face interviews. Participants confirmed that face-to-face learning continues to be valued as a strong methodology in nursing education. Their experiences focused on humanism, the importance of “presence,” physical proximity, classroom as “the real thing,” immediacy of feedback, and learning and knowing by human connections and interaction. The study findings were a rich source for understanding how nursing students process learning experiences. Increased understanding of the meaning and essence of face-to-face learning is essential as we decide how nursing content will be taught.

Dr. Gruendemann is Principal Educator and Consultant, G4 Productions, Dallas, Texas.

Presented in part at the AORN Congress, Philadelphia, Pennsylvania, March 2011.

The author has no financial or proprietary interest in the materials presented herein.

The author thanks Dr. Gail Davis for her review of the manuscript.

Address correspondence to Barbara J. Gruendemann, PhD, RN, CNOR, FAAN, P.O. Box 740485, Dallas, TX; e-mail: bgruen@msn.com.

Received: June 01, 2011
Accepted: August 23, 2011
Posted Online: September 30, 2011

This is a transformative era of many changes in education, most notably nursing education. The current nursing shortage, coupled with developing technology, has been a factor in the growth and rapid adoption of Web-based technologies supporting online learning. To address the barrier of student access to learning opportunities, nursing programs are offering increased distance learning options, making these methods a common way of obtaining a nursing education. According to the American Association of Colleges of Nursing (AACN) (2009), almost 50,000 qualified applicants from baccalaureate and graduate nursing programs were turned away in 2008. An AACN White Paper (1999) stated that technological advances were enhancing quality and access to nursing education, expanding the capacity of educational institutions far beyond their own geographic areas. It also noted that technologies could be used to complement traditional face-to-face classroom teaching and as tools to enhance education (AACN, 1999).

The literature has reflected varied views of the efficacy of face-to-face and online educational environments in enhancing student learning and providing the space for professional growth and excellence in nursing practice. No clear position has been provided. Oermann (2006) questioned whether nursing was moving too quickly into implementing online learning and stated that some faculty were concerned that distance education had initiated the demise of the traditional classroom. After examining the role of technology in transforming nursing education, Simpson (2003) cautioned that virtual reality Web-based technologies were unlikely to solve all of the issues currently confronting nursing education, no matter how promising and exciting they might be. He warned, “the imminent demise of the traditional classroom [face-to-face] may have been greatly exaggerated” (Simpson, 2003, p. 86). In addition, Hall (2009) noted that as more nurse educators turned to online teaching, students continued to value traditional face-to-face approaches.

Even as discussions of the efficacy of online learning in nursing grew, the dynamics of face-to-face learning have remained an unresolved issue in nursing education. Diekelmann (2000) translated the meaning of face-to-face into physical presence as she argued that in online learning, the teacher could not see or read faces; thus, reading students’ faces could no longer be used to influence the breadth and depth of content. Buckley (2003) noted that face-to-face communication contained nonverbal cues that conveyed overt, as well as unspoken, meanings that could contribute to learning. The AACN (1999) posed questions regarding the traditional relationship of technology to the humanistic practice-oriented care that is the hallmark of nursing. Neumann (2006) captured two legitimate questions that must be considered when the future formats of nursing education are discussed: “What is the future of human touch and face-to-face contact in the impersonal technological world? What impact will technology have on the historically valued, interpersonal relationship in nursing?” (p. 15). Questions such as these, as they relate to nursing education, prompted the need for this research study.

Research Questions and the Literature

Two research questions were addressed: What are the lived experiences and meaning of face-to face learning among nursing students? What is the essence of face-to-face learning? The overall purpose of this qualitative study was to put forth a scholarly understanding of the meaning of face-to-face lived experiences in learning, including the essence of this learning.

Most studies of face-to-face learning have been comparisons of this type of learning with online learning. Studies have compared the outcomes of each type of learning, including student perceptions, satisfaction indices, examinations, and course grades. No known significant differences in scores or satisfaction indices for face-to-face versus online modalities have been found in these studies (Bata-Jones & Avery, 2004; Leasure, Davis, & Thievon, 2000; Ryan, Carlton, & Ali, 1999). Johnson, Aragon, Shaik, and Palma-Rivas (2002) spoke of comparative studies, saying that they are often discounted because of the great dissimilarity between the two learning environments that represent “a classic example of comparing apples to oranges” (p. 31). Comparison studies, according to Meyer (2004), were likely to be poorly designed but are relatively easy to conduct; thus, they continue to be used.

