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Faculty Caring Behaviors in Online Nursing Education: An Integrative Review

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Title: Faculty Caring Behaviors in Online Nursing Education: An Integrative Review
Language: English
Authors: Jones, Kate (ORCID 0000-0002-0743-4771), Raynor, Phyllis (ORCID 0000-0002-7311-0978), Polyakova-Norwood, Vera
Source: Distance Education. 2020 41(4):559-581.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 23
Publication Date: 2020
Document Type: Journal Articles
Information Analyses
Education Level: Higher Education
Postsecondary Education
Descriptors: Nursing Education, Nursing Students, Graduate Students, College Faculty, Teacher Student Relationship, Teacher Behavior, Caring, Feedback (Response), Learner Engagement, Communities of Practice, Inquiry, Electronic Learning, Virtual Classrooms, Distance Education, Educational Research
DOI: 10.1080/01587919.2020.1821601
ISSN: 0158-7919
Abstract: As online programs for nursing education continue to grow, nursing faculty must develop strategies for engaging with and supporting students in this form of distance learning. The concept of caring, which is central to nursing education, overlaps with teaching and social presence concepts from the community of inquiry model in education. After reviewing both distance education and nursing literature for background, we conducted an integrative review of studies focusing on online graduate nursing education. We found consistency in the types of faculty behaviors that were described, and that those behaviors aligned with our definition of caring. Implications for distance education include the need to better prepare faculty for online teaching so that they can be intentional about implementing caring behaviors when designing and delivering online education.
Abstractor: As Provided
Entry Date: 2020
Accession Number: EJ1275003
Database: ERIC
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  Value: <anid>AN0146822917;5f001nov.20;2020Nov06.01:44;v2.2.500</anid> <title id="AN0146822917-1">Faculty caring behaviors in online nursing education: an integrative review </title> <p>As online programs for nursing education continue to grow, nursing faculty must develop strategies for engaging with and supporting students in this form of distance learning. The concept of caring, which is central to nursing education, overlaps with teaching and social presence concepts from the community of inquiry model in education. After reviewing both distance education and nursing literature for background, we conducted an integrative review of studies focusing on online graduate nursing education. We found consistency in the types of faculty behaviors that were described, and that those behaviors aligned with our definition of caring. Implications for distance education include the need to better prepare faculty for online teaching so that they can be intentional about implementing caring behaviors when designing and delivering online education.</p> <p>Keywords: online learning; caring; social presence; faculty behaviors</p> <p>Over 1.1 million graduate students took at least one distance education course in 2016, which is an increase of almost 28% from 2012 (Seaman et al., [<reflink idref="bib27" id="ref1">27</reflink>]). Distance education includes multiple delivery mechanisms, including asynchronous online education (Seaman et al., [<reflink idref="bib27" id="ref2">27</reflink>]), which allows for greater flexibility with students' time and course scheduling making it an appealing option for working adults returning to school to pursue graduate education. In nursing, distance education is available at the undergraduate, master, and doctoral levels. The Commission on Collegiate Nursing Education in the United States of America (2019, p. 5) recognizes programs offered partially or entirely online by considering such programs for national accreditation. The Institute of Medicine's landmark report "The Future of Nursing" ([<reflink idref="bib19" id="ref3">19</reflink>]) included, as its second key message, that "nurses should achieve higher levels of education and training through an improved academic system that promotes seamless academic progression" (p. 163). The number of graduate degrees awarded in nursing increased from approximately 10,000 per year in 2002 to approximately 38,000 in 2014 (Buerhaus et al., [<reflink idref="bib7" id="ref4">7</reflink>]).</p> <p>The increase in graduate nursing education combined with the growth of distance education presents unique challenges for schools and colleges of nursing. Nursing requires discipline-specific psychomotor, cognitive, and affective skills that translate into authentic caring behaviors (Brown, [<reflink idref="bib6" id="ref5">6</reflink>]). Nursing programs that aspire to prepare students with these competencies need to be intentional about curricular design elements that support these outcomes (Brown, [<reflink idref="bib6" id="ref6">6</reflink>]). A team of educators at a large college of nursing in the Southeastern United States had an interest in exploring the concept of caring in distance education. The purpose of this study was to review online education and nursing education literature to identify specific faculty behaviors that convey caring to nursing graduate students in online learning environments. Although distance education is a broad term that encompasses many delivery methods, including online, CD-ROM, DVD, and audioconferencing (Seaman et al., [<reflink idref="bib27" id="ref7">27</reflink>]), the focus of this review was online education.</p> <hd id="AN0146822917-2">Engaging and supporting students in online education</hd> <p>From the early days of online education, educators and scholars have been exploring ways to construct learning environments, where students can successfully pursue educational goals and feel welcome, safe, encouraged, motivated, and engaged with the subject matter and with their professors and fellow learners. Garrison et al. ([<reflink idref="bib13" id="ref8">13</reflink>]) developed the community of inquiry (COI) framework for computer-mediated communication in higher education, consisting of cognitive presence, social presence, and teaching presence as a guide for course development, teaching, and research. Cognitive presence, which is crucial to success in higher education, is the extent to which the participants in a COI engage in critical thinking and construct meaning through sustained communication (Garrison et al., [<reflink idref="bib13" id="ref9">13</reflink>]). Social presence is the ability of participants to project their personalities through a medium of communication, develop interpersonal relationships, identify with the community, and communicate purposefully in a trusting manner (Garrison, [<reflink idref="bib12" id="ref10">12</reflink>]). Teaching presence is the "binding element" in the COI, as it supports the development of social and cognitive presence, and it includes design and organization, facilitation of the discourse, and direct instruction (Garrison et al., [<reflink idref="bib13" id="ref11">13</reflink>]). These three presences intersect and work together to form a foundation for a successful learning experience.</p> <p>Anderson et al. ([<reflink idref="bib1" id="ref12">1</reflink>]) provided a useful delineation of the teaching presence roles and behaviors by grouping teaching behaviors under the three primary roles of the online teacher: instructional design and administration (setting curriculum, designing methods, establishing time parameters, establishing netiquette); discourse facilitation (identifying areas of agreement or disagreement, seeking consensus, setting the climate, drawing in participants); and direct instruction (posing questions, focusing discussion, summarizing, diagnosing misconceptions, providing explanations, responding to technical concerns). In their examination of the importance of course design, feedback, and facilitation, Hosler and Arend ([<reflink idref="bib17" id="ref13">17</reflink>]) found that students perceived that course organization, clearly articulated goals, and relevant course assignments positively impacted critical thinking, and lack of organization was perceived as detrimental to the thinking process. Students appreciated faculty guidance and support that was encouraging and feedback that was timely and specific. Students expressed a desire for both group and individual feedback, and they felt that such feedback contributed to developing critical thinking. Students also wanted faculty to keep the discussions focused and meaningful and to facilitate discussions in ways that were nonbiased (Hosler & Arend, [<reflink idref="bib17" id="ref14">17</reflink>]).</p> <p>Underscoring a connection between teaching presence and social presence, Anderson and colleagues ([<reflink idref="bib1" id="ref15">1</reflink>]) noted that that faculty's role "carries higher levels of responsibility for establishing and maintaining the discourse that creates and sustains social presence" (p. 7). The impact of social presence reported in online education literature included outcomes such as enhancing group interaction and cohesion, predicting satisfaction and cognitive presence, and positively affecting learning outcomes and academic performance (Mykota, [<reflink idref="bib23" id="ref16">23</reflink>]).