AN INVESTIGATION INTO THE EXTENT TO WHICH A CARING ENVIRONMENT 
IN NURSING EDUCATION IS PROVIDED AT THE NORTH WEST UNIVERSITY, 
MAFIKENG CAMPUS 
BY 
BOTHUTU ANGELINA MOKWENA 
B CUR {I et A) & MA 
THESIS SUBMITTED IN FULFILLMENT OF THE REQUIREMENTS FOR THE 
DEGREE OF DOCTOR OF EDUCATION IN THE FIELD OF CURRICULUM 
DEVELOPMENT AND PLANNING IN THE SCHOOL OF POSTGRADUATE 
STUDIES IN THE FACULTY OF EDUCATION, NORTH WEST UNIVERSITY, 
MAFIKENG CAMPUS 
Promoter: Prof M. W. Lumadi 
Co-promoter: Dr M. A. Mokoena 
LIBRARY 
MAFIKENG CAMPUS 
June 2010 CALL NO.: 
2021 -07- 2 8 
ACC .NO.: W 
NORTH-WEST UNIVERSITY 
DECLARATION OF ORIGINALITY 
I , Bothutu Angelina Mokwena, declare that this thesis for the degree of Doctor of 
Education at the North West University, Mafikeng Campus has not been previously 
submitted by me for a degree at this or any university. It is my own work in design and 
execution. All the materials taken from other sources contained in t~is thesis have been 
dully acknowledged . 
Signature: ... ............... .. ......... ... . 
Date: ...................................... . 
iii 
DEDICATION 
I dedicate this thesis to the memory of my mother, Mrs Mary Mokwena. Thank you for 
making things possible for me. I am grateful to have had a mother like you. I also 
dedicate this work to my children, Lungie and Tshepo, and my two grandsons, 
Letlhogonolo and Ntando. 
iv 
ACKNOWLEDGEMENTS 
I wish to express my appreciation and grateful thanks to the ALMIGHTY GOD, my very 
own Father, without His unfailing love, wisdom, strength, guidance and support, this 
work would not have been completed but " .. .w ith God all things are possible" (Matthew 
19:26). 
I would also like to express my sincere gratitude and appreciation to: 
My promoter, Prof M. W. Lumadi, not only for his professional expertise, but also for his 
unfailing patience, support, guidance and time spent meticulously reading my work. 
My co-promoter, Dr M. A. Mokoena, for her outstanding support through the process of 
this thesis, unfailing patience, encouragement, sound advice, guidance, professional 
expertise and time spent meticulously reading my work. 
Dr L. Makondo for the wisdom and knowledge he shared with me. I also thank him for 
the unwavering support and the kindness displayed including outstanding language 
editing . 
North West University for granting me permission to conduct this study which has 
widened my horizon of thinking thus sharpening my research competences. 
Faculty of Education, Mafikeng Campus for providing me with this golden opportunity to 
pursue an interdisciplinary career path in curriculum development and planning. 
Faculty of Agriculture, Science and Technology for financial assistance in 2005. 
My colleagues in the Department of Nursing Science for encouragement and support. 
V 
All the Bachelor of Nursing Science degree nursing students who have completed and 
those who are still pursuing their study; without my interaction with them since 1986, 
this work would have not taken place. 
The nursing students who participated in this study; without their genuine sharing of 
perceptions and expectations regarding a caring environment in nursing education, this 
work would not have materialised. I really salute them. 
The library personnel for the excellent library support service. 
My children: Lungie and Tshepo and my grandsons, Letlhogonolo and Ntando for their 
unfailing love, support and encouragement during some of my most vulnerable 
moments throughout this journey. 
vi 
ABSTRACT 
This qualitative study used exploratory and descriptive research strategies to investigate 
whether or not nursing education, as presented at the North West University, Mafikeng 
Campus, provides a caring environment to Bachelor of Nursing Science degree students. 
A sample consisted of sixty seven (n=67) nursing students and made up of·two groups. 
Both groups were at the fourth year level but in different years of their study. One group 
comprised of twenty seven (n=27) and another group was made up of forty (n=40) and 
were conveniently chosen due to their geographical availability and accessibility. A 
purposive sampling was also employed since both groups had been in the programme a 
long time and had similar characteristics therefore they had the theoretical understanding 
of a caring environment within the context of nursing education as a concept under 
investigation. This study's theoretical underpinning is grounded in interaction and caring 
perspectives. 
Data was collected through narrative sketches among 27 participants in 2005 and four 
focus group interview sessions conducted in 2006 among 40 participants. Their 
perceptions and expectations regarding a caring environment in nursing education were 
elicited, explored, described and analysed through an open coding data analysis 
process. The results which ·reached a comprehensive description were outlined and 
clustered as responses, themes, statements and finally summarized as categories and 
subcategories. 
vii 
While the literature highlights the importance of nursing education incorporating a caring 
environment in order to develop this professional attribute, the findings of this study 
revealed that this may not necessarily be the nursing students' perceptions. From the 
nursing students' accounts of their perceptions regarding their nursing educational 
experiences, it emerged to a large extent that a caring environment in nursing 
education at the North West University, Mafikeng Campus, is not adequately provided. 
