Posted: March 28th, 2021

Effectiveness of Student/tutor Interactions in Healthcare

Chapter 2

Review of Related Literature and Studies

For the development of the research work, the researcher must systematically be familiar with both previous theory and research. To guarantee this familiarity, there is a review of the research literature which is needed to be done. A review of related literature and studies related to the present study was conducted and presented herein to allow the researcher to know the amount of work done in the concerned area, guide the researchers in their work and the readers who may be interested in this research which enables them to improve their own investigation and to arrive at the proper perspective of the study. Through this, there is a possibility for clarity of problem in the area of research because this review suggests the method, procedure, sources of data and statistical technique needed for the solution of the problem. This section also provides insight regarding strong points and limitation of the previous studies.

The review of related literature was divided into different categories such as nursing competence, student’s learning or effective ways of teaching, interpersonal relations and evaluation.

Nursing Competence

In order for nursing students to have a better real life practice, attributes that makes a clinical teacher effective needs to explore. According to Jahan, (2008), the most important attributes/characteristics of an effective clinical teacher were knowledge, interest in teaching, clinical competency and next are having a good communication skills and being non-judgemental. In addition, Ali (2012) state that interpersonal relationship and evaluation procedures are also an important effective characteristics of a clinical instructor most specifically about respectful sharing and appreciation of life’s meanings because students wanted to spend their clinical training with specialized educators and more experienced instructors to make them feel more secure in the clinical environment.

Excellent nursing qualities really help students to become great nurses in the future. Day & Smith (2007) discussed 5 nursing qualities that a healthcare provider should have: patient-centered care, teamwork and collaboration, employing evidence based practice, applying quality improvement principles and using informatics. The authors demonstrated that in order to assist nursing students to increase and practice the skills associated to quality and safety competencies, clinically based exercises in the acute care setting are significant since acute care setting is full of complex and demanding situations that gives them the opportunity to interact with different healthcare team members. Divulging the students to different clinical site is equally important as well. Students taking part in chart reviews or audits can give them a better understanding of safety issues and a stronger commitment to safety and documentation standards. Furthermore, maintaining a close relationship between a school of nursing and clinical sites is similarly significant. In accordance with Bobay, Gentile, & Hagle (2009) they found that some of the nurses’ professional characteristics such as: clinical experience as an RN, years of experience and age does make a difference in the development of clinical nursing expertise. However, experience must be meaningful and must be in the context of reflective practice to transform experience into expertise. Also, more on the job experience for nurses is required and shows that peer, manager and CNS support are important to ongoing professional development of nurses, which will all then lead to improved patients outcomes in the long run. Moreover, one of the greatest foundations of every successful professional is getting involved in a practicum. Every student undergoes an on-the-job training wherein they apply what they have learned in classrooms on the tasks that will be assigned to them. Actual scenarios help the student practice on how to react and solve a challenge as if they are real professionals. Different professions such as engineers, nurses and teachers may have a different approach in mentoring their respective students but all of them have the same result: either the student excels after graduating because of the positive mentoring he/she experienced thus making them inspired or the student would have a difficulty in adapting to the work place since he/she didn’t learn good things from the mentor and doesn’t know how to react appropriately on a given task (Ralph, Walker, & Wimmer, 2008).

Student’s learning/ effective ways of teaching

The knowledge and skills that clinical instructors possess affect the educational life of each nursing students. It requires critical thinking and problem-solving abilities, specialized psychomotor and technological skills. For this, clinical instructors should do some efforts to provide a good quality of education to each student such as providing excellence in teaching and excellence in teaching scholarship. According to Farmer & Frenn (2009), in order for the process of teaching excellence to continue in evolving and to be able for the students to engage in learning, five major themes of dynamic engagement emerged: (a) strategies, (b) relevance, (c) student centeredness, (d) facilitation of learning, and (e) tapping the affect domain. Excellence in teaching is way that educators were involved in activities that provide teaching and strategies and methods of evaluation in which it drives the student to be more creative and critical thinker. And excellence in teaching scholarship is about the in depth knowledge of the discipline, teaching and learning and critical reflection which engages in research and continuity of the educator to learn (Sawatzky, 2009). There is an article (Zafrir & Nissim, 2011) that describes the use of a practical model for clinical teachers in nursing education. The tool named Reflective Interaction Analysis in Nursing Education (RAINE) Model that is meant for the students to let them involve into a well-defined concrete reflection and process of analysis. This promotes transference of clinical knowledge and skills from theory into practice. The model represents process and has the following components: information gathering, description of the situation or interaction, clarification of students’ perspective on the situation or interaction, reflective analysis and actions needed to improve nursing students’ competence.

