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Students' conceptions of the effectiveness of clinical teachers in nursing Kelly, Claudette 1989

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STUDENTS' CONCEPTIONS OF THE EFFECTIVENESS OF CLINICAL TEACHERS IN NURSING By CLAUDETTE  KELLY  B.Sc.N., The U n i v e r s i t y o f A l b e r t a ,  1974  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS  FOR THE DEGREE OF  MASTER OF ARTS in THE FACULTY OF GRADUATE Department  of A d m i n i s t r a t i v e ,  We  accept to  this  Adult  STUDIES and H i g h e r  t h e s i s as c o n f o r m i n g  the r e q u i r e d  standard  THE UNIVERSITY OF BRITISH COLUMBIA JANUARY, 1989 © C l a u d e t t e A. K e l l y , 1989  Education  In  presenting  degree freely  at the  this  thesis  in  partial  University  of  British Columbia, I agree  available for reference  copying  of  department  this thesis for or  by  his  or  fulfilment  of  and study. 1 further  the  representatives.  that the  It  is  granted  Department The University of British Columbia Vancouver, Canada  DE-6 (2/88)  an  advanced  Library shall make  by the  understood  publication of this thesis for financial gain shall not be allowed permission.  for  agree that permission for  scholarly purposes may be her  requirements  that  it  extensive  head  of  copying  my or  without my written  i i  ABSTRACT  "Students'  The a) and  purpose  similarities third  year  effective affected  of and  by  this  of  the  Effective  d i f f e r e n c e s between nursing  teachers;  b)  instructor's  conceptions  Clinical  d e s c r i p t i v e study  college-based  clinical  students' for  Conceptions  could  was  Teachers"  to  determine:  conceptions  students  i f either  of  regarding  groups'  opinion  c o n t r a c t u a l agreement; provide  further empirical research  into  a  second  theoretical  clinical  and  was  c) i f  framework  teacher  effectiveness. Transcript second based  and  in  third  diploma  capable the  a n a l y s i s of  of  nursing  identifying  clinical  students clinical  [X*=8.66  area,  differed  students program  thirty in a  three  revealed  f a c t o r s which although  year  that  and  with  college  students  enhance  second  somewhat i n t h e i r  interviews  their  third  perceptions  are  learning  year of  effective  teachers.  Lastly, faculty  year  the  than  a  significantly  part-time  (df-1)  faculty  p.<.01].  greater  number  of  were d e s c r i b e d  as  full-time most  effective  i ii  T A B L E OF  CONTENTS  page Abstract Table List  i  of Contents  i  of Tables  i i  i  v i i  Acknowledgements  .  viii  CHAPTER I. |  C L I N I C A L TEACHER  EFFECTIVENESS 1  Introduction Purpose  8  Definitions  9  Assumptions...  10  Significance  11  of Research  12  Limitations Outline  II.  of Remaining  LITERATURE  13  Chapters  REVIEW 14  Introduction.... Teacher  Effectiveness  i n General  Education  14  Teacher  Effectiveness  i n Medical  Education  24  Teacher  Effectiveness -in Nursing  Education  26  Communication Models Misuse of Classroom Evaluation Tools Summary  i n Nursing  Education  28  Teaching 31 37  iv  III.  METHODOLOGY Introduction  40  Rationale  41  Methodology  41  Description Data  42  of Subjects..  45  Collection  Ethical  47  Considerations.  48  Data A n a l y s i s  IV.  P R E S E N T A T I O N OF STUDENT'S TEACHERS  C O N C E P T I O N S OF  EFFECTIVE 52  Introduction Timing  o f Most  Effective  Teachers  A n a l y s i s by I n s t r u c t o r s ' Agreements..... Student's Clinical  Conceptions  53  Contractual 54  of Effective 54  Teachers  Knowledge How S t u d e n t s V i e w Knowledge  of Educational  Pedagogical Content  "Knowledge" Contexts  57 59 62  Knowledge  66  Knowledge  Knowledge, o f L e a r n e r s .  69  Knowledge  72  of Other Content  Knowledge o f E d u c a t i o n a l and C u r r i c u l u m  Aims, Purposes 74  V  Feedback Introduction  78  Honesty  79  and T r u s t . .  Positive  Feedback. .  81  Negative  Feedback  83  Communication  Skills 87  Introduction How  Students View  87  Communication  Empathy  89  Congruence  92  Positive  94  Regard  Environmental  Factors  Introduction  100  Availability  102  Acceptance  103  by S t a f f  107  Climate  V.  SUMMARY C O N C L U S I O N S AND  IMPLICATIONS  Introduction  I l l  Timing of Student's Choices of E f f e c t i v e Instructors  112  Instructors'  113  Contractual  Agreement.  Comparisons o f Second and T h i r d Students' Conceptions C l i n i c a l Teacher E f f e c t i v e n e s s : A T h e o r e t i c a l Framework  Year 113  117  vi  Conclusions  122  Implications  124  Recommendations  References  For Further  Study  126  128  vi i  TABLES  1.  Timing  o f Most E f f e c t i v e  Teachers  2.  Frequencies of Statements W i t h i n M e n t i o n e d by s t u d e n t s  53 Categories 56  vi ii  ACKNOWLEDGEMENTS  To my s t u d e n t s who s o w i l l i n g l y d e s p i t e busy schedules and d i d t h e i r  shared t h e i r experiences v e r y b e s t t o t e a c h me.  To my a d v i s o r s , D r . D a n i e l P r a t t a n d M r s . J u d y M o g a n , who s h a r e d t h e i r e x p e r t i s e a n d i n f i n i t e p a t i e n c e w h i l e a s s i s t i n g me i n s h a p i n g a n d r e s h a p i n g my t h e s i s . To my c o l l e a g u e s , S h a r o n , Dawn a n d K a r e n , who u r g e d me o n w a r d a n d j o u r n e y e d w i t h me, n e v e r d o u b t i n g t h a t we w o u l d reach the f i n i s h l i n e together. a  To my f a m i l y , who l e a r n e d t i m e w i t h o u t f o r g e t t i n g me.  a mom  t o s t a y away  To S h a u n a a n d J e n n i f e r , who l e a r n e d and "turned o u t " i n s p i t e of i t .  f o rmonths a t  to live  without  To my m a t e a n d p a r t n e r , R i c k who t o o k o n m o r e t h a n h i s s h a r e o f h o u s e h o l d p r o b l e m s , t a u g h t me some e d i t o r i a l skills a n d who s t o o d b y me e v e r y i n c h o f t h e w a y . Thank y o u seems s o l i t t l e  - so inadequate  now.  -1-  C h a p t e r One  CLINICAL  TEACHER  EFFECTIVENESS  Introduction  In an  recent  interest  effective  years  i n comparing  teacher  1981;  K i k e r , 1973;  1979;  Pugh,  1986;  W o n g , 1978; indicate factors there  being  found  a good  'worst'  'best'  nursing  clinical  students,  similar  teachers  characteristics  faculty  and the  there  agree  1980;  studies on c e r t a i n  teacher e f f e c t i v e n e s s , I n a study  andstudents highest  lowest  faculty  regarding was l e s s  o f 'worst'  Parsons,  with  f o r e x a m p l e , Mogan a n d Knox  model was the  teachers  (Brown,  Stuebbe,  o f these  andfaculty  i n many a r e a s .  teachers. While  fairly  Results  taken  perceptions of  nursing  1978;  & Graves,  students  that both role  andfaculty  have  & M o g a n , 1987; O ' S h e a &  Stafford  determine  educators  in clinical  Zimmerman, 1988).  which  'best'  were  Knox  i s disagreement  (1987),  student  behaviors  that while  university  for  a number o f n u r s e  rated  agreed  that  characteristic  rated characteristic  andstudents'  perceptions  rated characteristics of agreement  teachers.  on r a t e d  for  -2-  Comparisons students  i n an  indicated teachers found  of p e r c e p t i o n s of u n i v e r s i t y  earlier  that students as  they  that students  frequent ("not  by  i n each  us  independently") year  students'  in values.  students  c o m m e n t was  watching  to  the  a hawk",  second  comments  and  of  "freedom  mostly  the  teacher's  ability  to e v a l u a t e , her  and  her  students  First  continuous year  students  ability  to evaluate  i n a l l four years  approximately  The  values  to  of  for  although  example,  however of  also  more  independence  work  students. the  Third  instructor's  overlapped  regarding  interpersonal skills  personality.  teacher's  clearly  They  four years,  to  year  Student  fourth  the  promotion  skills.  area.  study.  'Availability'  fourth  related  clinical  characteristics  communication  A  of  (1982)  of  i n a l l four years,  given  like  by  a program  teachers  some o v e r l a p  Knox  became more c r i t i c a l  different  there  mentioned  Mogan and  valued  clinical  was  by  moved t h r o u g h  effective  was  study  nursing  25%  and  of  a l l of  second year  feedback students  focused but  important  the  program,  since  their  comments  related  students  wanted  w i t h ample d i r e c t i o n ,  preferred high spelled  of  appeared  on  to  frequent  whereas  expectations  this i f not  third  expectations. Senior  realistic  to  level  that  out.  instructor's  ability  to  relate  to  students  and  and  were  -3-  others  also  however this  received similar  third  aspect  effective  year  of  students  clinical  comments  from  effective  helpful,  teacher  effectiveness.  empathetic  and  intimidating  and  with  Most  approachable,  encouraging.  t e a c h e r s were d e s c r i b e d as  unapproachable,  years,  appeared most concerned  t e a c h e r s were d e s c r i b e d as:  supportive,  a l l four  Least  non-supportive,  not  empathetic  to  students'  needs. Although year  first  students  generally  of  On  students  the  have  resulted  an The  are  comparative  not  behaviors,  effectiveness.  and  flexible,  nursing education  teaching  of  the  a p p r e c i a t e d the  organized,  whole,  researchers  lack  commented  least  and  instructor's teacher  who  third  personality, was  c h e e r f u l and  had  a  'good  humor'.  clinical  has  students  commented most on  enthusiastic, sense  year  how  Attempts  at  classifying  data  accepted  i n the  existing  collected  students.  of  teacher  behaviors  literature  due  to  the  of e f f e c t i v e n e s s  system.  s t u d i e s are from  clinical  clinical  teacher  definition  classification  because  to c l a s s i f y  a definition  i n much c o n f u s i o n  studies in  been d i f f i c u l t  on  m a j o r i t y of  university  on  of  nor  incongruent  on  has  agreed  a universally  based  analysis  American  quantitative  and  undergraduate  I t i s i n d i s p u t a b l e t h a t much  research  -4-  is  needed  college  i n this  based  area  nursing  to reflect  teacher  effectiveness i n  programs.  T e a c h i n g i s a c o m p l e x s k i l l , a n d t h e r e i s no s i n g l e variable that f u l l y describes or explains the q u a l i t i e s o f an e f f e c t i v e t e a c h e r . R e g a r d l e s s o f t h e p e r c e i v e d c o m p l e x i t y o f t h i s t a s k , nurse e d u c a t o r s have a r e s p o n s i b i l i t y t o t h e i r s t u d e n t s , t h e p r o f e s s i o n , and t h e i r c l i e n t s t o i d e n t i f y and use t h e q u a l i t i e s o f effective clinical teaching. 1986,  (Zimmerman & W a l t m a n , It base  i s debatable  for this  agreed  that  1972;  others  rate  teachers  In source  vital More  on p e r s o n a l  1974;  rather  instances,  there  to observe  1983; that  have  of and  instructors 1986)  Zimmerman, students'  may  result  i n instructor  tendency to i n a  evaluation  1987). i s need  f o r more t h a n  one  when e v a l u a t i n g a t e a c h e r ' s e f f e c t i v e n e s s . researchers'  of data  importantly,  understanding  than  recipients  clinical  qualities  Mogan & Knox,  i t i s this  source  position  of their  the data  Some r e s e a r c h e r s  the direct  have been concerned  of data  However,  being  Pratt & Magill,  contest  most  suited to provide  research.  are i n the best  while  popularity  i s best  needed  the behaviors  (Armington,  (MacKay,  much  students,  instruction, evaluate  who  p.31).  instruction  i f nurse  accountable  for their  that  students  i n the evaluation of c l i n i c a l  i ti s essential  o f how  belief  students  to attempt  perceive  educators teaching.  teachers.  to gain  effective  are a  an  clinical  a r e t o become i n c r e a s i n g l y  -5-  That  students'  education express them  concern  i s legitimate,  their  views  andthat they  on a l l matters  on the process  a n dThompson c o n c l u d e s :  student  ratings  Dawson  of teachers  support  students' specific  that the  ofeffective  s t u d i e s as evidence ofeffective  instructors,  students, best  component  andr e l i a b l e  students' teaching evidence  the r e l i a b i l i t y o f  ofthis.  but does not  I na review  behaviors  recipients  t o observe  o f the  Similarly,  i s empirical  teachers  teacher  obtained,  ( p . 27).  Zimmerman and Waltman  as direct  position  and  A 1987  f a c u l t y by  andr e l i a b l e  that there  the v a l i d i t y  ratings  literature nursing  both  concern t o  by Armington.  a r e , as measures o f t h e i r  She c l a i m s  be a l l o w e d t o  "When p r o p e r l y  d i s c u s s e s how v a l i d  effectiveness. to  o f genuine  of teaching effectiveness"  (1986)  ratings  c a n be a v a l i d  of their  should  ofevaluating nursing  Coleman  measurement  the q u a l i t y  i n a 1972 s t u d y  i s documented  study  about  for  o f the  clinical  (1986)  reiterate  of instruction  the behaviors  cite  are i n  oftheir  clinical  instructors. It  i s also widely  research  on c l i n i c a l  partially teacher  recognized teacher  due t o unusual  that the p a u c i t y o f  effectiveness i s at least  problems  associated with  evaluation. Evaluation techniques  classroom  use are not u n i v e r s a l l y  designed  clinical for  a p p l i c a b l e t o the  clinical  -6-  setting  (Brown  evaluating  clinical  complicated  by the  provide  1979).  & Hayes,  teacher fact  individuals  with  effectiveness is further  that  with  The d i f f i c u l t y  many g r a d u a t e  basic  programs do not  information  on c l i n i c a l  instruction. In  a survey  conducted  1986),  a startling  agreed  with  provide  the  prepared to  (p.  the  inadequately consisted  for  i n the  priority more  classroom  information  were  educator  Although nurse  the  programs do not  on c l i n i c a l  indicated that but  they  they  population  i s considered  expected were  surveyed  35 o f t h e  from  there  h a d been  frequently  for which  educators  sampled  i s no e v i d e n c e the  sufficient  50 ofa  ability to preparation  teaching. instruction expected  makes d u a l  t omaintain  must  competence  for nurse  likely  expertise  o f nurse  one f i e l d  clinical  They  c o n t i n e n t a l U.S.,  are  Naturally,  "...most g r a d u a t e  basic  (Karuhije,  educators  d i f f e r e n c e i n Canada. G e n e r a l l y ,  i n the  they  1983 a n d 1986  211 n u r s e  specialists  prepared.  Clinical  on  138).  role  clinical  since  with  of volunteer  significant teach  statement:  as c l i n i c a l  assume  states  78% o f t h e  individuals  instruction"  between  take  expertise  precedence.  hasdetermined  educators.  t o be q u e s t i o n e d  than  demands o n t e a c h e r s ,  regarding  her  that  The c l i n i c a l regarding teaching  her  i ntwo f i e l d s .  Recent this  emphasis  is the  teacher clinical  expertise.  i s much  -7-  Employers attempted in  fact  and p r o f e s s i o n a l  to define  whether  clinical  clinical  practice.  become a s y m b o l is  viewed  hiring  setting.  by  classroom  t e a c h i n g has  lower  that c l i n i c a l  current  classroom always  the other  trends  -  1986  survey,  i n the c l i n i c a l  practice  when t h e i n s t r u c t o r  to  assist  based  teacher on  setting.  the c l i n i c a l  data  current theoretical  "Contrary to  teacher  and the  nursing education  from  the teacher content  the integration  should  143).  p.  i s not familiar  In addition,  with  clinical  one i n t h e  n o t b e n e f i t t o t h e same e x t e n t  students  the  on  K a r u h i j e makes t h e  ( K a r u h i j e , 1986,  may  with  are employed  within  educators,  i n undergraduate  content.  i n the  e f f e c t i v e n e s s i s compromised  of nurse  b e t h e same p e r s o n "  teaching  where  h a s h a d on  Furthermore,  Students  dealing  clinical  i s reflected  instructors  practice  and p r a c t i c e s ,  teacher  theoretical  This  exclusively  teacher  two g r o u p s  classroom,  this  i s unknown.  i n h e r 1983  having  status.  while  of educational institutions,  What e f f e c t  collected point  A t t h e same t i m e ,  basis to teach  effectiveness  debated  constitutes  numbers o f c l i n i c a l  time  They have  i n itself  of increased status,  practices  part  competence.  recently  instruction  as h a v i n g  increasing a  clinical  a s s o c i a t i o n s have  clinical  with the who  i s poorly  i s not equipped  o f t h e o r y and  practice. Studying  the effectiveness of having  two s e p a r a t e  groups  -8-  of  nurse  educators  student-faculty between hours instruction impact  contact  hours  of contact  has o n l y  perceptions  conceptions  diploma  studies  into  nursing  programs.  students'  teachers  tend  clinical  teachers.  (Dawson,  compared  clinical  there  students'  teachers  perceptions  an  and  teachers,  from  In addition,  t o be c o m p a r a t i v e  clinical  1986).  students'  regarding  clinical  relationship  s t u d i e d and c o u l d have  of effective  of e f f e c t i v e  The  takes  evaluation of  mentioned  t o be a l a c k o f r e s e a r c h  when one  account.  r e c e n t l y been  s e v e r a l s t u d i e s have  teachers' appears  into  and student  on a l l o f t h e f a c t o r s  While  based  i s further complicated  college  empirical  of effective  and focus  clinical  on b e h a v i o r s  of  Purpose  The and  purpose  of this  d i f f e r e n c e s between  year  students  clinical third  regarding  teachers.  year  conceive  groups'  opinion  agreement  their  of second  characteristics  of  clinical related  with  year  teacher  How  could  college  e f f e c t i v e n e s s ? Was  nursing  students  either  contractual  collected  clinical  third  d i d second and  nursing diploma  the data  effective  and  effective  to the i n s t r u c t o r ' s  c o l l e g e based  experiences  similarities  the perceptions  i n a three  and l a s t l y ,  interviewing  was t o d e t e r m i n e  More s p e c i f i c a l l y :  students  program  study  from  regarding  teachers  provide  a  -9-  theoretical clinical based  framework  teacher  for future empirical research  e f f e c t i v e n e s s ? When s t u d e n t s  n u r s i n g p r o g r a m were a s k e d  clinical current  instructor, findings  were t h e i r  clinical  students?  In a d d i t i o n ,  within  teachers  the  than  clinical  carried  clinical  clinical  an  conceptions  college  effective to  s t u d i e s on university  also  practice  t e a c h e r s who  a  similar  out w i t h  were t e a c h e r s who  concurrently with  differently  recall  reported in quantitative  effective  theory  to  from  into  taught  nursing  viewed  taught  exclusively  arena?  Definitions  1.  C o l l e g e based enrolled college  and  designated  who  in  be  R.N,  of  of  eligible  student study  who  in a  to w r i t e  upon c o m p l e t i o n  is community  nursing of  the  study.  diploma  t e a c h e r s who  student:  course  examinations  a community  program.  time  will  course  C o l l e g e based nursing  diploma  in a full  registration  2.  R.N,  faculty:  have c l i n i c a l  college  based  a l l of  the  teaching  responsibilities  R e g i s t e r e d Nurse  diploma  -10-  3.  Part  time  c o n t r a c t u a l agreement: a c o n t r a c t u a l  a g r e e m e n t whereby a f a c u l t y weekly or s e s s i o n a l a part-time 4.  Full  time  member  is hired  on an h o u r l y ,  basis to teach  clinical  p r a c t i c e on  basis.  c o n t r a c t u a l a g r e e m e n t : a c o n t r a c t u a l agreement  w h e r e b y a f a c u l t y member teach both full-time 5.  Clinical in  6.  on an a n n u a l  basis to  practice  on a  basis.  the p r a c t i c e  "one who i n s t r u c t s setting"  Characteristics  stated  i s hired  n u r s i n g t h e o r y and c l i n i c a l  teacher:  observed  ;  (Brown, 1981,  of c l i n i c a l  by s e c o n d  nursing  and t h i r d  teachers: year  students  p.6). attributes  n u r s i n g s t u d e n t s as  i n open-ended i n t e r v i e w s .  Assumptions  The second  study  i s based  and t h i r d  experience provide clinical  with  year  nursing students  a variety  an a c c o u n t  comparable their  have had enough  teachers  t o be a b l e t o  of e f f e c t i v e  different  teaching styles.  is  t h a t our u n d e r s t a n d i n g  of c l i n i c a l  be e n h a n c e d by s t u d y i n g s t u d e n t s ' t e a c h e r s based  Firstly,  clinical  opportunity f o r c l i n i c a l  demonstrate  clinical  will  conceptions  Secondly,  to  can  of c l i n i c a l  of t h e i r  instructors.  have p r o v i d e d  upon t h r e e a s s u m p t i o n s .  on t h e i r  own  The f i n a l  settings teachers  assumption  teaching effectiveness conceptions experiences.  of e f f e c t i v e  -11-  Significance  Due  of  Research  to the increasing  scarcity  increasing  student  increasing  student-faculty ratios  clinical that  practice  nurse  demands  teaching  by  educators.  teaching of  learn  more a b o u t  practice  learners'  effective  definition  constitutes  c a n be d e t e r m i n e d  conceptions  of their  clinical  of  effective  repeated  effective  with  effective  teachers. Research  teachers  i n guiding students  practice  and c o n t r i b u t e t o the f o r m u l a t i o n o f measurable  criteria  f o r the c l i n i c a l  clinical  m u s t come  students  development enhances nursing  value  the potential practice  of student,  appropriately  faculty.  t o be m o s t e f f e c t i v e to understand i n their  Identification  growth and values  f o r successful implementation  characteristics perhaps  teachers  to that level  of  of  I f i t could  are valued  be  more by one  c o u l d be a s s i g n e d  student.  with  what i t i s  of those  and e d u c a t i o n a l outcomes.  shown t h a t c e r t a i n level  wishes  at various stages  as s t u d e n t s .  of theory to  evaluation of nursing  who  that  assist  i n the a p p l i c a t i o n  A nursing teacher students  will  analysis  clinical  her  area  enquiry  clinical  by s y s t e m a t i c  experiences  i n this  time f o r  i t i s imperative  i s only p o s s i b l e through What  resources,  accountability,  and l i m i t e d  Achieving a universal  clinical nurse  for instructor  i n n u r s i n g programs,  educators  instruction.  of c l i n i c a l  more  -12-  The two  effect  groups  other The  to  of  of  definition  such  nurse  of  faculty the be  and  not  this  a f f e c t e d by  administrators If  effect  on  that  the  hiring  the  hand,  a clinical  effective  as  of  not  theory, been  as  the  of  the  evaluated.  search  be  for  c o n t r a c t u a l agreements  provide  guidance  teachers' nature  there  teacher  was  was  when e m p l o y e d  more p a r t - t i m e  has  well  of  c o u l d more e a s i l y  other  teach  most v a l u a b l e  shown t h a t a c l i n i c a l  was  to  employment  a  teacher e f f e c t i v e n e s s .  e m p l o y e r s may  management of  one  the  i s a q u e s t i o n w h i c h must  educators  the  toward  clinically  practice  clinical  Similarly,  trend  faculty,  students  outcome of by  recent  nursing  teach  addressed  a  on  staff  in  If i t could  perceived effectiveness her  c o n t r a c t u a l agreement,  meet  staffing  sufficient by  full-time may  to employers  resource.  perceived a  between  be  requirements.  evidence  students  b a s i s , the  as  to  show  more  trend  to  questionned.  Limitations  There limited which must  i s one  major  generalizability  the  data  were  t h e r e f o r e be  nursing  limitation  diploma  due  collected.  limited  programs.  to  to  to  the  the  study.  student  Inferences students  from  It  has  population  from  this  from  study  college-based  -13-  Outline  of  Remaining  Chapter teacher study. and  One  has  introduced  e f f e c t i v e n e s s and Terms u s e d  a s s u m p t i o n s upon which Chapter  studies  clinical  on  difficulties models  to  Two  upon a b l e n d field  of  their  Strauss, will  data of  1967;  the  this defined  have  review  been  previous  explore  classroom  the  teaching  e f f e c t i v e n e s s . The  selection,  (Marton,  collection  Three  and  1984),  a  and  i s based distinct  analyzing students' descriptions  1978;  f i n d i n g s and  and  grounded  Strauss, Chapter  s t a t e c o n c l u s i o n s and  education  as  as  of  i n Chapter  findings,  well  of  have been  i s based  use  teacher  experiences  Glasser,  paper  the  phenomenography  clinical  clinical  purpose  paper w i l l  f o r sample  at  the  of  e f f e c t i v e n e s s and  clinical  aimed  topic  study  this  i s described  inquiry  present  the  associated with  evaluate  of  the  teacher  methodology u t i l i z e d analysis  of  the  outlined  throughout  discussed.  of  Chapters  theory  1987).  Chapter  Five w i l l  implications for  recommendations  (Glaser  for further  &  Four  discuss nursing study.  the  Chapter  Two  LITERATURE  REVIEW  Introduction  Understanding requires  an  education. therefore  overall A  review  follows,  misuse  classroom  evaluation  tools  of as  Teacher  education and  clinical  evaluation  studies have  knowledge  constitutes  on  focused base  the of  on  the  studies  misuse  of  five  in  the  the  factors  classroom  on  are  evaluation  teachers.  Education  teacher's  teaching.  teacher  nursing  a discussion  effectiveness  attempt  in  education.  in  tools  Lastly,  clinical  teacher  for  in  chapter  medical  evaluation  i n General  i n an  effective  basis  teaching.  for  and  of  effectiveness  the  teaching  in this  overview  education  forming  effectiveness  effectiveness  literature  teacher  Effectiveness  Recent  the  teacher  a brief  of  reasons  i n the  instructor  of  i n general  education  suggested  of  begins with  i n depth  of  view  review  effectiveness An  clinical  to  in  general  thought  determine  processes  what  Some r e s e a r c h e r s  (Wittrock,  -15-  1986;  Calderhead,  antecedent  events  interactive answer:  and f a c t o r s  d e c i s i o n making  similar  researchers  begun  teachers.  examined  influence the teacher's They  have  attempted  d e c i s i o n making  which  approach  teachers  to diverse  groups?"  Shulman  They  have  attempted  1987)  and R i c h e r t ,  view  subject matter  both  equally essential  that  effective  knowledge  c) knowledge knowledge;  investigations and pedagogy  teachers  employ  have  "What d o  content;  educational  aims,  goals  curriculum.  Shulman  teaching.  seven types  They  hence  the process  knowledge;  pedagogical of  a n d o b j e c t i v e s ; g) k n o w l e d g e  to transform  that are suitable  d) g e n e r a l  claim  o f knowledge:  o f l e a r n e r s ; f ) knowledge  (1987)  forms  teachers  domains;  o f e d u c a t i o n a l c o n t e x t s ; b) c o n t e n t of other  base o f  l e d them t o  as two s e p a r a t e  to effective  e) k n o w l e d g e  a teacher  t o answer:  has f u r t h e r e x p l o r e d h i s or her content  of  the capacity  knowledge  into  t o a d i v e r s e group of l e a r n e r s ,  of information transformation  from  teacher  to l e a r n e r . Transformations, combination  to  by a  t o i n v e s t i g a t e the p r o f e s s i o n a l knowledge  t o know?" T h e i r  of  have  which  content  (Wilson,  need  a)  1983)  process.  a n d "What d e t e r m i n e s  i n teaching  Other have  Pratt,  "What c o n s t i t u t e s e f f e c t i v e  teacher?" employ  1987;  according  t o Shulman,  or ordering of the following  require processes:  some  -16-  preparation  ofmaterials, representation of ideas,  of  methods,  the  teaching  material tosuit  compares the  manufacturing  particular  on a rack.  Once  style,  i t must  t oteaching t o  Adaptation color,  i t i s prepared  however,  tailoring of  o f t h e s t u d e n t s . He  ofclothing.  ofa particular  customer,  and  thinking in relation  ofa suit  a suit  be hung  i s like  ands i z e  that  f o r purchase  by a  be t a i l o r e d  to f i t  (p.17).  perfectly  Wittrock interactive behaviors studies  the c h a r a c t e r i s t i c s  the teachers'  preparing can  as well as adaptation  selection  (1986)  and o t h e r s  explored  teachers'  d e c i s i o n m a k i n g a s a means o f i d e n t i f y i n g  ofeffective  w h i c h have  of  effective  of  characteristics  teachers.  attempted  teachers  during  Based on three  empirical  t odescribe  thought  interactive  teaching,  ofeffective  teachers  have  processes a number  been  identi fied. Other teacher  researchers  flexibility  (Peterson  and  found  alternative  teaching  employ  ( i . e . showed  them  decision  that  m a k i n g ) , were  less  bound  found  that  compared  judgement,  in  planning.  t ounsuccessful  whose  interactive  students  Doyle  teachers,  scored  objectives (1977)  successful  the h i g h e s t on  hadthe f o l l o w i n g c o g n i t i v e s k i l l s :  chunking  explored  who h a d  t o the i n s t r u c t i o n a l  had e s t a b l i s h e d d u r i n g  examinations)  teachers  flexibility  they  (those  1978)  Clark,  s t r a t e g i e s i n m i n d b u t who d i d n o t  which  teachers  and  and d i f f e r e n t i a t i o n .  