Philosophical Framework

Interpretive phenomenology and Gadamerian hermeneutics (Gadamer, 1960/2004) were the primary philosophical frameworks of this study. Gadamerian hermeneutics provided a framework for illuminating the context of language and text in face-to-face learning.

Layered under a qualitative research methodology, interpretive phenomenology included the concept of “lived experience” and the understanding of meanings as relevant to a study of learning. The lifeworld, the world of lived experience (van Manen, 1990), is the source and the object of phenomenological research. Four lifeworld existentials—lived space, lived body, lived time, and lived human relation (van Manen, 1990)—were guides for reflection in the phenomenological research process. Gadamerian hermeneutics (Gadamer, 1960/2004) captured the essence of language and text.

Research Plan

Registered nurse (RN) students who were pursuing a bachelor’s or master’s degree in nursing were selected for addressing the purpose of the study, which was to understand the lived experiences of face-to-face learning. A study of face-to-face learning from the perspective of students’ lived experiences was needed to more fully reveal the essences, meanings, and characteristics of this mode of learning. To describe and elucidate the meanings of human experience, a qualitative approach based on a philosophical phenomenological orientation was selected (Roberts, 2004; Rudestam & Newton, 2007). This approach is in keeping with the writing of van Manen (1990), who stated that, when the emphasis is on the meaning of lived experience, texts must be oriented, strong, rich, and deep.

Participants

Criteria for participant selection in this study were as follows: current RN licensure and enrollment as a nursing student; had experienced both face-to-face (classroom) and online (Web-based) classes; 18 years or older; English speaking; and available for individual interviews no more than 2 hours in length. Recruitment began after approval from the university’s institutional review board. Recruitment flyers, asking student volunteers to send an e-mail to the researcher, were sent by e-mail to RN to BS/MS program instructors. Those who were interested in participating were given a brief study explanation and an opportunity to ask questions prior to signing an informed consent form. Interviews were number-coded for confidentiality and then audiotaped and transcribed verbatim. These interviews became texts for data analysis.

It was anticipated that 5 to 15 participants would be sufficient, depending on when saturation began to appear in the collection of data. According to Rudestam and Newton (2007), saturation is reached when no new relevant data are discovered in a category and all of the categories are well developed. In this study, saturation began to occur after four to five interviews, and eight participants were interviewed to insure saturation.

Interviews

Conversational interviewing, using the hermeneutic phenomenological approach explained by van Manen (1990), provided a method for participants to reveal personal stories. The interviewing process was guided by the research questions. Although my plan was not to ask many questions but rather to allow the participants to enlarge on their learning experiences, an interviewing guide contained a few questions. Prompts such as “Can you give me an example?”, “What was it like?”, and “How did that make you feel?” were used to direct discussions when appropriate. My first question was, “What is the first thing that comes to mind when I say ‘face-to-face learning?’” van Manen’s (1990) precise use of language in describing the interactions among researcher and participant supported my understanding about the interviewing process: being sensitive to the undertones of language, being a true listener, and being able to listen to the way the world speaks to us, as well as seeking understanding and meaning of the human experiences voiced by the participants. Being sensitive to the subtle undertones of language and using the power of silence were necessary to give meaning to the thick rich descriptions the participants gave so freely.

Methodological Rigor

Rigor, described as trustworthiness and labeled as a “truth value,” is necessary if the research is to be considered credible and valid (Holloway & Wheeler, 2002, p. 250). They referred to the alternatives terms of naturalistic inquiry of Lincoln and Guba (1985) to further describe trustworthiness. Trustworthiness denoted methodological soundness in four dimensions—Dependability: accurate and consistent findings in context; Credibility: the “truth of findings”; Transferability: not necessarily generalizability; and Confirmability: meaning that findings and recording of learner data experiences achieved their aims and were not the result of any of my prior preconceptions. Fairness was inherent in this research. By way of my demeanor and utmost desire to treat participants honestly, respectfully, and in a forthright manner, participants were treated fairly. Holloway and Wheeler (2002) noted that “The researcher’s findings are, at least, compatible with the perceptions of the people under study” (p. 255). To ensure rigor, I validated participants’ comments and asked for clarification if I was unsure of the participants’ meanings. The ensurance of rigor was ongoing and was taken seriously to provide high quality and uncompromised integrity to the study.