However, in 2011, Eta, found that the major challenges that the clinical instructors faced was related to their students which mainly the lack of preparedness being less than average and those related to the clinical instructors’ themselves or their environment which mainly the lack of opportunities to update knowledge and skills. Negative impacts on student nurses were related to these challenges specifically difficulty in teaching. But varieties of ways were still employed to deal with these challenges such improvising and “self-research on the internet”. To address the increase in complexity and demand in today’s health care, Healey (2008), think differently on how to promote better clinical education. Students’ learning has 3 approaches: first is surface learning, where students tend to rely on memorization of details and have difficulty of making connections. Second is strategic learning where students are more concerned with context and are more competitive. The first two approaches have lower quality outcomes compared to the third approach, the deep learning, where students try to understand the deeper connection of things. The author discovered that the three main factors that promoted deep learning are as follows: interaction with patients especially complex and challenging patients, good clinical environment, and lastly construction of individual framework of patient care. Likewise, Kring, Ramseur, & Parnell (2013), affirmed that both hospital adjunct clinical instructors and faculty employed by schools of nursing impart a high degree of clinical effectiveness, although there is a substantial difference on their daily basis work activities. The HACI group consumes more of their time in the hospital as bedside nurses and only a little portion is spend on lectures while the SON faculty expends more of their time in the classroom educating students.

Interpersonal Relations

In nursing, the quality of the student-teacher interaction is important in order for the students to have a good integration of theory to practice. In addition, excellence in teaching leadership is the educators’ ability to lead, inspire, cooperate and share. It involves in role modelling and mentoring of your students and others (Sawatzky, 2009). Early in 2009, Cadosales reported that students which are the respondents evaluated their clinical instructors’ professional decorum and interpersonal skills and also their clinical teaching skills were then found that clinical instructors got the highest rating in professional decorum than interpersonal skills. Vanaki & Memarian (2009) state that this professional ethics emerged with concepts of commitment, responsibility and accountability which include three categories: personal characteristics, the care of environment and provision of productive work practices. Professional conduct of the nurse will be at the center of a progressive virtuous circle with professional ethics at its core and ultimately leads to professional competency.

There is a study (Asfour & El-Soussi, 2011) that found out that students had enough orientation, are under stress because of lot of work and duties, the ration of instructors to students is adequate, duration of clinical training is not enough, open lab system is helpful to students, organized schedule decrease students’ irritability, students are well oriented with ILOs of their clinical training, instructors and students enjoyed OSCE, the evaluation tools are good for students, students and instructors don’t like portfolio and logbook, students like their clinical instructors they see them role models, students and instructors are satisfied with training in labs because there’s adequate equipment and supplies compared to hospitals and students dislike caring for patients in isolation room. These findings support the need for Faculty of Nursing to plan and implement nursing curriculum in a way that nursing students be involved actively in their education. However, Clark (2008) observe that incivility or an impolite behaviour like being rude and discourteous has grown worse most commonly in academic environment like in nursing education. Faculty incivility is one of the most common problems in teaching-learning environment and there were three main themes of faculty incivility; behaving in an improper manner, unfair treatment between their students and pressuring the students to do what the faculty demands. Thus the concept of rankism emerged in result of incivility in order to reverse patterns of discrimination such as abusive use of power and control to an individual. Academic incivility in nursing education has been increasing both with the students and teachers. In addition, according to Altmiller (2012), students have been accusing teachers as the starters of being uncivil in classes. Likewise, teachers complain about the uncivil behavior of the students. Students and faculty have similar perceptions regarding uncivil behavior, particularly in defining it, acknowledging its existence, and noting its increasing frequency in the academic setting. The bottom line is that the students want their faculty to be their role model in setting a standard of how to achieve civility in the learning environment. An important first step includes implementing effective strategies that de-escalate incivility and foster appropriate professional behaviour. Faculty reflection, the sharing of experiences and adequate preparation for classroom management will support an environment where incivility can be deterred.

Through an effective characteristics or attributes of clinical instructors, nursing students and instructors can easily express each other’s views and mention their concerns about clinical teaching.