</p> <p>As teaching presence and social presence overlap, the same faculty behaviors may be associated with both. For example, timely and supportive feedback is usually identified as a teaching presence behavior, but it can also enhance social presence if the feedback is presented in a warm, conversational style and includes examples from the faculty's own experiences. Other faculty behaviors facilitating social presence are posting welcome messages, creating course orientation videos, providing biographies with interesting and personal facts, inviting students to introduce themselves, and modeling appropriate responses and interactions, including synchronous and asynchronous video communication (Aragon, [<reflink idref="bib2" id="ref17">2</reflink>]; Mykota, [<reflink idref="bib23" id="ref18">23</reflink>]). The use of conversational posts by faculty (those that revealed the faculty's personality and increased social presence) when facilitating online discussions was found to significantly improve students' perception of the quality of the faculty and the course and appeared to have a small impact on students' actual achievement (Hoey, [<reflink idref="bib16" id="ref19">16</reflink>]). Ice et al. ([<reflink idref="bib18" id="ref20">18</reflink>], p. 14) reported that providing feedback in audio format enhanced students' learning in several ways: it increased the ability to understand nuance and retain content; and it was associated with feelings of being more involved, being "'a real part' of the class" and that the faculty cared more about the student.</p> <p>Whipp and Lorentz ([<reflink idref="bib38" id="ref21">38</reflink>]) provided helpful lists of faculty behaviors associated with cognitive and social support when teaching, which may affect student perceptions of support, student help-seeking behaviors, and final course grades. Cognitive support behaviors include encouragement, praise, affirming feedback, probing and challenging questioning, requests of elaboration and evidence, providing examples in presentations of content, general advice, focsusing discussion on specific issues, and task structuring. Social support behaviors include greetings and salutations, use of first names, social sharing unrelated to the course, expressions of emotion/empathy, invitations and personal offers to seek help, use of humor and personal examples (Whipp & Lorentz, [<reflink idref="bib38" id="ref22">38</reflink>]). While the term <emph>caring</emph> rarely occurs in online education literature outside of nursing and related health disciplines (this may reflect differences in disciplinary thinking), faculty behaviors included in teaching and social presence express genuine empathy and concern for students, their comfort in the learning environment, and their success in and satisfaction with learning. These behaviors aim to humanize the digital learning environment, promote cognitive development and academic achievement, fulfill students' emotional and social needs, and align directly with nurse faculty caring behaviors. However, Smadi et al. ([<reflink idref="bib33" id="ref23">33</reflink>]) reported that, despite the applicability of the COI framework to nursing education, only 26 participants in their study (<emph>N</emph> = 138) self-rated as familiar or extremely familiar with this model.</p> <hd id="AN0146822917-3">The centrality of caring in nursing</hd> <p>Nursing literature is replete with definitions of caring, with both implicit and explicit references to the centrality of caring for the profession of nursing (Wolf & France, [<reflink idref="bib40" id="ref24">40</reflink>]). The International Association for Human Caring, began as the Caring Research Conference, gathering together a group of scholars who shared the philosophy "care and caring are the essence of nursing and the unique and unifying focus of the profession" (Wagner & Gaut, [<reflink idref="bib34" id="ref25">34</reflink>], p. 5). Many nurse scholars have studied the theoretical perspective of caring in the nursing profession, as demonstrated in nursing practice. We have provided brief descriptions of the work of three prominent caring theorists, whose scholarly efforts have helped to illustrate the visibility of caring in nursing practice and framed the dimensions of nursing caring for this integrative review.</p> <p>Jean Watson is a nurse theorist and founder of the Watson Caring Science Institute (https://<ulink href="http://www.watsoncaringscience.org/">www.watsoncaringscience.org/</ulink>). Her work on caring, originally called the theory of human caring, has evolved since the late 1970s and today is referred to as Watson's caring science theory. The theory includes 10 caritas processes, which describe ways of being that reflect caring. These processes, abbreviated here to provide an introduction to readers, include practicing loving-kindness, being authentically present, developing loving, trusting-caring relationships; and engaging in transpersonal teaching and learning within context of caring relationships. The full list of the 10 processes is found on the Watson Caring Science Institute website. In the context of caring as relationship, Watson believes that caring is created by both participants—in the case of nursing care, by both the patient and the nurse (Wolf et al., [<reflink idref="bib40" id="ref26">40</reflink>]).</p> <p>Zane Wolf is a caring theorist, former president of the International Association for Human Caring, and editor of the International Journal for Human Caring (https://<ulink href="http://www.humancaring.org">www.humancaring.org</ulink>). In response to calls to define caring and specify the dimensions of caring, Wolf and colleagues ([<reflink idref="bib41" id="ref27">41</reflink>]) used factor analysis of patient and nurse responses to the Caring Behaviors Inventory, an instrument originally developed by Wolf in 1981. In this preliminary study, Wolf et al. identified five caring dimensions: "respectful deference to others, assurance of human presence, positive connectedness, professional knowledge and skill, and attentiveness to the other's experience" (p. 110). Wu et al. ([<reflink idref="bib42" id="ref28">42</reflink>]) refined the instrument to decrease from 42 to 24 items; and in 2017, Wolf et al. published validation and psychometric properties of a 16-item version of the instrument. Researchers from many countries have requested and obtained permission to use the Caring Behaviors Inventory over the last several decades (Wolf et al., [<reflink idref="bib40" id="ref29">40</reflink>]).</p> <p>Joanne Duffy is a nursing theorist who has explored the implications of caring for clinicians, leaders, and educators. Duffy's work is also influenced by Watson's and has evolved as the quality-caring model. Duffy ([<reflink idref="bib11" id="ref30">11</reflink>]) referred to caring as the "central, organizing component of nursing work," not as "soft, intangible and unworthy" (p. 47). Caring in Duffy's model is defined by behaviors called the caring factors: mutual problem solving, attentive reassurance, human respect, encouraging manner, appreciation of unique meanings, healing environment, basic human needs, and affiliation needs (p. 51).</p> <p>The commonalities between these theories of caring are important to nursing practice, as they validate the presence of certain essential caring behaviors. The measures of caring that have evolved from the theoretical perspectives demonstrate that caring happens in relationship where there is respect and authenticity, basic needs are met, knowledge is shared, and support is given.</p> <hd id="AN0146822917-4">Caring in nursing education</hd> <p>Nursing education requires attention to all three domains of learning—cognitive, psychomotor, and affective. A student nurse who has learned to skillfully insert an intravenous cannula and can verbalize the reasons why he or she has done so in a specific manner, has still not completed the task. He or she must also learn to do this with the patient (in relationship), rather than to them. That includes introducing the procedure, explaining what will happen, being attentive to the patient's unique perspective (fear of needles, for example) and providing supportive reassurance ("you're doing great") as the procedure is completed. The student will also need to process his or her own feelings about the procedure, such as reluctance to hurt the patient, fear of not being successful on the first attempt, nervousness, or lack of confidence. This affective domain is where the caring science of nursing is most visible. The dimensions of caring as described by theorists become real in the actions of nursing practice. For nurse caring to occur, the nurse has to know why (cognitive), how (psychomotor), and in what manner (affective) care should be delivered in relationship with the patient and the patient's family or support system.