Validity does not carry the same connotations in qualitative research as in quantitative research, nor is it a companion of reliability. According to Creswell (2003), validity is a strength of qualitative research, suggesting that the findings are accurate from the standpoint of the research, the participant, and the reader. I used reliability in a limited way to check for consistent patterns of theme development. Consistency of patterns and themes was obligatory.

Analysis and Interpretation of Data

The data collection, analysis, and interpretation focused on the meaning of face-to-face lived experiences of learning in RN nursing students and were guided by the study purpose and research questions, as well as the philosophical framework. Illumination of the meaning of face-to-face learning as experienced by a cohort of these students resulted. Data analysis in this study included concentrating on the nature of experiences as lived, reflecting on essential themes, and writing and rewriting to accurately transform texts into words and language that were meaningful in interpreting patterns and themes. Patterns and themes were categorized using van Manen’s (1990) four lifeworld existentials as the categorical compass. Discovering insights, meanings, and lived experiences of face-to-face learning from rich and deep texts was the goal of this phenomenological study.

During the interviews, participants contextualized vivid stories and dwelled, with some direction from me, on face-to-face learning. Participants gave meanings that were real and “full of the world” lived experiences. Their stories were analyzed and patterns and themes emerged from the data. The importance of the teacher, as experienced by the students, was also discussed.

Patterns and Themes

A pattern is the first heading for the lifeworld existential findings of this research. The word pattern was chosen because it exemplifies a broad structure or a category (Wolf, 2007) and is a discernable coherent system based on intended interrelationships of component parts (Merriam-Webster’s Collegiate Dictionary, 2007). Theme, then, was the subheading of each of the four lifeworld existentials. Theme, said van Manen (1990), gives control and order to research and writing; theme is a phenomenological structure of experience and a reduction of a notion. Theme is the form that captures the phenomenon one tries to understand.

Patterns and themes emerged while the data were carefully analyzed. Each of van Manen’s (1990) four existentials, or experientials, comprised a face-to-face category (Table).

Lived Experiences of Face-to-Face Learning: Patterns and Themes

Table: Lived Experiences of Face-to-Face Learning: Patterns and Themes

Lived space (spatiality), van Manen’s (1990) first existential, is the felt space in which we find ourselves and is also the space that helps to determine how we feel. This space has a semblance of a home, where we can be what we are and feel protected. It is a spatial environment that has the social character of conventional space. For this study, lived space was the human face-to-face classroom where students connect, share, feel, learn, talk, share, and understand, with each other and with a teacher.

Judy (pseudonym) gave voice to the classroom spatiality when she said, “I have to have that humanistic communication with people” and “it matters and makes a big difference when the teacher is there because she wants you to understand, not just give you information.” Molly, too, echoed her impression of a “good classroom”: “Yes, you get that ‘going in the right direction’ feeling. If you get the right kind of encouragement and the right kind of nudges, it’s good.”

Experiencing the classroom from the participants’ points of view was a “coming and being together,” where feelings and insights meshed to create an atmosphere of “live” closeness. Students spoke of face-to-face teachers: “Good teachers give encouragement and feedback that helps us learn; but if the teacher doesn’t care, we don’t care.” Nancy described her experience with a teacher drawing pictures of fetal tracings on the board, and discussing the normalities and aberrations of the tracings:

I can still see those pictures on the board. Now that I’ve had experience in it, that helped a lot, just remembering the teacher showing that information to us, how she presented it to us, versus just reading about it and looking at it in the book. I now can remember it and why.

Nancy found meaning in the lived experience of learning tracings by the way the teacher taught and how she (Nancy) remembered; the teacher connected with her by her positive teaching attributes, which included the pictures she drew.