rapid  Inadditionto  -17-  being  able  t o make  environment, events  into  immediate  units  and  ability  similar that to  to  a larger  their  of  This  (Calderhead,  and role  interactive  research  held and  Western  doesn't  the  of  educational active  from  the  that  gain  they  they  novice  is  scores  took  able  into  the  and  tended  into  indicating  that to  meaningful  flow  of  s u b s t a n t i a t e d by  of  is  reported  were not  anticipate  making  finding  ( 1 9 7 5 ) who  environment  i s further  'selectivity',  This  decision-making peers,  the  incidental  achievement items  group  events.  teaching.  Thinking  a variety  of  the  teacher,  tasks  process  from  Europe. Although  provide  are  the  comparisons  expert  i t provides  the  James of  teachers  Teaching  teachers'  on  teachers'  States, teachers'  framework  insight  Calderhead  the  United  research  a theoretical  approached.  i n which  (1987),  conceptions  educational experts  thinking r61e  to  1981).  explore by  of  Vallance  thereby  decision  classroom  ability  (1981) c a l l e d  student  E x p l o r i n g Teachers'  others  Canada  and  number o f  c h u n k s and  the  important  more e f f e c t i v e  interactive  In  out  c o m p l e x i t i e s from  conceptual events.  what Corno  low  complex  d i f f e r e n t i a t e between  interactive  with  had  significance  separate  during  transform  could  t h a t of Morine  mention  unlike  or  d\iring  teachers  account  and  long-term  to  information  decisions in a  successful teachers  Differentiation, the  rapid  into  for  studying  how  various  i s described  knowledge  provides  as  an  the  -18i  source  of identifying  and i n t e r p r e t i n g  professional  situations !  and  responding  some e x t e n t  t o t h e m . How a t e a c h e r  o n 'common s e n s e '  responds  i n addition  i s basedj t o  t o a body o f I  i professional educational  knowledge aims,  including:  subject matter,  knowledge  of learners,  curriculum materials,|  i teaching earlier  strategies  research, Calderhead  classroom Based  changes  from  (1981)  beginning  interactive  and p r o f e s s i o n a l  a t hand  not solely  compared  manner, based  teachers.  p.230).  on p r a c t i c e ,  competing  teachers are  Although  experience  can transform  teacher.  are  more o f t e n c o n s t r a i n e d b y t h e way t h e t e a c h e r s ' by t h e s c h o o l , whereas  reflected skills.  on t h e i r  They have  gradually  which  Getting  suitable  become  practices they  through  assessing  experience  became e x p e r t s  Teacher's within  the beginning  work  transformed iri their  remedial  task i s have  metacognitive  by t h e i r  e x p e r i e n c e and  field.  a r e a l s o i n f l u e n c e d by t h e c o n t e x t  and the t a s k s  learners'  work.  practices  t e a c h e r s who  have d e v e l o p e d  t h e s y l l a b u s may t a k e  individual  teacher's  experienced  to the expertise  the  defined  For example,  on  thinking  routines sensitively  ( W i t t r o c k , 1986,  dependent  Expert  In  descriptions of  and e x p e r i e n c e d  interests.  who c a n e m p l o y a n d a d a p t  situation  (p.108).  processes  r e s e a r c h , he b e l i e v e s t h a t t e a c h e r s '  i n a fluid,  personal  is  incidents  on t h a t  those  and classroom  they  must  precedence  difficulties  Similarly,  accomplish. over  and p r e s c r i b i n g  the teacher's  attempt  at  -19-  controlling  classroom  intellectually teacher's or  behavior  often  practice  of  these  reflection  on  perpetuating  i s b a s e d on  preconceptions  in training  practice existing  student  education  r a t h e r than  a concept or why  students or  skill  apparent  previous  professional knowledge attempts  who  being  teaching  little  avoid  efforts  to  on  process.  at understanding  c u r r i c u l u m c a n n o t be understanding  behavior  at e x p l o r i n g t e a c h e r s '  reflective  and  how  after,  of  how  teachers'  is limited.  the  of  related  Continued  c o n c e p t u a l i z a t i o n s of  improve  why  forgotten i t shortly  k n o w l e d g e . Our  classroom  for  to demonstrate mastery  knowledge base d e v e l o p s  guide  a  Critical  to  focussed  aimed  t o have  m a s t e r y o f the  informs  role w i l l  must c a l l  were a b l e  appear  existing  teachers.  than  poor p r a c t i c e s . P r o f e s s i o n a l  Much o f a t e a c h e r s ' work must be even t h o s e  about  takes  i s required i n order  development programs f o r t e a c h e r s teacher  in a less  c h a l l e n g i n g c u r r i c u l u m . W h i l e much o f  knowledge b a s e , p r o f e s s i o n a l e d u c a t i o n  account  to  results  quality  of a  their  teachers'  practice. Pratt  (1988)  effectiveness perspective  discusses three  in adult education.  s i n c e the  The  f i r s t and  1950's i s b a s e d on  psychology  and  performer.  This perspective  exists  i s one  p e r s p e c t i v e s of  of  the  most  dominant  behavioral  teacher  as  skilled  i s based  on  the  a u n i v e r s a l set of t e a c h i n g  teacher  manager  belief  principles  and  that skills  and there  -20-  applicable this  t o most  perspective leads  mechanical wisdom and  or  The decade  a  procedures insight  resembles  seen  l e a r n e r s i n most  compares  as  a  and  which  and  f u n c t i o n of  r o u t i n e s . I t does not  i s prevalent rather than  most d o m i n a n t  teaching  clinical  i n good  education  practitioner to  and  teacher  solve  problems w i t h i n the  as  encompass  (p.  perspective  of  teaching  teaching  to problem-solving.  one's a b i l i t y  unpredictable  Adoption  to a m i s r e p r e s e n t a t i o n of  training  second  situations.  the  practice  247).  i n the The  past  teacher  is  effectiveness is  complex,  ambigious  and  l e a r n i n g environment.  A n e f f e c t i v e t e a c h e r i s o n e who i s a b l e t o i n t e r p r e t c o m p l e x and d i v e r s e s i t u a t i o n s and i s t h e r e b y a b l e t o derive r a t i o n a l s t r a t e g i e s . In t h i s p e r s p e c t i v e , j u d g e m e n t s a b o u t e f f e c t i v e t e a c h i n g a r e b a s e d on t h e t e a c h e r ' s a b i l i t y t o p r e d i c t common c o n c e p t i o n s , m i s c o n c e p t i o n s , d i f f i c u l t i e s and m o t i v a t i o n a l o r i e n t a t i o n s of e n t e r i n g s t u d e n t s (p. 248). The  third  relationship teachers' is  of  cultural  able  to  affect concern of  recent  implicit  about what  perspective and  the  means and of  the  i s taught,  v a l u e s . An  critically  h i s or  professional practice f o r the  teaching  and  social  (p.  the  one's  between  effective  examine  as  ends of  link  focuses  explicit  E f f e c t i v e n e s s i s viewed  acknowledgement and  most  between  thinking  taught.  awareness  and  values  as  well  level  on  the  and  the  as of  and  i t  critical  teaching  teaching  how  and personal  teacher  i s one  who  is  her  values  as  they  249).  own  This  teacher  conditions w i t h i n which  l e a r n i n g i s conducted,  as  well  the as  has  a  process the  -21-  relations  o f power  influence  those  While practice, of  each  experience  skills  they  shift  area  awareness  Later  move  For novice  who now w i s h  i n ones'  to deriving Lastly,  relationships  Movement t h r o u g h  roles  to teach  each  with  that  to guidelines,  teaching  career, the  and f u n c t i o n s from t h e  the balance  shifts  and c o n f i d e n t  even  teachers  as  and p r o f e s s i o n a l  the perspectives, according to  and r e g r e s s i v e and s h o u l d  increase  one's  between p e r s p e c t i v e s . An  c o n c e p t u a l i z a t i o n of teacher  t h a t acknowledges  through  teachers  between v a l u e s  of the relationship  appropriate  teachers  e m p h a s i s m u s t be g i v e n  i n context.  i s cyclical  p e r s p e c t i v e s has a place i n  that  f o r highly experienced  practice.  one  three  experience.  and procedures.  emphasize  Pratt,  gain  appropriate  variations further  of these  i n a content  e m p h a s i s may  s t r u c t u r e and  conditions.  i ti s conceivable  them as t h e y  content,  and a u t h o r i t y t h a t  the interdependence  effectivenessi s of a l l three  perspectives. As  p r e v i o u s l y mentioned, Wilson,  (1987) h a v e of  provided  a framework  the p r o f e s s i o n a l knowledge  that  effective  teachers  employ  Shulman and R i c h e r t  f o runderstanding  base  of teaching.  the following  knowledge: Knowledge General  of educational  pedagogical  contexts.  knowledge.  components  They  types  of  claim  -22-  Content  knowledge.  Knowledge  of learners.  Knowledge  of other  Knowledge  of curriculum/goals/objectives (p.113).  Knowledge  of educational  must be f a m i l i a r field.  classroom  who  of nursing  theory  theory  contexts  that  i s able  role  i n action,  and p r a c t i c e .  pedagogical  how  to teach  they  are l i k e l y  o f knowledge  knowledge. I t represents  into  problems  or issues are organized  highly varied interests  material student  can best to achieve  Content  "x" outcome  the blend  f o r both  concepts  w i t h i n a domain, as w e l l  the s c i e n t i f i c  application.  of content  and  topics,  and r e p r e s e n t e d  student  i s the subject matter  to learners  a s how  In addition,  proofs  and  teacher.  i s t o be  of facts  and  the fundamental  content  that guide  t o "x"  which  I t i s an u n d e r s t a n d i n g  are organized.  meaningful  general  and r e p r e s e n t e d  by t h e s t u d e n t .  includes  i s most  o f how v a r i o u s  mastered  principles  students  a n d a b i l i t i e s , h e n c e how " x "  be o r g a n i z e d  knowledge  When  and the l i n k  then,  t o as  i n the  to recognize the  and u s e f u l  i s referred  pedagogy  with  i s t o be u s e d i n t h e  f o r students.  Knowledge  an u n d e r s t a n d i n g  the teacher  and t h e o r i e s t a u g h t  i t c a n be shown t o h a v e d i r e c t Knowing  that  t o d e m o n s t r a t e "hands on"  model  body  means  knowledge  principles  of augmenting t h e i r  between when  how  i s a powerful  experience value  with  The t e a c h e r  application  content.  knowledge  enquiry  and  practice.  -23-  Knowledge o f l e a r n e r s and t h e i r  characteristics  knowledge o f m o t i v a t i o n a l and d e v e l o p m e n t a l students to  learn.  aspects  includes o f how  I t i s t h e acknowledgement o f what s t u d e n t s  the l e a r n i n g s i t u a t i o n ,  including  bring  a t t i t u d e s s h a p e d by p a s t  experiences. Knowledge o f o t h e r than  the f i e l d  which  teachers  upon many a r e a s enrich  content  of p r a c t i c e teach.  I t addresses  area  i s much  broader  or the scope o f the d i s c i p l i n e  of i n d i r e c t l y  the p r i n c i p a l  i s t h a t which  the teachers'  related  of content  knowledge under  ability  within t o draw  that serve to  study.  Knowledge o f c u r r i c u l u m and o b j e c t i v e s c o n t r i b u t e t o the. teacher's of  pedagogical  t h e p r o g r a m and how p a r t i c u l a r  level  content  knowledge o f t h e l o g i c a l  broad  clinical  or p r a c t i c a l  teacher  knowledge  c a t e g o r i e s i s new t o t h e s t u d y  effectiveness.  of  clearly data  studies.  o f d e s i r e d outcomes. I t  and o f t h e d e s i r e d a c h i e v e m e n t  That  Perhaps  understanding  s u b j e c t s and t o p i c s a t e a c h  c o n t r i b u t e t o the achievement  includes  and  d e c i s i o n s and i n c l u d e s h e r  sequencing  of l e a r n i n g .  c a n be v i e w e d of c l i n i c a l  i t has been t h e a b s e n c e  teacher  i n these  teacher  o f such  e s t a b l i s h e d c a t e g o r i e s t h a t has impeded  on c l i n i c a l  of  specific  the a n a l y s i s  effectiveness i n previous  research  -24-  Teacher  E f f e c t i v e n e s s i n Medical  Pioneering of  medical  indicated student Hain of and  students  Grimes,  specific  availability  emphasis  references  teaching and  (1978) f o u n d skills,  and  Grimes  (1975) f o u n d  on  active  student  on  s e s s i o n s , (56  that  rating  scales medical to  interpersonal s k i l l s , Similarly,  that medical  participation,  students  preceptor  student-centered  study  orientation  of  Hinshaw  chairmen,  and  on  clinical (1964) o b s e r v e d floor  faculty  and  Despite  f o r change or  82  rounds) students.  haphazard, mediocre  excitement.  suggestions  t e a c h i n g were made.  (Stritter,  dentistry  o f w h i c h were m e d i c a l  t h a t t e a c h i n g was  in intellectual no  using  a humanistic  R e i c h s m a n , B r o w n i n g and  observations  studies  research.  interviewed departmental  lacking  o b s t a c l e s to  instructor-student rapport.  as w e l l as  1979)  w h i c h o f them c o n t r i b u t e d most  strategies  They c o n c l u d e d  Collins,  education  t e a c h i n g approaches asked  a much more c o m p r e h e n s i v e  teaching,  1978)  applied problem-solving,  instructional  In  major  similar  Mayberry, or  t e a c h i n g i n the  C a s s i e and  Two  communication  and  Hain  attitude,  1975;  Mayberry  valued  Stritter,  (p. 158).  students  learning.  placed  (Daggett,  behaviors  dentistry  students  clinical  t h a t " t e a c h e r s m i g h t be  learning"  and  their  s t u d i e s of  Education  and  their  improvement  of  -25-  Bazuin teachers of  and  of medicine  clinical  rather  faculty  than  being  activities. problems  i n role  and  similarities  nursing. Observation  engaged w i t h found  students  that faculty  definition,  lecturing  problem-solving  experienced  utilization  instructional  videotapes  of  teaching  o b j e c t i v e s and  dealing  i n t e r p e r s o n a l problems.  Irby  i n f o r m a t i o n on  (1986) o u t l i n e s  e d u c a t i o n . While medicine based  clinical  s t r e n g t h s and  the  teaching i n medicine problems of  s t r e n g t h s of c l i n i c a l  i n c l u d e a problem centered  learning  limited  and  combined  emphasis on  individual  problem  clinical  of  p h y s i c i a n s i n c l u d e : l a c k of c l e a r l y  inadequate these  seven  t e a c h i n g . Other  solving  feedback  and  difficulties  characteristics  clinical  teachers  knowledgeable, organized skillfully  problems  creates  i n the  w i t h i n the  demonstrated  students,  clinical  clinical  characteristics.  skills  Irby viewed  In  Irby  teachers  spite found  and  were  in a well  interacted  clinical  modelled  these  teaching  outstanding  ideas c l e a r l y  and  clinical  area,  Outstanding  provided  difficulties  models.  f a s h i o n . They were e n t h u s i a s t i c , with  learning,  stated expectations,  o f e x c e l l e n c e among  presented  in  experience  team  inappropriate role  i n medicine.  they  and  by  clinical  education  approach,  in  of  in  between  of  r e v e a l e d t h a t t e a c h e r s were  developing  Recent  the  (1978) f o u n d  They a l s o  strategies, with  Yonke  supervision,  professional  characteristics  within  -26-  the  three  model,  keyroles played  clinical  Teacher  An  historical  clinical in  each  associated  regarding  reveals  that  teaching  strategies  behaviors  h a sended  conducted  examined  jointly.  i s a major  up w i t h  with  effective  studies  t h e 1960's a n d t h e 1970's  researcher  "role  Education  of theliterature  e f f e c t i v e teacher  different  problem categories  behaviors. Availability  is  overview  andc l i n i c a l  Classifying since  i nNursing  i nnursing  t h e U.S. d u r i n g  teachers:  and i n s t r u c t i o n a l l e a d e r / s c h o l a r " .  o f f a c u l t y andstudents  teaching  classroom  of  supervisor  Effectiveness  perceptions  by c l i n i c a l  valued  Karns  by students  & Schwab,  interpersonal his/her  anda c c e s s i b i l i t y  skills  h a sbeen  effectiveness  knowledge  andp r o f e s s i o n a l  mentioned  as valuable  mentioned traits ability  Kiker,  teachers' as c r i t i c a l t o  1987).  a r ea l s o  a t t r i b u t e s (Armington, Kiker,  as enthusiasm  1973).  evaluation  t h e time  Karns  General  frequently  1972;  Other skills,  anda non-judgemental  taking  1966;  Jacobson,  & Knox,  competence  & S c h w a b , 1982;  t o r o l e model,  1983;  1973; M o g a n  attributes include:  such  A  1966;  Jacobson,  identified  (Griffith,  1982;  Karns  1973).  Kiker,  & Schwab,  1966;  1972;  (Armington,  1982;  o f t h ei n s t r u c t o r  Jacobson,  frequently personality attitude,  t o g e t t o know  -27-  students  individually  encourage and/or  and a b i l i t y  them t o t h i n k .  to motivate  However, c a t e g o r i e s  of behaviors  c h a r a c t e r i s t i c s a r e a r b i t r a r y because  defined  and a u n i v e r s a l c l a s s i f i c a t i o n  systematic  collection  complicated regarding  o f agreement  the placement  terms a r e p o o r l y  system  and a n a l y s i s o f d a t a  by t h e l a c k  students or  i s l a c k i n g . The  h a s been  among  further  researchers  of findings within  behavioral  categories. Although behaviors studies data.  vary  three  classification from  (professional personal  researcher  to five  F o r example,  Kiker  competence,  (teaching  interpersonal  for effective  to researcher,  behavioral  attributes),  categories  systems  (1973)  categories has three  categories:  skills,  evaluation  s t u d e n t s and  (1987)  whereas Mogan & Knox nursing  i n many  emerge f r o m t h e  r e l a t i o n s h i p s with  skills,  teacher  have  five  competence,  skills  and p e r s o n a l i t y  traits). Student-teacher preparation teacher  treated  of educational  i n relation  e f f e c t i v e n e s s . As e a r l y as 1966, ratios  i n determining on p e r c e n t a g e  increased (p.  and l e v e l  have a l s o been s t u d i e d  student-teacher factor  ratios  220).  i n the c l i n i c a l teacher basis,  as t h e c l i n i c a l  to c l i n i c a l  Jacobson  area  identified  as a s i g n i f i c a n t  e f f e c t i v e n e s s . " When d a t a was the % of i n e f f e c t i v e  faculty-student  ratio  incidents  increased  "  -28-  Neither have  J a c o b s o n nor any o t h e r  shown any  teachers  and t e a c h e r  Even a f t e r & Hayes models  relationship  more t h a n  a decade o f i n v e s t i g a t i o n  classroom  and  educating  Models i n N u r s i n g  h e a l t h care  serve  as t o o l s u s e d  p r o f e s s i o n a l s to prepare  throughout  d e v e l o p m e n t model  neurolinguistic framework  programming  the 1 9 7 0 ' s  them  clients  with  and 1 9 8 0 ' s i n c l u d e :  Most  Grinder's offers of  h e a l t h care workers  problem-solving. i n h e a l t h c a r e programs become  r e l a t i o n s h i p s with self  and  human  t h e s t e p s or components  a c o m m u n i c a t i o n model, t h e y  clients'  as  popular  (NLP) model. E a c h model  c o m m u n i c a t i o n p r o c e s s whereby  therapeutic the  and B a n d l e r  for understanding  Once s t u d e n t s with  accepted  Education  o f c o m m u n i c a t i o n models  in curricula  assist  Brown  clinical  h e l p e r s . T h r e e models w h i c h have e n j o y e d  relations  the  setting.  however,  Rober C a r k u f f ' s c o u n s e l l i n g model, George Gazda's  a  of  (p. 7 7 8 ) .  A variety  use  the p r e p a r a t i o n l e v e l  e f f e c t i v e n e s s i n the c l i n i c a l  for evaluating effective  Communication  skilled  however,  ( 1 9 7 9 ) s t a t e d t h a t t h e r e were no u n i v e r s a l l y  teaching  in  between  researchers  are able  clients,  to apply  ultimately  a w a r e n e s s and p r o b l e m s o l v i n g  t h e r a p e u t i c c o m m u n i c a t i o n models  familiar i t in enhancing  skills.  i n c u r r e n t use  -29-  are  based  on  facilitate  Carl  Roger's .theories  positive  interactions.  about Rogers  c o n c e p t s - empathy, c o n g r u e n c e and critical  d i m e n s i o n s of  human l e a r n i n g  listen those  feelings of  potent  factor  139), in  describes  c a r e f u l l y to  degree  back  sees d i r e c t  that  experiences An  for  relationship about  as  oneself self.  as  It  teacher  of  the  of  cues to  well  the  congruent  of a l l  of  the  learner,  learning  role to  teacher  ability  has  experiences.  (p.  and  and  on on  ability  conveys  within inner  genuineness.  with to  an  real. It  the  and  pleasure  interactions  reflects  manner.  i s being  matching v e r b a l  the  155).  (p.  listens actively,  Rogers,  to  show  classroom  in a caring  showing g e n u i n e  also  most  responses  improves  feelings  integration  t o day  the  learning  meaning o f  student's  projects  high  m e a n i n g f u l . When t e a c h e r s  reflect  of  a  empathetic  as  the  to  reflect  that  i s going  i n day  and  to  awareness o f what  educator  displeasure  feelings  an  and  is possibly  therefore  student  i s a state  congruent  and  ability  change and  students,  Congruence, a c c o r d i n g means h a v i n g  as  the  believes  application  their  perceptions  feelings He  they understand  for  appreciation  regard  relationships  empathy as  138).  situations  empathetic  back her  (p.  in bringing  educational  evidence  others  empathy i n a  and  that  i d e n t i f i e d three  positive  interpersonal  conditions  situations.  (1980)  Rogers  the  The  non-verbal and  students.  A  self-disclose  -30-  The  teacher with  positive  r e g a r d has a  approach  to education  (Rogers,  1980,  respect  f o r the student  high degree  of s e l f  regard  with  the teacher with  self  concept;  student's  method studied have of  i n college  student-teacher  The t e a c h e r w i t h a t h e f o l l o w i n g (compared  disclosure;  positive  c) r e s p o n d s  d) g i v e s more p r a i s e ;  more t o  e) i s more  i d e a s , and f ) employs  level  showing  the l e c t u r i n g  have n o t been  t e a c h e r s , however n u r s e  educators  i n studying the a p p l i c a t i o n  models i n t h e r a p e u t i c r e l a t i o n s h i p s t o interaction  (Griffith,  1983; K a r n s and  1982).  Schwab,  K a r n s and Schwab educators  communication  apply  clinical  (1982)  "In spite  i n using  following  and B a k a n a u s k a s  relationships  nursing  dimensions of  i n t e r a c t i o n s with  them, t h e l i t e r a t u r e  when t e a c h i n g "  a review  critical  students  o f knowledge o f t h e s e  and a n x i e t y s u g g e s t skills  that although  and u s e them i n p a t i e n t c a r e ,  them t o t h e i r  area.  some s k i l l  Griffith  found  teach Rogers' three  therapeutic  these  always  r e g a r d ) : a) a more  become i n t e r e s t e d  communication  stress  p. 307),  i n t e a c h i n g . These a t t r i b u t e s  recently  rarely  low s e l f  to student's  less  exhibits  b) more s e l f  feelings;  responsive  as a p e r s o n .  person-centered  that c l i n i c a l (Karns  (1983)  d e s c r i b i n g student faculty  came t o a s i m i l a r  i n nursing education.  i n the  c o n c e p t s and  do n o t u s e  & Schwab, 1982,  of the l i t e r a t u r e  they  p. 4 1 ) . conclusion  on s t u d e n t - i n s t r u c t o r "The t h e r a p e u t i c  -31-  relationship lectures Student  and c l i e n t  nurses,  principles  however,  with  seldom e x p e r i e n c e  a nursing instructor,  experiences.  this  'helping  although  of a t h e r a p e u t i c r e l a t i o n s h i p  nursing  t h e same  c a n be a p p l i e d "  105). The  literature  important  i n nursing education  questions  m o d e l s i n day t o day  interactions.  Why,  skilled  of t h e r a p e u t i c  student-teacher  f o r example, a r e n u r s e  these  same s k i l l s  of Classroom  with  Teaching  The m i s u s e o f c l a s s r o o m teaching  practice  The  their  educators  who  are  tools  to evaluate  Jacobson,  i n both 1966;  relationship  between  student  crucial  i n the c l i n i c a l  setting  than  Clinical  t e a c h e r s must  classroom  possess  skills  and a b i l i t y  g r o u p s has a s i g n i f i c a n t  impact  clinical  Canada and t h e  Knox & Mogan,  and f a c u l t y  i t i s i n the  different  t e a c h e r s . F o r example,  communication  students?  Evaluation Tools  i s w e l l documented  (Brown & Hayes, 1979;  1985).  raises  i n t h e use o f a t h e r a p e u t i c c o m m u n i c a t i o n model n o t  employing  Misuse  clearly  r e g a r d i n g the a p p l i c a t i o n  communication  U.S.  i s l e a r n e d from  and r e a d i n g s , and a p p l i e d i n c l i n i c a l  relationship'  (p.  between n u r s e  their  skills  classroom.  than  questionning  to assess on t h e i r  i s more  skills,  learners i n small  effectiveness.  -32-  Their  ability  theoretical Teaching to  to a s s i s t  students  and c l i n i c a l  students  knowledge  how t o t h i n k  inappropriate  clinical  teaching  difficulty  i s also  while  important.  a l s o showing  use of classroom  them how  i n conducting  educational  not designed  2)  o f e m p h a s i s on c l i n i c a l  lack  education teaching 5)  social  Jacobson educational situation, significant  3)  emphasis  4) l a c k  role  teaching  describes  research  i n nursing  skills  the d i f f i c u l t y  in a clinical  setting.  one. The l e a r n i n g s i t u a t i o n and t h e c l i n i c a l  controlled specifically  nursing  student  only"  over excellence  with  conducting  "In the c l i n i c a l  to teacher i s often  isa one t h a t  l e a r n i n g m i l i e u i s not  f o r the t e a c h i n g  of the  (p. 218).  f o r l e a r n i n g are to a large  by t h e p a t i e n t p o p u l a t i o n  P a t i e n t s ' needs must a l w a y s  learning  needs o f s t u d e n t s .  exercise  p r o f e s s i o n a l judgement  possible within  environment;  f o r teaching  the r e l a t i o n s h i p of student  Opportunities  i n a work  skills  on n u r s i n g  o f rewards  usually  area.  research  confusion.  (1966)  c a n n o t be r e p e a t e d ,  dictated  f a c t o r s : 1)  p r i m a r i l y as a l e a r n i n g  programs; skills;  tools to evaluate  c a n be a t t r i b u t e d t o f i v e  setting  as  i n t e g r a t i o n of  do, r e q u i r e s a good knowledge base as w e l l . The  and  with  a given  within take  Clinical  clinical  precedence  over  i n s t r u c t o r s must  to a s s i s t  clinical  each  extent  as many  setting.  students  S t u d e n t s and  -33-  teachers times  must i j i a i n t a i n  i n order  diverse  work  Lack  open l i n e s  t o maximize  o f communication  learning i n this  at a l l  complex and  setting.  o f emphasis  on c l i n i c a l  graduate programs i s n o t unique  teaching  skills  i n most  to nursing.  Although the p r a c t i c i n g p r o f e s s i o n s - teaching, s o c i a l work, n u r s i n g , law, m e d i c i n e , t h e m i n i s t r y and c l i n i c a l and c o u n s e l i n g p s y c h o l o g y r e q u i r e t h a t the n e o p h y t e be t r a i n e d i n t h e s k i l l s o f t h e p r a c t i c e as w e l l as t h e t h e o r y , c l i n i c a l i n s t r u c t i o n h a s been f o u n d t o be q u i t e p r o b l e m a t i c a l a c r o s s a l l t h e disciplines (Daggett, Prompted  (1980),  Due^pohl not  by t h e p r e f a c e  provide  purpose of  stated  "...most g r a d u a t e p r o g r a m s do  nurse  (1983)  educators  o f the survey  basic  respondents  from  felt  that* t h e y  'were for  information  earlier,  which  they  Emphasis competence Rauen  question:  i n d i v i d u a l s with Nurse  as c l i n i c a l  t o assume t h e r o l e  teachers  s p e c i a l i s t s but of nurse  educator  were n o t p r e p a r e d . on n u r s i n g  among n u r s e  (1974)  78% o f  a startling  instruction".  h a d been p r e p a r e d  f r e q u e n t l y expected  S t a t e s . The  the forced-choice  on c l i n i c a l  o f 211  e m p i r i c a l l y the v a l i d i t y  "... m o s t . g r a d u a t e programs do n o t p r o v i d e basic  on c l i n i c a l  a survey  the United  was t o t e s t  agreed with  information  conducted  t h e s t a t e m e n t . As m e n t i o n e d  the :  Karuhije  1979).  & Collins,  i n a book by C a r p e n i t o and  i n d i v i d u a l s with  instruction," volunteer  that  Cassie  offers  competence  educators  suggestions  rather  t h a n on t e a c h i n g  i s less well f o r nurse  documented.  educators  regarding  -34-  the m a i n t e n a n c e  6'f c l i n i c a l  competence.  The r e s p o n s i b i l i t y t o be an e f f e c t i v e r o l e model s h o u l d be s t a t e d i n the c l i n i c a l i n s t r u c t o r j o b d e s c r i p t i o n , . . . E m p l o y e r s need t o e n f o r c e minimum s t a f f n u r s e experience requirements for a l l c l i n i c a l i n s t r u c t o r s . A n o t h e r means o f s e l f - i m p r o v e m e n t w o u l d be t o f u n c t i o n as a s t a f f p u r s e f o r a few weeks e a c h y e a r ( p . 3 8 ) . 'Although have n o t  dictated  experience" considered able  tQ  :  leja'ders o f p r o f e s s i o n a l  f o r nurse  educators,  clinically  perform  required  what c o n s t i t u t e s  to  the  competent  nursing associations  "minimum s t a f f  an  instructor  t o the  extent  n u r s i n g f u n c t i o n s which  nurse  i s generally t h a t she  students  is  are  perform.  P r o b a b l y i t i s n o t n e c e s s a r y f o r i n s t r u c t o r s o f the n o v i c e t o be a b l e t o p e r f o r m c l i n i c a l l y a t t h e a d v a n c e d l e v e l s . But as t h e s t u d e n t s advance i n c l i n i c a l s p e c i a l i z a t i o n , t h e y need t e a c h e r s who can themselves demonstrate advanced l e v e l s of c l i n i c a l judgement ( B e n n e r , 1 9 8 4 , p . 