Defining and Characterizing the Nursing Student-Faculty Relationship in Clinical Practice: A Concept Analysis

Introduction

The nursing student-faculty relationship (NS-F) is a dynamic and influential aspect of nursing education that significantly impacts aspiring nurses’ learning process and professional growth.¹ According to Snijders (2022),² supportive student-educator relationships can promote both professional and personal growth in addition to increased student involvement. The relationship has significant implications for both students’ social and academic development, which are positive, and long-lasting.³ Therefore, nurse faculty need to examine their roles as teachers and determine whether what they do facilitates or hinders the relationship development process for student nurses.⁴

Despite its importance, there is a lack of comprehensive understanding and clear definition of this relationship in clinical settings, which can lead to inconsistent teaching practices and suboptimal student outcomes. This concept analysis aims to fill this gap by systematically identifying and characterizing the attributes, antecedents, and consequences of the NS-F relationship, thereby providing a foundation for future research and practical guidelines for nurse faculty.

Background

The relationships and interactions between educational faculty and their students are essential components of the educational learning process.⁵ The faculty-student relationships can be seen as predictors of students’ academic outcomes and overall success.^6,7 The ultimate goal of the nursing profession is to produce nurses who have caring attributes⁴ and student-faculty relationships and their interconnectedness is one of the factors that contribute to the nursing students’ academic success and caring attributes.⁸ Similarly, Read et al (2013),¹ indicated that student-faculty relationships are key determinants of undergraduate nursing students’ academic outcomes. Positive student-faculty interactions are associated with student success, influencing academic performance, satisfaction with their educational experience, persistence in their studies, intellectual and personal growth, and career ambitions.⁷

Additionally, the quality of faculty-student relationships is crucial for students’ successful development into a caring professional.⁹ Nursing education is built on the fundamental principle of caring, which also forms the basis of the interaction between nurse faculty and students.¹⁰ In nursing education, the caring relationship between faculty and students improves students’ desire to care for others, and learning experiences to care, and promotes a sense of self-actualization.¹¹ Currently, nursing education is experiencing a shift in paradigm from a behaviorist perspective to a humanistic approach.¹² Reviewing the literature on nursing education, however, finds a dearth of studies exploring the student-faculty relationship from the perspective of the humanistic paradigm.¹³ In this paradigm, the “Students as Partners” (SaP) model is gaining attention, where students and educators engage in a collaborative, reciprocal relationship to enhance learning. This partnership changes the usual roles between learners and teachers, encouraging mutual respect, independence, and increased motivation in the learning experience.¹⁴ While much of the existing literature has focused on student-faculty relationships in the classroom and outside classroom settings within higher education,^2,15–17 there is limited research exploring these relationships among nursing students both in classroom and clinical settings, where they play a pivotal role in shaping nursing students’ learning experiences and their professional socialization.^13,18 In addition, many studies have focused on the impact of this relationship on students learning and well-being.^4,18–21 However, the defining attributes and characteristics of the student-faculty relationship in clinical practice remain unclear. It is important to define and characterize this concept to provide an operational definition and its characteristics (identify its attributes, antecedents, and empirical referents) as a basis for understanding the teaching and learning processes in clinical education.

This gap in the literature underscores the need for a detailed concept analysis to systematically define and characterize these relationships in clinical settings and inform future scientific research. Such an analysis will provide valuable insights for nurse faculty, enabling them to foster more effective interactions, enhance student outcomes, and support professional development. Additionally, addressing this gap is essential for optimizing clinical education and ultimately improving the quality of nursing care provided by future nursing professionals as well as their social well-being.

Materials and Methods

Approach to Concept Analysis

Concept analysis is a formal process of breaking down a phenomenon to gain a better understanding of it and to provide a definition that makes it measurable.²² The concept analysis employed the Walker & Avant concept analysis process which provided a systematic approach to define and characterize the concept. It was modified and simplified from Wilson’s (1963) original version of the concept analysis approach and consists of eight steps instead of eleven,²² making it easier for beginner researchers to comprehend and apply.²³ There are various approaches to concept analysis, but Walker and Avant is a commonly used in nursing discipline as the basis for analyzing the core concepts of nursing.^24–26 It has the following steps which this analysis followed:

(1) select a concept; (2) determine the aim or purpose of analysis; (3) identify all possible uses (definitions) of the concept; (4) determine the defining attributes; (5) identifying a model case; (6) identify a borderline, related and contrary cases; (7) identify antecedents and consequences of the concept; and (8) define empirical referents of the concept (Walker & Avant, 2019, p.170).²²

The literature review involved systematically looking at all the ways the NS-F relationship is discussed in both nursing and education. Since the student-faculty relationship is a concept that goes beyond just nursing, the review explored how the concept is used in both nursing and broader educational research. This review focused on identifying relevant definitions, key attributes, and characteristics of the relationship, ensuring a comprehensive understanding of the NS-F relationship in clinical settings.