Kleiman (2007) discussed relationships or connections between the student and the teacher, evolving as coming to know and understand the nature of nursing with its values and meanings. Participants echoed these relationships: “immediate gratification,” “getting it first person,” “the real thing,” “humanistic connections,” and “hearing and seeing it in real time helps learning.” In nursing, being present, or presence, was a gift of one’s self in human interactions and relationships (Easter, 2000). Physical, or body-to-body, presence includes “being there,” or in other words, human proximity. According to Feenberg (1999), this proximity is far from being reproduced in the space of the World Wide Web. All participants voiced the supreme importance of the teacher-student relationship as a major factor in their learning.

Lived body (corporeality) is van Manen’s (1990) second lifeworld existential. We are always bodily in the world. According to van Manen (1990), “When we meet another person in his or her landscape or world we meet that person first of all through his or her body” (p. 103). The human senses personify lived body and were the most talked about attributes of face-to-face learning during each interview. In this study, lived body was a primary characteristic of face-to-face learning and was how we reveal ourselves to others through our bodies. Sight was the most frequently discussed human sense, followed by hearing; “being there” was included as a subtheme. Judy stated, “In face-to-face, you can see their emotions, see whether they’re hiding something or lying to you. When you’re talking with others, there is no filter.” Nancy said, “I want to be there to hear the teacher to really understand it.” Participants talked of the ability to know someone personally through their eyes and body language. The meanings of face-to-face learning, they said, come from body language, facial expressions, and caring teachers.

The overall pattern was “in-person presence,” and the theme was “learning through the senses.” Subthemes of lived body (in participants’ words) included “getting it first person rather than a secondary source,” “can’t see it in a textbook,” “seeing a face enriches learning,” “seeing interaction between student and teacher promotes learning,” and “tell me, show me, and I’ll learn.”

There also was the strong context of Gadamer’s (1960/2004) interpretation of language, a belief that all learning is about language and its textual components. Gadamerian hermeneutics captured the essence of language and text (both inherent in face-to-face learning). Another participant, Alice, stated, “The main thing about face-to-face learning is immediate gratification with the teacher answering questions,” leaving little doubt as to what she meant—she portrayed the satisfaction of getting answers to questions instantly, paramount in the context of her learning. Textual data, brought forth by participants through dialogue and speech, represented language with all of its undertones and kaleidoscopic meanings.

Data analysis for this study included concentrating on the nature of experiences as lived; reflecting on essential themes; writing and rewriting to accurately transform texts into words and language that are “in this world” and were meaningful in discovering key meaning units; and accurately defining and interpreting patterns and themes. Patterns and themes were categorized using van Manen’s (1990) four lifeworld existentials as the categorical compass. Peer debriefing of sample transcripts provided verification of a sample of assignments of patterns and themes. Discovering insights, meanings, and lived experiences of face-to-face learning from rich and deep texts was the goal of this phenomenological study.

Lived time (temporality) is van Manen’s (1990) third lifeworld existential. The temporal dimension of past, present, and future constitute the horizon of a person’s temporal landscape. According to van Manen (1990), “Lived time is our temporal way of being in the world” (p. 104). Lived time was subjective time for participants. They talked of time that affected their learning. For example, when participants experienced the extended time it took to get immediate help from the teacher (primarily in online learning), it seemed like an eternity, they said, and was therefore a hindrance to their learning and progress. When immediate responses took place, they processed this as essential to their thinking and internalization of information. Each participant defined time as related to fully understanding the concepts and meanings of what they were truly learning. The immediacy of receiving feedback or confirmation of what they were learning was a coveted parameter of students’ learning in a face-to-face classroom. One student, Ella, said, “It’s the real time that constitutes face-to-face learning. When the instructor is right there, you can ask the question and deal with it immediately; it’s immediate gratification; clarification happens right then.” The overall pattern of lived time was “immediacy,” and the theme was “timely feedback.”

Subthemes of lived time (in the participants’ words) included “it’s real time,” “waiting hinders understanding,” “when fresh in mind, learning is immediate,” “in the zone of learning,” “delayed responses hinder learning,” “don’t have to wait to get that e-mail,” “not too little, too late,” and “time affects remembering.”