1 8 6 ) . All  instructors  clinical  r o u t i n e s and  area w i t h i n which is  provided  to  al low ;  returning Although on  expected  they  to ; p r a c t i c e such  w i t h i n the  clinically.  clinical  are  with  the  e x p e r t i s e f o r the  their  employed clinical  in a hospital  provision  basis,  familiar  t e a c h . P r o f e s s i o n a l development  them t o m a i n t a i n  no  t o be  particular  f o r t e a c h e r s who  a part-time  hospitals  are  exists  many a r e field  full-time  time  i n order  e x p e r t i s e by  setting  f o r most  annually.  faculty  employed  c o n c u r r e n t l y employed  of e x p e r t i s e i n which  they  by teach  The since  instructor's clinical  formative  attention  to the teachers'  does n o t o c c u r no  standard  with  Perhaps  a reward  g e n e r a l l y draw  skills,  skills.  There  however appears  to recognize and t h e s o c i a l  reward  institutions  role  within  i s the primary mission  educational  teaching  t o be  the lack  excellence  confusion  a clinical  (Karns  that e x i s t s  setting.  That  i n a l l non-research  means t h a t  s t r u c t u r e o f those  that  teacher  i s not s u r p r i s i n g given  when n u r s e s a r e e d u c a t o r s  the  clinical  teaching  this  system  and. Schwab, 1982)  teaching  evaluations  for practice related to c l i n i c a l  expertise. of  a n d summative  competence may be r e w a r d e d  i t must be r e f l e c t e d i n  institutions  (Van O r t &  Longman,1986). I n a d d i t i o n t o t h e l a c k o f r e w a r d s f o r excellence  in clinical  m i x e d messages  teaching,  from e m p l o y e r s  nursing  regarding  faculty  receive  desirable  c h a r a c t e r i s t i c s .of i n s t r u c t o r s ( S t a f f o r d & G r a v e s , Decisions to  be b a s e d  including tasks,  Pugh, nurse  members  faculty  "fitting (1986)  discovered  for various  and p r o f e s s i o n a l g r o u p m e e t i n g s and  i n t o the group".  studied  the r o l e  i n the c l i n i c a l that  behavior.  appear  functions  committee membership, v o l u n t e e r i n g  educators  faculty  the promotion of f a c u l t y  of\ a v a r i e t y o f n o n - t e a c h i n g  attending  generally  and  regarding  1978).  confusion  area  there  were t h r e e  " Nurse,  Teacher,  within  that  exists for  the l a s t  distinct  decade  patterns of  and N u r s e - T e a c h e r .  -36-  Nurses enact teacher using  primarily  behaviors;  both  predict  roles.  the  Pratt  and  Nurse-Teachers  behavior  Magill  (1983),  adopting  three basic r o l e s :  Learners  too  and  adopt  participant".  clarification. role  should  learner's  and  social  of c o n f l i c t conflict  teachers to  arises  as  be  i n the  facilitator".  absence  to adopt  stage,  role  a  competitive of  role  particular the  circumstantial  important  a  performance.  in part attributed  socialization  as  They b e l i e v e t h a t l a c k o f  b a s i s f o r t e a c h i n g and  d u r i n g the  itself  teachers  "dependent,  e x p e c t a t i o n i s as  is deficient  can  in  to a d i a g n o s i s of  (p. 464). role  does n o t  " e x p e r t , model and  developmental  needs"  comfortable  describe c l i n i c a l  teacher's decision  current role,  a theoretical  role  Difficulty  enact  faculty".  three basic r o l e s :  "The  agreement about  Role  of  Teachers  appear  identity  be' made i n r e s p o n s e  constraints,  source  behaviors;  Faculty role  observed  and  nurse  t o the  l a c k of  g u i d i n g would-be  process  from  one  expected  andther.  Becoming; a rktrse e d u c a t o r i s n o t an a d d i t i v e p r o c e s s ; ' - ."that i s , ' .i,t' i s n o t a m a t t e r o f a d d i n g the r o l e o f .educator t o t h a t o f n u r s e . I t r e q u i r e s a change i n k n o w l e d g e , s k i l l s , b e h a v i o r s , and v a l u e s t o p r e p a r e f o r n e w l y a s s i m i l a t e d r o l e s , s e t t i n g s and g o a l s s h a r e d by new r e f e r e n c e g r o u p s ( I n f a n t e , 1986, p. 9 4 ) . The While  clinical  staff  a setting  setting  nurses  and  to p r o v i d e  provides  head n u r s e s  quality  a source v i e w the  of  role  conflict.  clinical  area  c a r e where p r o b l e m - s o l v i n g  is  as  -37-  .rapid,  and  clinical  client  setting  their'families skills.  The  the  skills. and  as  a place  to acquire !  teacher  hypothesizing, while  needs are  Educational  varied places,  clinical  specialties. a number o f  achieved p.  a high  values  and  clinical Clinical  settings,  degree  of  and and  take  and  comfort  technical  must  be  i n a number  of  move f r e q u e n t l y  never  there  data,  i n numerous  instructors sometimes  and  outcomes,  educator  competence  the  psychomotor analyzing  place  nurse  view  meet c l i e n t s  appraising  efficiency  t h e r e f o r e the  to maintain  educators  students  collecting  activities  prepared  through  where  hunches  practitioner  nurse  intellectual  values  testing  met,  having  (Infante,  1986,  95).  Summary  Studies  on' t e a c h e r  teaching  f o r the  into  complexity  the  education  of  effectiveness excellent  of  teacher  in clinical  clinical  enthusiasm,  clinical  most p a r t . W h i l e  p h y s i c i a n s are  (1986) i n c l u d e : a ideas,  effectiveness apply  sound  more a k i n  supervision with  to  Seven  i n medicine  knowledge  skillful  offer  classroom some  insight  effectiveness, studies in  nursing.  teachers  they  to  base,  interaction  demonstrated  s t u d i e s on  teacher  characteristics identified clearly with  by  of  Irby  presented  students,  clinical  the  expertise  -38-  and  role  modelling  of p r o f e s s i o n a l c h a r a c t e r i s t i c s .  , ';ft0toiparisoh')o'£;'effective c l i n i c a l  teacher  i  nursing  education  i s still  universally-accepted agree  however  availability  the  teaching The  Other  studied formal  system  ability  nurse  appreciated  behaviors,  of student  teacher  clinical  use of classroom  due  five  educational  factors  attitude,  research  on t e a c h i n g  (1966)  and years  have  also  accepted  of  been  classification  characteristics.  evaluation tools  within  effectivenessi s  1) d i f f i c u l t y i n  i n a practice  skills  clinical  effectiveness i n  teacher  factors:  on  Jacobson  ratios  factors  teacher  to evaluate  of emphasis  include  performance,  s t u d i e d . For example,  tile .-clinical., s e t t i n g  conducting  and p r o f e s s i o n a l  i n d i v i d u a l i z e her  environmental  on e n v i r o n m e n t a l  to the following  value:  by s t u d e n t s  student  by t h e l a c k o f a u n i v e r s a l l y  Inappropriate  lack  knowledge  p r e p a r a t i o n on t e a c h e r  for effective  Students  students.  of certain  Studies  Researchers  and p o r t r a y a non-judgemental  has a l s o been  teacher  system.  of the i n s t r u c t o r , her  t o : evaluate  and m o t i v a t e  the effects  nursing. impeded  attributes  due t o t h e l a c k o f a  values.  her general  appropriate  impact  teachers  skills,  enthusiasm  r o l e , mqdel  student  and a c c e s s i b i l i t y  teacher's  maintain  classification  on c e r t a i n  interpersonal competence.  impossible  behaviors i n  setting;  i n graduate  nursing  2)  -39-  programs; teaching  3)  skills;  recognizing nursing teaching  emphasis 4)  on  the  excellence  programs  and  w i t h i n the  5)  clinical lack  of a  skills  rather  than  reward  system  for  for teachers i n role  clinical  confusion setting.  on  undergraduate f o r nurse  educators  -40-  Chapter  Three  METHODOLOGY  Introduction  The  purpose  conceptions students  of t h i s  o f second  enrolled  study  was t o d e t e r m i n e t h e  and t h i r d  year  i n a three year  college  diploma  program  regarding  effective  guided,by  t h e f o l l o w i n g q u e s t i o n s : a) What do s t u d e n t s  'a of  clinical second  clinical  nursing  instructor; and t h i r d  instructors.  b) t o what e x t e n t  year  students  related  to the nature  contractual  a g r e e m e n t ; and d) c a n s e c o n d  students'  provide  a theoretical  of  clinical This  of the i n s t r u c t o r ' s and t h i r d  of e f f e c t i v e  clinical  b a s i s f o r the f u r t h e r  outlines  a rationale  o f methodology,  - how,data were c o l l e c t e d , data  c) a r e t h e i r  year teachers  e m p i r i c a l study  teacher e f f e c t i v e n e s s ?  chapter  discussion  conceptions  value i n  are the conceptions  similar;  conceptions  nursing  The r e s e a r c h was  analysis  procedures  f o r the study, a  a description  ethical  of the s u b j e c t s ,  c o n s i d e r a t i o n s and t h e  t h a t were  followed.  -41-  R a t i o n a l e .. s  '•  >— ••  •The need of  t o combine q u a l i t a t i v e  investigation  clinical  instructors  researchers accepted More  into  students' i s due  has  system  b e h a v i o r s . Rather  attributes  and  year  uniqueness  than  nursing students'  a  of  with  their  universally  are  asked  to  discrete  of e f f e c t i v e  most e f f e c t i v e  that  students'  suggesting  of a l l of  effective  effectiveness.  researcher explored recall  methods  difficulty  for teacher  characteristics  t h e r e f o r e , the  associated  of  been s e t a s i d e when s t u d e n t s  categorize  teachers  conceptions  in establishing  i m p o r t a n t l y however, the  conceptions  quantitative  i n p a r t t o the  have e x p e r i e n c e d  classification  and  clinical second  the  and  third  factors  clinical  instructor  to  date.  Methodology  A qualitative for  t he d e s c r i p t i o n , ;  relations to  approach based  existing  seek an  effective  analysis  experiences  with  and  phenomenography  understanding  between c o n c e p t i o n s .  understanding clinical  on  o f the  teachers  effective  from  The  students' their  of  study  allows logical  was  conceptions  descriptions  t e a c h e r s . In the  study,  of  designed of past  students'  -42-  conceptions from an  audiotaped  categories year  were the  of  of a n a l y s i s . T r a n s c r i p t s  semi-structured  conceptions  college-based  clinical  object  instructors.  interview yielded  c u r r e n t l y h e l d by  nursing  students  I t i s the  second  regarding  interrelationship  c a t e g o r i e s t h a t was  researcher  i n a c q u i r i n g a better understanding components o f e f f e c t i v e  Simultaneously, responses  data  generated  t o open-ended  items  a q u a n t i t a t i v e dimension enabled  the  researcher  comments. T h i s Knafl new  approaches  to  of  i s needed  Description  students nursing  the  with  design diverse  relative recent  to of  the the  of  researcher the  to  data.  values  to  add  This  students'  recommendations  development and  of  rank o r d e r i n g the  third  instruction.  a n a l y s i s of  f o r the  research  clinical  by  of c r e a t i v e ,  emphasized  techniques  t o answer a p a r t i c u l a r  of  of  calls  significant  allowed  to a t t a c h  combining  the  i f this  research  is  question.  Subjects  Respondents population  by  to the  i s i n accord  (1988), which  desirability what  most  and  effective  conceptual  essential  generated  47  for this  study  second year  e n r o l l e d i n a three program. S i x t e e n  were  and year  67  randomly third  s e l e c t e d from a  year  c o l l e g e based  Registered  Psychiatric  nursing diploma Nurse  (RPN)  -43-  s'tudents who j o i n e d 1987  September, from  the t h i r d  and who g r a d u a t e d  t h e p o p u l a t i o n . The 16  because  year  t h e y were  of the diploma  joined  t h e 51  students  third  year  i n September,  population  1987.  the " r e g u l a r "  o f those  instructors students  1988,  year clinical  of the general  i n the w i n t e r  instructors.  settings.  and t h i r d  years of  regarding conceptions of  Although  i n v o l v e d , t h e y were  clinical  informed  instructors  of the nature  t h e study.. The  nursing  setting  f o r t h e s t u d y was a t h r e e y e a r  program w i t h  an a v e r a g e  y e a r . The n u r s i n g d e p a r t m e n t and  third  of c l i n i c a l  o f the second  t h e p r o g r a m p r o v i d e d t h e d a t a base  were n o t d i r e c t l y  i n March  of  y e a r s w o u l d have had f o u r t o e i g h t  i n a variety  i n each  clinical  group  semester  They g r a d u a t e d  of n u r s i n g students. Students  clinical  of  i n the f i f t h  were t h e r e f o r e u n c h a r a c t e r i s t i c  o f each  effective  T h i s R.P.N,  Their previous experiences with  semes.ter  Fifteen  students  one month b e f o r e  graduated.  instructors  excluded  i n a m o d i f i e d program d e s i g n e d t o  them t o r e e n t e r t h e w o r k p l a c e .  approximately  were d e l e t e d  R.P.N, s t u d e n t s were  enable  the program  1988  i n March,  program i n  eighteen part-time  part-time  female  enrolment  o f 60  faculty,  chairperson. Full-time  full-time  one f u l l - t i m e  as w e l l  based  students per  c o n s i s t e d of eleven  l a b o r a t o r y demonstrators  administrative  college  and two  as one  faculty  were  assigned  -44-  classrobm  and c l i n i c a l  responsibility  t e a c h i n g d u t i e s as w e l l as  f o r the implementation  program. P a r t - t i m e  f a c u l t y were employed  t e a c h w i t h i n the c l i n i c a l Students  and one 350  the  last  semester  f o u r t e e n weeks  e x c l u s i v e l y to  setting.  were a s s i g n e d  care h o s p i t a l  and e v a l u a t i o n o f t h e  primarily bed a c t i v e  t o one 200 treatment  of the program. D u r i n g  of the program s t u d e n t s  bed  extended  hospital  the l a s t  until  twelve  to  were e n c o u r a g e d t o  c h o o s e one o f e i g h t t o t e n s m a l l h o s p i t a l s w i t h i n t h e r e g i o n (ranging  45-150 b e d s ) f o r a f o u r t o s i x - w e e k  from  experience. Although 'buddies'  within hospital  maintained  liaison  responsibility faculty  the  with  also  by s t a f f  the c l i n i c a l  student  settings,  third  the a g e n c i e s  f o r student  member was  consultation within  s t u d e n t s were w o r k i n g  with year  clinical nursing  faculty  and assumed  e v a l u a t i o n at a l l times.  available  a t a l l times f o r  or s t u d e n t s .  area v a r i e d  but the average  8:1..-The p r o g r a m was d i v i d e d  Instructor-student ratios  depending  ratio into  One  on t h e l e v e l o f  of student  to f a c u l t y  s i x semesters  was  of equal  duration. Each and  semester  c o n s i s t e d o f two weeks  two six-^-we'ek r o t a t i o n s  clinical  area  combined w i t h  two o r t h r e e  d u r i n g which clinical  of c l a s s r o o m students  were  days or e v e n i n g s  two days p e r week o f c l a s s r o o m  theory  study.  i n the p e r week  Students  -45-  in  the f i n a l  twelve  weeks  leadership Sixth  role  with  scheduled  specialty  students' those  were  included:  of theory  during  which  for entry  clinical  of their  into  hours were  otherwise  students  exposure often  the operating  room, d e l i v e r y room, a d u l t  assumed  scheduled  F o r one  to shifts  t o two  selected a  clinical  to a v a r i e t y of  unaccessible  a  the workplace.  "buddy"; u s u a l l y 12-hour  semester,  to gain  combined w i t h  they  a seven day workweek.  the f i n a l  i n order  areas which  duty  i n preparation  throughout  weeks w i t h i n  had two weeks  of c l i n i c a l  semester  coincide  areas  semester  clinical  t o them.  room, p o s t - a n e s t h e t i c  Such  recovery  and n e o n a t a l  i n t e n s i v e care  to take  i n the study  units.  Data'Collection  S t u d e n t s were of  a random  volunteered study  was  table. A l lstudents to take  explained  one week p r i o r required term.  selected  part  semester  during  the s i x t h  structured  were  initially  The  purpose  i n t e r v i e w . Taped  and were h e l d  students  were  prior  interviewed  whereas t h i r d - y e a r students and f i n a l  semester  i n t e r v i e w schedule  was  by use contacted  and agreement f o r p a r t i c i p a t i o n  30-40 m i n u t e s  fourth  who  i n the study.  to the scheduled  Second-year  part  of the sought  interviews  t o the end o f t h e during were  the interviewed  of the program. A  developed  to gain  semi-  insight  -46-  into  the s t u d e n t s '  instructors  conceptions  of e f f e c t i v e  clinical  ( s e e A p p e n d i x A ) . I n t e r v i e w s were c o n d u c t e d  a. one month p e r i o d . A l l i n t e r v i e w s were t a p e d consent did  to allow  not appear  scheduled  to a f f e c t  coincide with  students'  classroom  complaining  o f a headache was  rescheduling carry  or c a n c e l l i n g  on as p l a n n e d .  35 m i n u t e  given  i n conducting f o r the i n t e r v i e w  the c h o i c e of  t h e i n t e r v i e w b u t he c h o s e t o half  way  through  the  difference  from  Open-ended q u e s t i o n s qualitative  data.  female  students  successfully  rooms w i t h o u t  any n o t i c e a b l e  of the i n t e r v i e w s . allowed  F o r example,  f o r the c o l l e c t i o n of  the f i r s t  he  t o be i n t e r v i e w e d  i n t e r v i e w s were  conference  i n the q u a l i t y  Two  the r e s e a r c h e r  a r e a . Both  in private  him  t h e i n t e r v i e w and once a g a i n ,  to completion.  permission  the c l i n i c a l  completed  i n order  i n t e r v i e w , t h e r e s e a r c h e r once more o f f e r e d  to continue  requested  arrived  Approximately  option of c a n c e l l i n g  chose  who  area  two  hours.  irregularities  One male s t u d e n t  were  e n v i r o n m e n t . Twenty e i g h t o f  clinical  interviews.  in  Interviews  outside of  rooms i n t h e c l i n i c a l  T h e r e were t h r e e m i n o r  the  equipment  i n t e r v i e w s were h e l d i n t h e r e s e a r c h e r ' s o f f i c e ;  were h e l d i n c o n f e r e n c e to  responses.  convenience  in a quiet, private  students'  a n a l y s i s . Audiotape  students'  at the student's  activities the  for transcript  with  over  question  asked  -47-  respondents:  "Please  recall  t h e most e f f e c t i v e  instructor  you've had r e c e n t l y  throughout  your  interviewer] Closed their  clinical  about your  responses  experiences  tested  Piloting  from  resulted  the  researcher  year  students  each  This  allowed  data  collection  transcribed a secure  Ethical  t o rank  order  and t o p r o v i d e was  first  year  pilot-  students  of the q u e s t i o n s  to p i l o t  accessible  who  feelings  was  Second  t o the r e s e a r c h e r .  to begin  data  summarized  analysis  Each a u d i o t a p e d  Original  from  allowed  and r e a c t i o n s t o t h e i n t e r v i e w .  ongoing.  verbatim.  and  the i n t e r v i e w s because  i n t e r v i e w , the r e s e a r c h e r  the r e s e a r c h e r  copies  instructor".  her i n t e r v i e w i n g s t y l e .  p l a c e and p h o t o c o p i e s  as w o r k i n g  that  f o u r second  i n refinement  to c r i t i q u e  thoughts,  me [ t h e  the t a r g e t p o p u l a t i o n f o r the study.  t h e y were more r e a d i l y  salient  items  1988, w i t h  were c h o s e n  Following  with  The i n t e r v i e w s c h e d u l e  i n January,  were d r o p p e d  Tell  t o ask r e s p o n d e n t s  t o open ended  demographic d a t a .  o r one you've had a t a n y t i m e  experience.  q u e s t i o n s were u s e d  clinical  transcripts  i n t e r v i e w was  were  of the o r i g i n a l s  which data  while  a n a l y s i s was  stored i n were  used  c a r r i e d out.  Considerations  Written permission  consent  was  to conduct -  obtained  the study  from was  students  obtained  and  from  college  -48-  administration  as w e l l  Columbia  Behavioral  Research  and  to  the  Other  scheduled  Student  data  transcribed  the  one  with  month t o  order  given  opinions for  the  U n i v e r s i t y of  Screening  guaranteed  they  of  Committee  (see Appendix  from t r a n s c r i p t s .  copies  by  content  Several  much t h o u g h t  about  to t h i s  effective  opportunity  to e x p r e s s  the  the  had  and  mail in  students  when i t  that although they  by  interviews  study  teachers  their  were  transcripts of  topic,  clinical  had  i n t e r v i e w . Many  f i n d i n g s of  subjects admitted  author  Students  individual  of each  prior  B).  Once the  were e r a s e d .  their  i n the  For  removing a l l  s i x weeks f o l l o w i n g t a p i n g the  British  I n v o l v i n g Human S u b j e c t s ,  interviews  interest  completed. never  Studies  tapes,  to v e r i f y  expressed  f r o m the  Sciences  a n o n y m i t y was  identifying  provided  as  they  was had  definite  were  grateful  views.  Data A n a l y s i s  A modified data &  was  grounded  carried  Strauss,  1987).  out  of  subjects  that  i s the  of data  s a m p l e d . The  fundamental  approach  to a n a l y s i s of  (Glasser & Strauss,  This  whereby c o m p a r i s o n s  theory  patterns  constant  are  comparative  theory  within  approach  social  1978,  Glasser,  made between and  grounded exist  1967;  the  method  among  groups  presumes  systems.  The  -49-  researcher category sorting  arrives  through the  at a f i n a l  integrative  d i s c o v e r y by  c o n s t a n t l y comparing  theory  i s not  a specific  (Strauss,  1986);  including  a number o f d i s t i n c t and  i t i s a style  certain  method or  of doing  qualitative  f e a t u r e s , such  methodological  development  and  d e n s i t y (p. 5 ) . Through a s e r i e s  and  theorist  captures  theory and p.  interpretations  under  the  "because of  23).  data  analysis  i n which  the  Data a n a l y s i s  constant  c o m p a r i s o n s and  sentence  the  in  a c a u s a l sense  of  a concept-or  categories  and  of data  and  aim but  then  the  of  detailed  grounded  i s termed  the  of  the  phrase  by  phrase  integration  of  i d e a s and  1986,  analysis,  seeking  to prove the  a  theory  plausibility  g r a d u a l l y as  aspects  product  (Strauss,  transcript  rather to demonstrate  relational  theory  ideas.  researcher  This occurs  grounded  g e n e r a t i o n of  i s grounded"  l i n k a g e s of  o f the  belief.  emerge and  theory  t h e o r y w h i c h emerges i s the sorting  constant  conceptual  reality  i n v o l v e s repeated  by  i s not  o f the  i t s emphasis on  sentence  It  theoretical  study.  qualitative  the  to ensure  o f the d a t a ,  complexity  analysis  g u i d e l i n e s (e.g.  coding  analysis  procedures)  as  and  The  and  technique  comparisons  experience  core  data.  Grounded  sampling  i d e a or  core  are uncovered.  of s y s t e m a t i c accounts  for  The  coding, frequent  -50-  changes  i n the researcher's point of view  analytical repeated  process.  active  Coding processes. and  of transcripts Initially,  appeared  f o reach  salient  p o i n t s from  recurrent  were  yielded  brief  place  i n t e r v i e w were from  each  reviewed.  i n two s e p a r a t e  reviewed  the data.  transcript.  circled  and a t t r i b u t e s  p e r c e i v e d by informants  students  referred  t o more  substantive codes  code.  See A p p e n d i x  coding  the  characteristics  and  third  data  i n margins;  s e c t i o n s were  constituted a l l  of this  characteristics C f o rthe l i s t  study. i n a  When  single  constituted  of substantive  generated. Once open  ended  jotted  one c h a r a c t e r i s t i c  of the perceived  t o be  of effective  teachers  each  were  o f t h e 30 i n t e r v i e w s  clinical  statement  on  Secondly, a l l  and important  than  to reflect  Memos  o f 30 s u b s t a n t i v e c o d e s w h i c h  the possible behaviors  feelings  what a p p e a r e d  Key i d e a s were  Transcript analysis  a list  i s the result of  summaries o f thoughts,  interview, outlining  themes were  highlighted.  took  t o be e m e r g i n g  written  transcripts  description  the entire  inspection of the data.  r e a c t i o n s t o each  what  of  Analytic  during  year  was c o m p l e t e d ,  were  students.  t a b u l a t e d and compared Comparisons  and c l o s e d q u e s t i o n s had been  emerged  from  coded  were  and compared  the data.  f r e q u e n c i e s o f each o f  of responses  carried five  f o r second  out.  t o open-  When a l l o f t h e  conceptual  codes  a  -51-  Quantitative rtonparametric observed full-time  a n a l y s i s of  statistical and and  expected  the  test,  the  frequencies  part-time  clinical  data  of  c o n s i s t e d of  chi-square,  to  respondents  teachers  as  most  a determine  choosing effective.  -52-  Chapter  Four  PRESENTATION OF STUDENTS' CONCEPTIONS OF E F F E C T I V E TEACHERS  Introduction  The  purposes  characteristics perceived college  of this  s t u d y were t o i n v e s t i g a t e t h e  of e f f e c t i v e  by s e c o n d  and t h i r d  n u r s i n g program,  conceptions  were s i m i l a r  contractual  agreement  teacher.  clinical  In a d d i t i o n ,  year  influenced their  assessing  clinical  teacher  Section  including:  c h o s e n by s e c o n d  year  basis for of this  i n two major s e c t i o n s . related  nursing students,  c h o i c e s o f most e f f e c t i v e  contractual most  a theoretical  e f f e c t i v e n e s s ? The r e s u l t s chapter  effective  conceptions of  frequencies of conceptual  and t h i r d  their  c h o i c e o f most  I i s a presentation of findings  information  student's  in this  of a three-year  the i n s t r u c t o r ' s  c o u l d the student's  teachers provide  i n n u r s i n g as  t o what e x t e n t  and/or w h e t h e r  clinical  are presented  students  to determine  effective  study  teachers  clinical  agreements of i n s t r u c t o r s  to background  categories timing of  i n s t r u c t o r , and  recalled  by s t u d e n t s as  effective.  The  second  categories  section  i s a p r e s e n t a t i o n of the four  of e f f e c t i v e  clinical  teachers  (Table  conceptual  2, p. 5 6 ) .  -53-  It  i s divided  feedback,  into  communication s k i l l s ,  Whereas  the f i r s t  within  the c o n t r o l  this  the f o l l o w i n g  Timing  of c l i n i c a l with  Effective  Of t h e 30 r e s p o n s e s  second of  teachers,  year  teachers  environmental  factors  which are  most  effective  t h e m a j o r i t y r e c a l l e d an i n s t r u c t o r half  rotation  of the t h i r d year i n which they  teacher  (fifth  experienced  i s represented  i n Table  i n the semester) their 1.  1.  Timing  o f Most  Semester  Year  Effective  Teachers  Rotation  1  Rotation 2  Sem.  1  1  Sem.  2  1  Sem.  3  2  SSSS TT  SSS  Sem.  4  2  SSS  SSS TT  Sem.  5  3  TTTTT  Sem.  6  3  n=30  which are  (internally controlled),  r e g a r d i n g the s t u d e n t ' s  effective clinical  Table  factors.  Teachers  or the f i r s t  t h e p r o g r a m . The  most  and e n v i r o n m e n t a l  controlled.  o f Most  clinical  knowledge,  three c a t e g o r i e s include f a c t o r s  i s not the case  externally  subsections:  Timing  of  SS  TT  S  TTTT  S=second y e a r s t u d e n t s ; T = t h i r d y e a r s t u d e n t s  T  Interview  -54-  Analysis  A  by  Instructor's Contractual  significantly  than p a r t - t i m e X  1  = 8.66  faculty  (df=l)  between the  greater  (n=6)  p <.01.  i n the  Cummulative  clinical  repeatedly  communication  and  in that  the  majority  166  the  content,  d)  Clinical  her  perceived  choices  Teachers  s e l e c t e d by  both  of e f f e c t i v e  f a c t o r s were v i e w e d  four b)  t o the kinds  had  full  as  groups  teacher feedback  the  ability  goals  and  knowledge b a s e ,  o f k n o w l e d g e : a)  knowledge  knowledge; c)  the of  content  l e a r n e r s . Knowledge o f o b j e c t i v e s were  and  internally  c o n t r o l over  teachers'  pedagogical  knowledge o f  curriculum,  infrequently.  and  r e l a t e d t o knowledge,  teacher  references  contexts;  k n o w l e d g e ; and  effective  them.  a l l u d e d to  educational  revealed  These  most  (n=24)  a significant relationship  of b e h a v i o r s  behaviors  skills.  to d i s p l a y each of Of  as  faculty  area.  Effective  frequencies  characteristics  controlled  were d e s c r i b e d  T h e r e was  Student's Conceptions of  students  full-time  i n s t r u c t o r ' s c o n t r a c t u a l agreement  effectiveness  of  number o f  Agreement  other  mentioned  -55-  T h e r e were 140  references  most o f w h i c h were comments providing within that  positive  this  ability comments  of t h e i r  to d i s p l a y alluded  f e e d b a c k . A number  and  comments  empathy, w h i l e  communication  skills,  skill in of responses  of t r u s t  and h o n e s t y  teacher.  communication  to congruence  feedback  the t e a c h e r s '  to the l e v e l s  t o the t e a c h e r ' s  one h a l f  non-verbal  referred  between s t u d e n t  References Virtually  regarding  and n e g a t i v e  category  existed  t o the t e a c h e r s '  related  s k i l l s numbered to the t e a c h e r s '  the remainder  of their  i n the i n s t r u c t o r s '  and h e r a b i l i t y  127.  verbal  t o become  and  a student  a d v o c a t e when t h e s i t u a t i o n demanded i t . Given  the o p p o r t u n i t y may  t o comment  those  that  be o u t s i d e  their  clinical  performance,  three  factors.  