Literature Search

The following questions underpinned the integrated review: What is the NS-F relationship? What attributes or elements define the NS-F relationship? A systematic search using the following search equation was done: (Student nurse – faculty relationship OR Nurs* student-faculty relationship OR Student-faculty relationship OR Student-teacher relationship OR Student - Lecturer relationship OR Nursing student-instructor relationship) AND (Clinical Practice OR Clinical area OR Clinical setting* OR Nurs* education). Inclusion criteria comprised of (a) Peer-reviewed quantitative and qualitative research articles and grey literature published in the last 10 years (2013–2023), (b) Articles available in English, (c) Articles defining the concept of NS-F relationship, (d) describes one or more features, conditions or attributes characterizing the NS-F relationship. The exclusion criteria included articles not directly addressing the NS-F relationship in clinical practice on the basis that such articles would not provide the required information on the construct.

Mendeley served as the reference management software for organizing retrieved articles in this study. To ensure reliability, an independent individual searched, and titles and abstracts were screened for relevance. Full-text articles were obtained for further evaluation. In cases of disagreement, each researcher independently read the full article to resolve discrepancies and reach a consensus through joint discussions. Fifteen (15) articles were considered for final review and the search spanned from 6^th to 25^th December 2023.

Data were analyzed employing a thematic analysis approach, and common themes emerging were extracted and synthesized to gain a comprehensive understanding of the concept. A narrative synthesis of the selected studies was conducted, and a word table was prepared, detailing author(s) and year, country of origin, purpose, study design, sample, antecedents, elements/attributes, and outcomes of the relationship. Despite efforts to include a diverse range of sources, limitations may exist due to database constraints and variations in terminology across different nursing literature sources. Figure 1 depicts the PRISMA flow diagram for the sampling process.

Figure 1 PRISMA flow diagram.

Results

A narrative summary was created by combining the results from the chosen research studies to understand the concept. Table 1 illustrates the summary of this information for ease of reference.

Table 1 Summary of Studies

Selecting the Concept

The nursing students and faculty relationship is vital for achieving learning outcomes and fostering the professional and personal development of nursing students.¹² Literature suggests that a strong learner relationship can result in positive outcomes such as academic success,⁴ improved clinical learning experiences,²⁹ and enhanced student resilience.²⁰ However, its defining characteristics including what it is and what it is not, and its impact on teaching and learning are not well documented.

Determining the Aim and Purpose of the Analysis

It is essentially necessary to analyze the NS-F relationship through an integrated review because its definitions and conception vary among authors¹² and its key characteristics and attributes have not been fully and clearly defined.

Definition and the Uses of the Concept

The NS-F relationship refers to the academic connection between nursing faculty and nursing students within clinical practice, characterized by dynamic interpersonal interactions during practical learning experiences in healthcare environments.^1,2,4 It encompasses the interactions between students and faculty as they collaborate in real-world patient care scenarios.^2,4 The actions and attitudes within the nursing student-faculty relationship influence each other, reflecting the reciprocal nature of this interaction. Nevertheless, educators seem to play a vital role in creating an environment that shields students from adversity and promotes healthy development and psychological well-being essential for learning.³³

Attributes

At its core, concept analysis aims to identify an idea’s distinguishing features in an attempt to identify the attributes or elements most commonly connected with the concept providing the analyst with a broader understanding and deeper insights into it.²² There has been relatively limited exploration into the nature of the nursing student-faculty relationship and its impact on student learning,³⁴ with the current trend still the same. Considering that relationships and interactions are complex human phenomena, a holistic and integrated approach is required for it to be clear and understood. NS-F relationship has many attributes, however, the common defining attributes of this relationship in clinical practice as identified in the reviewed literature are discussed below.