</p> <p>Because the professional identity of nurses is closely connected to the concept of caring, it is necessary for nursing students to observe caring behaviors in their educational environment (Beck, [<reflink idref="bib4" id="ref31">4</reflink>]). One way that nursing students learn the behaviors consistent with professional nursing practice is through role modeling. In an integrative review on this topic, Baldwin et al. ([<reflink idref="bib3" id="ref32">3</reflink>]) reported that, of the 33 papers included in the review, only seven articles addressed role modeling in the academic setting, while the majority addressed role modeling in the clinical setting (p. e19). Several of the papers characterized teaching of professional nursing behaviors (i.e., caring behaviors) as informal, while Del Prato ([<reflink idref="bib10" id="ref33">10</reflink>]) called this "hidden curriculum" stating that "faculty who role model caring and respect in the formal and hidden curriculum contribute to the positive formation of future nurses" (p. 289). Nurse caring behaviors include the outward manifestation of technical, knowledgeable caring for in a manner that expresses caring about. The Baldwin et al. review addressed undergraduate nursing in the traditional academic setting and did not address role modeling in online environments or across programs. However, in 2010, Sitzman wrote that "Productively moving forward with online delivery of nursing education, while honoring, preserving, and <emph>modeling</emph> [emphasis added] core caring values, requires mindful and deliberate intention on the part of faculty" (p. 178). While numerous validated instruments exist for measuring nurse caring in the clinical setting (Watson, [<reflink idref="bib36" id="ref34">36</reflink>]), few instruments are available to measure caring in nursing education. One such instrument, student perceptions of caring online, was developed by Sitzman ([<reflink idref="bib29" id="ref35">29</reflink>]) based on her research in online nursing education.</p> <p>Faculty members who are nurses bring this identity to their faculty role through intentional caring behaviors in student interactions. Sawatzky et al. ([<reflink idref="bib26" id="ref36">26</reflink>]) stated that in nursing education, caring is central to teaching excellence. Watson ([<reflink idref="bib35" id="ref37">35</reflink>]) emphasized curricular design in nursing that reflects human caring in educational and practice worlds. Almost 30 years later, Sitzman and Watson ([<reflink idref="bib32" id="ref38">32</reflink>]) addressed faculty caring in the "digital world," writing that "establishing and then actively maintaining a firm intent to care is key to creating digital learning environments that convey and sustain caring" (p. 62). However, nursing faculty members who may feel confident conveying caring behaviors in the traditional classroom and in the clinical setting where they are able to engage students or clients in person may be less certain that these caring behaviors translate to the online learning environment.</p> <p>With the work of Sitzman and Leners ([<reflink idref="bib30" id="ref39">30</reflink>]), Leners and Sitzman ([<reflink idref="bib20" id="ref40">20</reflink>]), and Sitzman ([<reflink idref="bib28" id="ref41">28</reflink>]) on faculty caring in online nursing programs, and Garrison et al.'s ([<reflink idref="bib13" id="ref42">13</reflink>]) COI framework from distance education literature guiding this review, we explored faculty caring in online nursing education. In the context of online learning, we are defining caring as intentional communication and actions designed to meet students' actual and potential needs for human connection, learning, support, and respect.</p> <hd id="AN0146822917-5">Methods</hd> <p>An academic team at a large public university in the Southeastern United States conducted an integrative review to explore online education and nursing education literature to identify faculty behaviors that convey caring in online nursing programs. We employed a process of integrative review of the literature (Whittemore & Knafl, [<reflink idref="bib39" id="ref43">39</reflink>]) with the assistance of a research librarian specialist to explore faculty caring behaviors in online nursing courses. We searched the Cumulative Index for Nursing and Allied Health, PubMed, and ERIC databases for relevant articles using specified search criteria. Consistent with this type of integrative review, our goal was to identify relevant studies regardless of the study design. On recommendation of the research librarian specialist, we removed all subject heading criteria for wider range and used the following broad search terms: online courses and caring, and faculty. We also included associated words connected to these key phrases to further broaden our search within the three databases. Associated words for "online education" included "virtual classrooms", "distance education", or "web-based instruction". Associated words for caring included "compassion" or "social presence". Associated words used for faculty included "graduate education" or "higher education". In addition to database searches, using the Whittemore and Knafl ([<reflink idref="bib39" id="ref44">39</reflink>]) method of integrative review, journal hand searching, cross-searching, networking, and a review of reference lists of relevant articles yielded additional articles for consideration. We identified 25 relevant articles using the search term phrases and associated words after applying inclusionary and exclusionary criteria. The breakdown of results by database was as follows: PubMed (<reflink idref="bib16" id="ref45">16</reflink>), Cumulative Index for Nursing and Allied Health (<reflink idref="bib9" id="ref46">9</reflink>), and ERIC (0).</p> <p>Our team met on two occasions to review each article for inclusion and exclusion criteria. After discussing all articles, we resolved any discrepancies regarding appropriateness for inclusion. Inclusion criteria for in-depth review were full-text articles, reference and abstract availability, geographical location of the United States, and publication dates between 2004 and 2019. We included articles if the research focused on online nursing education and faculty caring behaviors in the United States. Exclusions were articles not written in English, those focused solely on non-nursing faculty and/or non-nursing students, and those referring to clinical education in a hospital or clinic and not in an academic setting. We also excluded book chapters and unpublished doctoral works.</p> <p>The final literature search yielded 11 relevant articles after duplicate removal and the application of inclusionary criteria. We created a matrix to facilitate organization and analysis of the studies selected for inclusion.</p> <hd id="AN0146822917-6">Results</hd> <p>A total of 11 articles were included in the final selection after application of all inclusionary and exclusionary criteria (see Table 1 in Appendix A). All of them discussed faculty caring behaviors of nursing faculty were in detail. Of the 11 articles, three explored students' perceptions of faculty caring behaviors (Brown & Wilson, [<reflink idref="bib5" id="ref47">5</reflink>]; Mayne & Wu, [<reflink idref="bib22" id="ref48">22</reflink>]; Post et al., [<reflink idref="bib24" id="ref49">24</reflink>]). Two of them were systematic reviews that explored faculty caring behaviors from both student and faculty perspectives (Gazza & Hunker, [<reflink idref="bib14" id="ref50">14</reflink>]; Gdanetz et al., [<reflink idref="bib15" id="ref51">15</reflink>]). Another two studies addressed faculty caring behaviors through exploring faculty perceptions only (Cox-Davenport, [<reflink idref="bib9" id="ref52">9</reflink>]; Mastel-Smith et al., [<reflink idref="bib21" id="ref53">21</reflink>]). One article identified effective strategies to increase retention of students in graduate online nursing courses (Gazza & Hunker, [<reflink idref="bib14" id="ref54">14</reflink>]). We highlighted specific behaviors that foster social presence and faculty caring. These behaviors included welcoming students, being available to answer questions, and providing timely feedback and clear directions for assignments. We noted program and course quality measures such as obtaining student feedback, providing faculty development, and facilitating interactions among students and among students and faculty. Another indication of faculty caring behaviors was understanding students' individual needs and identifying at-risk students. Each of the techniques listed can be applied as an intentional strategy to retain nursing students in online education.</p> <p>Mayne and Wu's ([<reflink idref="bib22" id="ref55">22</reflink>]) pilot two-group comparison study explored the effect of integrating social presence strategies in an online graduate nursing course. The experimental group received the intentional behaviors promoting social presence while the control group had usual instruction. These strategies to promote social presence and faculty caring included personalization of interactions with each student in the experimental group, creating a safe online environment for students where students engaged with faculty and received timely instructor feedback on ungraded assignments. In addition, course navigation aids were placed in the course for students to find course content easily. The social presence group had significantly greater perception that online learning expectations were met and higher intention to continue in online courses.</p> <p>Three articles specifically explored nurse faculty caring behaviors in online education for nursing students. Sitzman and Leners ([<reflink idref="bib30" id="ref56">30</reflink>]) first explored faculty caring behaviors as perceived by undergraduate nursing students. Later that year, they replicated their study with graduate students (Leners & Sitzman, [<reflink idref="bib20" id="ref57">20</reflink>]). In 2010, using data gathered from the previous studies, Sitzman studied how students prioritized the previously identified caring behaviors using a Likert-type scale and added one open-ended question to allow for the possibility that other behaviors might emerge (Sitzman, [<reflink idref="bib28" id="ref58">28</reflink>]). Eight themes emerged in the initial study, and six themes in the replicated study (see Appendix A). The 2010 study was the first time that students were asked to prioritize the behaviors. This study led to a measurement instrument named Student Perspectives of Online Caring, which was found to have internal consistency using Cronbach's alpha of.8313 (above.70 is indicative of adequate internal consistency) (Sitzman, [<reflink idref="bib29" id="ref59">29</reflink>]).