Those e x t e r n a l  the  instructor;  and  c) s t a f f a c c e p t a n c e  externally  availability clinical  setting.  studies  mention  1982;  setting  Jacobson,  Parsons,  1979).  factors climate  factors,  These  on c l i n i c a l  students  teacher  (Armington, Kiker,  (i.e.  affecting  study i d e n t i f i e d  were: a) a v a i l a b i l i t y o f i n the c l i n i c a l  both w i t h i n  setting;  references to  o f them r e l a t e d and o u t s i d e  are not mentioned  effectiveness  the a v a i l a b i l i t y  1966;  in this  one h a l f  factors  factors  of the teacher)  o f s t u d e n t s . Of t h e 27  o f the teacher  studies  clinical  the c o n t r o l  b) e m o t i o n a l  controlled  on e x t e r n a l  except  o f an i n s t r u c t o r  1972;  Barham, 1965;  1973;  Mogan  t o the  of the  i n other that  numerous  within  the  K a r n s & Schwab,  & Knox, 1983;  O'Shea &  -56-  Table  2.  Frequency  of Statements W i t h i n C a t e g o r i e s Mentioned  Categories  Second  (INTERNALLY  Year  by S t u d e n t s Third  Year  CONTROLLED)  KNOWLEDGE Knowledge o f e d u c a t i o n a l c o n t e x t s P e d a g o g i c a l knowledge C o n t e n t knowledge Knowledge o f l e a r n e r s Knowledge o f o t h e r c o n t e n t Knowledge o f c u r r i c u l u m / g o a l s / o b j e c t i v e s TOTAL  20 18 13 10 9 7  20 25 10 11 8 15  77  89  29 28 23  24 21 9 6  80  60  FEEDBACK Positive Negative Trust Honesty  feedback feedback  TOTAL COMMUNICATION  SKILLS  Empathy Congruence Student Advocacy TOTAL  37 17 19  25 12 17  73  54  10 5 4  3 3 2  19  8  (EXTERNALLY CONTROLLED) ENVIRONMENTAL  FACTORS  Availability A c c e p t a n c e by s t a f f Climate TOTAL  -57-  Knowledge  How  Students  View  Comparative  "Knowledge"  analysis  of student  twenty e i g h t o f the t h i r t y reference students  determinant  viewed  values  frequently  viewed  of teacher  Students ascribed  of other  less  o f knowledge knowledge  content  o f knowledge when s p e a k i n g  and  spoke o f t h e t e a c h e r ' s  critical  year  student  qualities  R 27:  of learners.  knowledge were m e n t i o n e d to the l a t t e r  t o meet t h e i r  who was a s k e d  of c l i n i c a l  setting.  of educational  of the i n s t r u c t o r ' s  her t e a c h i n g i n order  A third  important  of e d u c a t i o n a l aims,  referred  individualize  of the  a c c o r d i n g l y . T h e i r comments  and knowledge  they  direct  v e r y d i f f e r e n t l y and  and knowledge  and o b j e c t i v e s and c u r r i c u l a r  when t h e y  b a s e " . Most  knowledge, knowledge  knowledge  frequently. Indirectly,  types  "knowledge  a l l u d e d to content  Knowledge  i n t e r v i e w e d made  e f f e c t i v e n e s s i n the c l i n i c a l  to teacher  pedagogical  revealed that  "knowledge" as t h e most  types  contexts,  goals  students  t o the i n s t r u c t o r ' s i n fact  transcripts  two  a b i l i t y to  learning  needs  expectations. t o name t h e t h r e e  instructors  most  responded:  Knowledge, you have t o have a u t h o r i t y , t h e knowledge and a u t h o r i t y so t h a t p e o p l e a r e g o i n g t o r e s p e c t you and I t h i n k i f t h e y ' r e an i n s t r u c t o r , t h e y s h o u l d have t h e knowledge i n o r d e r t o be a b l e t o r o l e model [ a p p r o p r i a t e n u r s e b e h a v i o r s ] .  -58-  Another effective  third  year  instructor  student  asked  to d e s c r i b e her  most  said:  R 28:  I t h i n k her knowledge base i m p r e s s e d me, she had s u c h a d e p t h f o r t h e d i f f e r e n t p r o t o t y p e s , s u c h an u n d e r s t a n d i n g of p u l l i n g t o g e t h e r a l l the l a b . [ l a b o r a t o r y ] r e s u l t s and i t a l l f i t . She knew what you were t r y i n g [ t o do] and she w o u l d add knowledge to t h a t or add e x p e r i e n c e t o t h a t .  I:  What do you t h i n k a r e the q u a l i t i e s o f any c l i n i c a l  R 28:  I want a smart t e a c h e r , I've g o t t a have a smart t e a c h e r and as much knowledge as she h a s , I want i t l  When g i v e n specified  opportunity  of  than  theory. the  They d i d n o t  other  but  knowledge a t work. S t u d e n t s instructor's R  to e l a b o r a t e , students u s u a l l y  t h a t knowledge meant b o t h  application important  the  3:  knowledge  t h r e e most c r i t i c a l instructor?  theory  and  perceive  r a t h e r saw  one  a need  a l s o e l a b o r a t e d on  level  impacted  Her knowledge l e v e l learn.  will  directly affect  clinical as  more  f o r both how on  your  kinds  of  an them:  ability  to  *************** R  As  4:  p r e v i o u s l y mentioned,  descriptions vital  An i n s t r u c t o r has t o have knowledge, I've run a c r o s s a c o u p l e o f i n s t r u c t o r s who i f you a s k e d tham a q u e s t i o n , t h e y k i n d o f , w e l l t h e y d o n ' t even a t t e m p t to t h i n k i t o u t . L i k e p e r h a p s t h e y d o n ' t r e a l l y know what the answer i s .  of the  for effective  types  how  effective  of  (Wilson,  provided  detailed  o f knowledge w h i c h  clinical  demonstrated knowledge  they  instruction.  clinical  Shulman and  specific  considered  T h e i r comments  teachers  Richert,  they  and  employ  1987).  seven  clearly types  -59-  Knowledge o f E d u c a t i o n a l  Contexts  Knowledge o f e d u c a t i o n a l c o n t e x t s that  the  must be  teacher able  must be  to r o l e  familiar  Students  clinical  experience  expectations  with  noted had  the on  r e g a r d i n g an  application  impact their  t o be  learning,  instructor's  and  they  they  had  a sound o r i e n t a t i o n  illustrated R  2:  this  t o the  they  clinical  experience  i n which  of value  to  that a teacher's years  when t h e y had  area  setting  taught area. A  and  behaviors.  I n s t r u c t o r s were most e f f e c t i v e i n the  t e a c h i n g means  the p r a c t i c e  model a p p r o p r i a t e n u r s e  Knowledge must have p r a c t i c a l learner.  in clinical  had  the  of  certain  background.  extensive  students few  clinical  or when  student  comments  point.  I f t h e i n s t u c t o r i s f a m i l i a r w i t h t h e p l a c e she w o r k i n g i t h e l p s . The i n s t r u c t o r i s t h e one who t h e tone f o r e v e r y t h i n g .  is sets  *************** R  4:  The i n s t r u c t o r comes w i t h q u i t e a few y e a r s o f e x p e r i e n c e . You e x p e c t them t o be k n o w l e d g e a b l e , e s p e c i a l l y i n the f i e l d t h a t t h e y work i n and t o a b l e t o l o o k more i n t o t h e f u t u r e .  be  *************** R The  6:  She knew the f l o o r , she was a b l e t o p u t i t t o work. She r e a l l y knew what she was d o i n g .  teacher's  knowledge o f the  clinical  ability  to  role  model, and  students  ability  to  role  model d e s i r a b l e 'nurse  area  affected  p e r c e i v e d an behaviors'  real  her  instructor's as  essential  -60-  t o her role  clinical  modelling R  28:  e f f e c t i v e n e s s . They saw and  knowledge  a direct link  between  level.  She was v e r y w e l l o r g a n i z e d and she knew the f l o o r and t h e p a t i e n t s i n s i d e o u t . I t d i d n ' t m a t t e r who [what p a t i e n t ] she gave you, her homework was done and b e c a u s e o f t h a t I t h i n k t h a t she n e v e r l o o k e d h a p h a z a r d , she n e v e r l o o k e d s t u p i d o r she n e v e r l o o k e d l i k e she wasn't aware o f what was happening a l l the t i m e . **********  R A was  2:  You need someone who can show you how t h i n g s can done. The k i n d o f n u r s e I'd l i k e t o be someday.  third  year  a powerful R:  The  28:  student  to  explained  Other R  3:  i n the  integrate  i t this  the  instructor  who  theory  to  r e l a t e t h e o r e t i c a l knowledge  clinical  area  was  vital  w i t h p r a c t i c e . One  to  in assisting  student  way:  [I l i k e d ] the way she i n t e g r a t e d t h i n g s , she would t e l l me t h i n g s a b o u t t h e s e p a r t i c u l a r p a t i e n t s t h a t were r e l a t e d t o t h e i r i l l n e s s and i t ' s s o m e t h i n g you remember, b e c a u s e y o u ' r e t h e r e a t the t i m e and i t s t i c k s i n y o u r head.  references 11:  view of  She was a r e a l good r o l e model, not one o f us d i d n ' t f e e l t h a t [ s h e ] wasn't the i d e a l . We were v e r y p r o u d o f h e r , l i k e l i t t l e c h i c k s [who] w a l k e d b e h i n d her w i t h g r e a t p r i d e . She's a v e r y s t r o n g and good r o l e model and I have t o r e s p e c t h e r .  instructor's ability  students  her  r o l e model:  everyday occurrences  R  stated  be  to  integration  follow:  The t h i n g t h a t r e a l l y i m p r e s s e d me was her knowledge l e v e l and the way she i n c o r p o r a t e d i t i n t o u s e , put i t i n t o p r a c t i c e . The s e c o n d t h i n g i s t o be a b l e t o i n t e g r a t e p r a c t i c a l w i t h t h e o r y and l a b s . She's got t o be a b l e t o put the whole t h i n g t o g e t h e r b e c a u s e e v e r y t h i n g i s so c o m p l i c a t e d and e a c h p a t i e n t even  -61though i t ' s a s t a n d a r d k i n d o f assessment, each p e r s o n i s d i f f e r e n t and you've g o t t o be a b l e t o t r e a t t h a t d i f f e r e n c e [ s h e c o u l d do t h i s ] w i t h h e r e x p e r t i s e and t h e f a c t t h a t she c a n i n c o r p o r a t e and integrate a l l this. ************** I:  [ I s t h e r e ] a n y t h i n g e l s e about t h i s p e r s o n was r e a l l y h e l p f u l t o y o u a s a s t u d e n t ?  R 19:  [ S h e ] makes y o u t h i n k a b o u t t h i n g s , d i g i n t o y o u r p a t i e n t ' s c o n d i t i o n and why t h e y ' r e on c e r t a i n drugs.  Students expertise  who p e r c e i v e d t h a t  in a particular  consequences. inadequately R  1:  Two s t u d e n t s prepared  their  clinical  clinical  setting  explained their  that  instructor  experienced concerns  lacked  negative  about  instructors.  L o o k i n g back a t d i f f e r e n t i n s t r u c t o r s i n some o f t h e a r e a s t h e r e ' s n o t as much c o n f i d e n c e o r l e t ' s s a y you need h e l p w i t h a s k i l l , and sometimes t h e y d i d n ' t know a whole l o t more t h a n we d i d . . . w h i c h was u n d e r s t a n d a b l e b e c a u s e t h e y h a d n ' t been t o t h e area f o r a w h i l e , but I found t h a t q u i t e hard b e c a u s e i t d i d n ' t h e l p me as much. ***************  R 14:  I f I'm n o t t o o s u r e t h a t t h e y know what t h e y ' r e t e l l i n g me, t h e n I'm n o t t o o c o m f o r t a b l e . *************** •  A  third  year  student  stated  that  doing.  She went on t o s a y :  R 30:  a good  expressed  teacher  similar  concerns  when she  i s someone who knows what she i s  Knowledge l e v e l means t h e a b i l i t y t o a p p l y i t i n p r a c t i c a l s i t u a t i o n s , t h e a b i l i t y t o be a l e a d e r and a b i l i t y t o r o l e m o d e l . I t ' s more t h a n knowledge l e v e l , y o u s h o u l d n ' t have somebody t h a t j u s t i s n e r v o u s o r t h a t d o e s n ' t know t h e s y s t e m and knows j u s t about as much as y o u [ t h e s t u d e n t ] g o i n g o u t t o t e a c h . They c a n ' t g u i d e y o u .  -62-  In is  summary,  the i n s t r u c t o r ' s  a key d e t e r m i n a n t  Students  were  extensive area; who  best  of the s t u d e n t ' s  an i n s t r u c t o r a good  i n the area who  was  role  e n h a n c e d by someone who their help  theoretical them  'pull  Pedagogical  able are of  Three and  who  very  i s able  t o the  k n o w l e d g e a b l e and  Their learning  knowledge;  was  the i n t e g r a t i o n of  someone who  could  need  instructor's  and  pedagogical  t o s t u d e n t s . They a p p r e c i a t e t h e  to get ideas a c r o s s  clearly,  and who  o f t h e o r y . Her q u e s t i o n i n g  in assisting also value  when she i s u n a b l e  students  R 30:  either  i s t h a t w h i c h i s n o t s u b j e c t bound  integration  alternative  to t h e i r  f o r them.  t o ' o f t e a c h i n g . The  important  outright  suggest  had  or a good o r i e n t a t i o n  c o u l d h e l p them w i t h  knowledge  knowledge. Students  admit  area.  i t a l l together'.  to help with also  model  i s a major c o n c e r n  instructor  who  v i e w e d as b e i n g  and c l i n i c a l  t o t h e 'how  knowledge  view of t h a t  area  Knowledge  Pedagogical refers  of the c l i n i c a l  s e r v e d by an i n s t r u c t o r  experience  provided  knowledge  students with  the t e a c h e r who t o answer  is  skills  integration i s able to  a q u e s t i o n and can  resources.  a l l u d e d to t h e i r for clearly  pragmatic  need  f o r knowledge  stated explanations:  She was a good t e a c h e r . than j u s t l o g i c a l .  She was  practical  rather  -63-  R 28:  Some i n s t r u c t o r s d o n ' t e x p r e s s i t [ k n o w l e d g e ] t h a t w e l l and she d i d , so t h a t w o u l d be s u p e r i m p o r t a n t f o r any i n s t r u c t o r . I'm t h e r e t o l e a r n b e c a u s e someday I won't have t h a t p e r s o n and I d o n ' t want t o l o o k l i k e an i d i o t . ***************  R 21: T h e r e was no h e s i t a t i o n i n h e r a b i l i t y t o t e a c h you | t h e s k i l l b e c a u s e some p e o p l e may be v e r y p r o f i c i e n t i n how t h e y do t h i n g s b u t t h e y d o n ' t have t h e a b i l i t y t o p a s s on t h a t k n o w l e d g e . :  Many s t u d e n t s pedagogical integrate  to the f a c t  knowledge was r e s p o n s i b l e  their  different  attested  knowledge, hence  that  the i n s t r u c t o r ' s  f o rhelping  these  five  them t o  statements  from  interviews:  R 3:  The way she i n t e g r a t e d t h i n g s , she w o u l d t e l l me t h i n g s a b o u t t h i s p a r t i c u l a r p a t i e n t t h a t were r e l a t e d t o t h e i r i l l n e s s , so what she was d o i n g was a u g m e n t i n g y o u r knowledge o f t h e t o t a l p i c t u r e o f the p a t i e n t y o u were l o o k i n g a f t e r . ***************  R 14:  When I went t o t h e c h a r t i t was t o l o o k up t h e l a b r e s u l t s and a n y t h i n g on t h e r e t h a t was a b n o r m a l , I w o u l d have t o f i n d o u t why and I l e a r n e d t h e whole overall situation. ***************  R 19:  She makes y o u t h i n k a b o u t t h i n g s , d i g i n t o y o u r p a t i e n t ' s c o n d i t i o n and why t h e y ' r e on c e r t a i n d r u g s , why t h e y ' r e h a v i n g c e r t a i n t e s t s done. ***************  R 28:  C o n f e r e n c e time i s v e r y v e r y i m p o r t a n t i n t h e d a y . Y o u ' r e b r i n g i n g t h e s t u f f t h a t you had i n t h e i c l a s s r o o m i n t o t h e c l i n i c a l a r e a and t h e c o n f e r e n c e time i s t h e t i m e y o u ' r e t a k i n g t h e c l i n i c a l p a t i e n t i n t o t h e r e and p u t t i n g i t a l l t o g e t h e r .  |  -64-  R 29:  The in  We do l e a r n , b u t whether we c a n r e c a l l i t o r n o t , t h a t seems t o be t h e p r o b l e m , so i t seemed i f y o u d i d n ' t know i t , i t was amazing how she c o u l d make you [ r e c a l l i n f o r m a t i o n ] .  instructor's  pedagogical  her q u e s t i o n i n g s k i l l s .  Students  who c o u l d q u e s t i o n them w i t h o u t questioning order  techniques  to t a i l o r  motivated. R 11:  responded  intimidation  assignment  r e q u i r e d ongoing  F o r example,  best  manifested to a teacher  and who  used  t o g e t t o know them as i n d i v i d u a l s i n  the c l i n i c a l  n e e d s . Many s t u d e n t s  knowledge was a l s o  three  t o meet t h e i r  learning  questioning to stay  students  stated:  She h e l p e d y o u l e a r n , a s k e d y o u q u e s t i o n s and t h e n i f y o u d i d n ' t know t h e answers she made y o u l o o k them up. ***************  R 14:  I was q u e s t i o n e d c o n s t a n t l y on my knowledge b a s e . A f t e r a w h i l e , I a p p r e c i a t e d h e r making me u s e my knowledge. ***************  R 17:  Another tool  She a s k e d a l o t o f q u e s t i o n s a l m o s t e v e r y day and i t c o u l d be a n y t h i n g from d r u g p r o f i l e s t o p r o t o t y p e s , p a t h o p h y s i o l o g y and n u r s i n g i n t e r v e n t i o n s . referred  to the i n s t r u c t o r ' s  questioning s k i l l s  as a  f q r h e l p i n g her i n t e g r a t e her knowledge: R  7:  She a p p l i e d t h e c l i n i c a l e x p e r i e n c e s t h a t y o u were e x p e r i e n c i n g . She t i e d i n t h e t h e o r y w i t h t h a t , she q u e s t i o n e d y o u so t h a t y o u c o u l d remember. You c o u l d a s s o c i a t e p r i n c i p l e s w i t h something t h a t you had a c t u a l l y done.  A few s t u d e n t s  acknowledged  knowledge was d i r e c t l y  t h a t the t e a c h e r ' s  responsible for their  pedagogical  growth.  -65-  R  .22:  The one t h i n g I r e a l l y f e l t was h e r her a b i l i t y a l w a y s made me go t o my r a t h e r t h a n j u s t g e t t i n g by o r j u s t w i t h o u t h a v i n g t o know e x a c t l y what  knowledge and full potential g e t t i n g by t h i s drug does.  I:  You s a i d t h e i n s t r u c t o r had a l o t o f knowledge, what made y o u s a y t h a t ?  R 22:  J u s t b e c a u s e when s h e ' d ask q u e s t i o n s , i t [ t h e . a n s w e r ] was r i g h t t h e r e , she d i d n ' t have t o t h i n k a b o u t i t t o o l o n g whereas o t h e r i n s t r u c t o r s had t o t h i n k about i t . ***************  R  In  9:  c e r t a i n s i t u a t i o n s i t i s e s s e n t i a l f o r an i n s t r u c t o r t o  admit  that  situation learning let's be  She gave me a d r u g q u i z z and h e r d r u g q u i z z was t y p i c a l o f h e r . You'd t h i n k I know t h i s one and s h e ' d t a k e y o u t h a t much f u r t h e r u n t i l y o u f i n a l l y had t o s a y I d o n ' t know t h e n y o u had t o go back and t h a t ' s what she wanted. She wanted t o b r i n g y o u t o a p o i n t t o g e t y o u t o go on, t o go l o o k i t up.  she d o e s n ' t a t hand. P a r t  t o s a y : "I don't  to point  examples o f t h i s R  11:  12:  by t h e  know t h e answer  to this  t h e answer as a g r o u p " ,  the student  to the a p p r o p r i a t e  skill is  o f f hand, b u t or a t l e a s t to  resources.  Three  follow:  I f y o u ask a q u e s t i o n you need an h o n e s t answer w h e t h e r t h e y know s o m e t h i n g a b o u t i t , n o t t r y t o f a k e i t w h i c h i s r e a l l y e m b a r r a s s i n g , and i f she d o e s n ' t have t h e answer she c a n t e l l y o u where y o u m i g h t f i n d i t o r r e f e r y o u t o someone who c o u l d know.  second year R  required  o f any i n s t r u c t o r ' s p e d a g o g i c a l  t r y t o come up w i t h  able  A  have t h e knowledge  student  expressed  similar  concerns:  You know t h a t i f y o u have p r o b l e m s and y o u ask them h o p e f u l l y , and even i f t h e y d o n ' t know t h e answer t h e y ' l l s a y w e l l l e t ' s go and l o o k h e r e , or h e r e ' s a book.  -66-  The  same c o n c e r n  was  e c h o e d by y e t a n o t h e r  second  year  student: R 21:  An as  instructor's  the  using  ability every  setting  through  to m a i n t a i n  h e l p i n g the  student's  all,  nurses  the be  They  value  r e s p e c t the  of a s s i s t a n c e but  appropriate  Content  the  skills  approach  to  the  can  rather  guide by  student's t o be  to  the  than student  taking  key  but  to  above  their  deals with  their  in situations  where  skill  to d i r e c t  or knowledge  the  over  problem the  integration  t e a c h e r who  teaching,  clinical  t h e whole  response  especially  i s able  into  appear  honest  l a c k s the n e c e s s a r y  i s best described  r a t h e r than  enhanced  an  then  t e a c h e r who  learners with  f o r help openly,  instructor  t o see  example  Questioning  assisting  student  by  p r o b l e m has  successfully  requests  student  solving  skills.  questions.  knowledge  a pragmatic  of p a t i e n t care. A  problem  solving  pedagogical  o p p o r t u n i t y to b r i n g theory  and  fragments  the  Her knowledge and c a p a b i l i t i e s were t o p n o t c h but i f a s i t u a t i o n a r o s e where she d i d n ' t know t h e answer, i t d i d n ' t s t o p her from s a y i n g I d o n ' t know the answe r .  student  to  to  an  resource.  Knowledge  Content concepts  knowledge  i n c l u d e s an  within a field  principles  are  organized  understanding  as w e l l as (Wilson,  of the  the ways i n w h i c h Shulman and  facts  or  fundamental  Richert,  1987,  -67-  p . 1 1 3 ) . To a l a r g e e x t e n t  an i n s t r u c t o r ' s  content  determines her e f f e c t i v e n e s s i n the c l i n i c a l interviews content  revealed a relationship  knowledge  clinical  i s able  classroom  into  assisting  students with  to  the f a c t  t h e most  the c l i n i c a l  integration  to, s t u d y .  i s most  instructor's In a d d i t i o n ,  to c a r r y content setting  forward  with  the  f r o m the  effective in  of content  Generally, students'  t h a t the t e a c h e r  Student  sound c o n t e n t  knowledge comments  and i n attested  knowledge  was  effective.  I: R  them  the  and h e r q u e s t i o n i n g s k i l l s .  t e a c h e r who  motivating  between  area.  knowledge  You f e l t r e a l l y c o m f o r t a b l e can you expand on t h a t ? 1:  with  h e r knowledge b a s e ,  I t h i n k she had a l o t o f e x p e r i e n c e w i t h t e a c h i n g and w i t h t h e m a t e r i a l we were w o r k i n g on. ***************  I: R  Can y o u t h i n k o f a n y t h i n g e l s e t h a t made h e r p a r t i c u l a r l y e f f e c t i v e i n terms o f y o u r l e a r n i n g ? 6:  She  gave me  the i m p r e s s i o n  o f knowing  everything.  *************** I:  What a r e t h e t h r e e most clinical instructor?  critical  qualities  of a  R 26:  A good g r a s p o f t h e knowledge i s e s s e n t i a l so t h a t t h e y a r e a b l e t o t e a c h . You c a n ' t know t h e c l i n i c a l i f you d o n ' t know the t h e o r y . ***************  I: R  Can y o u t h i n k o f a n y t h i n g h e l p f u l t o you? 8:  else  t h a t has been  really  She's r e a l l y good i n c l a s s . I t h i n k when I h e a r h e r l e c t u r e s i n c l a s s and I had h e r as an i n s t r u c t o r i t a l l comes t o g e t h e r .  -68-  A second  year  student  who  was  asked  c h a r a c t e r i s t i c s w h i c h d e s c r i b e d her  t o rank  order  most e f f e c t i v e  the  five  instructor  replied: R  6:  The learning  I t h i n k k n o w l e d g e a b l e has t o be number one b e c a u s e t h r o u g h t h a t comes r e s p e c t . I l i k e a c a p a b l e k n o w l e d g e a b l e i n s t r u c t o r who has h e r b a s i c s down so I d o n ' t f e e l any h e s i t a t i o n when I ask q u e s t i o n s . instructor's  and  is closely  expectations  and  her  content  knowledge m o t i v a t e s  associated with  the  questioning s k i l l s .  student  instructor's  Two  third  year  students  commented: R 29:  She has a good knowledge b a s e . We t h o u g h t she e x p e c t e d us t o become r e a l d o c t o r s , b u t she d i d n ' t . ***************  R 17:  She i s f a i r l y t o u g h so you r e a l l y d i d r e s p e c t h e r and you d i d n ' t d a r e come t o c l i n i c a l u n p r e p a r e d w i t h a l l the answers t o any p o s s i b l e q u e s t i o n t h a t you c o u l d t h i n k o f . She a s k e d a l o t o f q u e s t i o n s a l m o s t e v e r y day. You c o u l d n e v e r p u l l the wool o v e r t h i s p e r s o n ' s e y e s , you c o u l d n e v e r BS y o u r way o u t o f it.  In summary t h e n , to motivate level  students  them and  of content i s able  them w i t h  integration  knowledge p r o v i d e s  knowledge.  her  teacher's  e x p e c t a t i o n s are d i r e c t l y  knowledge. A  knowledge  therefore  her  b e l i e v e t h a t the  teacher with  to q u e s t i o n students o f t h e o r y and  t h e b a s i s f o r her  e x p e c t a t i o n s are  also  sound  Her  contextual a reflection  related  to  her  content  effectively  practice.  ability  and  assists  content  knowledge, of her  content  -69-  Knowledge o f L e a r n e r s  Knowledge o f l e a r n e r s students'  to  among o t h e r  c h a r a c t e r i s t i c s and t h e i r c o g n i t i v e  motivational students  includes  and d e v e l o p m e n t a l  referred  things,  maps as w e l l  l e v e l s . Throughout  to the importance  the  difficult  t o meet  situations  t h e i r needs, and o f a c t i n g  as  interviews  of the i n s t r u c t o r ' s  g e t t o know them as i n d i v i d u a l s , o f t a i l o r i n g  opportunities  knowing  ability  learning  of o f f e r i n g support i n on t h e i r b e h a l f  when t h e need  arose. Students valued meet  their learning  t h e i n s t r u c t o r who went o u t o f h e r way t o needs by p r o v i d i n g  learning  opportunities  interview  i f anything  setting,  a third  R 13:  Offering  year  else  affected  student  When a s k e d  a s many new  a t t h e end o f t h e  her l e a r n i n g  i n the c l i n i c a l  responded:  The i n s t r u c t o r who g i v e s y o u a good a r r a y o f c l i n i c a l s i t u a t i o n s t o work w i t h , a wide v a r i e t y [ o f e x p e r i e n c e s ] i s most h e l p f u l . them s u p p o r t  important. A t h i r d s u p p o r t meant R: 8:  as p o s s i b l e .  them w i t h  year  in difficult student  situations  r e c a l l e d what  i s also  that  kind of  to her.  One o f my p a t i e n t s d i e d and she [ t h e i n s t r u c t o r ] was r e a l l y good. She was t h e r e f o r me. He d i e d r i g h t t h e r e when I was l o o k i n g a f t e r him and she went t h r o u g h e v e r y t h i n g w i t h me, she came i n t o t h e room and h e l p e d me g e t him r e a d y t o t a k e him t o t h e morgue, went down and g o t t h e morgue s t r e t c h e r , b r o u g h t i t back up, went t h r o u g h a l l t h e p a p e r work w i t h me and b e f o r e we took him down she s a t me down and t a l k e d w i t h me a b o u t how I f e l t a b o u t  -70-  i t and really thing. There to  were many r e f e r e n c e s t o t h e need  know s t u d e n t s  needs. A R  third 5:  Another instructor R  9:  as  year  individuals student  i n order  for instructors t o meet t h e i r  to  get  learning  recalled:  She had t o know w h e t h e r I was up t o t h a t l e v e l or n o t . The r e a s o n she was e f f e c t i v e was due t o t h i s a b i l i t y t o t a k e a moment f o r e a c h s t u d e n t and say 'who a r e you and where a r e you g o i n g ? ' l e t ' s t a k e a l o o k a t you, n e v e r mind e v e r y b o d y e l s e and t h i s p a r t i c u l a r i n s t r u c t o r d i d take the time. third  year  student  f o r much the  recalled  her  most  same r e a s o n when she  effective  said:  The most i m p o r t a n t t h i n g t h a t I f o u n d w i t h her was t h a t she i n d i v i d u a l i z e d f o r e v e r y o n e i n our g r o u p she f o u n d o u t how we l e a r n e d the b e s t , where we were at i n our knowledge base and t r i e d t o g e t us t o be the b e s t t h a t we c o u l d be. She d i d n ' t j u s t g e n e r a l i z e and g e t a l l e i g h t o f us t o do the same t h i n g s . She r e a l l y took the t i m e t o o l  Similarly, for  h e l p e d me g e t a l l the f e e l i n g s o u t . T h a t h e l p e d and she was t h e r e t h r o u g h t h e whole  yet another  third  year  student  expressed  the  need  individualization: R 28:  She took the time t o g e t t o do t h a t t o o [know us i n d i v i d u a l l y ] , I t h i n k s u b t l y t o o . I t wasn't t h a t she t a l k e d t o you f o r h o u r s a b o u t y o u r p e r s o n a l l i f e or a n y t h i n g b u t t h e r e were l i t t l e q u i c k q u e s t i o n s and she'd f i n d o u t where you were a t and what was h a p p e n i n g w i t h you and I t h i n k maybe t h a t ' s good p s y c h o l o g y b e c a u s e I know t h a t she h a n d l e d each one o f us d i f f e r e n t l y , so d i f f e r e n t l y . The i n d i v i d u a l i z i n g i s r e a l l y i m p o r t a n t b e c a u s e some i n s t r u c t o r s say t h e s e a r e my s i x s t u d e n t s and t h e y a l l g e t the same, m e a n w h i l e , you've g o t someone l i k e me who i s p u s h i n g f o r t y and someone who just g r a d u a t e d from g r a d e t w e l v e so our e x p e r i e n c e s a r e so d i f f e r e n t , so i t ' s r e a l l y i m p o r t a n t b e c a u s e I have been p u t i n the same can as my p e e r s .  -71-  A third  year  student  was m o t i v a t e d  and i m p r e s s e d  t e a c h e r who went o u t o f h e r way t o n o t e commented  on h e r p r o g r e s s  R 24:  Other  taking  or l a c k t h e r e o f  g r a d e s and  regularly.  T h i s i n s t r u c t o r w o u l d l o o k i n t o o u r t h e o r y marks as w e l l as n o t i c e how we were w o r k i n g i n t h e c l i n i c a l a r e a and i f she f e l t t h a t t h e two w e r e n ' t c o r r e s p o n d i n g , t h e marks were low o r y o u r clinical wasn't showing t h e knowledge, t h e n s h e ' d work on an a l m o s t t h r e a t e n i n g way t o t e l l y o u how t o make y o u work h a r d e r and t h e n y o u ' d r e a c h y o u r p o t e n t i a l .  