Trusting Relationships: Creating a Conducive Teaching and Learning Environment

Saturday, 7 November 2015

Gisela H. Van Rensburg, DLittetPhil, MACur, BACur (Hons), BACur, RN, RM, RCN, RPN1
Ellie C. van Dyk, MACur, BACur, BCur, RN2
Elsie Sophia Janse van Rensburg, DCur, MCur, BA (Hons) (Psych), BCur1
(1)Department of Health Studies, University of South Africa, Pretoria, South Africa
(2)Department of Health Studies, University of South Africa, PRETORIA, South Africa

ABSTRACT – Trusting relationships: creating a conducive teaching and learning environment

Trust is regarded as the cornerstone of a society and the ‘glue’ to maintain social order, but also the emotional glue that binds leaders and employees together in leadership (Bell & Duffy 2009:50; Rotenberg, Fox, Green, Ruderman & Slater 2005:271). Dodgson (1993:83) defines trust to be “a state of mind, an expectation held by one partner about another that the other will behave in predictable and mutually acceptable manner. Trust is an essential component of nursing practice and nurse education is potentially influenced upon the formation of trust and distrust in the health care (Pask 1995:190). McCabe (2006:252) argues that nursing is a trusted profession and is perceived on issues of honesty and ethics. The average person refers nursing to caring and the word nurse is a significant term of a clear identity with compassion, caring, and collective comfort which give respect to the profession. It is then imperative to build and maintain professional trust in nursing education where educators, students and professional nurses can rely on quality teaching and performances in the teaching and learning environment for future trust in nursing.

The purpose of the research was to explore the needs of students and the views of educators’ regarding trust in the teaching and learning environment of nursing education and to identify strategies to make recommendations in order to develop a model of trust for the nursing education environment. The research was guided by the following objectives. The objectives were to: identify the building blocks of trust for the nursing education environment; discover the value of the building blocks of trust in the nursing education environment; identify strategies to build the trust in the teaching and learning environment and to enhance the performance of students to become a competent professional nurse; make recommendations to build trust in the nursing education environment; and, develop a model of trust that will foster trust relationships in the nursing education environment.

The research was a qualitative grounded theory approach because it follows a systematic approach to data collection and analysis to discover the value of trust in the nursing education environment and to develop a model. A qualitative research was systematic and aimed to describe meanings and experiences to understand the phenomenon. The model for trust is grounded in the reality with the utilisation of a grounded theory approach with a systematic collection of data, categorising them and describes the emerging central phenomenon in the context of the nursing education environment.

The target population in this research consists of two groups which were educators and students, involved at accredited nursing education institutions (NEI). The educators were registered at the South African Nursing Council as professional nurses with a nursing education qualification working at a NEI as an educator. Students were in their third and fourth year at a NEI registered in a programme leading to the registration as a professional nurse. The accessible population was at NEI’s of a university and colleges which are in the Free State namely the University of the Free State and the three campuses of the Free State School of Nursing.

In this research fourteen face to face interviews were conducted with female educators between the ages of fourty to sixty. Sixty-four students between the ages of twenty to thirty-four years participated in fifteen focus group interviews. Interviews were digitally recorded with informed permission from the participants. Data collection was collected concurrently with literature review. The interviews were conducted until theoretical saturation was evident.

Four categories in the open coding emerged which are important for trust in the teaching and learning environment. They are the educator, student, professional nurse and the context of the nursing education. The categories and subcategories are interrelated to each other. Competencies such as expert knowledge regarding the subject of interest were expected from educators. Educators should be equipped with knowledge and skills pertaining teaching methods and applying it in the classroom or simulation environment. Clinical skills enable educators to integrate the theory and practice. These skills make effective clinical accompaniment possible to students. Student competencies include expectations of creativity and evidence to take responsibility for their own learning. The development of critical thinking is essential for the ability to integrate the theory and practice in the clinical learning environment. The competencies of the professional nurse include their knowledge about nursing, as well as the expected clinical experience in the specific clinical learning environment. The role of facilitating and accompaniment of student specifies the ability of the professional nurse to transfer knowledge and experience to students and create clinical learning opportunities to integrate the theory and practice.  

In the shared subcategory of professional credibility, the educator, student and professional nurse need trustworthy attributes such as openness, reliability, honesty, reliability, benevolence and integrity. These trustworthy attributes’ are based on the expectation and internalising of professional virtues, ethical codes and values. In the presence of professional virtues the expected professional ethical conduct and role modelling will emerged. Educators, students and professional nurses required the demonstration of professional credibility and intentions amongst each to promote trust in the nursing education environment.    

Trusting relationships amongst the educator, student and professional nurse resulted in benefits of trust in the educators and students. Trust in the educator plays a role in their own self-trust and the relationship with students. Students experiencing trust from the educator and professional nurse expressed how it influences their motivation, confidence, self-trust and performance in both theoretical and clinical learning environment. Disadvantages of trust in the educator and student lead to the opposite of the trust and mistrust resulted in negative relationship between them. Trusting relationships are supported with consistencies and congruencies in expected professional intentions and behaviour. Trust experiences in the teaching and learning affect the views of the program leading to a professional nurse and the end product as a professional.        

The fourth category which arose from this research was the context of nursing education. In the teaching and learning context there should have been sufficient human resources such as educators, professional nurses and preceptors to mentor students and facilitate learning. The resources were not only restricted to availability of the mentioned but also the availability of adequate equipment, in the theoretical and clinical learning environment such as access to information medical, pharmaceutical and material supplies in the clinical learning environment. Furthermore, the theoretical learning environment educators’ teaching skills, support and students’ learning abilities optimise trust in the context. Professional nurses teaching role and clinical support to student enhance the students learning opportunities. Integration of knowledge and skills acquired has to take place in the theoretical and clinical learning environment, where the educator and professional nurse assist the student to relate the practical exposure and learning to their theoretical content and outcomes. Maintaining of standards includes standards of educator, student and professional nurse as well as the theoretical and clinical environment.   

Trust and interpersonal trust in the nursing education environment is essential to optimise the education and learning opportunities for students.

Strategies and recommendations regarding trust and trust relationships focus to building, maintaining, enhancing trust and preventing mistrust. A model was developed to promote trust amongst educators, students and professional nurses, as well as the context of education and training.