</p> <p>In 2018, Sitzman and Muller explored the usefulness of Watson's Caring Science in an interprofessional massive online open course for both nursing and non-nursing professionals. Of those who completed post-course reflections, 58 were nurses and 94 were non-nurses. Findings from this qualitative study supported the view that caring science, which has its origins in nursing, is perceived by non-nurses as applicable and useful (Sitzman & Muller, [<reflink idref="bib31" id="ref60">31</reflink>]).</p> <p>Post et al. ([<reflink idref="bib24" id="ref61">24</reflink>]) explored 10 graduate and undergraduate nursing students' perception of faculty caring behaviors in online courses and identified meaning interactions with faculty, faculty's online presence, engagement, availability, and course organization as behaviors that were valued from faculty. Faculty caring behaviors included flexible approaches to learning, eliciting feedback about courses from students, arranging for additional student learning opportunities, exhibiting flexibility and understanding of life issues, providing timely responses, seeing students in person (residency), providing detailed feedback, and conveying a desire for students to be successful.</p> <p>Mastel-Smith et al. ([<reflink idref="bib21" id="ref62">21</reflink>]) conducted a three-phase concept development process to define online caring presence from the faculty perspective. There was consensus among faculty participants that online caring presence meant "helping students succeed" (p. 150). Again, the reciprocal nature of the relationship was noted, as connecting with students required student engagement. Several strategies were used to create online caring community to foster student success. Three factors that defined online caring presence emerged: student success, student affirming, and caring feedback from faculty.</p> <p>Gdanetz et al.'s ([<reflink idref="bib15" id="ref63">15</reflink>]) qualitative metasynthesis study explored how technology influences the interpersonal relationship of nursing students and nursing faculty in online graduate and undergraduate nursing programs. Faculty caring behaviors identified from the major themes included frequent student feedback, the abilities of the instructor beyond the traditional classroom setting to engage and have a strong online presence, and the intentionality of the instructor that allows for personal connections. Findings support that technology does alter communication, thereby positioning the intentionality of the instructor at the heart of developing and sustaining interpersonal relationships in the online learning environment.</p> <hd id="AN0146822917-7">Discussion</hd> <p>The integrative review provided a significant number of faculty behaviors which students perceived as caring. Table 2 in Appendix B provides a listing of faculty caring behaviors from the reviewed articles, identifies the dimension of nurse caring for each behavior, and shows their intersection with social, teaching, and cognitive presence in the online classroom. The table shows a significant overlap between faculty caring and social and teaching presence, which is logical, as four out of five dimensions of nurse caring identified by Wolf et al. ([<reflink idref="bib41" id="ref64">41</reflink>]) (deference to others, assurance of human presence, positive connectedness, and attentiveness to the other's experience) are related to human interactions and relationships. The fifth dimension of nurse caring (professional knowledge and skills) correlates with the cognitive presence. However, to be perceived as caring, cognitive presence behaviors should be accompanied by those representing social and/or teaching presence. For example, feedback on assignments should be timely, contain affirmation and praise for work well done, and provide suggestions for improvement (Mastel-Smith et al., [<reflink idref="bib21" id="ref65">21</reflink>]).</p> <p>As shown in Table 2, faculty caring for and about students begins with course design and organization even before students access the course. During this stage, faculty should be aware of diverse students' learning needs, present content in a variety of ways, provide guidelines and rubrics for course assignments, and set up the course for easy navigation and offer navigational aids (Mastel-Smith et al., [<reflink idref="bib21" id="ref66">21</reflink>]; Mayne & Wu, [<reflink idref="bib22" id="ref67">22</reflink>]; Post et al., [<reflink idref="bib24" id="ref68">24</reflink>]). These recommendations are congruent with Hosler and Arend's ([<reflink idref="bib17" id="ref69">17</reflink>]) findings that course organization and clearly articulated goals for assignments may positively impact student critical thinking and that lack of organization can be detrimental to the thinking processes. Online courses should contain items and activities that put students at ease (e.g., early course availability, instructor's biography with personal information and pictures, personal email contact by instructor), enable students to meet each other face-to-face or virtually and stay connected throughout the course (e.g., with students-only discussion forums, feedback on assignments) (Mayne & Wu, [<reflink idref="bib22" id="ref70">22</reflink>]). Inclusion of group work may provide a mechanism to sustain connections among students and create perceptions of a caring community (Mastel-Smith et al., [<reflink idref="bib21" id="ref71">21</reflink>]).</p> <p>To maintain a sense of caring presence throughout the course, faculty should facilitate connections among students, model appropriate interactions, and provide praise, encouragement, and affirmation (Cox-Davenport, [<reflink idref="bib9" id="ref72">9</reflink>]; Post et al., [<reflink idref="bib24" id="ref73">24</reflink>]). Feedback on assignments should be balanced addressing stronger and weaker points of student work and suggesting ways for improvement (Mastel-Smith et al., [<reflink idref="bib21" id="ref74">21</reflink>]). Additionally, caring can be shown by remaining flexible and understanding of students' busy lifestyles and the impact of unpredictable life events (Post et al., [<reflink idref="bib24" id="ref75">24</reflink>]). These faculty caring behaviors are similar to cognitive and social support behaviors described by Whipp and Lorentz ([<reflink idref="bib38" id="ref76">38</reflink>]).</p> <p>The role modeling component of the nurse faculty caring necessitates making expressions of online faculty caring explicit to students to enable them to learn these digital caring behaviors by observation. Faculty should also encourage students to practice the same caring behaviors toward other members of the course. As telehealth is gaining acceptance and is being implemented in a variety of healthcare settings (Ronquillo et al., [<reflink idref="bib25" id="ref77">25</reflink>]), nursing students will need to develop skills to convey caring in their interactions with patients and colleagues through digital technologies.</p> <p>Although faculty caring encompasses many faculty behaviors associated with online course design and delivery, it cannot be viewed as the sole contributor to student academic success. As in the nurse-patient relationship, caring in the online learning environment should be reciprocal. Faculty caring behaviors provide the necessary conditions for student academic success by meeting students' needs for human connection, learning, support, and respect. In academic caring contexts, students are expected to reciprocate faculty caring and take responsibility for their own learning and for their behaviors toward other members of the course. Caring online is displayed when mutual trust and respect are present and both students and teachers want to help each other succeed (Sitzman & Leners, [<reflink idref="bib30" id="ref78">30</reflink>]).</p> <hd id="AN0146822917-8">Recommendations and conclusion</hd> <p>Although each of the articles addressed caring behaviors and/or social presence in the online learning environment, few addressed in detail the level of support or professional development needed for faculty competence and confidence in this venue. Brown and Wilson ([<reflink idref="bib5" id="ref79">5</reflink>]) noted that time is needed for faculty training and support. Mayne and Wu ([<reflink idref="bib22" id="ref80">22</reflink>]) discussed the instructor efforts required to establish and maintain social presence but did not address how faculty members could learn to develop these skills. Gazza and Hunker ([<reflink idref="bib14" id="ref81">14</reflink>]) mentioned that relationship building is something that all staff who interact with students online should be attentive to. Cox-Davenport ([<reflink idref="bib9" id="ref82">9</reflink>]) recommended identifying strategies to help students feel humanized in the online setting in both nursing and other disciplines.