students  interest  her theory  by t h e  a p p r e c i a t e d the i n s t r u c t o r  i n them as p e o p l e  the time  to enquire  who took  o u t s i d e of the c l i n i c a l about  future plans  a general  situation,  and f a m i l y  relationships. R 11:  In for  She seemed t o want t o know us as a p e r s o n as w e l l as j u s t a s t u d e n t . I n o u r c o f f e e b r e a k s some o f us would go down w i t h h e r and she'd a l w a y s ask how you guys d o i n g r i g h t now? She'd ask where we were from and d i f f e r e n t t h i n g s a b o u t o u r b a c k g r o u n d , w h i c h r e a l l y made y o u want t o do w e l l t o p l e a s e her.  summary, t a k i n g time  instructors  t o g e t t o know l e a r n e r s has r e w a r d s  and b e n e f i t s f o r s t u d e n t s  l e a r n e r s means t h a t i n s t r u c t o r s student  as an i n d i v i d u a l ,  meet e a c h p e r s o n ' s changing difficult  must  tailoring  needs and b e i n g  n e e d s . I t means o f f e r i n g situations,  achievements.  take  as w e l l .  Knowledge o f  interest  i n each  the l e a r n i n g sensitive  support  s i t u a t i o n to  to the student's  to students i n  and t a k i n g an i n t e r e s t  in their  scholastic  -72-  Knowledge o f O t h e r  Content  Knowledge o f o t h e r subject  matter  not  w h i c h makes one instructor a variety the  Several be  R  The  R  i s able  4:  arise.  to share second  her  year  field  of study  Students who  value can  of  - that  the  deal  with  They l e a r n v i c a r i o u s l y diverse theoretical  student  knowledge o f o t h e r  students  commented  i n many a r e a s  s t a t e d her  from  and  views  on  content:  on  the  need  o u t s i d e of  s t u d e n t s . One  for teachers  to  the  specialty  clinical  student  commented:  I'm t h i n k i n g o f t h a t i n s t r u c t o r t h a t we t a l k e d a b o u t e a r l i e r , I n o t i c e a l o t o f t i m e s , we w o u l d n ' t e v e n be a s k i n g a q u e s t i o n , i t m i g h t j u s t be a t o p i c t h a t came up and she s t i l l knew a l o t a b o u t the o t h e r a r e a s o f n u r s i n g , n o t j u s t what she f o c u s e d on as a s p e c i a l t y . She had t h e a b i l i t y t o r e a s o n o u t o t h e r areas.  same t h i r d  instructors  to the  knowledge base and  they  t h e y worked w i t h 4:  related  understanding  She had enough w o r l d wide e x p e r i e n c e . She knew what was i m p o r t a n t , what c o u l d be l e f t o u t , so i t ' s b e i n g k n o w l e d g e a b l e , but r e a l i s t i c t o o .  knowledgeable  i n which  a broad  background. A  6:  i m p l i e s a broad  ' w e l l rounded' person.  o f p r o b l e m s as  instructor's R  directly  has  t e a c h e r who  clinical the  who  a  content  year  respondent  to demonstrate problem  spoke o f t h e solving  need f o r  skills:  I t h i n k the body o f knowledge w o u l d be h e l p f u l , but i f you've got t h e a b i l i t y t o s i t down and s a y : w e l l , t h i s i s the p r o b l e m , what m i g h t be o u t s i d e i n t e r f e r e n c e s t h a t d o n ' t r e l a t e ? You [ t h e i n s t r u c t o r ] d o n ' t j u s t f o c u s on the c o m p l a i n t t h a t has b r o u g h t t h i n g s t o the s u r f a c e . She has t h e a b i l i t y t o say p e r h a p s t h e r e ' s some u n d e r l y i n g problem.  -73-  An  instructor's  ability  requires  the a b i l i t y  guidance  to allow  in  three statements:  these R  5:  to help  t o s t e p back  the student and g i v e  h e r t o come up w i t h  problem  the student  the answers  as  solve, some  illustrated  When I r u n i n t o a p r o b l e m I want some backup and I want t o know where I'm g o i n g t o go, how I'm g o i n g t o s o l v e t h i s p r o b l e m and I d o n ' t want h e r t o g i v e me the answer b u t I want h e r t o c l u e me i n t o how I'm g o i n g t o come up w i t h t h e a n s w e r s , w h e t h e r I'm g o i n g [ a b o u t i t ] r i g h t o r wrong so t h a t I c a n s o l v e i t . She has t o l e t me know when t h e p o t e n t i a l f o r a p r o b l e m i s coming up i f she c a n f o r e s e e i t . ***************  R 18:  She had a l o t o f knowledge t o o f f e r and y e t she d i d n ' t j u s t g i v e y o u t h e answer, e a c h o f us had t o f i n d o u t s o m e t h i n g , so she u r g e d us t o f i n d t h i n g s out f o r o u r s e l v e s . ***************  R 30:  The  I need somebody t o g u i d e me. When I need a q u e s t i o n answered I d o n ' t need e v e r y t h i n g done f o r me, b u t I do need somebody t h a t when I'm h a v i n g a p r o b l e m , I can go t o them and s a y : "now what?"  t e a c h e r who b r i n g s  knowledge  h u m a n i t i e s and whose knowledge experiences solving base,  has a sound  clinical  the greater  f r o m t h e s c i e n c e s and  i s b a s e d on a v a r i e t y  resource  base upon w h i c h  t o draw i n  p r o b l e m s . The b r o a d e r t h e t e a c h e r ' s i s her p o t e n t i a l  day t o day p r o b l e m s o l v i n g  to a s s i s t  i n the c l i n i c a l  of c l i n i c a l  knowledge  the student  setting.  with  -74-  Knowledge o f E d u c a t i o n a l  Aims,. P u r p o s e s and  Knowledge o f e d u c a t i o n a l clear  vision  pedagogical hand  the  d e c i s i o n s . Knowledge o f c u r r i c u l u m ,  particular  teacher's  spelled  effective R  I: R  t o p i c s at given  levels.  Students  out expectations  r e f e r r e d to  a i m s , p u r p o s e s and  spoke o f h e r e x p e c t a t i o n s .  by most s t u d e n t s .  1:  on t h e o t h e r  o f program m a t e r i a l s designed f o r  knowledge o f e d u c a t i o n a l  c u r r i c u l u m when t h e y who  and o b j e c t i v e s i m p l i e s a  o f t h e outcomes o f l e a r n i n g and c o n t r i b u t e s t o  i s the understanding  teaching  aims, g o a l s  Curriculum  The  instructor  e a r l y i n t h e r o t a t i o n was  considered  The f o l l o w i n g a r e e x a m p l e s :  Some o f t h e t h i n g s i n s t r u c t o r s d i d were good, e s p e c i a l l y a good o r i e n t a t i o n i n f i r s t y e a r was i m p o r t a n t . What's a good o r i e n t a t i o n ?  1:  F i r s t day, g o i n g t h r o u g h t h e ward and e x p l a i n i n g some o f t h e t h i n g s t h a t a r e e x p e c t e d and d i r e c t i o n w i t h c a r e p l a n s I f e l t was r e a l l y i m p o r t a n t i n f i r s t year. ***************  R 2 4 : [ I t ' s h e l p f u l t o ] have t h e i n s t r u c t o r s i t y o u down and s a y t h i s i s what I l i k e t o do w i t h my s t u d e n t s ; t h i s i s how i t ' s g o i n g t o be. I f y o u d o n ' t l i k e i t come and t a l k t o me. *************** R 28:,  She was t h e r e so t h a t y o u w o u l d grow and t h a t was her main o b j e c t i v e , she was g o i n g t o see g r o w t h i n her s t u d e n t s and she g o t i t ! I f y o u knew t h a t y o u were g o i n g t o be d i s c u s s i n g p r i n c i p l e s o f c h e s t trauma i t was good t o a t l e a s t r e a d up so t h a t y o u c o u l d t a l k on h e r l e v e l 'cause she d i d n ' t have time f o r y o u i f y o u d i d n ' t do y o u r homework. Her e x p e c t a t i o n s were h i g h b u t n o t u n r e a l i s t i c .  -75-  R 30:  The  I t ' s v e r y i m p o r t a n t t o know t h e e x p e c t a t i o n s . C l e a r l y e s t a b l i s h the e x p e c t a t i o n s ! L a y i n g the ground r u l e s because e v e r y clinical i n s t r u c t o r i s so d i f f e r e n t . She h a s t o l a y i t on t h e l i n e and t h e n t h a t h e l p s w i t h t r u s t .  instructor's  however b e c a u s e according  expectations  should  n o t be b i a s e d n e g a t i v e l y ,  t h a t may have a d e t r i m e n t a l  t o the f o l l o w i n g t h i r d  year  impact  on t h e l e a r n e r  students.  I:  Is there anything e l s e the c l i n i c a l area?  that a f f e c t s  your  learning in  R 23:  preconceived  I:  On t h e p a r t o f t h e i n s t r u c t o r ?  R 23:  Y e s , she a l r e a d y has s o m e t h i n g a t t h e back o f her mind a b o u t me and how I'm g o i n g t o do b e f o r e I even g e t t h e r e .  notions  *************** I:  What k i n d s o f t h i n g s have h e l p e d r a p p o r t w i t h an i n s t r u c t o r ?  R 30:  W e l l , t r u s t i n g me, i m m e d i a t e l y I'm o u t t o be s t u p i d and make  I:  assuming  the best  R 30:  Assuming  the best yeah, b e f o r e  The for  teacher's  expectations  many s t u d e n t s .  enough  Many f e l t  f r o m them. One t h i r d  instructors  may have lower  about  you t o e s t a b l i s h  not assuming mistakes  you?  determined  judging  the l e v e l  t h a t the i n s t r u c t o r year  that  student  expectations  me. of motivation  d i d not expect  feared that part than  full  time  time  instructors. R  9:  They [ p a r t time t e a c h e r s ] d o n ' t have t h e same e x p e c t a t i o n s as f u l l t i m e r s and I f o u n d t h a t f o r me I f e l t apprehensive t h a t the p a r t t i m e r s weren't e x p e c t i n g as much as t h e f u l l t i m e r s and I w o u l d s u f f e r l a t e r on and maybe we g o t o f f t o o e a s y .  -76-  R 24:  Some h a d n ' t p u s h e d me h a r d  Many a p p r e c i a t e d with  high  the i n s t r u c t o r  enough.  who was " t o u g h " o r  "strict",  expectations.  R 17:  She i s f a i r l y t o u g h so y o u r e a l l y d i d r e s p e c t h e r . You d i d n ' t d a r e come t o c l i n i c a l u n p r e p a r e d w i t h a l l t h e a n s w e r s t o any p o s s i b l e q u e s t i o n y o u c o u l d t h i n k of. ***************  R 28:  She was s u c h a p e r f e c t i o n i s t and h e r e x p e c t a t i o n s were so h i g h t h a t y o u t h o u g h t i f I c a n p l e a s e h e r I can do a n y t h i n g ! ***************  R 29:  Her e x p e c t a t i o n s may have been a b i t h i g h so t o keep up t o t h a t s t a n d a r d we w o u l d p u t i n a good e i g h t h o u r s i n c l i n i c a l and more a t n i g h t .  I:  You s a i d she had h i g h c o n v e y t h a t t o you?  R 29:  She seemed i s o l a t e d , and I g u e s s we f e l t i n o r d e r t o s h o r t e n t h e d i s t a n c e we'd have t o come up i n o u r knowledge.  "Those h i g h stated  three  R 28: A  Not b e i n g  while spoon  one t h i r d  Part  by t h e r e a l i t y  potential"  student t o me.  that the i n s t r u c t o r s ' t h a t they  stated:  were s t i l l  expectations  students.  She had h i g h e x p e c t a t i o n s o f us b u t on t h e o t h e r hand, she a l s o r e a l i z e d t h a t we were s t u d e n t s .  of the teachers'  r e a l i s m i n h e r e x p e c t a t i o n s were  t h e v i e w t h a t she s h o u l d  capable  year  full  f e d was i m p o r t a n t  few a p p r e c i a t e d t h e f a c t  R 15:  on  e x p e c t a t i o n s made me go t o my  students,  were tempered  e x p e c t a t i o n s . How d i d she  of doing  herself.  not expect  anything  based  she was n o t  -77-  R  9:  I f she p r a c t i c e s what she p r e a c h e s t o me t h a t ' s an i m p o r t a n t a s p e c t . We're l o o k i n g a t them f o r what we're g o i n g t o be when we g r a d u a t e . You c a n ' t e x p e c t y o u r s t u d e n t s t o do what y o u c a n ' t .  Questioning student's  skills  mind. A s t u d e n t  by t h e i n s t r u c t o r ' s R  2:  knowledge  not  conceptions  or  willing  without  knowledge  clinical  affected  teacher's  having  to perform  as b e i n g  state  their  preconceived  Lastly,  negative  the i n s t r u c t o r  perceived theoretical  of teacher  setting, they  content w i t h i n a s p e c i a l i z e d  bias  should  also  skills.  Utilizing  area  clinical  Wilson,  Shulman  students  to the teacher's  how t o t e a c h  valued  and  knowledges,  to a t t a c h the g r e a t e s t s i g n i f i c a n c e  the l e a r n e r . Secondly,  high but  Her e x p e c t a t i o n s were  e q u a l l y important.  o f : the c l i n i c a l  expectations  d u t i e s w h i c h she was n o t c a p a b l e  to c a r r y out h e r s e l f . i n her q u e s t i o n i n g  their  stated expectations.  and who m a i n t a i n e d  effective.  R i c h e r t ' s (1987) model  appeared  of  students  to c l e a r l y  rotation  c o n c l u s i o n , students  knowledge and  standards  c o n s i d e r e d most  In  able  i n the c l i n i c a l  reflected  o f how t h e i r  i n c l u d e d t h o u g h t s on c l e a r l y  expect  i n the  skills.  o f c u r r i c u l u m and e d u c a t i o n a l g o a l s a f f e c t e d  realistic were  tied  spoke o f h e r m o t i v a t i o n b e i n g  questioning  I n s t r u c t o r s who were early  closely  She h e l p e d y o u l e a r n , a s k e d y o u q u e s t i o n s and t h e n i f y o u d i d n ' t know t h e answers she made y o u l o o k them up.  Students'  learning  and e x p e c t a t i o n s were  and knowledge  the t e a c h e r ' s  knowledge o f  o f n u r s i n g . They a p p r e c i a t e d a  -78-  teacher  who p o s s e s s e d  draw i n o r d e r perceived and to  a broad  t o enhance  student  individualize early  they  knowledge o f c u r r i c u l u m  and o b j e c t i v e s i n s o f a r  her teaching  from which t o  learning. Lastly,  consequences o f the t e a c h e r ' s  of educational goals  clearly,  base o f knowledge  a s she was a b l e  and t o s t a t e h e r e x p e c t a t i o n s  i n the c l i n i c a l  rotation.  Feedback  Introduction  According  to students  characteristic ability  ability  feedback.  Researchers  constitutes  ranks  progress"  among t h e f i v e  effective  clinical  ability  o f the nine  increase  teachers  student  strategies  feedback.  Griffith  t o be  and f a c u l t y (1983)  Zimmerman  on s t u d e n t  rated c h a r a c t e r i s t i c s  t o "give honest  teacher  t o d e s c r i b e what  u s e f u l feedback  by s t u d e n t s  elaboration. Similarly,  teacher's one  highest  i s the  comments t e n d  to provide  "provides  important  r a t i n g s of the teacher's  have n o t a t t e m p t e d ability  instructor  s t u d i e s on c l i n i c a l  however, t h o s e  the teacher's  f o r example,  further  Nursing  feedback,  t h e s e c o n d most  clinical  often include students'  to give  general.  (1986)  o f an e f f e c t i v e  to give  effectiveness  interviewed,  o f most  without  refers  t o the  a p p r a i s a l and e v a l u a t i o n " as  that nurse-teachers  employ t o  l e a r n i n g . She does n o t s t a t e however what  -79-  constitutes  "honest  appraisal  Students  in this  study  negative  feedback  balanced  fashion  heed  divided trust,  evaluation".  indicated  must be g i v e n  that  p o s i t i v e and  on an o n g o i n g b a s i s  and i n a  t o be most e f f e c t i v e . They a l s o m e n t i o n e d t h e  f o r immediate  from honest  and  feedback  feedback. This  i n t o the f o l l o w i n g p o s i t i v e feedback  as w e l l  as t h e t r u s t t h a t  s e c t i o n on f e e d b a c k three  subsections:  and n e g a t i v e  ensues  i s therefore h o n e s t y and  feedback.  H o n e s t y and T r u s t  The as  i n s t r u c t o r who i s c a p a b l e  being  student R  A  honest  and t r u s t w o r t h y .  described 8:  student  student  second year  one t h i r d  year  r e c a l l e d how o n g o i n g p o s i t i v e  feedback  of t r u s t with i n s t r u c t o r s :  They [ i n s t r u c t o r s ] a p p r e c i a t e d t h e f a c t t h a t I c o u l d h e l p t h a t s t u d e n t , t h a t I was u n d e r s t a n d i n g o f t h e o t h e r s t u d e n t s . T h a t ' s t h e word t h a t was u s e d , and t h a t t o me was s o r t o f s u p p o r t i v e b e c a u s e t h a t made me s o r t o f f e e l l i k e t h e p e r s o n [ i n s t r u c t o r ] t r u s t e d me. I t was r e i n f o r c e m e n t f o r what I had done.  Students g e n e r a l l y both  F o r example  i s perceived  h e r i n s t r u c t o r as f o l l o w s :  her l e v e l  R 12:  feedback  She's v e r y s t r a i g h t f o r w a r d and h o n e s t and she l e t s you know where y o u s t a n d . The number one c h a r a c t e r i s t i c o f any c l i n i c a l i n s t r u c t o r i s p r e f e r a b l y h o n e s t y , t h a t i s l e t t i n g them [ s t u d e n t s ] know where t h e y s t a n d .  second year  increased  of g i v i n g  agreed  that  and i n s t r u c t o r , t h e i r student  stated:  without  h o n e s t y on t h e p a r t o f  l e a r n i n g was c o m p r o m i s e d . A  -80-  R  2:  Several  Without  h o n e s t y , y o u have n o t h i n g , i t ' s number one!  students referred  "give  i t t o you s t r a i g h t " .  being  able  question career third  Instructors  to say they're s o r r y ,  or problems  whether  f o r the i n s t r u c t o r to  demonstrate  they don't  or by d e m o n s t r a t i n g a g e n u i n e  year  h o n e s t y by  know t h e answer  interest  they are r e l a t e d  to a  i n the student's  to school  or not. A  student explained:  I:  T e l l me what particularly  R24:  her a b i l i t y  I:  How d i d she go a b o u t  R24:  She'd come up t o y o u and s a y I d o n ' t t h i n k y o u ' r e w o r k i n g t o y o u r f u l l p o t e n t i a l . She's v e r y h o n e s t , v e r y f r a n k , w h i c h i s r e a l l y good and i f y o u d o n ' t b u c k l e down, y o u ' r e g o i n g t o f a i l . E i t h e r I'm g o i n g to f a i l y o u o r y o u ' r e g o i n g t o f a i l y o u r t e s t . You have a c h o i c e ! Then you s a y y e s I'm g o i n g t o show her. I f you're the kind of person t h a t ' s i n t i m i d a t e d w h i c h I was i t r e a l l y worked w e l l w i t h me. L a t e r she s a i d : I knew y o u c o u l d do i t . I t r e a l l y opened up my r e s p e c t f o r h e r and u n d e r s t a n d i n g how she was w o r k i n g .  The the  t o t h e need  instructor  trust  to notice  who d i d , n o t  between h e r s e l f  came f r o m n o t knowing s t u d e n t ' s mind a b o u t R 9:  i t i s about helpful.  this  instructor  the p o t e n t i a l doing  give  that  i n you  that?  ongoing  f e e d b a c k was  reducing  and h e r s t u d e n t . The u n c e r t a i n t y  how one was d o i n g l e f t her a b i l i t y  was  much d o u b t  that  i n the  to succeed.  I ' d r a t h e r have c o n s t a n t o n g o i n g f e e d b a c k . I n e v e r f o u n d t h a t I had a s i t u a t i o n where I had t o go and ask where I was a t o r g o t a b i g s u r p r i s e a t t h e end, and t h a t t o me i s c r i t i c a l b e c a u s e i t b r e a k s the bond o f t r u s t i f a l l o f a sudden y o u t h i n k you're not doing w e l l out of the b l u e .  -81-  The  t e a c h e r who was c o n s c i e n t i o u s a b o u t  andjnegative  feedback with  on  basis i n spite  setting  was v i t a l  both  positive  on a c o n s i s t e n t b a s i s was e s t a b l i s h i n g a  bond o f t r u s t an o n g o i n g  giving  h e r s t u d e n t s . Her a b i l i t y  to provide  o f t h e b u s y pace  to the student's  success  feedback  i n a hospital  w i t h i n the c l i n i c a l  area.  Positive  Feedback  While  t h e need  feedback  h a s l o n g been  interesting frequency  The  concerns  recognized,  feedback.  students  t o be l i n k e d  with  student's  effect  Positive frequently ongoing R  raised  t i m i n g and  feedback  having  i t . Similarly, rotation  as t h e  t h e amount  may have an  motivation.  was a m o t i v a t o r  commented on t h e need  without  themselves.  t o t h e same e x t e n t  i n the c l i n i c a l  on t h e s t u d e n t ' s  positive 5:  ideal  perceptions of  feedback  the p r a i s e d i d not b e n e f i t  praise given early  adverse  study  t o l e a r n i n g when g i v e n t o o soon o r i n d i s c r i m i n a t e l y  s t u d e n t who b e l i e v e d she had e a r n e d of  in this  positive  The n o t i o n t h a t p r a i s e may be  s t u d e n t who was g i v e n p o s i t i v e  "earned"  and immediate  a b o u t what i s c o n s i d e r e d  for positive  detrimental appeared  f o r c o n s i s t e n t , ongoing  f o r many s t u d e n t s .  They  f o r c o n s i s t e n t , g e n u i n e and  feedback.  Good p o s i t i v e i n p u t , once a g a i n g e n u i n e i n p u t [ I mean] p o s i t i v e f e e d b a c k on a c o n s i s t e n t b a s i s t o o . Not on an i n c o n s i s t e n t b a s i s . I d i s c o v e r e d l o t s o f t i m e s when I wasn't g e t t i n g t h e i n p u t I n e e d e d . Remember I'm t h e s t u d e n t .  -82-  Students feedback.  d i s a g r e e d on  Some s u g g e s t e d  have more v a l u e be  given  than  ideal  t i m i n g and  that occasional positive  frequent praise.  s p a r i n g l y and  frequency  perhaps not  Others  too  early  felt  of  positive  feedback  may  that i t should  i n the  clinical  rotation. I: R  Is t h e r e a n y t h i n g t h a t i n f l u e n c e s your t h a t we h a v e n ' t t a l k e d a b o u t ? 15:  learning  Making you f e e l t h a t what you a r e d o i n g i s good, g i v i n g you p o s i t i v e f e e d b a c k , j u s t o c c a s i o n a l l y . I w o u l d n ' t l i k e i t a l l the t i m e , but when you d e s e r v e it. ***************  R  24:  You c a n ' t r e a l l y use p r a i s e a t the b e g i n n i n g . You have t o g e t t o know them a l i t t l e f i r s t u n t i l you see what t h e y can do. I f you p r a i s e them t o o soon t h e y ' r e n o t g o i n g t o t r y t o improve c l i n i c a l l y . ***************  R 28:  I f she was i m p r e s s e d you'd know a b o u t i t b u t i t had to be s o m e t h i n g t h a t r e a l l y i m p r e s s e d her...the f a c t t h a t you g o t t h r o u g h e i g h t h o u r s wasn't v e r y impressive 1 **************  R24:  In in  the  She knew when t o p r a i s e you, n o t t o o much. She d i d a b i t o f s a n d w i c h t e c h n i q u e , where a b i t o f p o s i t i v e and a b i t o f n e g a t i v e w i t h a l i t t l e more p o s i t i v e so t h a t oh good! you've l e a r n e d t h i s but you s t i l l need t o g e t t h i s so i t ' s coming a b i t s m o o t h e r , and t h e n s o m e t h i n g e l s e p o s i t i v e .  summary, p o s i t i v e right  determining for of  each having  feedback  amount, a t the the  student  optimal appears  earned i t .  i s a motivator  right  amount and t o be  time.  The  when i t i s g i v e n  crucial  factor  t i m i n g of p o s i t i v e  based  on  the  student's  in  feedback perception  -83-  Negative  "A  Feedback  good  teacher  i s someone who c a n e v a l u a t e y o u and s e e y o u r  weaknesses" s t a t e d  a third  was most e f f e c t i v e  when g i v e n i m m e d i a t e l y  error  or misbehavior.  comments k e p t strongly  factor  student.  Negative after  the a l l e g e d  I t s h o u l d be tempered w i t h  i n p e r s p e c t i v e and c a r i n g  feedback  positive  must be c o n v e y e d  as  as d i s a p p o i n t m e n t .  R 10:  The  year  When I d i d s o m e t h i n g t h a t wasn't r i g h t she d i d n ' t come down h a r d on me, she d i d n ' t jump on y o u i f you made a m i s t a k e , and I t h i n k f i r s t o f a l l t h e p o s i t i v e s , y o u [ t h e s t u d e n t ] need t o g e t some positive.  instuctor's  ability  some s t u d e n t s  most e f f e c t i v e  t o g i v e n e g a t i v e feedback  recalled  first  instructor. A third  when a s k e d year  was a  to describe their  student explained:  I:  T e l l me what i t i s about t h i s been p a r t i c u l a r l y h e l p f u l .  R 8:  She's v e r y s t r a i g h t f o r w a r d know where y o u s t a n d .  I:  What e x a c t l y  R 8:  S h e ' l l t e l l you r i g h t o f f . S h e ' l l say look I don't t h i n k y o u ' r e g o i n g t o make i t so do s o m e t h i n g about i t and she d o e s n ' t b e a t a r o u n d t h e b u s h .  Immediacy R 12:  i n receiving  instructor  and h o n e s t .  t h a t has  She l e t s you  do y o u mean by t h a t ?  feedback  was o f i m p o r t a n c e  to students.  I f I'm n o t d o i n g s o m e t h i n g r i g h t I need t o know a b o u t i t and I need t o know r i g h t t h e n and t h e r e , n o t s i x weeks l a t e r .  -84-  R 13:  A f t e r e v e r y s k i l l she or a s k e d how you f e l t  always s a i d about i t .  what you  d i d wrong  *************** R 28:  I f she saw a s k i l l t h a t she t h o u g h t t h a t you s h o u l d be above t h a t , of making a mess o u t o f i t , she would l e t you know how d i s a p p o i n t e d she was.  Students  recognized  most d i f f i c u l t teacher  who  feedback  p a r t o f an  had  feedback without and  R15:  instructor's the  role  f e e d b a c k was and  valued  skill  to d e l i v e r  genuine  manner. The  instructor  who  embarrassing  or b e l i t t l i n g  d i d n ' t blow the  gained  negative  maintain  negative  the  problem a l l out  the  the negative  gave  negative  student  did  so  of p r o p o r t i o n .  She would e x p l a i n a n y t h i n g t h a t she f e l t t h a t you s h o u l d know a b o u t , t i p s t h a t she l e a r n e d , a n y t h i n g t h a t she f e l t you w e r e n ' t d o i n g q u i t e c o r r e c t l y she w o u l d t a k e you a s i d e a f t e r w a r d and p o i n t i t o u t t o y o u . I t t a k e s c o u r a g e t o t e l l someone i f s o m e t h i n g needs t o be t a u g h t o v e r .  Students give  acquired  in a positive  privately  that giving  feedback  a balance  described  the  negative  feedback.  R 22:  much r e s p e c t  need  for instructors  in a positive  in giving  both  for balance  manner and  types  of  in receiving  who  were a b l e  who  strived  feedback. positive  to  Students and  I f I d i d g e t n e g a t i v e f e e d b a c k , she d i d t e l l me when I d i d s o m e t h i n g wrong but i t wasn't a b i g major t h i n g . ***************  R 20:  She gave l o t s o f f e e d b a c k , a l o t o f p o s i t i v e f e e d b a c k b u t even when she had s o m e t h i n g n e g a t i v e to say i t was s a i d i n a p o s i t i v e way.  to  -85-  R 14: -She's g i v i n g p o s i t i v e f e e d b a c k , on e v e r y t h i n g t h a t you d i d . I f y o u d i d s o m e t h i n g t h a t y o u needed [ h e l p w i t h ] an e r r o r , s h e ' d s a y t h a t ' s ok y o u c a n c o r r e c t t h a t e r r o r t h e n e x t t i m e . I f I was d o i n g s o m e t h i n g wrong I was made aware o f my e r r o r i n a way t h a t I d i d n ' t f e e l p u t down. She'd s a y y o u ' v e done t h i s b u t t h i s i s n ' t q u i t e r i g h t , n e x t t i m e y o u c a n do it. *************** R 18:  The main t h i n g a b o u t t h i s i n s t r u c t o r i s t h a t she i s v e r y good as f a r as l e t t i n g y o u know r i g h t away when she d i d n ' t t h i n k y o u were d o i n g s o m e t h i n g r i g h t and she d i d n ' t b e a t a r o u n d t h e b u s h . She s a i d ok, I d o n ' t t h i n k y o u d i d t h i s r i g h t . T h i s i s how you s h o u l d do i t and y e t a t t h e same t i m e when you d i d s o m e t h i n g r i g h t , she was v e r y q u i c k t o c o m p l i m e n t y o u on t h a t and s a y why she l i k e d what y o u d i d , so she was v e r y b a l a n c e d as f a r as feedback goes.  Although part  giving  negative  of the i n s t r u c t o r ,  negative  feedback  manner. A t h i r d R  9:  telling  the student  r e q u i r e d c o u r a g e on t h e d i d not i n t e r n a l i z e  u n n e c e s s a r i l y i f i t was g i v e n  year  student  when t h e t e a c h e r i t kept  R 19:  failed  them g u e s s i n g  them a n y t h i n g  i n a caring  stated:  You a l w a y s g o t t h e f e e l i n g even i f she was g i v i n g y o u j u s t r e e m i n g y o u o u t . When need t o know t h a t i t ' s n o t  Lastly, feedback,  feedback  t h a t she g e n u i n e l y c a r e d [negative feedback], y o u g e t i n heck y o u personal.  to give students  about  their  any k i n d o f  p e r f o r m a n c e . Not  made them wonder what was g o i n g on.  I'd say g i v i n g p o s i t i v e feedback i s important; o n g o i n g f e e d b a c k t o l e t t h e s t u d e n t s know how t h e y ' r e d o i n g , o r i t c o u l d be any f e e d b a c k . Not t e l l i n g them makes them wonder what i s g o i n g on.  On t h e o t h e r  hand, t h e t e a c h e r  who f a i l e d  to balance  negative  -86-  feedback with R  3:  some p o s i t i v e s  f e e d b a c k was most e f f e c t i v e  and  given  not  embarrassed  i n a positive  recognized  skillfully.  manner, e n s u r i n g  or b e l i t t l e d  that giving  teacher's  negative  student  confidence.  I f t h e r e ' s n o t h i n g p o s i t i v e and a l l y o u h e a r i s t h e n e g a t i v e t h i n g s , they never say the t h i n g s t h a t y o u ' r e d o i n g r e a l l y g r e a t , b u t t h e y s a y oh t h a t ' s good i n t h e i r mind b u t t h e y d o n ' t t e l l y o u and t h e n you f e e l l i k e oh 1 I c a n ' t do a n y t h i n g r i g h t b e c a u s e you know a l l you've h e a r d i s t h e bad t h i n g s .  Negative  the  soon d e s t r o y e d  role,  A balanced  immediate  that the student  i n the p r o c e s s . Although  negative  they  when i t was  valued  approach  feedback  to feedback,  f e e d b a c k was a c c o m p a n i e d  by p o s i t i v e  a p p r o a c h went a l o n g way i n c o n v e y i n g  students  was a d i f f i c u l t  the i n s t r u c t o r  who  was  part of  c o u l d do  this  required that feedback.  