Caring

Caring is one of the key elements in a NS-F relationship reflected through mutual trust and respect.^5,20,35 It was consistently mentioned in studies such as Ingraham et al (2018),⁴ Garcia-Moya et al (2020),⁵ Froneman et al (2016),²⁰ Factor & Guzman (2017)³⁰ and Scarbrough (2013).²⁸ According to Chipeta et al (2022)³⁶ students perceived faculty caring as being available, being fair, being respectful, seeing the person in the student, and communicating. Similarly, Del Prato (2013)³⁷ reported that nursing students recognize the caring nature of their interactions with nursing faculty, both in formal and informal settings, entailing that caring has to be demonstrated in this interaction.

Most articles have looked at the caring aspect of this relationship as demonstrated by faculty and not the students themselves. In their paper, Chan et al (2017)²⁹ explored power dynamics in student-teacher relationships during their clinical practice and asserted that teachers should have more power than students so that students should not cause harm to patients. A lack of care in the learning environment can negatively impact student-faculty relationships, especially when students feel undervalued or isolated from the learning process, which can further hinder student-faculty interactions.³⁸ Nursing students argue that when educators are approachable, they feel both supported and cared for during their academic journey.¹

Caring is also demonstrated through mutual trust in which faculty are reliable, sincere and perform their role effectively.^2,16,28 Successful teacher-student relationships are often defined by the teacher earning the student’s trust, providing emotional safety, and ensuring students are supported and encouraged to excel academically.³⁹ Such a relationship in nursing education is described as “a place of possibility”.

Additionally, students feel cared for when the nurse educator genuinely cares about the students as persons and respects them as individuals.^5,16,30 Coyle – Rogers’ (2005)⁴⁰ findings indicated that clinical instructors recognized that while students make mistakes, there is a difference between intervening aggressively and simply being harsh for the sake of it. Chipeta et al (2022)³⁶ also found that students felt cared for in their interaction with faculty when students felt more supported and less criticized, particularly when faculty communicated with them respectfully, rather than shouting at them in front of nurses, patients, and peers.

Interpersonal Connectedness

Interpersonal connectedness reflects a deeper emotional and professional bond between students and faculty.^2,5 This was significant in several studies like, Snijders et al (2022),² Yaghoubina et al (2014),¹² Fitzmorris et al (2022),¹⁶ Chan et al (2018),¹⁸ Froneman et al (2016),²⁰ Factor & Guzman (2017),³⁰ Shahsavari et al (2014),²⁷ and Proverbs & McClunie-Trust (2018).³² This connectedness involves both the faculty’s commitment to teaching and the student’s engagement in learning.^17,30 When students viewed their interactions with educational faculty as satisfying, they demonstrated a greater commitment to their clinical responsibilities.⁴¹ The connectedness is also reflected in the faculty’s genuine concern for students’ learning and achievement of students’ learning outcomes which reflects their dedication to supporting students’ development.¹⁶ The educator must exhibit qualities such as love and care, patience, respect, responsibility, morality, openness to new ideas, motivation, punctuality, and willingness to “go the extra mile”.²⁰

Nurse educators are critical in bridging the theory-practice gap because of their teaching in both classroom and clinical settings.^42–44 This dual role helps nursing students develop clinical skills and integrate into the professional culture of nursing.⁴⁵

Motivation and Constructive Communication

Another key attribute seen in the NS-F relationship is constructive communication which is seen through giving students words of encouragement and constructive feedback.¹⁶ This was a recurring theme in studies by Snijders et al (2022),² Froneman et al (2016),²⁰ Kucirka (2017),²¹ Scarbrough (2013),²⁸ Proverbs and McClunie-Trust (2018)³² and Afzal et al (2023).³¹ Faculty can provide this directly or through compliments² responding²¹ or expressing words of motivation.^5,31 This kind of communication helps create a trusting relationship, as students know they can rely on honest and constructive feedback from their educators.

Case Studies

The following case studies are fictional illustrations constructed based on generalized experiences as a nurse educator to highlight the main characteristics and dynamics of the NS-F relationship. While inspired by actual student experiences, certain details have been adapted to fully represent the concept as analyzed. The names used serve solely to illustrate an interaction of students and faculty within the NS-F relationship.

Model Case

Jb, a nursing student, engages in a case study discussion with his lecturer, Mrs. B, in a female ward during the clinical placement as per their previous agreement (interpersonal connectedness). Mrs. B comes to the ward at 2:30 pm as agreed and takes a personalized approach (caring), guiding Jb through various aspects of patient care concepts and current guidelines. She fosters group discussion, providing constructive feedback, and words of encouragement whilst maintaining a calm and respectful voice even when mistakes are made (caring and motivation and constructive communication).

