Nursing Students' Perceptions of Faculty Trustworthiness: Thematic Analysis of a Longitudinal Study

Sunday, 22 July 2018: 11:15 AM

Lynn M. Varagona, PhD, MSN, MBA, RN, PMHCNS-BC
WellStar School of Nursing, Kennesaw State University, Kennesaw, GA, USA
Judith L. Hold, EdD, RN
Wellstar School of Nursing, Kennesaw State University, Kennesaw, GA, USA

Research has repeatedly found trust to be a significant component of effective interpersonal relationships and groups (e.g., Clark & Payne, 2006) and related to a number of important outcomes such as cooperation, performance, commitment, and profitability (e.g., Bijlsma-Frankema et al., 2008; Den Hartog & DeHoogh, 2009). In healthcare, the presence of trust in nurses’ work relationships has been favorably associated with outcomes such as (a) lower frequencies of adverse patient outcomes (Wong & Giallonardo, 2013), (b) nurse well-being and team commitment (Lehmann-Willenbrock et al., 2012), (c) physician-nurse collaboration (Tang et al., 2013), (d) low levels of missed nursing care (Kalisch et al., 2012), and (e) emotional exhaustion, burnout, and cynicism among nurses (Bobbio & Manganelli, 2015).

Relatively fewer studies can be found on the impact of trust in higher education. Student trust in faculty has been favorably related to outcomes such as (a) student class participation (Demirtas, 2016), (b) students’ academic self-concept (McClain & Cokley, 2017), (c) increased student out-of-class communication with instructors, and (d) student motivation and empowerment (Corrigan & Chapman, 2008). Even fewer studies can be found on nursing student trust in faculty. One exception is Scarbrough (2013), who found nursing student trust in faculty to be significantly related to students’ total mood disturbance—particularly anger and confusion.

Researchers have tended to focus more on the outcomes of trust than on the processes and characteristics that foster it. Developing a culture of trust – in order to realize the benefits that come from it – involves establishing what the nature and content of trust-based cultures should be (Tyler & Blader, 2000). Perceived trustworthiness—perception of whether a trustee manifests characteristics which indicate that he/she will likely act in the trustor’s interests in a situation entailing risk (Bews & Rossouw, 2002)—is one of two main antecedents to trust. More work is needed to understand how perceived trustworthiness can be created (Sekhon et al., 2014).

Purpose:

The purpose of this longitudinal study was to explore nursing students’ perceptions of faculty trustworthiness (i.e., characteristics which indicate that a faculty member will likely act in the nursing student’s interests in a situation entailing risk; Bews & Rossouw, 2002).

Methods:

This exploratory, longitudinal study used focus groups to generate qualitative data. Before commencing each focus group, a consent form was distributed, read aloud, and participants’ questions were answered by the focus group facilitator(s). Included in the consent form was approval to audio record the focus group sessions.

At a state university located in the southeastern United States, purposeful sampling was used to recruit baccalaureate nursing students during the beginning, middle, and end of their advancement through the nursing school curriculum. Two cohorts of nursing students beginning in the Fall of 2015 and Spring of 2016 were invited to participate. In all, 78 nursing students participated; 66 females and 12 males. The mean age was 28 years with a range from 20 to 42. Most students were Caucasian (n =62), followed by African Americans (n=8), Asians (n=5), and Hispanics (n=3).

Recruitment occurred via email and announcements during a required nursing course lecture approximately two weeks before the focus groups were scheduled. A brief overture of the study was provided and students were given an opportunity to ask questions.

Open ended questions, designed from reviewing the research literature on trust, guided the focus group interviews to obtain students’ perceptions about their experiences with faculty members who gained, lost, and/or re-established the student’s trust. Each focus group commenced with participants completing a demographic questionnaire. Eleven focus groups were conducted during a two-year period, from Fall of 2015 to Spring of 2017, as each cohort progressed through the nursing curriculum.

The researchers chose thematic analysis to generate themes from the focus group interviews. Braun & Clarke’s (2006) thematic analysis process was used. To become familiar with the data, the researchers independently read the transcripts several times. Specific data passages were manually underlined and assigned appropriate codes by each researcher. After all the codes were individually generated, the researchers collaborated to collapse and collate the codes to form main themes and sub-themes. Codes that were not aligned with the study’s purpose were discarded. Three themes reflective of the qualitative data were identified at the conclusion of the analysis.