This  a caring attitude to  students. In c o n c l u s i o n , how, as w e l l as when, f e e d b a c k were two c r i t i c a l of  effective  students  factors  clinical  at least,  i n determining  instructors.  impact  students'  I t would a p p e a r  t o o much p o s i t i v e  may have had a n e g a t i v e  was  feedback,  on t h e i r  given  perceptions t h a t f o r some  given  t o o soon  l e a r n i n g i n the c l i n i c a l  setting. The well be  need  f o r honesty  and immediacy  as p r o v i d i n g b a l a n c e d  uppermost  addition, across  positive  i n p r o v i d i n g f e e d b a c k as  and n e g a t i v e  i n t h e minds o f a l l e f f e c t i v e  maintaining  a t a l l times  p r i v a c y and e n s u r i n g  are important  feedback  clinical  must  t e a c h e r s . In  t h a t c a r i n g comes  when g i v i n g  negative  feedback.  -87-  The  teacher  tended  who  to give  uncertainty  failed  to provide  any  p r i m a r i l y negative  at best  and  feedback  at a l l ,  f e e d b a c k was  destroying  Communication  student  or  creating  motivation  who  great  at  worst.  Skills  Introduction  Students important is  her  characteristic  ability  researchers clinical 1982; the  effective  acted  reported  in  the  clinical  the  a role very  others.  importance  of  Nurse the  ( K a r n s & Schwab, (1983)  one  which  described involves  i n a peer r e l a t i o n s h i p .  indicated that  model  instructors,  with  r e l a t i o n s h i p as  study  most  t o the  extent  same c o m m u n i c a t i o n  the  clinical  that  skills  she that  they  theory.  S t u d e n t s View  Based  third  Knox & Mogan, 1 9 8 6 ) . Pugh  in this as  the  effectively  e x c e l l e n t communication  demonstrated learned  1973;  that  interpersonal s k i l l s  teacher-student  Students teacher  of  frequently  teacher's  ideal  believe  t o communicate  have  Kiker,  good o r  How  interviewed  on  communication  Communication  student skills  interviews are  the  the i n s t r u c t o r ' s  third  most  important  factor in  -88-  determining Students  teacher  e f f e c t i v e n e s s i n the  p l a c e d a h i g h degree  instructor's  ability  communication  third  student  the most  important  R 12:  importance  t o communicate. A  associated year  of  skills  clinical  with  on  second  role  described rapport with  area.  the year  student  modelling, while her  ingredient in a learning  instructor  a  as  situation.  [The most i m p o r t a n t would be] good c o m m u n i c a t i o n s k i l l s b e c a u s e I t h i n k i f you have good c o m m u n i c a t i o n s k i l l s the o t h e r ones a r e g o i n g t o f o l l o w through. ***************  R 18:  Communications modelling.  comes s t r o n g l y i n t o  role  *************** R  30:  The likely  The r a p p o r t w i t h y o u r i n s t r u c t o r i s more i m p o r t a n t t h a n a n y t h i n g e l s e . The r a p p o r t w i t h the i n s t r u c t o r i s the most i m p o r t a n t i n f l u e n c i n g factor [ i n determining success].  instructor  to hear  provide  her  from  with  the  good c o m m u n i c a t i o n  a student  skills  in difficulty,  and  opportunity for input into  learning.  One  teacher's  busy schedule  R 13:  third  with  year  student was  no  commented  excuse  was  thus her  t h a t the  f o r poor  I f s o m e t h i n g went wrong or i f you she was r e a l l y good t o t a l k t o .  more could  own clinical  communication. had  a  problem,  ************** R  Carl  4:  I'm s u r e the i n s t r u c t o r ' s busy w i t h e i g h t s t u d e n t s but i f you have t h e a b i l i t y t o communicate e f f e c t i v e l y you s h o u l d be a b l e so i n a s h o r t t i m e .  Roger's  cornerstones  of t h e r a p e u t i c  to  do  communication:  -89-  empathy,  congruence  established  and  positive  c a t e g o r i e s f o r the  study  interpersonal  s k i l l s . According  the  teachers'  ability  her  active  caring  attitude.  ability was to  listening  to  The  remain  demonstrated self-disclose  showed p o s i t i v e  to maintain  a joy of  under  of  clinical  i n how  her  she  teacher  was  known f o r  s e n s e o f humor. An  attitude.  a  her  Congruence her  ability  instructor  i n her  w i l l i n g n e s s t o be  a positive  on  demonstrated  genuineness,  students  study,  dependent  a l l circumstances.  f o r her  clearly  teacher's  to s u b j e c t s i n t h i s  teachers'  i n her  teaching  and  empathetic  regard  approachability, and  skills  the  and  have p r o v i d e d  t o d i s p l a y empathy was  calm by  regard  The  a student teacher  a l s o demonstrated p o s i t i v e  advocate  who  regard  showed for  others.  Empathy  The  clinical  teacher  students,  s t a t e d her  of  events  and  to  c o n c l u s i o n s . She  feelings  them a t t h e i r R  4:  a l l of  was  A  the  skilled  their  level.  actively  observations,  gathered  regarding  who  year  to  c o n f i r m i n g her facts,  experiences student  her perceptions  r a t h e r than  at e l i c i t i n g  clinical  third  listened  jumping  student's and  related  to  stated:  When she communicates w i t h the s t u d e n t s s h e ' s on t h e i r l e v e l . I f t h e r e ' s a problem s h e ' l l say to you: " t h i s i s what I'm s e e i n g , i s i t t r u e ? " She d o e s n ' t jump t o c o n c l u s i o n s .  -90-  Another  student  R 23:  She would l i s t e n t o what you had t o say and o f f e r s u g g e s t i o n s as t o w h e t h e r i t ' s a p p r o p r i a t e or t h i s i s how you s h o u l d c o r r e c t i t , she t r i e d t o g e t an u n d e r s t a n d i n g o f what you were experiencing.  Students non-verbal it  was  said:  a p p r e c i a t e d the  cues,  like  s t a t e d her  being  a  t e a c h e r who  observed  o b s e r v a t i o n s and  their  recalled  what  student.  R 12:  What was h e l p f u l was the f e e l i n g t h a t the i n s t r u c t o r knew t h a t I g o t r e a l l y n e r v o u s i f someone was h a n g i n g o v e r me.  I:  How  R 12:  She s a i d : you g e t n e r v o u s watching you.  d i d she  know t h a t ? i f somebody i s  *************** R 18:  By the end seem t o be She's v e r y  she c o u l d p o i n t out y o u r day d o e s n ' t g o i n g as s m o o t h l y as i n the p a s t . i n tune. ***************  R  7:  They can e m p a t h i z e w i t h y o u r l e a r n i n g needs b e c a u s e you d o n ' t have t h e same l e v e l o f knowledge as t h e y do. They remember what i t l i k e being a student too.  was  *************** R 24:  She'd come a c r o s s as a p e r s o n t o o , l i k e s h e ' s a s t u d e n t t o o w o r k i n g on some d e g r e e so s h e ' s a s t u d e n t l i k e us and we'd t r y t o h e l p h e r t o o . She knew when t o be an i n s t r u c t o r ; she knew when she c o u l d be j u s t a p e e r t o o .  Displaying  a caring  students  as b e i n g  base and  the  attitude  more i m p o r t a n t  second  most  was than  important  d e s c r i b e d by having  after  two  a good  honesty.  knowledge  -91-  R  8:  I t h i n k the most i m p o r t a n t a c t u a l l y her concern about  i s t o be h o n e s t and students i s next.  **************** I:  Can you rank t h o s e t h r e e most c r i t i c a l o f any c l i n i c a l i n s t r u c t o r ?  R 21:  Honesty f i r s t , knowledge base  When a s k e d respondents  how  caring attitude is third.  the t e a c h e r d i s p l a y e d  generally  mentioned  who  showed a p e r s o n a l i n t e r e s t  and  someone who  following  could  be  the  fact  second  a caring that  i n them and  qualities and  attitude,  i t was  their  then  someone  problems  supportive i n a l l situations.  is a description  o f the  instructor  with a  The  caring  attitude. R 12:  The  Say i f s o m e t h i n g happened t h a t you c o u l d go t o them and s a y , l i k e i f s o m e t h i n g h o r r i b l e happened a t home, and I'm n o t up t o p a r t o d a y so g i v e me two p a t i e n t s ? They w o u l d do t h a t . I t w o u l d be someone c o m f o r t a b l e g o i n g t o w i t h personal things.  instructor  maintained  an  "even  who  keel"  t o promote a p o s i t i v e that  a calm  s t a y e d c a l m under and  learning  environment  never  a l l circumstances,  appeared  environment.  enhanced  learning  r u s h e d d i d much Students  and  felt  increased  their self-esteem. R  4:  What I r e a l l y f o u n d h e l p f u l w i t h her was t h a t she was v e r y c a l m and r e l a x e d . I l i k e a c a l m a p p r o a c h b e c a u s e i f you have an i n s t r u c t o r who i s r e a l l y u p t i g h t or u n p r e d i c t a b l e , i t r e a l l y r e f l e c t s back on the s t u d e n t s t o o . They p i c k up the same v i b r a t i o n s .  -92-  R  9:  P a t i e n c e i s c r i t i c a l b e c a u s e I'm s u r e t h e y ' v e [ i n s t r u c t o r s ] g o t b e t t e r t h i n g s t o do t h a n s t a n d t h e r e f o r ages w h i l e you g i v e y o u r f i r s t n e e d l e . Not r u s h i n g you i s n o t b e l i t t l i n g what you're doing. ***************  R 23:  I t was more r e l a x e d t h a n u s u a l , she was c a l m and she a l s o c r e a t e d a c a l m a t m o s p h e r e . When s o m e t h i n g was g o i n g wrong she w o u l d s t a y t h e r e w i t h you and h e l p you work i t t h r o u g h and n o t get e x c i t e d about i t . She was so calm, t h a t you c o u l d n ' t g e t e x c i t e d , the c a l m n e s s c a r r i e d o v e r to her c o n f e r e n c e s .  Congruence  The for  instructor's  s t u d e n t s was  non-verbal their  5:  '  dependent  t o communicate  on how  messages were. T h i r d  feelings R  ability  about  congruent  year  genuine her  concern  verbal  and  students discussed  congruence.  [ I t ] i s the n o n - v e r b a l e x p r e s s i o n s t h a t the i n s t r u c t o r p o r t r a y e d , the g r e a t e m p h a s i s i s on l e a r n i n g t o do a good j o b b u t i f you made an e r r o r , t h e y m i g h t say oh, t h a t ' s n o t t o o bad b u t the nonr-verbal l o o k would be: what t h e h e l l a r e you d o i n g ? I t o l d you t h r e e t i m e s n o t t o [do t h i s ] . ***************  R 25:  D i s p l a y i n g a warm and c a r i n g conveyed through] n o n - v e r b a l f a c i a l e x p r e s s i o n s t o you so J u s t the way t h e y communicate t e l l when t h e y c a r e .  According teacher  helped  attitude [is cues and j u s t the the n o n - v e r b a l s . w i t h you, you can  to s t u d e n t s , s e l f - d i s c l o s u r e them l e a r n v i c a r i o u s l y  and  on  the p a r t of  enhanced  the  the  bond  -93-  between  student  effectively Six  included  omissions 4:  I: R  The  was  vicariously  experiences  ability  verbal  the need  from  the  self-disclose  non-verbal  for self  when s t a t i n g  very b e n e f i c i a l  and  to  i n the d e l i v e r y  messages,  disclosure  characteristics  students  t o them i n t h a t  instructor  who  of  indicated  shared  t h e r e b y h e l p i n g them t o a v o i d e r r o r s  on their  that  they her  and  of n u r s i n g c a r e .  She's w i l l i n g t o g i v e a b i t o f h i s t o r y o f h e r s e l f . She.can say you h a n d l e d i t t h i s way, p e r h a p s you can t r y t h i s a p p r o a c h , o r I f o u n d t h i s worked. How  4:  The  t e a c h e r . Many o t h e r  disclosure  R  congruent  of i n s t r u c t o r s  most e f f e c t i v e  learned  instructor.  students v e r b a l i z e d  the p a r t  self  and  does t h a t  h e l p you?  I t ' s q u i t e good b e c a u s e you can see a n o t h e r p o i n t of view. A l o t of times i t ' s v e r y h e l p f u l i f someone can do t h a t .  t e a c h e r who  demonstrating  was  a b l e t o use  r e s p e c t f o r them. She  self was  disclosure p e r c e i v e d as  was "more  human". R 30:  She's e m p a t h e t i c , u n d e r s t a n d s where p e o p l e a r e coming from. She e x p o s e d her own v u l n e r a b i l i t i e s , she was a b l e t o e x p r e s s h e r s e l f . ***************  R  I:  2:  She's w i l l i n g t o s h a r e h e r own b a c k g r o u n d her own f e e l i n g s so you can g e t a b e t t e r u n d e r s t a n d i n g about what l i f e i s a b o u t . How  does t h a t  h e l p you  as  the  learner?  and  -94-  sense  R  2:  Of  t h e t h r e e s t u d e n t s who m e n t i o n e d  o f humor as b e i n g a c r i t i c a l  performance, more  I'm j u s t a young pup so I h a v e n ' t l i v e d t h r o u g h much so i t r e a l l y gave me an i d e a o f someone e l s e s ' p e r c e p t i o n and i t makes y o u f e e l l i k e y o u r e a l l y know h e r , i t makes h e r more human.  two e x p l a i n e d  "human" and t h a t  that  their  was t h e r e b y e n h a n c e d .  the i n s t r u c t o r ' s  ingredient  i n her c l i n i c a l  t h e humor made t h e i n s t r u c t o r  r e l a t i o n s h i p with the i n s t r u c t o r  One o f them o f f e r s  Is there a n y t h i n g e l s e  R 19:  [She has a] s e n s e  I:  How i s t h a t [a s e n s e as a s t u d e n t ?  R 19:  I t ' s j u s t good and t h e r e i s humor t o n u r s i n g i n g e n e r a l . I t ' s not always j u s t r e a l l y s e r i o u s but t h e r e ' s s t i l l a l i g h t s i d e t o i t .  I:  How  R 19:  I t d o e s ! I d o n ' t know how b u t i t d o e s . I f an i n s t r u c t o r has a s e n s e o f humor, y o u know t h a t t h e y ' r e human t o o , i t b r i n g s them down t o y o u r level.  Positive  The  that  this  account:  I:  does  that  this  person  i s doing?  o f humor! o f humor] i m p o r t a n t t o y o u  enhance y o u r  learning?  Regard  instructor's  both  second  need  to approach  a p p r o a c h a b i 1 i t y was a major  and t h i r d  year  their  students. Several  instructor  regardless  o f knowledge, w i t h t h e a s s u r a n c e t h a t down o r made t o f e e l  stupid.  concern to  spoke  of the  of their  t h e y would  level  n o t be p u t  -95-  R  4:  She was v e r y a p p r o a c h a b l e . I t r e a l l y makes y o u f e e l c o m f o r t a b l e because i f you're h a v i n g a p r o b l e m o f any s o r t y o u c a n a p p r o a c h h e r w i t h o u t f e e l i n g i t ' s g o i n g t o be f r o w n e d on o r commented on. ***************  R  6:  She seemed v e r y a p p r o a c h a b l e . I f I had a p r o b l e m , I c o u l d go t o h e r and she w o u l d n ' t make me f e e l stupid. ***************  R 21:  I n e v e r f e l t t h a t i f I d i d n ' t know s o m e t h i n g I w o u l d be a f r a i d t o go t o h e r and s a y : "I'm s o r r y I d o n ' t know t h i s . "I a l w a y s f e l t c o m f o r t a b l e t o go and s a y : " I d o n ' t have a c l u e h e r e . " ***************  well  R 26:  I f o u n d h e r v e r y a p p r o a c h a b l e . I c o u l d go t o h e r w i t h a p r o b l e m and know t h a t I wasn't g o i n g t o be p u t down.  Others  gauged  she e m p a t h i z e d  herself the  the i n s t r u c t o r s '  above  top three  instructors.  with  them as s t u d e n t s  them. Ten s t u d e n t s characteristics Four  students  relationships.  They  and d i d n ' t p u t  rated approachability i n  of a l l e f f e c t i v e  (two from  a p p r o a c h a b i l i t y was t h e most student  a p p r o a c h a b i 1 i t y by how  each year)  important rank  ahead o f knowledge and f e e d b a c k  clinical  factor  felt  that  in instructor  ordered a p p r o a c h a b i l i t y skills.  One s e c o n d  year  student  stated: R  A  1:  second  The main t h i n g i s t o be a b l e t o e x p r e s s y o u r s e l f to t h a t i n s t u c t o r and she made i t known t h a t we were t o f e e l f r e e t o come t o h e r w i t h p r o b l e m s . year  approachability that  student  d e s c r i b e d the importance  as a team b u i l d i n g  i t had on h e r l e a r n i n g .  tactic  of  and t h e impact  -96R 20:  How  She's v e r y a p p r o a c h a b l e . You f e l t more l i k e a team r a t h e r t h a n i n s t r u c t o r and s t u d e n t . T h a t way when you went t o do y o u r s k i l l s , you went as a team as o p p o s e d t o "I'm w a t c h i n g what y o u ' r e d o i n g , " and you w e r e n ' t a f r a i d t o make a m i s t a k e i n f r o n t o f h e r . You s t i l l made them b u t i t was no b i g d e a l and you c e r t a i n l y l e a r n e d from y o u r m i s t a k e s .  approachable  the  outcomes when t h e r e was group a c c o r d i n g R 24:  t o one  student  determined  conflict  learning  within a  clinical  student.  Sometimes t h e r e ' s a s t u d e n t on t h e f l o o r t h a t you d o n ' t g e t a l o n g w i t h or d o n ' t work w e l l w i t h . I t ' s h a r d f o r an i n s t r u c t o r t o p i c k up on I'm s u r e . But i f you have an o p e n n e s s w i t h y o u r i n s t r u c t o r t h e n y o u ' l l be a b l e t o t e l l h e r [ a b o u t t h e p r o b l e m ] . When y o u ' r e a s t u d e n t t r y i n g t o l e a r n , you need t h a t o p e n n e s s w i t h y o u r instructor.  Little  insight  was  were more a p p r o a c h a b l e on what a c c o u n t e d that  t e a c h e r was,  i t was  due  while  the  third  attributed  gained than  i n t o why  o t h e r s . Two  certain  instructors  students  speculated  f o r a t e a c h e r s ' a p p r o a c h a b i 1 i t y . One  to her  non-threatening  o t h e r wondered the  i f i t was  instructor's  due  way  felt  of q u e s t i o n i n g  t o her  personality.  a p p r o a c h a b i l i t y to  A  her  personality. R  3:  I t was her non t h r e a t e n i n g way questions that helped.  of p u t t i n g  *************** R  4:  I'm n o t s u r e what makes her t h i n k i t ' s j u s t her n a t u r e . i s . She's j u s t l i k e t h a t .  that approachable, I T h a t ' s t h e way she  -97-  R 11:  The her  [ A p p r o a c h a b i l i t y ] has t o do w i t h p e r s o n a l i t y a s w e l l but I guess a t the b e g i n n i n g I asked a l o t o f q u e s t i o n s and I f i n d i t ' s r e a l l y i m p o r t a n t t o have r a p p o r t w i t h y o u r i n s t r u c t o r so t h a t y o u can f e e l c o m f o r t a b l e enough t o t e l l them I ' v e n e v e r done an NG [ n a s o - g a s t r i c ] tube i n s e r t i o n b e f o r e , w o u l d y o u l i k e t o be t h e r e i n c a s e I need you?  i n s t r u c t o r ' s w i l l i n g n e s s t o i n t e r v e n e on b e h a l f o f  students  their  d i d n o t go u n n o t i c e d .  instructor  themselves  a c t e d as a b u f f e r between  in difficult  relationships R 14:  Students  with  situations,  everyone  their  felt  t h a t when  t h e s t a f f and working  improved.  You c a n see when t h e i n s t r u c t o r ' s been t h e m e d i a t o r and t h e s t a f f seem t o a c c e p t t h e s t u d e n t s much b e t t e r when t h a t h a p p e n s . ***************  R 18:  The way she r e a c t e d w i t h t h e s t a f f and a c t e d as i n t e r v e n e r between t h e s t a f f and t h e s t u d e n t s [was h e l p f u l ] . She d i d n ' t u n d e r p l a y t h e s t u d e n t s , s a y i n g : "Oh w e l l , t h e y ' r e j u s t s t u d e n t s , " o r : " S o r r y a b o u t my s t u d e n t . "  A second deal with R 21:  year  conflict  e x p l a i n e d the t e a c h e r s ' a b i l i t y t o  i n the c l i n i c a l  setting.  When t h e r e was some s o r t o f i n c o n g r u e n c e o r c o n f l i c t where a s t u d e n t was i n v o l v e d , she a l w a y s gave y o u t h e o p p o r t u n i t y t o s a y : " T h i s i s t h e s i t u a t i o n as I saw i t and t h i s i s why I'm d o i n g t h i s and she a l w a y s b a c k e d us up.  Two t h i r d R 28:  student  year  students  expressed  similar  views:  As an a d v o c a t e , t h e i n s t r u c t o r a f f e c t s s t a f f a t t i t u d e s t o w a r d s s t u d e n t s . I have y e t t o s e e an i n s t r u c t o r t h a t d i d n ' t . T h a t ' s what's so good a b o u t o u r p l a c e b e c a u s e t h e i n s t r u c t o r s go t o b a t or t h e y w i l l s a y : " T h i s i s u n r e a l i s t i c h e r e , and I saw t h i s [ t h e t e a c h e r s ' o b s e r v a t i o n s ] i n h e r e and t h e n how c o u l d she be t h e r e ? "  -98R 30:  She p r o t e c t s , s h e ' s a s t u d e n t a d v o c a t e and i f s h e ' s good she d o e s n ' t s a y : " W e l l , we're i n a p o l i t i c a l s i t u a t i o n and we have t o d e a l w i t h t h e h o s p i t a l . " She s a y s : "OK, l e t ' s have a l o o k and l e t ' s be f a i r . "  Another being her  third  year  s t u d e n t spoke  a student i n t h i s  instructor  p r o g r a m and  as a r e s u l t  o f the p r i d e the  respect  o f the a d v o c a c y  her  she  she  had  in  had f o r  teacher  demonstrated. R 28:  The  optimistic  positively it"  She w o u l d n ' t l e t the s t a f f o r the head n u r s e push her s t u d e n t s a r o u n d and so we t h e n had a r e a l l y s t r o n g bond t h e r e . A t one p o i n t when we were s h o r t handed, t h e y d i d n ' t need t o c a l l f o r any more n u r s e s b e c a u s e t h e y had s t u d e n t s . She s t o o d up f o r us and s a i d : "My s t u d e n t s a r e h e r e to l e a r n , t h e y ' r e n o t h e r e t o s t a f f t h e ward" and we l o v e d i t ! A t t i m e s we t h o u g h t t h a t on s u c h a busy f l o o r we were b e i n g u s e d as s t a f f . I t ' s n i c e n o t t o be pushed a r o u n d b e c a u s e I t h i n k as s t u d e n t s we d o n ' t s t i c k up f o r ourselves.  and  instilled  students.  They  who  t e a c h e r , the one always  a sense found  conveyed  of p r i d e this  and  positive  who  could  the message  think "you  can  do  c o n f i d e n c e i n her attitude  conducive  to  success. R 14:  I f I was d o i n g s o m e t h i n g wrong, I aware o f my e r r o r i n a way t h a t I p u t down. She'd s a y n e x t t i m e you You d i d n ' t f e e l i n a d e q u a t e o r bad h a d n ' t done i t r i g h t . She made me to be i n n u r s i n g .  was made didn't feel c a n do i t . b e c a u s e you f e e l proud  *************** R 30:  Someone who i s a b l e t o see t h i n g s i n p o s i t i v e terms h e l p s us w i t h our c o n f i d e n c e .  -99-  Four  students  to enjoy who  her  really  them as  enjoyed  what she  and  example  was  instructor  a sense  as  someone  especially  of  renewal  enjoyed  to  her  follows:  They l i k e what t h e y ' r e d o i n g enjoy teaching.  I:  How  R 19:  I t ' s n o t a l w a y s r o u t i n e f o r them. T e a c h i n g i s n ' t a r o u t i n e job t h a t t h e y ' r e d o i n g e v e r y year but t h e y m i g h t b r i n g new t h i n g s t o t h e i r t e a c h i n g and keep s t i m u l a t e d f o r t h e m s e l v e s , n o t j u s t a j o b t h a t t h e y go t o f o r the money or w h a t e v e r . They keep t h e m s e l v e s up t o d a t e and t h e y r e a l l y e n j o y b e i n g w i t h the s t u d e n t s .  i s that  empathetic  observing their  c o n c l u s i o n s . She  attitude  by  goals.  Her  remain  calm  teacher  non-verbal  cues  appraised situations she  just  that  they  to s t i c k  a t a l l t i m e s was  by  listened  to  prior  arriving  to  carefully  demonstrated  showing a p e r s o n a l i n t e r e s t ability  not  manifested?  making d e c i s i o n s . Above a l l e l s e ,  before a  i n them and  them i n d i f f i c u l t i e s  f u r t h e r .evidence  her  of her  caring their and  to  empathy  students. The  and  appeared  R 19:  students,  for  really  d o i n g , who  who. b r o u g h t  In c o n c l u s i o n , the  at  t e a c h e r who  work. They d e s c r i b e d t h i s  students  work. An  spoke o f t h e  t e a c h e r who  non-verbal  d i s p l a y e d congruence  messages d e m o n s t r a t e d  students.  C o n g r u e n c e was  disclose.  The  clinical  a p p r o p r i a t e l y was  enhanced by  t e a c h e r who  p e r c e i v e d as  between h e r v e r b a l  genuine her  used  concern  ability  to  f o r her self-  self-disclosure  "more human". S i m i l a r l y ,  the  -100-  instructor  appeared  acknowledged Lastly, regard  the  f o r her  student felt  the  more human t o s t u d e n t s  student and  when she  The  conflict  situation took  demanded  Ultimately,  over  the  and  a positive  a key  would  Students  a teacher's  priority  attitude  she  the  role  clinical  institutional  instructor  who  needs  certain  teacher,  when  learning  a  and  a b o u t what  for service  maintained  Students  team b u i l d i n g  that their  the  needs was  vital.  positive  a sense  of p r i d e  students.  Environmental  Factors  Introduction  Once the  thirty  open ended q u e s t i o n s clinical than there  area,  a l l of the anything  i n t e r v i e w e e s had regarding teacher  they' were p o s e d w i t h t h i n g s t h a t we else  have  that affects  responded  t o the  two  e f f e c t i v e n e s s i n the  this  question:  just  talked  your  learning  a  teacher-student  approachability. Similarly,  i t , ensuring  i n her  in  model  were l e s s  a c t e d as  attitude.  factor  j o y of t e a c h i n g i n s t i l l e d  confidence  positive  approachable,  more a p p r o a c h a b l e  resolution.  determines  demonstrated was  maintained  the more s u c c e s s f u l l y  and  teacher  t h a t a p p r o a c h a b i l i t y was  relationships.  she  humor i n s i t u a t i o n s a p p r o p r i a t e l y . clinical  advocate  when  "Other  about, i s clinically"?  -101-  Answers  to t h i s  responses and to  related  t o how w e l l  ranging  the i n s t r u c t o r ' s  level  communication  the i n s t r u c t o r ' s of enthusiasm  established  from  frequent  students are accepted  t h e c l i m a t e on t h e ward, t o s i n g u l a r  staff,  had  q u e s t i o n were v a r i e d ,  ability  responses  skills  and t h e r a p p o r t t h a t Only  referring  v i s a v i s the  t o empathize w i t h  i n the classroom.  by s t a f f  student  them, h e r and t e a c h e r  one r e s p o n d e n t  had no  new i n f o r m a t i o n t o add a t t h i s p o i n t . College-based  nursing students  a teacher's a v a i l a b i l i t y ,  r e c o g n i z e d the impact o f  the s t a f f ' s  willingness  them, and t h e g e n e r a l c l i m a t e i n t h e c l i n i c a l learning.  They g e n e r a l l y a g r e e d  influenced little  a l l of these  control  over  due  to the nature  the  college,  climate  factors,  setting  factors  the  w i t h which  of  frequency  a variety  resources  by s t a f f  agreement  with  and t h e e m o t i o n a l  may be due t o m o r a l e ,  are highly  staff  effectiveness  first  year  of their  as w e l l  supervision.  more h i g h l y  students  clinical  and a r e a f f e c t e d by  are expected  settings,  for clinical  are understandably than  variable  instructors  of c l i n i c a l  students assigned  students  f o r example, may be  e x p e c t a t i o n s or l e a d e r s h i p w i t h i n the workplace.  Both o f these  through  the teacher  of the t e a c h e r ' s c o n t r a c t u a l  whereas a c c e p t a n c e  on t h e i r  i n many i n s t a n c e s she had  these. A v a i l a b i l i t y ,  i n the c l i n i c a l  workloads,  that while  area  to a s s i s t  valued  t o move  as t h e l e v e l Third  clinical  r e g a r d l e s s of the  instructor.  year  -102-  Availability  Availability students  interviewed.  availability she  was n o t a major  spent  O n l y one m e n t i o n e d  was a f f e c t e d  needless  concern  time  by g r o u p  seeking  t o most o f t h e that  she f e l t  s i z e and one s t a t e d  the i n s t r u c t o r ' s  that  assistance.  J u s t b e i n g a v a i l a b l e on t h e f l o o r [ i s a p r o b l e m ] . I f e e l that our c l i n i c a l groups a r e j u s t too l a r g e . You're l o o k i n g f o r h e r [ t h e t e a c h e r ] , s h e ' s n o t a v a i l a b l e and t h e team l e a d e r i s b u s y so y o u w a i t . I t ' s r e a l l y f r u s t r a t i n g . *************** The one t h i n g t h a t we f i n d h a r d as s t u d e n t s i s how a v a i l a b l e she [ t h e i n s t r u c t o r ] i s 'cause l o o k i n g f o r y o u r i n s t r u c t o r t o do s o m e t h i n g c a n be a p r o b l e m . On  t h e whole however, t h o s e who commented  always a v a i l a b l e R  6:  and n e v e r  t o o busy  to help  found  teachers  them.  She had t h a t k i n d o f p r e s e n c e . She was a l w a y s a r o u n d you and i f she wasn't w i t h y o u she was e a s y t o t r a c k down. She was a l w a y s a v a i l a b l e . **************  R  13:  She made h e r s e l f a v a i l a b l e f o r s u p e r v i s i o n . She d i d n ' t l e t s o m e t h i n g p a s s b y . I f t h e r e was an o p p o r t u n i t y t o do s o m e t h i n g she d i d n ' t s a y I'm too busy. ***************  R  16:  I l i k e t h e way she l e t s y o u do t h i n g s on y o u r own b u t i f y o u needed h e r i n s t r u c t i o n she'd be t h e r e . She's t h e r e when you need h e r .  How t h e i n s t r u c t o r made h e r s e l f concern  as s t a t e d  by t h i s s e c o n d y e a r  available  was o f  respondent:  greater  -103-  R 26:  She's a l w a y s a v a i l a b l e . I t seemed l i k e I needed h e r she was r i g h t t h e r e .  I:  How  R 26:  She'd come a r o u n d and check on me f r e q u e n t l y b u t I d i d n ' t f e e l l i k e she was s p y i n g on me, n o t l i k e one o t h e r i n s t r u c t o r . I t h o u g h t oh, s h e ' s c h e c k i n g on me.  It  d i d she  would a p p e a r  instructor  as how  by  time  that?  t h a t the manner  available  f r e q u e n t l y she  i n which  t o s t u d e n t s was was  the as  available.  