Survey tool or workshop is important to guarantee that student centeredness is fully practiced. According to Notzer & Abramovitz (2008), the part where you can perceive some enhancement in an instructor’s performance is when they make themselves available to their students for positive criticism that they continuously need for development. This demonstrates that, if well designed, even brief work- shops can help to internalize the concept that learners and their needs are the central focus of teaching. It is very likely that a brief workshop can meet student needs and change instructor behaviour even in the long run. It also gives the clinical instructors the opportunity to be more aware on their level of performance and for them to provide more efforts to the criteria they lack the most. And through this, instructors will view the evaluation as a positive means of growth and development for their profession. Knox & Morgan (1985) stated the importance of five categories of clinical teacher behaviors as perceived by university nursing faculty, students and practicing baccalaureate graduates. They used survey tool to measure clinical teacher effectiveness. But since there is a need of clearer definition of what an effective clinical teaching is therefore the validity of the instrument is difficult to assess and needs further study.

In addition, Newton, (2012), hypothesized that the significance of continuity of clinical teachers to the contribution of student centeredness is an important aspect to be considered and that students participating in the preceptorship partnership model would have more positive perceptions of the clinical learning environment compared to students participating in other models of clinical education. Clinical teachers play an essential role in students’ activities and it all depends on how they engage with their students. Consistent interaction is needed to obtain a greater understanding of the student’s individual needs.


Ali,W.G. (2012). Caring and Effective Teaching Behavior of Clinical Nursing Instructors in Clinical Area as Perceived by their Students.Journal of Education and Practice,3(7), 15-26.

Altmiller,G. (2012). Student Perceptions of Incivility in Nursing Education: Implications for Educators.Nursing Education Perspectives,33(1), 15-20.

Asfour,H.I., & El-Soussi,A.H. (2011). A Qualitative Study of Effectiveness of Clinical Teaching.Journal of American Science,7(7), 409-420.

Bobay,K., Gentile,D., & Hagle,M. (2009). The Relationship of Nurses’ Professional Characteristics to Levels of Clinical Nursing Expertise.

Cadosales,M.Q. (2009). Clinical Instructors’ Teaching Performance: A Framework for Enhancement Activities.National Peer Reviewed Journal,2, 272-288.

Clark,C. (2008). Student perspectives on Faculty Incivility in Nursing Education: An Application of the Concept of Rankism.Nursing Outlook,56(1), 4-8.

Day,L., & Smith,E. (2007). Integrating Quality and Safety Content Into Clinical Teaching in the Acute Care Setting.

Eta,V.E., Atanga,M.B., Atashili,J., & Cruz,G.D. (2011). Nurses and Challenges faced as clinical educators: a survey of a group of nurses in Cameroon.The Pan African Meidcal Journal,8(28).

Farmer,B.J., & Frenn,M. (2009). Journal of Professional Nursing.Teaching Excellence: What Great Teachers Teach Us,25(5), 267-272.

Healey,W.E. (2008). The Physical Therapist Student Approaches to Learning During Clinical Education Experiences: A Qualitative Study.Journal of Physical Therapy Education,22(1).

Jahan,F., Sadaf,S., Kalia,S., Khan,A., & Bin Hamza,H. (2008). Attributes of an effective clinical teacher: a survey on students’ and teachers’ perceptions.Journal of the College of Physicians and Surgeons Pakistan,18(6), 356-361.

Kring,D.L., Ramseur,N., & Parnell,E. (2013). How Effective are Hospital Adjunct Clinical Instructors?Nursing Education Perspective.

Knox, J. E. (1985). Nursing Clinical Teacher Effectiveness Inventory. Retrieved from _Clinical_Teacher_Effectiveness_Inventory.pdf?sequence=1

Newton,J., Jolly,B., Ockerby,C., & Cross,W. (2012). Student Centeredness in Clinical Learning: the Influence of the Clinical Teacher.Journal of Advanced Nursing,68(10), 2331-2341.

Notzer ,N., & Abramovitz,R. (2008). Can Brief Workshops Improve Clinical Instruction.Medical Education,42, 152-156.

Ralph,E., Walker,K., & Wimmer,R. (2008). The Pre-service Practicum: Perspective of Students from Three Disciplines.

Sawatzky,J.V., Enns,C.L., Ashcroft,T.J., Davis,P.L., & Harder,N. (2009). Teaching Excellence in Nursing Education: A Caring Framework.Journal of Professional Nursing,25(5), 260-266.

Vanaki,Z., & Memarian,R. (2009). Professional Ethics: Beyond the Clinical Competency.Journal of professional Nursing,25(5), 285-291.

Zafrir,H., & Nissim,S. (2011). Evaluation in Clinical Practice Using an Innovative Model for Clinical Teachers.Journal of Nursing Education,50(3), 167-171.


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