Results:

Three major themes related to nursing students’ perceptions of faculty who form, lose and re-establish students’ trust were identified: Being Giving of Oneself, Being Competent, and Being Ethical.

The theme Being Giving of Oneself revealed how some nursing faculty members went beyond their job duties to give of themselves to build and maintain a student-faculty relationship characterized by trust. Caring acts showing compassion for students did not go unnoticed. Participants emphasized that faculty gave of themselves in various ways, such as taking a personal interest in students’ lives and spending time with them to ensure understanding of content. Through these acts of kindness bestowed onto students, success was fostered as students believed they had clear expectations on how to succeed while faculty took on the role of student advocate. Faculty who went the extra mile to give of themselves were approachable as seen in their nonverbal cues and positive attitudes. Participants saw faculty who engaged in trusting relationships as genuine. For example, trusted faculty members frequently told stories about their nursing experiences even if their recounts made them vulnerable.

Participants viewed faculty members who engaged in trusting relationships with students as competent in the subject matter and teaching. In their teaching, trusted faculty members demonstrated trustworthiness through revealing a comprehensive knowledge base of content as well as a passion for nursing. Faculty who gained and maintained students’ trust were competent in their teaching skills, as revealed in their abilities to create fair tests and engage students in class lectures.

Faculty perceived as trustworthy were viewed by the participants as ethical people. They seemed open-minded and truthful in their interactions with students. Trusted faculty members showed respect through meeting students where they were at and not having unrealistic expectations or pre-judgments. Listening, validating, and answering questions were specific ways in which faculty demonstrated respect.

While relatively few global nursing research articles examine the impact of students’ trust in faculty members, a number of studies have looked at the impact on nursing students of particular faculty characteristics or behaviors related to the study findings. Being Giving of Oneself was associated with participants liking an instructor and feeling welcomed, included, and valued. Participants reported that these led to liking an instructor’s class more, as well as increased motivation, self-confidence, capacity to learn and likelihood of approaching the instructor about academic issues. These findings support related nursing research (e.g., Chan et al., 2017; Dale et al., 2013; Levett-Jones et al., 2009).

Being Competent was associated with teaching ability, the ability to manage a course and its components well, and professional competence. These findings support prior nursing research pertaining to nursing faculty effectiveness and civility (e.g., Clark et al., 2009; Tang et al., 2005).

Being Ethical was associated with faculty civility. Participants reported that uncivil behavior on the part of faculty members has led them to experience negative emotions such as anger or frustration, decreased confidence, increased stress, increased anxiety, decreased trust, dissatisfaction with the nursing program, and, at times, a negative impact on their learning. These findings also support related nursing research literature results (e.g., Caza & Cortina, 2007; Clark, 2008; Del Prato, 2013; Feldman, 2001; Marchiondo et al., 2010; Mott, 2014; Tiberius & Flak, 1999).

This study contributes to the literature by identifying antecedents of nursing students’ perception of faculty trustworthiness. In addition, it supports findings from prior research regarding related nursing student-faculty experiences.

Limitations of this study include use of a convenience sample consisting of a relatively small number of nursing student cohorts who attended the same university. Limitations also included the lack of quantitative data such as nursing student performance.

Future research should include outcome measures such as nursing student satisfaction, retention or academic success. The study should be replicated at other types of nursing programs, in other areas of the US, and in other parts of the world.

Conclusion:

This study begins to shed light on nursing faculty characteristics and behaviors that lead students to perceive faculty members as trustworthy. Not much research literature exists regarding nursing student perception of faculty trustworthiness and the impact of such perception. Given the vast research literature identifying the favorable impact of trusting relationships, nursing education will likely benefit from further exploring the impact on nursing students of perceived faculty trustworthiness.

The study findings can provide guidance to nursing faculty regarding how to promote students’ perceptions of faculty trustworthiness. Doing so may contribute to favorable student outcomes such as engagement in their learning, academic success, and decreased program attrition—thereby benefitting the global nursing shortage.