Staff  Acceptance the  then  made h e r s e l f  significant  Acceptance  do  every  need a r o s e ,  by and  staff  meant b e i n g  being  allowed  assisted  by  to c a r r y out  them when  nursing  care  independently. R  8:  How t h e s t a f f makes s t u d e n t s f e e l [ i s i m p o r t a n t ] . I f t h e y welcome s t u d e n t s and t r y t o h e l p them o u t , and d o n ' t t r y t o t a k e o v e r I t h i n k i t ' s a lot better. ***************  R 25:  Helpful and  thanked R  2:  The s t a f f ' s a t t i t u d e t o w a r d s us as s t u d e n t s [ a f f e c t s our l e a r n i n g ] . I f a p r o b l e m a r i s e s i n the b e g i n n i n g , you d o n ' t g e t s h u t o f f . staff  members gave s t u d e n t s  them f o r t h e i r  h e l p when the  positive day  was  feedback over.  [ I t i s h e l p f u l t o work w i t h ] s t a f f who a r e e n c o u r a g i n g and w i l l i n g t o thank you f o r y o u r h e l p , s t a f f t h a t can g i v e you the v i b e s t h a t hey, y o u ' r e ok, we r e a l l y a p p r e c i a t e you, how w o u l d we s u r v i v e w i t h o u t you?  -104-  A  second  R  3:  A being  student  aptly  described helpful  I f she h a d n ' t t a k e n t h e i n i t i a t i v e have m i s s e d o u t on i t . 3:  that  staff  acceptance  c o n s i d e r e d p a r t o f t h e team and h a v i n g  v a l u e d . A second R 24:  year  student  A third  their  meant opinions  said:  I l e a r n e d most where t h e s t a f f part  treated  me  like  o f them, i n c l u d e d me and v a l u e d my o p i n i o n .  year  student  felt  that  acceptance  by s t a f f  was  on t i m i n g i n t h e p r o g r a m . T h a t ' s one t h i n g , c a n y o u t h i n k o f a n y t h i n g e l s e ? [ a f f e c t i n g your l e a r n i n g c l i n i c a l l y ]  R 28:  Their  you would  Oh, I w o u l d n ' t have g o t t o see i t and t h e n on t h e o t h e r hand, I've been on t h e f l o o r s where she j u s t s a i d : " g e t o u t o f t h e way" y o u know l i k e y o u c a n j u s t f e e l t h a t t h e y d o n ' t want y o u t o be t h e r e o r y o u ' r e i n t h e room a l r e a d y d o i n g s o m e t h i n g and t h e y j u s t s o r t o f come i n and t a k e o v e r and s a y : "Oh w e l l , we have t o g e t t h i s done!"  few s t u d e n t s m e n t i o n e d  dependent I:  staff:  I mean t h e y ' r e w i l l i n g t o show y o u a n y t h i n g o r l e t y o u do t h i n g s t h a t maybe t h e y w o u l d be d o i n g . I c a n t h i n k o f a p a r t i c u l a r e x p e r i e n c e where she [the R.N.] was g o i n g t o go hang some b l o o d and she s a i d come w i t h me and I ' l l show y o u how t o hang t h i s b l o o d so I went i n and i t was interesting.  I: R  year  Oh, I t h i n k t h e s t a f f ! I f t h e y d o n ' t want y o u t h e r e . I t depends what y e a r y o u ' r e i n t o o , i f t h e y t h i n k t h a t y o u c a n ' t do a n y t h i n g and t h a t y o u ' r e i n t h e way and t h e y have t o show y o u e v e r y b l i n k i n g t h i n g , you can sense t h a t t h e y ' r e n o t happy. acceptance  result  o f how w e l l  staff.  Her f a m i l i a r i t y  by s t a f f ,  their  they  instructor  with  the area  felt,  was l a r g e l y t h e  was a c c e p t e d  by n u r s i n g  and r a p p o r t w i t h  staff  -105-  were v i e w e d  as s i g n i f i c a n t f a c t o r s  instructor's I: R  i n f l u e n c i n g the  acceptance. Do y o u t h i n k t h e i n s t r u c t o r has any b e a r i n g on the s t a f f ' s w i l l i n g n e s s t o h e l p y o u o u t ?  2:  I f the i n s t r u c t o r i s f a m i l i a r with she i s w o r k i n g i n , i t h e l p s .  the p l a c e  *************** I: R  What i s t h e i n s t r u c t o r ' s r o l e i f any, i n t h e s t a f f ' s willingness to help students? 3:  I f she has a good that helps.  relationship  with  the s t a f f ,  ************** R 29:  The s t a f f ' s a t t i t u d e has t o do w i t h how w e l l she s p e a k s up f o r s t u d e n t s , combined w i t h h e r credibility.  T h e r e was a d i r e c t  relationship  between how k n o w l e d g e a b l e  i n student's  the i n s t r u c t o r  was and t h e s t a f f ' s  willingness  t o a s s i s t them when t h e i n s t r u c t o r  unavailable  t o answer  opportunities  their questions  minds  was  o r when new  learning  arose.  R 21:  Where I l e a r n e d t h e most o r where I f e l t l i k e I was p r o g r e s s i n g , were t h e wards where t h e s t a f f t r e a t e d me l i k e I was a p a r t o f them and t h e y i n c l u d e d me i n t h i n g s , t h e y v a l u e d my o p i n i o n .  I:  Do y o u t h i n k in that?  the i n s t r u c t o r  R 21:  Yes, because  they  I:  How do you see t h a t  has a r o l e  r e a l l y respected her. happening?  to play  -106-  R 21:  I t h i n k b e c a u s e s h e ' s h o n e s t and t h e y can see t h a t and a l s o b e c a u s e t h e y know t h a t s h e ' s n o t g o i n g t o make a d e c i s i o n t o p u t a s t u d e n t where a s t u d e n t c a n ' t be l e f t a l o n e . They t r u s t h e r knowledge b a s e , t h e y know t h a t as s t u d e n t s we have l e a r n e d from h e r .  Three regarding  students the  staff's  the w i l l i n g n e s s of well had  the  R 11:  got  second  student  response  based  has  respondent  commented:  One involved assist  good her  e x p l a i n e d how on  t o the  instructor  R 12:  the  felt  that  d e p e n d e n t on  staff,  how  long  orientation  how  she  was.  How t h e y g e t a l o n g w i t h the s t a f f and I've n o t i c e d a l o t o f d i f f e r e n c e when an i n s t r u c t o r comes o n t o the f l o o r c o l d t u r k e y , we f e e l l i k e o u t s i d e r s r a t h e r t h a n p a r t o f the team. T h a t makes i t h a r d e r f o r the s t u d e n t t o b u i l d r a p p o r t w i t h the s t a f f . I f t h e y ' r e f a m i l i a r w i t h the r o u t i n e then i t ' s a l o t e a s i e r because e v e r y f l o o r runs d i f f e r e n t l y .  a p p r o a c h a b i l i t y and In  first  i n v o l v e d was  along with how  explanations  t o them. The  to get  t h a t ward and  t o w a r d s them was her  more complex  attitude  staff  instructor  been on  The  offered  anything  the  the  instructor's  behavior  question: t o do  r e c e p t i v e the  with  communication  of the  "Do the  you  staff  students  t h i n k the  c l i m a t e on  was skills,  themselves. clinical  t h e ward"? a  Yes, by her c o m m u n i c a t i o n s k i l l s and by the f a c t t h a t s h e ' s a p p r o a c h a b l e and o f c o u r s e by the b e h a v i o r o f the s t u d e n t s , t h a t i s g o i n g t o i n f l u e n c e how the s t a f f f e e l a b o u t h a v i n g you [the students] there.  student  felt  t h a t i f the  i n p a t i e n t care,  them when the  need  the  instructor  staff  arose.  would be  was  actively  more w i l l i n g  to  -107-  R 20:  I f the s t a f f see t h a t the i n s t r u c t o r p u l l s h e r w e i g h t , t h e y t h i n k t h i s i s g r e a t and t h e y ' l l be more f r e e t o h e l p s t u d e n t s .  General respected the  c o n s e n s u s was,  by  the  staff,  students  and  to a s s i s t  the  comments  however, t h a t  they  w o u l d be  i f the  instructor  more w i l l i n g  them w h a t e v e r  their  to  was  involve  needs may  be.  Climate  Most o f clinical  setting  staff.  few  A  behavior the  r e l a t e d t o the  students  i n the  ward. How  regarding  saw  clinical  much the  the  climate  in  the  i n s t r u c t o r ' s rapport  a direct setting  with  r e l a t i o n s h i p between  and  i n s t r u c t o r was  the  emotional  able  the  their  climate  to a l t e r  that  on was  debatable. I:  What e n h a n c e s y o u r  learning?  R 12:  The  ward  I:  Do you t h i n k with that?  R 12:  Yeah, b u t sometimes the i n s t r u c t o r c a n ' t change t h a t . I mean she can go t o the head n u r s e and t a l k t o her a b o u t t h i n g s t h a t a r e h a p p e n i n g l i k e i f t h e r e were a l o t o f n u r s e s who d i d n ' t l i k e students there.  I:  How  R 12:  By h e r c o m m u n i c a t i o n s k i l l s and a g a i n by the f a c t t h a t s h e ' s a p p r o a c h a b l e and i f s o m e t h i n g ' s r e a l l y h a p p e n i n g you c o u l d go t o her and s a y : "I'm really h a v i n g a rough time ."  climate  does she  on  the  the  [does].  i n s t r u c t o r has  impact  on  anything  to  do  that?  -108-  I:  O u t s i d e o f the i n s t r u c t o r ' s c o m m u n i c a t i o n s k i l l s , i s t h e r e a n y t h i n g e l s e t h a t you t h i n k i n f l u e n c e s the c l i m a t e on the ward when y o u ' r e t h e r e ?  R 12:  The b e h a v i o u r i n f l u e n c e how there.  o f the s t u d e n t s i s g o i n g t o the s t a f f f e e l a b o u t h a v i n g  you  *************** I:  Is there a n y t h i n g c l i n i c a l l y , other  e l s e that a f f e c t s your l e a r n i n g t h a n the t h i n g s we've d i s c u s s e d ?  R 17:  the  the  I:  Does the i n s t r u c t o r have a n y t h i n g do you t h i n k ?  R 17:  atmosphere  on  floor t o do  with  that  • Sometimes, but I d o n ' t r e a l l y t h i n k you can l a y t h a t on the i n s t r u c t o r , b e c a u s e t h e y [ s t a f f ] a r e i n d i v i d u a l s and i t depends on how r e c e p t i v e t h e y are to s t u d e n t s . ***************  I:  Do you t h i n k t h a t the i n s t r u c t o r has o v e r the c l i m a t e on the ward?  R 18:  I d o n ' t know i f she has a g r e a t amount o f c o n t r o l o v e r t h a t , b u t I t h i n k she can i n f l u e n c e i t . I f s t a f f a r e h a v i n g a h a r d time w i t h students, making i t b e t t e r , but I d o n ' t know how you go about d o i n g t h a t !  I:  You  R 18:  Yeah, i f t h e y r e s p e c t you as an i n s t r u c t o r , t h e y ' l l be more r e c e p t i v e t o s t u d e n t s .  Of  twenty nine  the  information the they  clinical  on  see  setting,  of  as w i t h i n her  students  who  the  by  the  majority  staff,  the  instructor.  control  realm?  chose  additional factors affecting  were a c c e p t e d  availability  that  any  chose  climate  to  provide  their  learning in  to d i s c u s s on  the  ward  how and  well  -109-  How be  o f t e n the  a major  concern  instructors this  was  instructor of the  appeared  achieved,  t o be  they  " s p i e d on"  example, w h i l e their to  the  rapport  perhaps  the  available  a matter  certain  students  during c l i n i c a l  Perhaps  the  the  teacher  conception  student's  has  with  to  most  to s t u d e n t s .  to f e e l  How  further  that  supervision for i n the  presence  conception  e s t a b l i s h e d with  i s linked  appear  that warrants  o t h e r s a r e more c o m f o r t a b l e  instructor?  d i d not  perhaps because  readily  however, was  What c a u s e s  being  available  student  investigation. are  was  the  is  the  of  related  student  instructor's  expectations. Acceptance carry  out  offered  by  nursing  staff  c o n s i d e r e d as  opinions  and  students  were a c c e p t e d  factors:  (third  year  well  the  the  area,  honesty, with on  input  into  students was  instructor  was  freedom and  not  a team member w i t h  by  staff  the  being  was  i n the  knowledge  skills  and  being  by  well  dependent  staff)  and  Familiarity  level,  level  w i l l i n g n e s s to  acceptance  of the  clinical  teacher.  on  program how  with  of  assist  p a t i e n t c a r e were a l l c o n s i d e r e d p o s s i b l e i n f l u e n c e s  staff's  It  worthwhile  at i n the  area.  to  available.  t o be  the most v a l u e d  staff,  solving  appeared  student  accepted  rapport with problem  the  p l a n n i n g p a t i e n t c a r e . How  what s t a g e  teacher  given  interventions independently  a s s i s t a n c e when the  meant b e i n g  two  meant b e i n g  or  -110-  Students emotional  on b e h a l f  that  c l i m a t e on t h e ward  communication situation,  recognized  skills  especially of her  also  had  their  but the  altered  the  instructor's  the p o t e n t i a l  i f the teacher  students.  behavior  was  t o change  the  w i l l i n g t o speak  out  -Ill-  Chapter  Five  SUMMARY CONCLUSIONS  AND  IMPLICATIONS  Introduction  The a)  purpose  of t h i s  similarities  second  clinical  future  teachers  effectiveness students'  Lastly, study.  of e f f e c t i v e  conceptions  a theoretical  teacher  of e f f e c t i v e basis for  effectiveness i n nursing.  choices of e f f e c t i v e  r e g a r d i n g the  i n s t r u c t o r s and  o f c o n t r a c t u a l a g r e e m e n t s on t e a c h e r  f o l l o w e d by c o m p a r i s o n s conceptions  teachers. A theoretical teacher  drawn f r o m  t h e r e was a  conceptions  students'  could provide  of student's  clinical  regarding c h a r a c t e r i s t i c s of  V i s a summary o f t h e f i n d i n g s  effect  determine:  and t h e i n s t r u c t o r ' s c o n t r a c t u a l  s t u d i e s on c l i n i c a l  apparent  year  individual  and c) whether  Chapter timing  students  to  between t h e c o n c e p t i o n s o f  t e a c h e r s ; b) w h e t h e r  between  teachers  agreement clinical  year  clinical  relationship  was t h r e e f o l d ,  and d i f f e r e n c e s  and t h i r d  effective  study  o f second  o f most e f f e c t i v e  framework  the f i n d i n g s  and i m p l i c a t i o n s  t h e r e s e a r c h e r makes  third  clinical  for further  e f f e c t i v e n e s s i s proposed.  and  study of  Conclusions are  are d i s c u s s e d .  recommendations  for further  -112-  Timing  of Students'  Although experiences effective students second  one  would  an  t e a c h e r s , one  rotation  instructor contributed preferred  the  to t h i s  clinical i n those  to  most e f f e c t i v e  second  semester  semester.  finding. areas  recall  by may  For  second  instructors or any  recent  year  from  example, or  the  effective  Perhaps extraneous  students not  most  r e g a r d i n g most  o n l y s p e c u l a t e why  first  areas  students  open-ended q u e s t i o n  can  recall of the  from  of E f f e c t i v e I n s t r u c t o r s  expect  when a s k e d  d i d not  students  Choices  they  staff  have been as  may  not  attitude conducive  factors have  toward to  learning. It recall  i s less  surprizing  most e f f e c t i v e  teachers  t h e y work more c l o s e l y during  t h a t semester.  instructors  and  nursing Since  diploma  "timing" teachers, unique  third  other of  with The  from  the  preceptors  nature  year  than  of t h e i r  a researcher asking year  students'  to t h i s  can  choices  can  with  of  based  findings.  r e p o r t e d on  regarding e f f e c t i v e  students.  since  only  college  similar  not  instructors  same q u e s t i o n  only speculate that this  group of  semester  with  One  in a similar  r e s e a r c h e r s have n o t  did  relationship  the  p r o g r a m would e x p e r i e n c e  nurse  one  students  students  sixth  changes d u r i n g t h a t semester.  s p e c u l a t e whether second  that t h i r d  finding  the clinical is  been  -113-  Instructors'  The  r a t i o of  effective third of  C o n t r a c t u a l Agreement  was  year  significant  students.  clinical  year  full-time  much h i g h e r  ( X * = 8.66  Given  teachers  students  to p a r t - t i m e  the  17:19) one  as most e f f e c t i v e . S t u d e n t s  than  those  in  the  in  other  full-time  number o f p a r t - t i m e  available  employed  clinical  on  This  clinical  teacher  (1986) r e p o r t e d a p o s i t i v e  number  o f c o n t a c t h o u r s and  instructors. time  In t h i s  instructors  full-time appear  study,  offers  instructors  t o have h i g h e r  who  their  own  and  past  personalities.  student  has  into  Conceptions  expectations  Year  cognitive  exclusively  effectiveness,  however  their  between  the  e v a l u a t i o n of  concerns  than  come t o t h e  experiences,  selected  reported  a r e more r e a d i l y  Third  not  a  been  students'  expectations  third  instructors  greater  relationship  students  insight  C o m p a r i s o n s o f Second and  Teacher  the  t o be  b a s i s to teach  finding  Dawson  and  ratios  s e c o n d and  full-time  having  a part-time  setting.  s t u d i e s on  part-time  instructors  as  most  w o u l d have e x p e c t e d  perceived  and  as  p,<.01) f o r s e c o n d  involved i n teaching  (13:18 and  as more r e a d i l y  instructors  regarding  preference available  part-time  Students'  learning  part-  for and  who  teachers.  Conceptions  situation  with  maps, e x p e c t a t i o n s  of e f f e c t i v e  clinical  teachers  and  -114-  among  the s u b j e c t s i n t h i s  study  knowledge and t h e ways i n w h i c h The  teacher's  ability  communication  skills  c o n s i s t e d of the t e a c h e r ' s she f a c i l i t a t e d  to provide were a l s o  feedback  and h e r  p e r c e i v e d as  important  determinants  of the e f f e c t i v e n e s s of c l i n i c a l  In a d d i t i o n ,  the l e a r n i n g  t o have  significant  Second-year availability  environment  impact  students  valued  f a r more t h a n  skills  juniors. with  and s e l f  This indicates  promotion  students  learning  clearly  environment  trust,  expectations,  problem  disclosure  f a r more t h a n  did their  t h a t t h e r e were some  valued  (1986) i n t h a t  t h e t e a c h e r who (trust),  who:  stated expectations clearly,  students  these  as n e c e s s a r y ,  stated  was a good  growth o f the s t u d e n t . ratios  person.  valued  was a v a i l a b l e , resource  Third-  the teacher provided  person,  Perhaps these  and  differences  at various levels  p r o g r a m s o r due t o a d i f f e r e n c e  methodology.  demonstrated:  resource  i n t h e same s t u d y  a r e due t o s t u d e n t - t e a c h e r of  second-year  availability,  and was a good  university  facilitated  similarities  (expectations), established a pleasant  year  guidance  a p p r o a c h a b i l i t y and  valued  of independence  explanations  was p e r c e i v e d  d i d the t h i r d - y e a r s t u d e n t s ,  t h e Knox and Mogan s t u d y  university  itself  instructors.  on t h e l e a r n e r .  whereas t h i r d - y e a r s t u d e n t s solving  learning.  i n research  i n each  -115-  Second  and t h i r d - y e a r s t u d e n t s  knowledge base e q u a l l y e x c e p t commented students goals the  more  than  twice  nature  the t e a c h e r ' s year  students  as f r e q u e n t l y as s e c o n d  year  knowledge o f c u r r i c u l u m ,  T h i s p e r c e p t i o n may w e l l be due t o  of senior student's  they  are approaching  need  for individualization  goals  that t h i r d  r e g a r d i n g the teacher's  and o b j e c t i v e s .  valued  clinical  graduation,  experience.  t h e y may w e l l show  i n meeting  their  Since more  educational  at this  time.  I t i s n o t p o s s i b l e t o compare  these  findings with  other  second  students,  since  they  clinical  and t h i r d  perceptions  level  students honesty  they  feedback  and n e g a t i v e times  the t e a c h e r s ' l e v e l  more  i n two  students  comments  Third-year l e v e l of  about  establishing  t h e t e a c h e r . Reasons f o r t h e s e  f i n d i n g s are  s p e c u l a t i v e . The r e s e a r c h e r  again,  their  comments  experiences  are t i e d  suspects  to the n a t u r e  a t t h e time  to  f r e q u e n t l y r e g a r d i n g the  on t h e t e a c h e r ' s  concerned  areas.  ability  year  h e l d b u t had no  purely  clinical  in their  second  of honesty.  occasionally  b u t were f a r l e s s  with  skills  feedback,  and i n s t r u c t o r s  commented  differed  e q u a l l y on t h e t e a c h e r ' s  two and a h a l f  regarding  trust  commented  positive  commented trust  of the t e a c h e r ' s  they  on  effectiveness.  S e c o n d and t h i r d - y e a r s t u d e n t s  provide  nursing  are not r e p o r t e d i n the n u r s i n g l i t e r a t u r e  teacher  Although  year  t h a t once of t h e i r  of the i n t e r v i e w s .  -116-  Second regarding similar  and the  third  the  congruence  Communication year of  students  this  year  are  and  positive  skills  show t h a t  i n each  learning  example, related the  be  aspect  subjects in this to communication  and  third-year  s t u d e n t s by  for  t i m i n g of that  to communication teacher  learn  thirdfindings  of  second-  communication  students skills  who tend  effectiveness.  most o f t h e  d u r i n g the  students  staff  i n the  availability  more t h a n  year  second  supervision  setting  clinical  first  to For  content two  years  three times  as  and  students  guidance  concerns  of the  teacher,  and  acceptance  students  mentioned  surprizing  f o r two  do  third  reasons:  with p r e c e p t o r s ;  r e q u i r e a h i g h e r degree  than  regarding  f r e q u e n t l y as  s t u d e n t s work more c l o s e l y year  equal  a r e a ) , except  Second y e a r  s t u d e n t s d i d . T h i s i s not  third  shared  (availability  clinical  teacher's a v a i l a b i l i t y .  b)  concern  program.  c l i m a t e i n the  and  to the  skills  emotional  a)  demonstrate  a greater concern  study  external factors  year  to  stated  regard.  of c l i n i c a l  regarding  the  ability  and  concerns  Knox s t u d y w h e r e a s  due  related  similar  skills  program. I t i s p o s s i b l e  content  this  Second  of  shared  were a major  t o be  s t u d e n t s . T h i s may  emphasize  of  instructors'  i n the Mogan and  study  content  students  t e a c h e r ' s communication  v i e w s on  empathy,  year  senior level  of  students.  -117-  Other  studies  availability  inclinical  as a k e y f a c t o r  (Barham, 1965; J a c o b s o n , 1982;  perceptions  Teacher  Based  feedback factors  however  studies  Effectiveness:  her e f f e c t i v e n e s s  1973; K a r n s & Schwab,  few c o m p a r i s o n s  a r e drawn  levels  i s dependent  within  inclinical  within  Findings  are also  general  (1987)  education.  Their  the a n a l y s i s  previous nursing mention  studies  (1978)  knowledge,  as on e x t r a n e o u s related  lists  teacher  teacher  on c l i n i c a l  with  knowledge  Shulman and  effectiveness i n  stresses  a useful  to the  effectiveness  with Wilson,  teacher  research  of c l i n i c a l  the teacher's  Irby  into  knowledge base and p r o v i d e s  teacher  a r e somewhat c o n s i s t e n t  consistent  research  clinical  as w e l l  inclinical  i n medicine.  Framework  s e t t i n g . Findings  medicine.  students  Richert's  skills  level  one o f s i x k e y f a c t o r s  study,  on t h e t e a c h e r ' s  the c l i n i c a l  knowledge  A Theoretical  i n this  and c o m m u n i c a t i o n  instructor's  for  i n determining  of students a t various  on r e s p o n d e n t s  effectiveness  with  the teacher's  program.  Clinical  as  mention  1966; K i k e r ,  Mogan & Knox, 1 9 8 6 ) ,  regarding each  teaching  the teacher's  theoretical  framework  effectiveness. teacher  While  effectiveness  knowledge as a d e t e r m i n a n t  of her  -Ineffectiveness  (Armington,  1972; G r i f f i t h ,  1983; K a r n s &  Schwab, 1982; K a r u h i j e , 1986; Mogan & Knox, 1986; Wong, 1978),  those  r e f e r e n c e s tend  while Armington are  "experts  think"  t o be b r o a d .  (1972) s t a t e s  i n their  are rated  field"  that  (1982) r e f e r  emphasis valued that  (1986) f o u n d  first  year  clinician students  t e a c h e r s made them f e e l concerned  with  Students a)  and r o l e  i s a content  study  expert;  students  m o d e l . Wong  competency value  placed  little  they  (1978)  sensitive  second year  791),  students.  i n nursing,  were e s p e c i a l l y while  (p.  teacher's  by n u r s i n g  knowledge  the teacher's i n this  valued  who  students to  students  to the c l i n i c a l  that while  on t h e i n s t r u c t o r ' s  an e x p e r t  instructors  and who " e n c o u r a g e  knowledge base as an a t t r i b u t e Mogan and Knox  clinical  above a v e r a g e by t h e i r  K a r n s and Schwab  F o r example,  found  t o how  s t u d e n t s were more  i n teaching.  the c l i n i c a l  b) knows t h e c l i n i c a l  teacher area  who:  well;  c) knows how t o t e a c h  and d) goes o u t o f h e r way t o g e t t o  know them as l e a r n e r s  and as i n d i v i d u a l s .  concerned outside of  with  the f i e l d  teacher's  of c l i n i c a l  knowledge o f c o n t e n t  n u r s i n g and w i t h  h e r knowledge  c u r r i c u l u m o r e d u c a t i o n a l g o a l s and o b j e c t i v e s . Feedback  on  the c l i n i c a l  They a r e l e s s  skills,  the teacher's  negative  feedback  according to respondents,  ability  to provide  and t o m a i n t a i n  balanced  a trusting  a r e dependent  p o s i t i v e and and h o n e s t  -119-  relationship  with  s t u d e n t s . T h e i r comments  effective  teacher's  basis  f i n d i n g s were  in  and  feedback  similar  well  as  ranked  the  a non-judgemental  characteristics Parsons those  teacher's  criticized  only provided negative Students and  positive be  in this  frequency  feedback  study  of p o s i t i v e  feedback.  about That  the  too  ideal  much  has  been documented  effectiveness.  optimal  on  Perhaps each  student's  are  interpersonal  type  or  skills  conceptions  feedback  effect  of  effective Determining  r e q u i r e d by  for c l i n i c a l  for positive t o her  of  not  clinical  investigation.  problem  numerous g e n e r a l  on  r e g a r d i n g the  amount of  need  literature  further  interesting  personality  There  students'  t i m i n g and  p o s e s an  i n the  Questions  teachers warrants  her  who  students  clinical  to  and  as  d e t r i m e n t a l t o the m o t i v a t i o n o f  feedback  student  concerns  and  rotation  positive  the  of others  feedback.  soon  three  teachers  enough  as  clinical  teacher  too  them,  i n the  previously  given  top  clinical  or n o t  raised  studies  t e a c h e r s . O'Shea  in front  feedback  that  that  to e v a l u a t e  clinical  students  of other  among t h e  an  on  (1987) f o u n d  ability  (1979) d e s c r i b e d i n e f f e c t i v e  who  timing  Knox  attitude  of e f f e c t i v e  were a n a y l z e d  to those  n u r s i n g e d u c a t i o n . Mogan and  students  may  skills  regarding  feedback  each  instructors. is  linked  preferred learning  style.  r e f e r e n c e s to the  i n the n u r s i n g l i t e r a t u r e  on  teacher's clinical  -120-  teacher Kiker, the  effectiveness (Griffith, 1973;  teacher  with  confidence, daily In  positive  the  this of  Rogers p r o v i d e d  K a r n s and this  employed  the  nature  dissimilar  of  these  student  research  teacher  in  the  in  this  study.  regarding  their  flexibility v i e w s on  the  enthusiasm, humor.  researcher  who  commitment  in daily  Students  (1982) and that  critical  for  the  value  congruence  found  three  populations  and Griffith  effective  dimensions  interactions  with  have d i f f e r e d  s t u d i e d or due  due  to  methodologies.  characteristics  Knox and  skills.  f i n d i n g s may  T h e r e were s i m i l a r i t i e s of  and  a framework  Schwab  Rogers  t h e r a p e u t i c communication Once a g a i n ,  one  students.  t o d i s p l a y empathy,  (1983),  as  spontaneity,  flexibility  communication  Unlike  teachers  students. to  Carl  ability  Bakanauskas  self-disclosure,  openness,  1982;  (1983) d e s c r i b e s  interpersonal s k i l l s  with  teachers'  regard.  clinical of  study,  teacher's  positive and  intensity,  interactions  analysis  K a r n s & Schwab,  Mogan & Knox, 1 9 8 6 ) . G r i f f i t h  demonstrates: appropriate  in  1983;  as u n i v e r s i t y  d i d not  teacher's  c h e e r f u l n e s s , a calm  the  students  college  appear  as  students concerned  organizational skills  students,  e f f e c t i v e n e s s o f the  conceptions  university  (1986) and  students  clinical  differences in  f a v o r e d by  Mogan s t u d y College  and  but  they  teacher  shared  who  manner and  or  similar  demonstrated  a sense  of  -121-  Previous not  studies  those this are  which are  over which  the  controlled  affected  by  by  factors  outside  teacher  has  effectiveness  influencing  the  realm of  full  of  the  the  climate  These and  external In  areas:  three  contact  of  b a s e d on  a theoretical  t e a c h e r s must  then,  the  include  knowledge b a s e , a b i l i t y  constitutes evaluating  skills  a major clinical  and  to  teacher  of  the  comments o f  criteria to  the  her of  factors  effectiveness  employer. students  emotional  constitute effectiveness. respondents evaluation  in  of  following  four  feedback,  factors. to  result  clinical  i n the  provide  since  a direct  teacher  environmental  category  factor,  staff,  for  and  setting.  availability,  framework  in  partially  acceptance  clinical  and  which  feedback  only  such  s t u d e n t s by  influencing  factors  hours are  and  control  Students  agreement w i t h  climate  factors  acceptance  communication  i s one  directly attributed  conclusion,  clinical  clinical  contractual  emotional  factors  study,  i n the  her  (knowledge,  do  teacher  control.  those which are  r a t i o s and  s t a f f c a n n o t be  teacher.  