Borderline Case

In another clinical setting, Maa, a nursing student, interacts with a committed nurse educator, Mrs. Le, who discusses a case study with her (interpersonal connectedness). Mrs. Le acknowledges students as individuals and provides constructive feedback without raising her voice (interpersonal connectedness, Motivation, and constructive communication). However, some of her teachings contradict current clinical guidelines and what the students learned in class.

Related Case

Dr. S, a lecturer, encounters AL attending to a patient during his routine clinical teaching rounds and takes that opportunity to teach AL (interpersonal connectedness). Despite wanting to teach, Dr. S loses patience when AL faces challenges with an IV cannulation procedure and he publicly criticizes AL, raising his voice and creating discomfort. Instead of guiding her through the procedure, he performs it himself, leading AL to feel disrespected and uncared for.

Contrary Case

Dd, a nursing student, works with a lecturer, Ms. B, who rarely offers positive words of encouragement but points out the negatives only. While Ms. B corrects errors, her approach lacks the constructive communication needed for growth. Dd, despite performing adequately, feels a lack of motivation and connection due to the absence of positive reinforcement.

Antecedents and Consequences

The antecedent of the NS-F relationship is the contact and interaction existing between the faculty member and the student, representing the relationship’s starting point.^12,20 This contact is essential for teaching and learning to occur, and the presence of a clinical environment further facilitates the establishment of the SN-F relationship. Literature also alludes to the perceptions and perspectives of the educators’ role as teachers and role models, as well as their power and commitment in their capacity as teachers, which are other antecedents to this relationship.^5,12,20

Extensive research highlights the significance of faculty-student interactions in students’ success,^{4,7,20,28,46,47} but also the educators’ success.¹⁶ Positive outcomes include but are not limited to students’ development, motivation, and engagement in multiple ways;^16,31,48 students’ academic success⁴ student engagement.^16,31,49 Moreover, it impacts the student’s ability to cope with the stresses of nursing care which result in strengthening students’ resilience and making students feel safer and more secure. Additionally, it improves the interpersonal relationship between the two and others.^2,17,49 However, Agyekum (2019)⁵⁰ asserted that a negative teacher-student relationship can lead to significant problems that profoundly affect students.

Empirical Referents

These refer to “categories or classes of the phenomena that by their presence demonstrate the existence of the concept itself” (Walker & Avant, 2019, p. 179).²² Empirical referents are not tools intended to measure phenomena or concepts, but they provide a means by which one can measure or identify the attributes or defining characteristics of that concept.²² Considering that the critical attributes of the NS-F relationship include a subjective component ie, different perceptions of caring, trust, respect, etc, an empirical referent of the NS-F relationship would be an individual subjective analysis of this relationship. Objectively, other tools can be used with a little modification to capture the specific clinical aspects ie the Student-Instructor Relationship Scale, which is a 36-item tool, can be used to assess the connectedness and anxiety of the student-instructor relationship.³⁸

Discussion

The current concept analysis indicates that the NS-F relationship is the connection and interaction that exists between the nursing student and the faculty to promote learning. Most literature has given attributes that are seen in the educators who seem to play a leading role in this relationship. This could be a result of their influence in the education cycle which is to facilitate learning where the teacher serves as the prime mover of the educational wheel.⁵¹ The NS-F relationship in clinical practice is an academic interaction between a student and a faculty characterized by the dynamic interpersonal connection established between nursing students and their faculty members during hands-on learning experiences in healthcare settings. This definition of the NS-F relationship is consistent with those from the related literature.^1,2,4

The model case highlights how a positive relationship between the students and faculty can enhance the learning experience. Jb’s interaction with Mrs. B reflects how interpersonal connection and a caring environment contribute to students’ learning and personal development. Constructive communication and words of motivation play a critical role in students’ success by creating a facilitative and conducive learning environment.