</p> <p>We suggest that specific education is needed to help faculty members become skilled online educators who create a climate of support that students perceive as caring. This is particularly important for nursing faculty who understand the importance of conveying caring but may not be sure how to translate caring behaviors demonstrated in the clinical setting to the virtual academic environment. Nurse educators can gain valuable insights from examining the COI framework (Garrison et al., [<reflink idref="bib13" id="ref83">13</reflink>]), discussing its relevance to online nursing education, and identifying faculty behaviors associated with social, teaching, and cognitive presence which convey caring. Mastering caring behaviors for online learning environments listed in Table 2 (Appendix B) can be achieved through mentoring, observing, attending distance education conferences and expert-led workshops, and collaborating with instructional designers and colleagues from other disciplines who may already excel in online teaching.</p> <p>Instructional designers working with nursing faculty should first understand the centrality of caring in the nursing profession and become aware of discipline-specific needs for online courses. Gaining understanding of caring from the nursing perspective will enable instructional designers to advise nursing faculty in selecting appropriate technologies and coach them in projecting caring in the online classroom through course design, teaching strategies (e.g., discussion facilitation, group work, feedback), and communication techniques. They can also assist the nursing faculty in developing specific learning activities to prompt students to practice online caring behaviors themselves (e.g., case studies, collaborative projects, online simulations, role plays). And finally, they can assist faculty with the evaluation of student perceptions of caring and recommend improvements to the course design, teaching strategy and/or communication patterns based on evaluation data.</p> <p>It is important for the administrators of nursing online programs to recognize the value that instructional designers can bring to their programs and include instructional designers among the staff. If that is not possible, they should encourage interprofessional collaboration with instructional designers available in other units on academic campuses.</p> <p>In addition to research on the best ways to develop faculty caring behaviors and social presence, it is also critical to identify the relationship between faculty caring behaviors and student outcomes such as retention, academic success, satisfaction with learning, and alumni engagement. There is also need for further study of student-to-student interactions in online education to better understand the student role in the context of social presence and caring behaviors.</p> <p>Although our study was focused on online nursing education, faculty from other disciplines may benefit from integrating caring frameworks into their online teaching practices to promote positive learning outcomes and student satisfaction.</p> <hd id="AN0146822917-9">Acknowledgments</hd> <p>The authors wish to acknowledge Amy Edwards, Research Librarian, Thomas Cooper Library at the University of South Carolina, for her assistance with the literature search.</p> <hd id="AN0146822917-10">Disclosure statement</hd> <p>No potential conflict of interest was declared by the authors.</p> <hd id="AN0146822917-11">Appendix A</hd> <p>Table 1. Study characteristics and analysis</p> <p> <ephtml> <table><thead><tr><td>Author(s)/year of publication</td><td>Purpose</td><td>Setting/design</td><td>Population characteristics</td><td>Faculty caring behaviors identified</td><td>Implications for distance education</td><td>Study limitations</td></tr></thead><tbody><tr><td>Brown & Wilson (<xref ref-type="bibr" rid="bibr5">2016</xref>)</td><td>Describe two strategies to promote caring in online graduate nursing program: online caring groups and caring connections</td><td>Graduate nursing program; State university; School of Nursing Design: Descriptive; Quality improvement</td><td>Caring groups: All students in a required Master of Science in Nursing (<italic>N</italic> = 50 approx.) or Doctor of Education course (<italic>N</italic> = 15 approx.) Caring Connections: optional participation by students enrolled in MSN or EdD program</td><td>Faculty should reply to student concerns in an "appropriate, caring, empathetic manner" (p. 406) Encouraged students to interact with faculty and other students Encouraged students to support and care for each other in meaningful ways Timely responses to students' discussion board posts; Faculty carefully read student posts to understand student context for query and respond in an appropriate, caring, empathetic manner</td><td>Research needed to identify outcomes related to caring in the online environment (i.e. student attrition rates) Time for faculty training and support is needed Encourage positive student: student interaction as well as faculty: student interaction</td><td>Student feedback on faculty behaviors was limited Site limited to one university No outcomes data on student attrition or academic success</td></tr><tr><td>Cox-Davenport (<xref ref-type="bibr" rid="bibr9">2014</xref>)</td><td>Study how faculty establish social presence in an online course</td><td>Participants were in many locations throughout the USA Method: Qualitative grounded theory</td><td>10 nurse educators; 1–30 years' experience in online and distance education; teaching in master's level nursing courses</td><td>Themes emerged from participants interviews, guided tour of courses and review of syllabi. Primary theme: faculty efforts to humanize the course and build a human connection with students. Professional education was expanded through use of stories, sharing of experiences Faculty nurtures connections between students Making the online environment learner centered empowers students Faculty sets a tone (termed "cyber role model", p. 20) Maintaining connection requires faculty participation/responses to students Faculty need to be aware of or attentive to what is happening in the course</td><td>Faculty need better understanding of the concepts of social presence, humanization, and the sub-themes of student control, facilitating connections, being a "cyber role model," maintaining the course and being aware/attentive Further study of "humanizing" for both nursing education and across other disciplines Study student perceptions</td><td>Small sample size Student perceptions were not addressed.</td></tr><tr><td>Gazza & Hunker (<xref ref-type="bibr" rid="bibr14">2014</xref>)</td><td>Identify strategies to increase retention of students in online nursing courses at the graduate level</td><td>Literature review</td><td>23 articles included; initial search was limited to online graduate nursing education but expanded to include higher education research outside of nursing</td><td>Recommendations provided in three categories: Social presence, which includes welcoming, availability, promptness, clear directions Program/course quality, which includes provide faculty development, obtain student feedback, facilitate both student to student and student to faculty interaction Individual student characteristics, which includes assess student satisfaction, consider impact of student employment, identify at-risk students</td><td>Increasing retention should be a focus during all phases of students' program (including enrollment) Social presence, course quality and student characteristics all contribute to potential for retention and success Further study of student characteristics that lead to retention</td><td>Lack of available research in nursing graduate education; initial scope expanded to include mixed graduate and undergraduate samples and literature outside of nursing</td></tr><tr><td>Gdanetz et al. (<xref ref-type="bibr" rid="bibr15">2018</xref>)</td><td>Purpose is to understand how technology influences the development of interpersonal relationships between students and faculty in a virtual learning environment</td><td>Qualitative metasynthesis</td><td>10 articles included in review</td><td>Intentionality of the educator—awareness of student's needs Continued education of faculty; An educator with a caring intention; creating a personal touch through stories, photos, and through authentic communication; modeling caring behaviors (i.e., empathy, timely feedback and engagement, trust, respect) to facilitate enhanced student-faculty connections</td><td>Continued education of faculty; Need to educate students with a caring consciousness framework for online nursing courses</td><td>None noted.</td></tr><tr><td>Leners & Sitzman (<xref ref-type="bibr" rid="bibr20">2006</xref>)</td><td>To explore online graduate nursing students' perception of caring in online classes</td><td>Single study site conducted at a research-intensive university. Methodology from the baccalaureate study was replicated.