and  instructor  instructor's  Similarly,  instructor  behavior  student-teacher the  the  skills),  her  Availability  this  teacher  s t u d y made a d i s t i n c t i o n between t h o s e  communication  by  clinical  d i f f e r e n t i a t e between  effectiveness  of  on  Each o f  consider in  in  nursing.  these  -122-  Conclusions  Based  on  to a r r i v e given  an  clinical  the  of  in this  o p p o r t u n i t y to teachers,  ranking  these  significance  three-year  the  setting. factors  to t h e i r  Secondly,  recall  students  enhanced  a clinical  college  based  i s approachable  expectations and  uses The  are  clearly,  providing  feedback  students.  Four  significant  second  and  teachers are  capable  or  third  the  teachers.  a teacher  teacher  who  t o s t u d e n t s . The  year  states skills  them.  and  clinical are  at communicating  of teacher  that  t o them. T h i r d  demonstrates problem-solving in assisting  of a  differ  clinical  with  available  hand, v a l u e  years  program  of e f f e c t i v e  and  as w e l l as  knowledge as w e l l as  those  importance  i n a number o f a r e a s  types  effective  identifying  conclusion i s that e f f e c t i v e  knowledgeable  with  students  a r e more c o n c e r n e d  self-disclosure third  of  In a d d i t i o n ,  conceptions  other  capable  n u r s i n g diploma  they  the  conclusion i s that  e f f e c t i v e n e s s of  i n the  students  on  reasonable  experiences  i n terms o f  Second-year trust,  first  past  are  i t is  learning.  students  somewhat i n t h e i r  students  study  a t f o u r c o n c l u s i o n s . The  f a c t o r s which within  findings  knowledge a r e  t e a c h e r who  c o n t e x t u a l knowledge  teachers  skilled with  at  staff  and  particularly  possesses  both  content  i s highly valued.  -123-  Those  two  types  o f knowledge, combined w i t h  to  teach  ( p e d a g o g i c a l knowledge) and  to  a large extent  clinical  teacher  importance g o a l s and The  on  the  her  i n an  relationship partially this  effectiveness. clinical  clinical  feedback  these  knowledge o f students'  Nursing  teacher's  teacher's ability  honest  between  due  t o the  study,  students  ability  to p r o v i d e p o s i t i v e  and  caring  student  manner. A  and  teacher's  effective  to p r o v i d e  teacher  feedback  clinical  and  of  less  curriculum,  i s at  negative  least  skills.  instructors  with  empathy,  According  role  interactions  students:  is  trusting  daily  in  model  the  their  congruence  and  regard.  Fourthly, affected  by  realm  the  clinical  extraneous teacher's  determined  teacher  effectiveness i s also  f a c t o r s w h i c h may  be  and  instructor-student ratios.  primarily  by  the number These a r e  c o n t r a c t u a l agreement w h i c h  administrative constraints.  d e c i s i o n s and  The  students  emotional are  be  outside  control. Availability,  may  toward  placed  feedback  of t h e r a p e u t i c communication  teacher's  the l e a r n e r ,  knowledge o f  cornerstones  of  how  conceptions  three  positive  of  objectives.  d e p e n d e n t on  to  constituted  knowledge  similarly  affected  f o r example, contact  hours  a f u n c t i o n of  i n t u r n i s based  s u b j e c t to  c l i m a t e and  of  the  the on  budgetary the by  staff's extraneous  attitude forces  -124-  over are  which  the  keenly  their  aware o f  clinical  Some o f in  clinical  nursing  has  impact  that  little these  control.  Students  f o r c e s have  on  experiences.  these and  however, due  the  teacher  conclusions  medicine  to the  generalizability  on  are  consistent with  clinical  teacher  homogeneous g r o u p  of  findings is  findings  effectiveness  in this  study,  limited.  Implications  The  f i n d i n g s of  curriculum clinical  and  students  since  value  preparatory  developing  second  and  improve  their  for  instructors  clinical  characteristics  Since  can  of  feedback  schools  of n u r s i n g ,  for  this  nursing  communication  f o r nurse  areas.  must  educators focus  skills.  at  for  faculty  about  teachers.  t h a t e v a l u a t i o n of  College  clinical  focus.  emphasized  both  O r i e n t a t i o n programs  information  clinical  skills,  on  Inservice planners  workshops t o h e l p  include  effective  and  levels  teaching  must e n s u r e  students  several implications for  third-year college  design  should  reflects  of  programs  i n these  of n u r s i n g  instructors  and  undergraduate  skills  administrators  have  for college administrators.  knowledge,  schools  new  and  educational  graduate  study  program p l a n n e r s  instructors  First,  the  this  characteristics  related  to  -125-  knowledge,  communication  skills,  clinical  instructors  maintain  current theoretical  to  employ e f f e c t i v e  interactions  with  thus  stress  on  positively Secondly,  different  setting  may  faculty  on  of  the  address  new  students'  appropriate setting.  or  of t h e r a p e u t i c setting self  values,  student  Part-time  e v a l u a t i o n at useful.  they  faculty  their  i n the  problem of a v a i l a b i l i t y  once  onset  be  clinical  students of  and  each  to  discussion  are  i t i s important availability  to  and  O r i e n t a t i o n programs  as w e l l as able  to attempt  t e a c h e r s who  orientation  be  not  students.  Therefore  instructors.  may  may  facilitate  r e g a r d i n g the  content  the  i n order  to at l e a s t  i n c l u d e an  valued  F a c u l t y must become aware  students  basis.  of p a r t - t i m e  theoretical  confidence,  clinical  learning  prefer c l i n i c a l  concerns  should  may  learning.  rapport with  a full-time  staff  their  Therefore, unless  of t h e i r  students  and  third-year nursing students  m i g h t be  t o enhance  on  in  compromised. D i s c u s s i o n s between  behaviors  to  knowledge  clinical  awareness of these  rotation  expectations for  and  skills,  effort  increase their  their  e x p e c t a t i o n s and  Thirdly, employed  and  affecting  conceptions  order  clinical  i n the  as p o s s i b l e and  change t h e i r in  students  second  be  and  interpersonal s k i l l s  characteristics.  as e f f e c t i v e  clinical  must make a c o n s c i o u s  students  t e a c h e r s have an  feedback  students. Application  communication w i t h reduce  and  to  the  t o the  clinical  t o overcome  i t i s recognized  as an  the essential  -126-  component greater  of e f f e c t i v e  faculty  clinical  access  for students  agreements of p a r t - t i m e support  clinical  Lastly, and is  the  preferred learner  learning  needs  as  similarities student  Further  collective  a d m i n i s t r a t o r s can  f o r each  faculty. and  The  the  student  relationship  between  effect  to e x p l o r e  of  feedback  differences  clinical  of  continued  in conceptions  that a f u l l  effective  conceptions  e v a l u a t i o n of c l i n i c a l  I t i s o n l y through  comparisons  clinical  on  the  Study  to continue  and  timing  explored.  for Further  populations  constitutes  college  feedback  a b a s i s f o r the  effectiveness.  modifying  effectiveness.  styles  t o be  is useful  students  by  While p r o v i d i n g  q u e s t i o n of what i s c o n s i d e r e d o p t i m a l  of n u r s i n g  Recommendations  It  staff,  teacher  amount o f p o s i t i v e a concern  instruction.  study of  understanding t e a c h i n g can  student's  teacher of  the  different o f what  be  conceptions  of  obtained.  i s therefore  recommended. Exploring agreement this  the  should  study  effect also  be  of  the  explored  show a s i g n i f i c a n t  effectiveness  of  the  instructors' contractual  clinical  further.  relationship teacher  agreement. Q u a n t i t a t i v e s t u d i e s w i t h populations  are  recommended.  and  I n d i c a t i o n s from between  the  her c o n t r a c t u a l  various nursing  student  -127-  Lastly, may  be  the c o n c e p t u a l  tested  teacher  i n future  effectiveness  educator  may  students  receive  enti tied.  framework  quantitative  provided studies  i n t h e hope t h a t  be e n h a n c e d the best  on  study  clinical  the r o l e o f the nurse  i n the c l i n i c a l education  in this  s e t t i n g and  to which  they are  that  -128-  REFERENCES  A r m i n g t o n , C. L., R e i n i k k a , E.A. and C r e i g h t o n , H. Student e v a l u a t i o n - Threat or i n c e n t i v e ? Nursing Outlook, 20 ( 1 2 ) , 7 8 9 - 7 9 2 .  (1972).  Barham, V. Z. 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F a c t o r s i n f l u e n c i n g c o n g r u e n c e b e t w e e n b e l i e f s , i n t e n t i o n s , and b e h a v i o r i n t h e c l i n i c a l teaching of nursing, Dissertation Abstracts I n t e r n a t i o n a l . Dec.  Pugh,  E. J . ( 1 9 8 6 ) . U s e o f b e h a v i o r a l o b s e r v a t i o n t o a u g m e n t q u a n t i t a t i v e d a t a when s t u d y i n g c l i n i c a l teaching, J o u r n a l o f N u r s i n g E d u c a t i o n . O c t . , 341-343.  Rauen, Reilly,  K. C. ( 1 9 7 4 ) . T h e c l i n i c a l i n s t r u c t o r a s r o l e J o u r n a l o f N u r s i n g E d u c a t i o n . Aug., 3 3 - 3 9 .  model,  D. E . and Oermann, M. H. ( 1 9 8 5 ) . The c l i n i c a l f i e l d , Norwalk, C o n n e c t i c u t : A p p l e t o n - C e n t u r y Crofts.  -132-  Rogers,  C.  (1980).  A way  of being,Boston:Houghton M i f f l i n C o .  Schuman, H. and P r e s s e r , S. q u e s t i o n , American Oct.,  ( 1 9 7 9 ) . The open and c l o s e d S o c i o l o g i c a l Review.  692-712.  Schweer, J . E . and clinical  G e b b i e , K.M. (1976). Creative n u r s i n g . T h i r d Ed., S t . L o u i s :  teaching in C.V. MosbyCo.  Shulman, L. ( 1 9 7 3 ) . Group work s k i l l and e f f e c t i v e c o l l e g e i n s t r u c t i o n , U n p u b l i s h e d D i s s e r t a t i o n , Temple University. Shulman, L . ( 1 9 8 7 ) . Knowledge and t e a c h i n g : F o u n d a t i o n s o f New Reform, H a r v a r d E d u c a t i o n a l Review. Skodol,  W. H. ( 1 9 8 5 ) . R e s e a r c h i n n u r s i n g , Don M i l l s O n t a r i o : A d d i s o n - W e s l e y P u b l i s h i n g Co.  Stafford,  L., and G r a v e s , C. evaluating teaching Aug.,  ( 1 9 7 8 ) . Some p r o b l e m s effectiveness.Nursing  in Outlook.  494-497.  Strauss,  A. L. ( 1 9 8 6 ) . Q u a l i t a t i v e a n a l y s i s f o r s o c i a l s c i e n t i s t s . N e w Y o r k : Cambridge U n i v e r s i t y P r e s s .  Stritter,  F.T., H a i n , J.H., and G r i m e s , D. A. ( 1 9 7 5 ) . C l i n i c a l t e a c h i n g re-examined, J o u r n a l of M e d i c a l Education. (50), 879-882.  Stuebbe,  B. ( 1 9 8 0 ) . S t u d e n t and f a c u l t y p e r s p e c t i v e s on the r o l e of a n u r s i n g i n s t r u c t o r . J o u r n a l of N u r s i n g E d u c a t i o n . 19 ( 7 ) , 4-9.  Tuckman, B.W. ( 1 9 7 8 ) . Conducting educational Second Ed., H a r c o u r t B r a c e J a n o v i c k Van  Ort,  research. Inc., 3 0 9 - 3 5 0 .  S., Noyes, A., and Longman, A. ( 1 9 8 6 ) . D e v e l o p i n g and i m p l e m e n t i n g a model f o r e v a l u a t i n g t e a c h i n g e f f e c t i v e n e s s , Image:Journal of N u r s i n g S c h o l a r s h i p . 18  (3),  114-117.  Wiersma, W. ( 1 9 8 6 ) . R e s e a r c h methods i n e d u c a t i o n F o u r t h T o r o n t o : A l l y n and Bacon I n c . Wilson,  the  H. S. ( 1 9 8 5 ) R e s e a r c h i n n u r s i n g . D o n M i l l s , A d d i s o n - W e s l e y Pub. Co., 395-428.  Ed.,  Ontario:  -133-  Wilson,  S. M. , Shulman, L. S., and R i c h e r t , A. E . ( 1 9 8 7 ) . 150 D i f f e r e n t ways o f knowing: R e p r e s e n t a t i o n s o f knowledge i n t e a c h i n g , E x p l o r i n g T e a c h e r s ' T h i n k i n g . Calderhead, J . ( E d ) , 104-124.  Wittrock,  M. C. ( 1 9 8 6 ) . Handbook o f R e s e a r c h on T e a c h i n g , 3 r d E d . , M a c m i l l a n P u b l i s h i n g Co.: New Y o r k , 1 1 9 - 3 8 9 .  Wong, S. ( 1 9 7 8 ) . N u r s e - t e a c h e r b e h a v i o r s i n t h e c l i n i c a l f i e l d : a p p a r e n t e f f e c t on n u r s i n g s t u d e n t s ' l e a r n i n g , J o u r n a l o f Advanced N u r s i n g . J a n u a r y , 369-372. Zimmerman, L. ( 1 9 8 6 ) . E f f e c t i v e c l i n i c a l b e h a v i o r s o f f a c u l t y : A r e v i e w o f t h e l i t e r a t u r e , N u r s e E d u c a t o r . 11  -134-  APPENDIX A  INTERVIEW SCHEDULE  Thank you f o r a g r e e i n g t o be i n t e r v i e w e d . I am w o r k i n g on a r e s e a r c h p r o j e c t t h a t l o o k s a t n u r s i n g s t u d e n t s ' thoughts about t e a c h e r e f f e c t i v e n e s s i n the c l i n i c a l a r e a . I'm g o i n g t o ask you q u e s t i o n s a b o u t y o u r own e x p e r i e n c e s w i t h i n s t r u c t o r s i n t h e c l i n i c a l s e t t i n g and how you v i e w an e f f e c t i v e c l i n i c a l instructor. The whole i n t e r v i e w s h o u l d t a k e 20 - 30 m i n u t e s . I'd a l s o l i k e to t a p e r e c o r d i t so t h a t I can l i s t e n t o you more c a r e f u l l y now and r e v i e w what you s a i d l a t e r on. Are you a g r e e a b l e t o t h a t ?  QUESTION  1  P l e a s e r e c a l l the most e f f e c t i v e c l i n i c a l i n s t r u c t o r you've had o v e r the l a s t 2 - 3 y e a r s . I t may be an i n s t r u c t o r y o u ' v e had r e c e n t l y or one y o u ' v e had a t a n y t i m e t h r o u g h o u t y o u r c l i n i c a l e x p e r i e n c e . T e l l me a b o u t your e x p e r i e n c e s w i t h t h a t i n s t r u c t o r .  a.  ( I f not a b l e t o r e c a l l the most e f f e c t i v e these probes; - s t i c k s out i n y o u r mind -has l e f t a f a v o r a b l e i m p r e s s i o n  b. What were the s p e c i f i c c h a r a c t e r i s t i c s which enhanced your l e a r n i n g ? (1) T e l l me what you mean by (2) C o u l d you expand on (3) How d i d t h a t make you f e e l ?  of  instructor)  this  use  instructor  c. Of the c h a r a c t e r i s t i c s you've m e n t i o n e d , and I ' l l review them f o r y o u . (You m e n t i o n e d the f o l l o w i n g : , and . Which of t h e s e do you c o n s i d e r t o be the most i m p o r t a n t t o y o u r l e a r n i n g ? I'd  like  t o move on  t o the  next  question  -135-  QUESTION 2  I'd l i k e t o ask a few q u e s t i o n s r e g a r d i n g s p e c i f i c c i r c u m s t a n c e s r e l a t e d t o t h e c l i n i c a l s i t u a t i o n you have j u s t r e c a l l e d f o r me. I s t h a t a l l r i g h t w i t h you?  a. What was t h e c l i n i c a l a r e a ? (If unable to r e c a l l the c l i n i c a l -medical -long-term care -surgical -psychiatry -obstetrics - c r i t i c a l care  area) use t h e s e -pediatric -other  probes;  b. T e l l me a b o u t y o u r a s s i g n e d w o r k l o a d . ( I f unable to r e c a l l the a s s i g n e d workload) use these -team l e a d i n g on a u n i t ? on a team? -how many p a t i e n t s a s s i g n e d ? - l e v e l o f c a r e r e q u i r e d by a s s i g n e d p a t i e n t s ? -degree of a s s i s t a n c e a v a i l a b l e with the care?  c. What was  the s i z e  of your  clinical  d. What was t h e t i m i n g i n t h e program?  group?  (semester  e. Was y o u r c l i n i c a l i n s t r u c t o r a p a r t - t i m e o r a i n s t r u c t o r ? i . e . D i d she a l s o t e a c h c l a s s r o o m  I'd  like  to conclude  this  probes;  interview with  &  rotation)  full-time content?  a few g e n e r a l q u e s t i o n s .  QUESTION 3 You have been t o a number o f c l i n i c a l a r e a s by now and have had a minimum o f t h r e e c l i n i c a l i n s t r u c t o r s . I'm g o i n g t o ask y o u about your o p i n i o n r e g a r d i n g the t e a c h i n g c h a r a c t e r i s t i c s o f these instructors.  -136-  In y o u r o p i n i o n , what 3 q u a l i t i e s o f t h o s e i n s t r u c t o r s was most c r i t i c a l t o y o u r l e a r n i n g ? (These may d i f f e r somewhat f r o m t h e ones you i d e n t i f i e d e a r l i e r o r t h e y may be t h e same) 1. 2. 3. Please  rank  those q u a l i t i e s  from most  to l e a s t  important.  O t h e r t h a n a l l o f t h e f a c t o r s you've m e n t i o n e d i s t h e r e a n y t h i n g e l s e t h a t a f f e c t e d your l e a r n i n g c l i n i c a l l y ?  THANK  YOU!  -140Summary  of  purpose  and  objectives  -  continued  r e s p o n s i b l e f o r d e t e r m i n i n g s t u d e n t - i n s t r u c t o r r a t i o s and for a s s i g n i n g f a c u l t y to c l i n i c a l areas w i t h s t u d e n t s r e q u i r i n g v a r i o u s l e v e l s of s u p e r v i s i o n . I t w i l l a l s o determine w h e t h e r t e a c h i n g e f f e c t i v e n e s s i s e n h a n c e d by assigning f a c u l t y t o t e a c h n u r s i n g t h e o r y and c l i n i c a l p r a c t i c e c o n c u r r e n t l y s i n c e f a c u l t y e m p l o y e d on a p a r t - t i m e seasonal b a s i s do n o t c o n c u r r e n t l y t e a c h n u r s i n g theory.  12 Summary o f m e t h o d o l o g y  and p r o c e d u r e s .  The m e t h o d o l o g y f o r t h i s s t u d y i s p h e n o i l i e f i o g r a p h i c , w h i c h i s a v a r i a t i o n o f phenomenology (Marton e t . a l ) . I t i s designed t o d e s c r i b e s t u d e n t n u r s e s ' p e r c e p t i o n s o f e f f e c t i v e c l i n i c a l i n s t r u c t o r s b a s e d o n t h e i r own u n i q u e c l i n i c a l experiences. Random s a m p l e s o f s t u d e n t s c u r r e n t l y e n r o l l e d i n t h e s e c o n d a n d t h i r d y e a r s of a community c o l l e g e n u r s i n g p r o g r a m w i l l be i n t e r v i e w e d u s i n g a s e m i s t r u c t u r e d i n t e r v i e w s c h e d u l e . The i n t e r v i e w w i l l c o n s i s t o f t h r e e b r o a d q u e s t i o n s i n c l u d i n g some d e m o g r a p h i c d a t a i n o r d e r t o f a c i l i t a t e u n i f o r m data c o l l e c t i o n f o r a n a l y s i s . R e s p o n d e n t p r o f i l e s w i l l be g a t h e r e d w i t h i n e a c h i n t e r v i e w t o f a c i l i t a t e t h e c o l l e c t i o n o f demographic d a t a . Audiotaped i n t e r v i e w s w i l l be t r a n s c r i b e d and s t u d e n t s w i l l b e p r o v i d e d w i t h a c o p y o f t h e i r t r a n s c r i p t f o r c o n t e n t verification. C o n t e n t a n a l y s e s o f t h e t r a n s c r i p t s w i l l be c a r r i e d o u t v i a t h e c o n s t a n t comparative methodology. C a t e g o r i e s o f d e s c r i p t i o n s w i l l be g e n e r a t e d from the e m p i r i c a l d a t a . D e s c r i p t i v e c a t e g o r i e s w i l l t h e n be c o l l a p s e d t o y i e l d an a n a l y t i c a l map o f s t u d e n t s ' p e r c e p t i o n s o f t e a c h e r e f f e c t i v e n e s s i n v a r i o u s c l i n i c a l areas a t v a r y i n g stages i n t h e i r growth and development as s t u d e n t n u r s e s . D e s c r i p t i v e s t a t i s t i c s w i l l be u s e d t o a n a l y s e t h e d a t a generated from t h e respondent p r o f i l e s e c t i o n o f t h e i n t e r v i e w s .  DESCRIPTION  OF POPULATION  13 How many s u b j e c t s How 14 Who  many  will  in the control  i s being  recruited  be u s e d ? 3 group?  0 N/A  a n d what a r e t h e c r i t e r i a f o r t h e i r  selection?  -second and t h i r d year n u r s i n g students e n r o l l e d i n t h e Cariboo c o l l e g e diploma n u r s i n g program d u r i n g t h e w i n t e r semester ( J a n A p r i l ) o f 1988. -fifteen  randomly  s e l e c t e d students  from  second  and t h i r d  year.  -14215  Wnat  subjects  will  be e x c l u d e d  from p a r t i c i p a t i o n ?  S i x t e e n RPN ( r e g i s t e r e d p s y c h i a t r i c n u r s e ) a c c e s s s t u d e n t s who j o i n e d the t h i r d y e a r o f t h e C a r i b o o C o l l e g e d i p l o m a p r o g r a m i n S e p t . 1987 and who g r a d u a t e i n M a r c h 1 9 8 8 .  16 How a r e t h e s u b j e c t s b e i n g r e c r u i t e d ? ( I f I n i t i a l c o n t a c t Is b y l e t t e r o r 1f a r e c r u i t m e n t n o t i c e 1s to be p o s t e d , a t t a c h a c o p y . ) NOTE t h a t UBC p o l i c y a b s o l u t e l y p r o h i b i t s i n i t i a l c o n t a c t by t e l e p h o n e .  - f i f t e e n s t u d e n t s f r o m each y e a r (second and t h i r d ) w i l l be r a n d o m l y s e l e c t e d b y u s e o f a t a b l e o f random n u m b e r s . Those s e l e c t e d w i l l be i n v i t e d by l e t t e r t o p a r t i c i p a t e i n t h e s t u d y .  17 I f a c o n t r o l g r o u p prov ide d e t a i1s .  i s involved,  and If t h e i r  s e l e c t i o n and/or  recruitment  differs  from  t h e above,  N/A  PROJECT  |  DETAILS —  18 Where w i l l  :  the p r o j e c t  be c o n d u c t e d ?  Interviews w i l l take place college, Science B u i l d i n g , 19 Who  will  a c t u a l l y conduct  Claudette  (room or a r e a )  i n t h e r e s e a r c h e r s o f f i c e S007 a t C a r i b o o K a m l o o p s , B.C. p h o n e : 8 2 8 - 5 4 3 6  the study?  Kelly  20 W i l l t h e g r o u p o f s u b j e c t s h a v e a n y p r o b l e m s g i v i n g i n f o r m e d c o n s e n t p h y s i c a l o r mental c o n d i t i o n , age. language, o r other b a r r i e r s .  on t h e i r  own b e h a l f ?  Consider  No  21  If the s u b j e c t s  a r e not competent  to give  fully  Informed c o n s e n t ,  who w i l l  consent  on t h e i r  behalf?  N/A  22 What on t h i s  i s known a b o u t issue?  the r i s k s  a n d b e n e f i t s of t h e p r o p o s e d  T h i s r e s e a r c h e r i s unaware o f any r i s k s of t h e p r o p o s e d r e s e a r c h a r e p r e v i o u s l y  research?  Do y o u h a v e a d d i t i o n a l  opinions  of the proposed research. Benefits o u t l i n e d ( s e e #8 o f t h i s f o r m ) .  -14323 What d i s c o m f o r t procedures?  or incapacity  are the subjects  likely  t o endure as a r e s u l t of the experimental  None  24 I f m o n e t a r y schedules.  compensation  i s t o be o f f e r e d  the s u b j e c t s ,  provide  d e t a i l s o f a m o u n t s a n d payment  N/A  25  How  much  20 2E  How  time w i l l  a subject  have  to dedicate  to the project?  - 30 m i n u t e s much  time  will  a member o f t h e c o n t r o l  group  ( i f any) have  to dedicate  j  to the p r o j e c t ?  N/A  1  ,  i  DATA  12 7 wro w i l l  have a c c e s s  t o the data?  O n l y t h e r e s e a r c h e r a n d h e r s u p e r v i s i n g c o m m i t t e e a t U.B.C. h a v e a c c e s ; to t h e t a p e d i n t e r v i e w s and t r a n s c r i p t s . S t u d e n t s w i l l be g i v e n a copy of t h e i r t r a n s c r i p t s . 28  How  will  c o n f i d e n t i a l i t y o f t h e d a t a be m a i n t a i n e d ?  Subjects w i l l A l l data w i l l  be i d e n t i f i e d by number o n l y . be c o d e d a n d s t o r e d i n t h e c o m p u t e r .  29 What a r e t h e p l a n s f o r f u t u r e w i l l the d a t a be d e s t r o y e d ?  use of the data  (beyond  D a t a may e v e n t u a l l y b e made a v a i l a b l e , to o t h e r r e s e a r c h g r o u p s . 30 w i l l any d a t a Un i v e r s i t y ?  No  which  identifies  that  with  described  in this  protocol)?  identification  i n d i v i d u a l s be a v a i l a b l e t o p e r s o n s  or agencies  How  and w  deleted,  outside the  CHECKLISTS  -14431  Will  your  project  | }  use:  (check)  Questionnaires  |~xl Q  (submit  a  copy)  Interviews  (submit  a sample of  Observations  (submit  a brief  Tests  (submit  a brief  questions)  description)  description)  INFORMED CONSENT  32  Who  will  consent?  [ 3 T j j  ]  (check)  Subject Parent/Guardian  fjx] Agency I n the c a s e t h a t agency  O f f i c i a l (s)  of p r o j e c t s c o n s e n t has  c a r r i e d out at other i n s t i t u t i o n s , the been r e c e i v e d . P l e a s e s p e c i f y below:  j  | Research  |  | Research c a r r i e d out i n a school - approval of School B o a r d r e a u i r e m e n t s d e p e n d on i n d i v i d u a l s c h o o l b o a r d s ; c h e c k w i t h members f o r d e t a i l s )  [~~]  Research  [x]  other,  carried  out  carried  out  in a hospital  - approval  in a Provincial  of  Committee  hospital  H e a l t h Agency  requires  r e s e a r c h or  written  ethics  proof  committee.  and/or P r i n c i p a l . ( E x a c t F a c u l t y o f E d u c a t i o n Comnrt-.ee  - approval  of D e p u t y  Minister  Cariboo College Administration (see attached letter o f p e r m i s s i o n f r o m D r . D. C a n e , V i c e - P r e s i d e n t , Cariboo College.  specify:  33 UBC P o l i c y r e c j i r e s w r i t t e n s u b j e c t c o n s e n t i n a l l c a s e s o t h e r t h a n q u e s t i o n n a i r e s whi c h a r e orro'eted by t h e s u b j e c t . ( s e e item #34 f o r c o n s e n t r e q u i r e m e n t s ) P l e a s e c h e c k e a c h item i n t h e f o l l o w i n g l i s t b e f o r e s u b m i s s i o n of t h i s form to e n s u r e t h a t t h e w r i t t e n c o n s e n t f o r m a t t a c h e d c o r - s - r : a l l n e c e s s a r y items. QH  Title  fx]  Identification  pTTj  B r i e f b u t c o m p l e t e o e s c r i p t i o n IN LAY p r o c e d u r e s t o be c a r r i e d o u t i n wnich  [x]  Assj-ance this will  t h a t i d e n t i t y of be a c c o m p l i s h e d  QO  Statement  of  •'''A [II [x]  of  Details  project  of  of  the  investigators  total  monetary  the  amount  (including  suDject  of  compensation,  time  a telephone  number)  LANGUAGE o f t h e p u r p o s e of the s u b j e c t s a r e I n v o l v e d . will  that  i f any.  be  kept  will  be  t o be  confidential  required  offered  to  of  the p r o j e c t  and  and  description  of  a"'  o f rc..  a subject  subjects.  An o f f e r t o a n s w e r any i n q u i r i e s c o n c e r n i n g t h e p r o c e d u r e s t o e n s u r e u n o e - s t o o d by t h e s u b j e c t and t c c r o v i d e d e b r i e f i n g i f a p p r o p r i a t e  that  they  are  fu'i/  f x ) A s t a t e m e n t o f the s u b j e c t ' s r i g n t t o r e f u s e t o p a r t i c i p a t e o r w i t h d r a w a t a n y t i m e a~c e s t a t e m e n t t h a t w i t h d r a w a l or r e f u s a l t o p a r t i c i p a t e w i l l not j e o p a r d i z e f u r t h e r t r e a t - = n r . m e d i c a l c a r e or i n f l u e n c e c l a s s s t a n d i n g a s a p p l i c a b l e . NOTE: T h i s s t a t e m e n t m u s t eU: a c c e a - on l e t t e r s of i n i t i a l contact. ;£)  A p a c e f o r s i g n a t u r e of s u b j e c t CONSENTING t o p a r t i c i p a t e i n v e s t i g a t i o n o r s t u d y and ACKNOWLEDGING r e c e i p t of a c o p y a1 a t tachements. 1  In of  the the  research project, c o n s e n t form incluc-g  QUESTIONNAIRES  (completed  by  -145-  subjects)  34 Q u e s t i o n n a i r e s s h o u l d c o n t a i n an i n t r o d u c t o r y p a r a g r a p h w h i c h i n c l u d e s t h e f o l l o w i n g I n f o r m a t i o n . P l e a s e c h e c k e a c h Item i n t h e f o l l o w i n g l i s t b e f o r e s u b m i s s i o n o f t h i s f o r m t o I n s u r e t h a t t h e i n t r o d u c t i o n contains a l l necessary items. Q  Title  of  project  |  | Identification  |  | A brief  r j  The  rj  A full  of  summary  i n v e s t i g a t o r s ( i n c l u d i n g a telephone  that  b e n e f i t s to te  i n d i c a t e s t h e p u r p o s e of  the  number)  project  derived  d e s c r i p t i o n of  the  procedures  t o be  carried  out  i n which  the  subjects  are  involved  |  | A s t a t e m e n t o f t h e s u b j e c t ' s r i g h t t o r e f u s e to p a r t i c i p a t e o r w i t h d r a w a t any t i m e without j e o p a r d i z i n g f u r t h e r treatment, medical c a r e or c l a s s s t a n d i n g as a p p l i c a b l e NOTE: T h i s s t a t e m e n t must a l s o a p p e a r on e x p l a n a t o r y l e t t e r s i n v o l v i n g q u e s t i o n n a i r e s .  |  | the  K/A  The has Q  f~[  amount  of  time r e q u i r e d  statement that been g i v e n  i f the  of  the  subject  questionnaire  A s s u r a n c e t h a t i d e n t i t y o f the t h i s w i l l be a c c o m p l i s h e d .  subject  For  submit  of  surveys the  circulated  by  mail  must be  stated  is completed  will  be  kept  a c o p y of  the  it will  be  confidential  explanatory  assumed  and  that  consent  d e s c r i p t i o n of  letter  as  well  as  how  a copy  questionnaire  ATTACHMENTS  35  Check  items a t t a c h e d [3  JJ/^Q  L e t t e r of  to  initial  Advertisement [ 3 3 Subject  consent  Control  N./AO  Parent/guardian  Questionnaires,  r j ]  Explanatory Other,  form  (item form  consent (item  specify:  16)  subjects  (item  16)  33) (if different  form  from  (if different  above)  from  above)  32)  tests,  letter  if applicable, (incomplete  (item  volunteer  grouo corsent  Agency c o n s e n t  M / A D  submission contact  for  X /A CD  [j§  this  with  interviews, etc. questionnaire  (item  (item  31) 34)  submissions w i l l  not  be  reviewed)  -146-  APPENDIX  SUBSTANTIVE  C  CODES GENERATED FROM DATA  Approachability Availabi1i ty  Positive  Regard  Calm  Positive  attitude  mariner  Caring  attitude  Communication  skills  Questioning Role  modelling  Confidentiality  Sense o f humor  Congruence  Self  Empathy  Student  Enthusiasm  Teaching  Expectations  Trust  Fai rness Feedback Follow  up  Honesty I n d i v i d u a l i z a t i on Integration Intimidating Joy  manner  of t e a c h i n g  Knowledge Personality  disclosure advocate skills  

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