Generally, caring has been seen as an attribute not just in this relationship, but in many others. They only differ on how that caring is defined and demonstrated in each aspect. The case of Maa and Mrs. Le demonstrates this despite some contractions in teaching which demeans trust. The literature supports this notion, indicating that caring behaviors such as being respectful, being available, approachable, and respectful are important in fostering a positive learning environment.^36,52 Similarly, the Early Career Framework emphasizes that fostering a culture of respect and mutual trust is essential for developing effective relationships⁵³ A strong and lasting relationship is built on trust and mutual respect, and teacher-student interactions that are merely based on academic performance or behavior management create barriers within a student and stifle genuine relationship-building.³⁸

These behaviors are demonstrated in the interaction between students and faculty as Brown (2011)⁵⁴ stated that caring in nursing education is expressed through interactions between nursing students and faculty, indicating an attribute in this relationship. Salehian et al (2017),¹¹ also assert that NS-F caring relationships enhance students’ learning experiences to care, fostering their desire to care for others and promoting self-actualization. Del Prato (2013)³⁷ argues that when students perceive their interaction with faculty as uncaring, as seen in the contrary case involving Dd and Ms. B, their practice becomes less caring as well. In contrast, the literature notes that when faculty members demonstrate caring behaviors towards their students, as in the model case, students emulate that behavior, which provides positive results in caring practices.^10,29,30,36 It is therefore important for caring to be enhanced in the NS-F relationship.

Teachers play an important role in ensuring that the practice–theory gap is reduced by being available to teach the students. The academic contact between the students and faculty builds on the relationship whose goal is to achieve learning outcomes. Similarly, Yaghoubinia et al (2014)¹² identified emotional connection as an attribute that contributes to enhancing the clinical learning experiences of students. This connection, in a way also shows that one is supportive of the learning process. The case of Dr S in the related case illustrates interpersonal connectedness through the willingness to teach. However, Dr. S’s impatient with AL undermines the students’ confidence and creates an uncaring atmosphere. In clinical environments, support is critical for student success, particularly when they encounter challenges.⁹ Students may struggle to achieve their learning goals if the environment is not supportive. In a study by Msiska et al (2014),⁵⁵ students perceived themselves as “lost sheep” when faculty did not come to support their learning. Support in clinical environments greatly enhances students’ success.⁹

Motivation and constructive communication play an important role as it guides students in improving their work.⁵⁶ The model case illustrates how Mrs B’s motivational words and constructive communication helps Jb feel encouraged and supported, leading to positive learning outcomes. Students who have a positive relationship with their teachers have a better sense of self-governance and can meet their needs.

Certain antecedents such as the clinical learning environment, the contact and interaction between the faculty and nursing students, and the role perceptions precede the development of a NS-F relationship. However, this relationship tends to lean towards the consequences that benefit the students more and directly. The relationships and interactions between students and faculty are critical for educational learning processes.⁵ Positive outcomes from these relationships include increased student motivation, involvement, and development in various ways as demonstrated in the model case.⁴⁸ Froneman et al (2016)²⁰ add that a successful student-educator relationship is evident when students achieve academic success and experience personal development. Nonetheless, a positive relationship motivates the faculty and the achievement of learning outcomes as students empower the faculty to do more. On the other hand, though not from the clinical perspective, McCormick and O’Connor (2015)⁵⁷ found that negative relationships hinder students’ academic progress and harm their social and emotional well-being, sometimes fostering dependency and feelings of insecurity as seen in the contrary case. In addition, if there is no caring and interpersonal connectedness, there are reduced learning opportunities and negative outcomes from distance relationships.^18,32 These can be handled through clear expectations and a good interpersonal relationship between the two.

Conclusion

The nursing student-faculty relationship is important in the academic arena as it influences the success of learning outcomes as well as motivation in the teaching-learning process. It forms a basis for shaping the student nurse as a professional. The attributes of this relationship include caring, interpersonal connectedness, motivation and constructive communication. These traits align closely with the core principles of the 6Cs model of nursing, particularly caring, commitment, and communication. By nurturing these attributes, nurse educators can enhance both the academic success and professional growth of nursing students.

Implications on Research, Policy, Practice and Education

This concept analysis has implications for nursing research, policy, practice, and education in such a way that it positively influences students’ learning outcomes, motivation, and personal development if incorporated into day-to-day interactions between students and faculty. By incorporating these characteristics, a supportive learning environment is created, allowing effective interaction between faculty and students without fear or anxiety.

The findings also impact on education through the development of curriculum both hidden and formal. If these attributes are integrated into the curriculum, they may enhance the teaching and learning environment. In addition, policies would be developed to promote a supportive learning environment in clinical settings. Notably, the limited existing literature on this concept and the absence of similar concepts provide a basis for future research.

Limitations

The constructed cases in this analysis, though based on real cases expressed by the students, are fictional representations and contain elements that were artificially developed to illustrate specific concepts. Despite these limitations, the analysis has profound significance as it may contribute to creating an agreed language enclosing the concept, which helps the readers discern the NS-F relationship from other closely related concepts or relationships.