</td><td>All master's and doctoral level students were invited. All students were enrolled in online courses. Total of 39 out of 49 eligible students participated (79% response rate)</td><td>6 themes emerged: Empathetic perspective Timeliness of communication Tone of appreciation Being the best I can be Finding a chord of harmony The passion of caring</td><td>Understand that students need to feel the connection; that feeling cared about is a motivator for student behavior; that caring is active Interactions with students matter Communicating availability is helpful to students; online tone conveys caring or lack thereof Feeling the passion is an overarching theme—students can sense it</td><td>Single site study</td></tr><tr><td>Mastel-Smith et al. (<xref ref-type="bibr" rid="bibr21">2015</xref>)</td><td>Implied purpose: to describe the development of a concept for online caring presence through a three phase data collection process</td><td>Setting: One college of nursing; Design: qualitative design</td><td><italic>N</italic> = 6 white women who were faculty in the college of nursing</td><td>4 major themes: online teaching experience, similarities and differences with online vs face-to-face teaching, online presence, and online caring presence Three factors that defined online caring presence emerged: student success, affirming, and caring feedback</td><td>Faculty valued group work in courses as creating a caring community, meaning personal connections and relating to students, and mandatory on-campus workshops; Need to organize and present course content differently and diversify to meet different students learning needs, Faculty new to online education should have guest access to established courses for the purpose of observing experienced online educators. Increased awareness and adjustment of one's communication style and tone can promote online caring presence. Balanced feedback equals constructive feedback more likely to be accepted by students (providing feedback to student on what was done well in addition to areas that need improvement)</td><td>Homogenous small sample; students not included in sample to determine their perceptions of faculty caring</td></tr><tr><td>Mayne & Wu (<xref ref-type="bibr" rid="bibr22">2011</xref>)</td><td>Pilot study to examine effect of integrating social presence strategies in online graduate course</td><td>University; college of nursing Design: pilot study using a two-group comparison design</td><td>38 eligible students who were enrolled in graduate-level courses in master's degree nursing programs; 26 students participated; 16 in the social presence group and 10 in the control group</td><td>The social presence group had significantly greater perception that online learning expectations were met and intention to continue in online courses. Sample strategies included: Personalization of interactions with students Creating a safe environment, including instructor feedback on ungraded assignment Course navigation aids</td><td>Purposeful application of social presence strategies (as compared to usual online strategies) is effective. Faculty need to know the how Social presence is an important aspect of distance education; research needed on a larger scale.</td><td>Small sample size in a single university</td></tr><tr><td>Post et al. (<xref ref-type="bibr" rid="bibr24">2017</xref>)</td><td>To explore graduate and undergraduate nursing students' perceptions of instructors' caring in an online environment</td><td>Setting: one university in a southeastern state; Design: descriptive phenomenology design (qualitative, mixed methods)</td><td>10 students</td><td>Major themes: What students valued: Perceived meaningful connections and interactions with faculty, faculty's online presence and making themselves available for students in a timely manner; course organization Faculty caring: flexible approach to learning, instructor's eliciting feedback about courses and arranging for additional learning opportunities, exhibit flexibility and understanding of life issues, timely responses, seeing them in person (residency); detailed feedback, and instructor conveying they want students to be successful</td><td>Further adaptation and refinement of Watson's (<xref ref-type="bibr" rid="bibr37">2012</xref>) caritas processes from the clinical environment to the academic environment; need to implement best practice caring standards and evaluate student performance, retention, satisfaction Students can perceive faculty caring in the online environment through intentional faculty behaviors; certain behaviors around social presence</td><td>Limited to one university; Potential selection bias, recall bias</td></tr><tr><td>Sitzman (<xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td>To ask 3 questions re: caring behaviors in online education: <list list-type="Bullet"><list-item><p>What (if any) caring behaviors are more important than the others?</p></list-item><list-item><p>What is the degree of importance of each of the individual caring behaviors?</p></list-item><list-item><p>In addition to the caring behaviors identified by Sitzman and Leners (<xref ref-type="bibr" rid="bibr30">2006</xref>) and alluded to in the literature, are there other preferred instructor behaviors that support students feeling cared for in the online nursing education setting?</p></list-item></list></td><td>Mixed methods study; 24 Likert-type survey questions based on 2006 work and one open-ended question to allow for additional qualitative data to emerge.</td><td>Requests for participation sent to 750 baccalaureate nursing students at 5 universities. 122 responses (16.27 %)</td><td>10 items emerged as most important: clear instructions (schedule), detailed class calendar, timely responses, clear instructions (online posts), excellent presentation of content, corrective feedback is private, express belief in student success, be specific in feedback, provide availability, shares remedies for meeting challenges. 5 themes emerged in response to the open-ended question: <list list-type="Bullet"><list-item><p>Empathetic presence</p></list-item><list-item><p>Clarity/expertise</p></list-item><list-item><p>Timeliness</p></list-item><list-item><p>Full engagement/accessibility</p></list-item><list-item><p>Flexibility/openness</p></list-item></list></td><td>Caring can be conveyed at a distance. Modeling caring behaviors requires intentionality</td><td>Limited to baccalaureate students.</td></tr><tr><td>Sitzman & Leners (<xref ref-type="bibr" rid="bibr30">2006</xref>)</td><td>To identify the factors that baccalaureate nursing students felt created a caring online environment</td><td>Single site qualitative study at a state university nursing program. Questions were asked in narrative format; responses were coded and sorted into themes.</td><td>11 of 13 invited students responded to an email request to participate. All had completed at least one online course.</td><td>8 themes emerged: <list list-type="Bullet"><list-item><p>Frequent feedback</p></list-item><list-item><p>Timeliness</p></list-item><list-item><p>Caring online is reciprocal</p></list-item><list-item><p>Personal connection and empathy</p></list-item><list-item><p>Clarity</p></list-item><list-item><p>Multiple contact opportunities</p></list-item><list-item><p>Commitment to learning</p></list-item><list-item><p>"Second-fiddle worries" (p. 258) —concern that faculty cared more about students in classroom setting</p></list-item></list></td><td>Understand students' need for behaviors (timeliness, feedback, clarity) that are perceived as caring. Recognize that students see this as a relationship, and don't want to be seen as second fiddle to in-person classes or students. Planning the course; being clear with instructions, providing prompt feedback are all perceived as caring.</td><td>Single site study with 11 participants</td></tr><tr><td>Sitzman & Muller (<xref ref-type="bibr" rid="bibr31">2018</xref>)</td><td>To explore usefulness of Watson's Caring Nursing theory non-nursing disciplines who teach and work in online settings</td><td>2 free and open online training courses openly accessible and available to anyone with access to the Internet both inside and outside a large university in the Southeast</td><td>58 reflective forms from training course (that incorporated principles from caring science) completed by nurses and 94 reflective forms completed by non-nurses; Qualitative study design</td><td>Not specifically listed but implied in 10 caritas processes based on Watson's Caring Science</td><td>Caring Science education and training are applicable and useful across non-nursing disciplines and settings. Caring Science may establish common ground upon which further interprofessional understanding and collaboration may be built.