Lived other (relationality) is van Manen’s (1990) fourth lifeworld existential. This existential was the lived relation we maintain with others in the interpersonal space that we share with them. As we meet others, we can develop a conversational relation by which we can transcend ourselves. This existential represents the social, interactional nature of face-to-face learning. Sara explained, “The interactions, the dynamics that go on between teacher and student, are very important.” Relationality is humanistic communication with people; learners receive reassurance from others—teachers and fellow students. According to Molly, “Doing things together makes a huge difference because I get reassurance from others.” Molly stated a perfunctory, yet crystal-clear reason: “We’re pack animals and we like being around each other!” The overall pattern of lived other, human relations, was “learning dynamics,” and the theme was “lived relation to the other.”

Subthemes of lived other included “feeling of needing others,” “learning together,” “learn a lot in group discussions,” “social aspects of learning are important,” “experiences of others bring insight,” and “human contact and camaraderie are important.”

One of the participants provided a novel, yet intriguing historical aspect to face-to-face learning that, not directly applicable to the existentials, provided valuable and clairvoyant insight into learning:

Face-to-face learning is the human experience—it’s just so; there are so many human emotions. At least 70% to 90% of human communication is nonverbal. We lose that when we don’t have face-to-face interactions. As humans we’re designed to interact with each other, beginning from the time we were created. We learn things as children and that’s how we continue to learn. I feel like that’s very important, especially in nursing. Nursing has such a human holistic care focus as we continue to care for other people. I think we’ll always have face-to-face and a classroom. It’s not that we’ve always done it this way, but it still is how we learn best. It’s worked from the beginning of time.

Summary and Conclusions

We are in an age of transformation in nursing education. At the crux of this transformation are nursing shortages and the use of technology; in light of these, there is a need for pedagogies that will further enhance nursing education. Although the use of technology and online nursing education programs are growing at a rapid pace, face-to-face learning methodologies continue to survive and even thrive (Halter, Kleiner, & Hess, 2006). This motivated me to ask two research questions: “What are the lived experiences and meaning of face-to-face learning among nursing students?” and “What is the essence of face-to-face learning?”

Patterns, themes, and meanings of learning, in relationship to van Manen’s (1990) lifeworlds, were inherent in classifying and understanding RN participants’ comments related to how they best learn and process face-to-face learning; these meanings became the answer to the first research question.

The second research question, the essence, or fundamental nature or quality, of face-to-face learning was “being present,” in the sense of “being there.” The theoretical framework appeared to be ideal for an investigation of face-to-face learning. Captured essences, language, and texts, voiced by the participants, revealed significant experiences and meanings. The language used by the participants appeared to judiciously illuminate lived experiences. This framework was key to data analysis and interpretation.

It seems obligatory that we pay marked attention to the human component of learning that may also be the primary mode of caring for patients. Is classroom humanism with peers or teachers the same, or different, than humanism in the care of patients?

Replication of this study, not seen elsewhere in the literature, in a variety of institutions of higher learning is recommended. The same, as well as different, study parameters would be of interest. Face-to-face learning could be examined within different philosophical worldviews. Many learning variables have not yet been unearthed. The mystery of learning, with all of its colors and complexities, has yet to be perfectly described.

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Lived Experiences of Face-to-Face Learning: Patterns and Themes

VariableLived SpaceLived BodyLived TimeLived Other
DescriptionHuman face-to-face classroomRevealing ourselves to others through our bodiesTime affecting learningThe “other” relationality
PatternThe learning spaceIn-person presenceImmediacyLearning dynamics
ThemeThe real thingLearning through the sensesTimely feedbackLived relation to the other
Authors

Dr. Gruendemann is Principal Educator and Consultant, G4 Productions, Dallas, Texas.

Presented in part at the AORN Congress, Philadelphia, Pennsylvania, March 2011.

The author has no financial or proprietary interest in the materials presented herein.

Address correspondence to Barbara J. Gruendemann, PhD, RN, CNOR, FAAN, P.O. Box 740485, Dallas, TX; e-mail: .bgruen@msn.com

10.3928/01484834-20110930-02

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