</td><td>None noted. Trustworthiness in qualitative design; methods clear and detailed</td></tr></tbody></table> </ephtml> </p> <hd id="AN0146822917-12">Appendix B</hd> <p>Table 2. Intersection among online faculty caring, social presence, teaching presence, and cognitive presence</p> <p> <ephtml> <table><thead><tr><td>Online faculty caring</td><td>Conceptual dimensions of nursing caring</td><td>Social presence</td><td>Teaching presence</td><td>Cognitive presence</td></tr></thead><tbody><tr><td>Before the course: Designing and organizing</td></tr><tr><td>Provide clear instructions and due dates for all assignments/posts (Sitzman, <xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item></list></td><td /><td>✓</td><td>✓</td></tr><tr><td>Provide rubrics for evaluation of assignments (Mayne & Wu, <xref ref-type="bibr" rid="bibr22">2011</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item></list></td><td /><td>✓</td><td>✓</td></tr><tr><td>Consider group assignments to facilitate connections among students (Mastel-Smith et al., <xref ref-type="bibr" rid="bibr21">2015</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Positive connectedness</p></list-item></list></td><td /><td>✓</td><td>✓</td></tr><tr><td>Provide detailed course calendar (Sitzman, <xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item></list></td><td /><td>✓</td><td /></tr><tr><td>Provide faculty contact and availability information; include multiple contact means (Gazza & Hunker, <xref ref-type="bibr" rid="bibr14">2014</xref>; Sitzman & Leners, <xref ref-type="bibr" rid="bibr30">2006</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Assurance of human presence</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Create a personal touch through stories & photos (Gdanetz et al., <xref ref-type="bibr" rid="bibr15">2018</xref>; Mayne & Wu, <xref ref-type="bibr" rid="bibr22">2011</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Positive connectedness</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Organize the course & provide navigation aids (Mayne & Wu, <xref ref-type="bibr" rid="bibr22">2011</xref>; Post et al., <xref ref-type="bibr" rid="bibr24">2017</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item><list-item><p>✓ Attentiveness to other's experience</p></list-item></list></td><td /><td>✓</td><td /></tr><tr><td>Include extensive Resources section for students to access as needed (Mayne & Wu, <xref ref-type="bibr" rid="bibr22">2011</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item><list-item><p>✓ Attentiveness to other's experience</p></list-item></list></td><td /><td>✓</td><td /></tr><tr><td>Post clear instructions regarding acceptable social behavior in the online classroom (Sitzman, <xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Attentiveness to other's experience</p></list-item></list></td><td /><td>✓</td><td /></tr><tr><td>Exhibit excellence in creating/presenting online content (Sitzman, <xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item></list></td><td /><td>✓</td><td>✓</td></tr><tr><td>Become proficient in the use of technology (Gdanetz et al., <xref ref-type="bibr" rid="bibr15">2018</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item></list></td><td /><td>✓</td><td /></tr><tr><td>Open the course early (Mayne & Wu, <xref ref-type="bibr" rid="bibr22">2011</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Attentiveness to other's experience</p></list-item></list></td><td /><td>✓</td><td /></tr><tr><td>During the course: Teaching and communicating</td></tr><tr><td>Welcome students to the course/program (Gazza & Hunker, <xref ref-type="bibr" rid="bibr14">2014</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Assurance of human presence</p></list-item><list-item><p>✓ Positive connectedness</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Start with introductions on the class and/or group discussion boards; share personal details (Brown & Wilson, <xref ref-type="bibr" rid="bibr5">2016</xref>; Mastel-Smith et al., <xref ref-type="bibr" rid="bibr21">2015</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Assurance of human presence</p></list-item><list-item><p>✓ Positive connectedness</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Encourage students to interact with faculty and other students (Brown & Wilson, <xref ref-type="bibr" rid="bibr5">2016</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Positive connectedness</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Encourage students to support and care for each other in meaningful ways (Brown & Wilson, <xref ref-type="bibr" rid="bibr5">2016</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Positive connectedness</p></list-item><list-item><p>✓ Attentiveness to the other's experience</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Personalize interactions with students (Mayne & Wu, <xref ref-type="bibr" rid="bibr22">2011</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Positive connectedness</p></list-item><list-item><p>✓ Attentiveness to the other's experience</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Respond to students' discussion board posts and emails in a timely manner (Brown & Wilson, <xref ref-type="bibr" rid="bibr5">2016</xref>; Sitzman, <xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Positive connectedness</p></list-item><list-item><p>✓ Attentiveness to the other's experience</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Carefully read student posts to understand student context for query and respond in an appropriate, caring, empathetic manner (Brown & Wilson, <xref ref-type="bibr" rid="bibr5">2016</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Attentiveness to the other's experience</p></list-item><list-item><p>✓ Deference to others</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Use stories & share experiences to expand professional education; (Cox-Davenport, <xref ref-type="bibr" rid="bibr9">2014</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item><list-item><p>✓ Assurance of human presence</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Set a tone for interactions and become a cyber role model (Cox-Davenport, <xref ref-type="bibr" rid="bibr9">2014</xref>); Model caring behaviors (i.e. empathy, timely feedback and engagement, trust, respect) (Gdanetz et al., <xref ref-type="bibr" rid="bibr15">2018</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Attentiveness to the other's experience</p></list-item><list-item><p>✓ Positive connectedness</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Maintain a tone of affirmation & appreciation (Leners & Sitzman, <xref ref-type="bibr" rid="bibr20">2006</xref>; Mastel-Smith et al., <xref ref-type="bibr" rid="bibr21">2015</xref>); provide praise & encouragement for work well done (Sitzman, <xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Attentiveness to the other's experience</p></list-item><list-item><p>✓ Positive connectedness</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Be aware of/attentive to what is happening in the course (Cox-Davenport, <xref ref-type="bibr" rid="bibr9">2014</xref>; Gdanetz et al., <xref ref-type="bibr" rid="bibr15">2018</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Assurance of human presence</p></list-item><list-item><p>✓ Attentiveness to the other's experience</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Present frequent, clear, & detailed feedback to students (Gazza & Hunker, <xref ref-type="bibr" rid="bibr14">2014</xref>; Sitzman & Leners, <xref ref-type="bibr" rid="bibr30">2006</xref>);</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item><list-item><p>✓ Attentiveness to the other's experience</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Identify at-risk students and devise academic support plan (Gazza & Hunker, <xref ref-type="bibr" rid="bibr14">2014</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Attentiveness to the other's experience</p></list-item><list-item><p>✓ Professional knowledge and skills</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Solicit feedback on the course; assess student satisfaction with online learning (Gazza & Hunker, <xref ref-type="bibr" rid="bibr14">2014</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Attentiveness to the other's experience</p></list-item><list-item><p>✓ Respectful deference to others</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Maintain flexible approach to learning & exhibit understanding of life issues (Post et al., <xref ref-type="bibr" rid="bibr24">2017</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Attentiveness to the other's experience</p></list-item><list-item><p>✓ Respectful deference to others</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Express belief in student success (Post et al., <xref ref-type="bibr" rid="bibr24">2017</xref>; Sitzman, <xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Positive connectedness</p></list-item></list></td><td>✓</td><td>✓</td><td /></tr><tr><td>Provide corrective feedback privately (Sitzman, <xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Attentiveness to the other's experience</p></list-item><list-item><p>✓ Professional knowledge and skills</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr><tr><td>Share remedies for meeting challenges in online learning (Sitzman, <xref ref-type="bibr" rid="bibr28">2010</xref>)</td><td><list list-type="Bullet"><list-item><p>✓ Professional knowledge and skills</p></list-item><list-item><p>✓ Attentiveness to the other's experience</p></list-item></list></td><td>✓</td><td>✓</td><td>✓</td></tr></tbody></table> </ephtml> </p> <ref id="AN0146822917-13"> <title> References </title> <blist> <bibl id="bib1" idref="ref12" type="bt">1</bibl> <bibtext> Anderson, T., Rourke, L., Garrison, D. 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V., Enns, C. L., Ashcroft, T. J., Davis, P. L., & Harder, N. (2009). Teaching excellence in nursing: A caring framework. Journal of Professional Nursing, 25 (5), 260 – 266. https://doi.org/10.1016/j.projnurs.2009.01.017</bibtext> </blist> <blist> <bibtext> Seaman, J. E., Allen, I. E., & Seaman, J. (2018). Grade increase: Tracking distance education in the United States. Babson Survey Research Group. https://onlinelearningsurvey.com/reports/gradeincrease.pdf</bibtext> </blist> <blist> <bibtext> Sitzman, K. (2010). Student-preferred caring behaviors for online nursing education. Nursing Education Perspective, 31 (3), 171 – 178. https://pubmed.ncbi.nlm.nih.gov/20635622/</bibtext> </blist> <blist> <bibtext> Sitzman, K. (2019). Student perspectives of caring online. In K. Sitzman & J. Watson (Eds.), Assessment and measuring caring in nursing and health sciences: Watson's caring science guide (3rd ed., pp. 281 – 286). Springer.</bibtext> </blist> <blist> <bibtext> Sitzman, K., & Leners, D. 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Educational Technology Research and Development, 57 (2), 169 – 192. https://doi.org/10.1007/s11423-008-9104-7</bibtext> </blist> <blist> <bibtext> Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52 (5), 546 – 553. https://doi.org/10.1111/j.1365-2648.2005.03621.x</bibtext> </blist> <blist> <bibtext> Wolf, Z. R., Dillon, P. M., Townsend, A. B., & Glasofer, A. (2017). Caring behaviors inventory-24 revised: CBI-16 validation and psychometric properties. International Journal for Human Caring, 21 (4), 185 – 192. https://doi.org/10.20467/HumanCaring-D-17-00039</bibtext> </blist> <blist> <bibtext> Wolf, Z. R., Giardino, E. R., Osborne, P. A., & Ambrose, M. S. (1994). Dimensions of nurse caring. Image: The Journal of Nursing Scholarship, 26 (2), 107 – 112. https://doi.org/10.1111/j.1547-5069.1994.tb00927.x</bibtext> </blist> <blist> <bibtext> Wu, Y., Larrabee, J. H., & Putman, H. P. (2006). Caring behaviors inventory: A reduction of the 42-item instrument. Nursing Research, 55 (1), 18 – 25. https://doi.org/10.1097/00006199-200601000-00003</bibtext> </blist> </ref> <aug> <p>By Kate Jones; Phyllis Raynor and Vera Polyakova-Norwood</p> <p>Reported by Author; Author; Author</p> <p></p> <p>Kate Jones is an associate professor and director the Nursing Administration and Nursing Executive Leadership graduate programs at the University of South Carolina, USA. Dr. Jones's scholarship focuses on caring in nursing leadership and academia, and her clinical practice area is home and community-based care.</p> <p>Phyllis Raynor is an assistant professor in the Psychiatric-Mental Health Nurse Practitioner program at the University of South Carolina, USA. As a public health nurse scientist, Dr. Raynor focuses on research, prevention, public advocacy, and health promotion initiatives for families affected by substance use disorders.</p> <p>Vera Polyakova-Norwood is the director of distributed learning at the University of South Carolina's College of Nursing. Ms. Polyakova-Norwood has more than 20 years of experience in designing, teaching, and managing distance education courses and programs. She has presented on technology-based teaching and learning at local, national, and international conferences.</p> </aug> <nolink nlid="nl1" bibid="bib27" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib19" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib13" firstref="ref8"></nolink> <nolink nlid="nl4" bibid="bib12" firstref="ref10"></nolink> <nolink nlid="nl5" bibid="bib17" firstref="ref13"></nolink> <nolink nlid="nl6" bibid="bib23" firstref="ref16"></nolink> <nolink nlid="nl7" bibid="bib16" firstref="ref19"></nolink> <nolink nlid="nl8" bibid="bib18" firstref="ref20"></nolink> <nolink nlid="nl9" bibid="bib38" firstref="ref21"></nolink> <nolink nlid="nl10" bibid="bib33" firstref="ref23"></nolink> <nolink nlid="nl11" bibid="bib40" firstref="ref24"></nolink> <nolink nlid="nl12" bibid="bib34" firstref="ref25"></nolink> <nolink nlid="nl13" bibid="bib41" firstref="ref27"></nolink> <nolink nlid="nl14" bibid="bib42" firstref="ref28"></nolink> <nolink nlid="nl15" bibid="bib11" firstref="ref30"></nolink> <nolink nlid="nl16" bibid="bib10" firstref="ref33"></nolink> <nolink nlid="nl17" bibid="bib36" firstref="ref34"></nolink> <nolink nlid="nl18" bibid="bib29" firstref="ref35"></nolink> <nolink nlid="nl19" bibid="bib26" firstref="ref36"></nolink> <nolink nlid="nl20" bibid="bib35" firstref="ref37"></nolink> <nolink nlid="nl21" bibid="bib32" firstref="ref38"></nolink> <nolink nlid="nl22" bibid="bib30" firstref="ref39"></nolink> <nolink nlid="nl23" bibid="bib20" firstref="ref40"></nolink> <nolink nlid="nl24" bibid="bib28" firstref="ref41"></nolink> <nolink nlid="nl25" bibid="bib39" firstref="ref43"></nolink> <nolink nlid="nl26" bibid="bib22" firstref="ref48"></nolink> <nolink nlid="nl27" bibid="bib24" firstref="ref49"></nolink> <nolink nlid="nl28" bibid="bib14" firstref="ref50"></nolink> <nolink nlid="nl29" bibid="bib15" firstref="ref51"></nolink> <nolink nlid="nl30" bibid="bib21" firstref="ref53"></nolink> <nolink nlid="nl31" bibid="bib31" firstref="ref60"></nolink> <nolink nlid="nl32" bibid="bib25" firstref="ref77"></nolink>
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  Data: Faculty Caring Behaviors in Online Nursing Education: An Integrative Review
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  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Jones%2C+Kate%22">Jones, Kate</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-0743-4771">0000-0002-0743-4771</externalLink>)<br /><searchLink fieldCode="AR" term="%22Raynor%2C+Phyllis%22">Raynor, Phyllis</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-7311-0978">0000-0002-7311-0978</externalLink>)<br /><searchLink fieldCode="AR" term="%22Polyakova-Norwood%2C+Vera%22">Polyakova-Norwood, Vera</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Distance+Education%22"><i>Distance Education</i></searchLink>. 2020 41(4):559-581.
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  Label: Availability
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 23
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2020
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Information Analyses
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Nursing+Education%22">Nursing Education</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+Students%22">Nursing Students</searchLink><br /><searchLink fieldCode="DE" term="%22Graduate+Students%22">Graduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22College+Faculty%22">College Faculty</searchLink><br /><searchLink fieldCode="DE" term="%22Teacher+Student+Relationship%22">Teacher Student Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Teacher+Behavior%22">Teacher Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Caring%22">Caring</searchLink><br /><searchLink fieldCode="DE" term="%22Feedback+%28Response%29%22">Feedback (Response)</searchLink><br /><searchLink fieldCode="DE" term="%22Learner+Engagement%22">Learner Engagement</searchLink><br /><searchLink fieldCode="DE" term="%22Communities+of+Practice%22">Communities of Practice</searchLink><br /><searchLink fieldCode="DE" term="%22Inquiry%22">Inquiry</searchLink><br /><searchLink fieldCode="DE" term="%22Electronic+Learning%22">Electronic Learning</searchLink><br /><searchLink fieldCode="DE" term="%22Virtual+Classrooms%22">Virtual Classrooms</searchLink><br /><searchLink fieldCode="DE" term="%22Distance+Education%22">Distance Education</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Research%22">Educational Research</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/01587919.2020.1821601
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0158-7919
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: As online programs for nursing education continue to grow, nursing faculty must develop strategies for engaging with and supporting students in this form of distance learning. The concept of caring, which is central to nursing education, overlaps with teaching and social presence concepts from the community of inquiry model in education. After reviewing both distance education and nursing literature for background, we conducted an integrative review of studies focusing on online graduate nursing education. We found consistency in the types of faculty behaviors that were described, and that those behaviors aligned with our definition of caring. Implications for distance education include the need to better prepare faculty for online teaching so that they can be intentional about implementing caring behaviors when designing and delivering online education.
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  Data: 2020
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  Data: EJ1275003
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/01587919.2020.1821601
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 23
        StartPage: 559
    Subjects:
      – SubjectFull: Nursing Education
        Type: general
      – SubjectFull: Nursing Students
        Type: general
      – SubjectFull: Graduate Students
        Type: general
      – SubjectFull: College Faculty
        Type: general
      – SubjectFull: Teacher Student Relationship
        Type: general
      – SubjectFull: Teacher Behavior
        Type: general
      – SubjectFull: Caring
        Type: general
      – SubjectFull: Feedback (Response)
        Type: general
      – SubjectFull: Learner Engagement
        Type: general
      – SubjectFull: Communities of Practice
        Type: general
      – SubjectFull: Inquiry
        Type: general
      – SubjectFull: Electronic Learning
        Type: general
      – SubjectFull: Virtual Classrooms
        Type: general
      – SubjectFull: Distance Education
        Type: general
      – SubjectFull: Educational Research
        Type: general
    Titles:
      – TitleFull: Faculty Caring Behaviors in Online Nursing Education: An Integrative Review
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Jones, Kate
      – PersonEntity:
          Name:
            NameFull: Raynor, Phyllis
      – PersonEntity:
          Name:
            NameFull: Polyakova-Norwood, Vera
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2020
          Identifiers:
            – Type: issn-print
              Value: 0158-7919
          Numbering:
            – Type: volume
              Value: 41
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Distance Education
              Type: main
ResultId 1