Role modelling and mentoring emerged as the most crucial profess'ional attributes that 
exemplify the interaction and caring practices the lecturers could display if a caring 
environment is to prevail in nursing education. A caring role model and mentor, according 
to the expectations expressed, are epitomized by genuine acceptance, empathy, respect, 
resilience, warmth integrated with caring, interaction conducts and attitudes. Seemingly 
these could mould the whole nursing students' educational experiences. It appears that 
positive role modelling and mentoring should ideally take precedence in the environment 
for teaching and learning in nursing education. Furthermore, these results guided the 
researcher to construct a framework with essential features to use in formulating 
guidelines for a caring environment in nursing education to optimize meaningful 
learning experiences in the classroom and clinical learning areas the nursing students 
require. The guidelines are presented in the format of twelve standards and criteria that 
the lecturers are to comply with. Each standard has a number of criteria which address 
the major findings of the research. 
viii 
TABLE OF CONTENTS 
Declaration iii 
Dedication iv 
'.  
Acknowledgements V 
Abstract vi 
Table of contents vii 
List of appendices xiii 
Acronyms and abbreviations xiv 
List of tables xv 
List of figures xvi 
CHAPTER ONE: ORIENTATION TO THE STUDY 
1.1 Introduction and background 1 
1.2 Problem statement 8 
1.3 Purpose of the study 10 
1.4 Objectives 10 
1.5 Significance of the study 11 
1.6 Delimitations and limitations of the study 12 
vii 
1.7 Definition of key concepts 13 
1.8 Ethical considerations of the study 16 
1. 9 Organisation of the study 19 
1.10 Summary 20 
CHAPTER TWO: LITERATURE REVIEW 
2.1 Introduction 22 
2.2 Conceptualisation of the key concepts for the study 23 
2.2.1 Guidelines 23 
2.2.2 Caring environment 24 
2.2.3 Nursing education 25 
2.3 Key policies and legislative frameworks 27 
2.3.1 Brief historical overview of nursing education curriculum in 
South Africa 27 
2.3.2 Key Higher Educational policies and legislative frameworks 29 
2.3.3 The South African Constitution Act No. 108 of 1996 as amended 30 
2.3.4 The South African Qualifications Authority Act No. 58 of 1995 as 
repealed by National Qualifications Framework Bill, 2008 31 
2.3.5 Higher Education Act No. 101 of 1997 as amended 32 
2.3.6 The White Paper on Transforming Public Service Delivery 34 
2.4 Overview of the theoretical perspectives 36 
viii 
2.4.1 Theoretical overview of an interaction perspective 37 
2.4.1.1 Interaction as a concept 37 
2.4.1.2 Formation of meaning through interaction 38 
2.4.1.3 An environment as a determinant of an interaction 42 
2.4.1.4 Emergence of self, self-concept and self-esteem 44 
2.4.2 Theoretical overview of a caring perspective \ · 52 
2.4.2.1 Caring as a concept 52 
2.4.2.2 Caring relationship perspective 54 
2.4.2.3 Lecturer-student relationship 56 
2.4.2.4 Moral education from an ethical caring perspective 61 
2.4.2.5 Caring traits 67 
2.4.2.6 Caring as a moral perspective in teaching learning process 71 
2.4.2.7 Fostering a child or student's growth and development 73 
2.5 Summary 74 
CHAPTER THREE: RESEARCH DESIGN AND METHODOLOGY 
3.1 Introduction 75 
3.2 Research design 75 
3.2.1 Type of research design 76 
3.2.2 Research strategies 78 
3.2.2.1 Exploratory research strategy 78 
ix 
3.2.2.2 Descriptive research strategy 79 
3.2.3 Research context 80 
3.3 Research methodology 81 
3.3.1 Population 81 
3.3.2 Sample and sampling techniques 81 
3.3.3 Data gathering ' ' 83 
3.3.3.1 Pilot study 84 
3.3.3.2 Data collection tools for the main study 85 
3.3.4 Data analysis 94 
3.3.4.1 Data analysis of narrative sketches and audio-tape recorded 
focus group interview session transcripts 94 
3.3.4.2 Independent coding 96 
3.3.4.3 Realisation of data analysis 98 
3.3.5 Measures to ensure trustworthiness 100 
3.3.5.1 Credibility or truth-value 101 
3.3.5.2 Transferability or applicability 109 
3.3.5.3 Dependability or consistency 110 
3.3.5.4 Confirmability or neutrality 111 
3.4 Summary 112 
X 
CHAPTER FOUR: DATA ANALYSIS AND INTERPRETATION 
4.1 Introduction 113 
4.2 Analysis of results 113 
4.3 Discussion and interpretation of results 120 
I·, 
4.3.1 Participants' current nursing education environment 
is non-caring 120 
4.3.1.1 Poor lecturer-student interaction relationships 120 
4.3.1.2 Poor role modeling and mentoring 123 
4.3.1.3 Lecturers' unprofessional attitudes and behavior 126 
4.3.1.4 Inadequate and non-conducive classroom 128 
4.3.2 Participants' expectations regarding a caring environment 128 
4.3.2.1 Quality lecturer-student interaction relationship 129 
4.3.2.2 Good lecturer-student interpersonal relationships 133 
4.3.2.3 Lecturer-student collaboration 136 
4.3.3.4 Good role modeling and mentoring 141 
4.3.2.5 Physical safety 145 
4.3.2.6 Adequately equipped classroom 146 
4.3.2.7 Lecturers' availability and presence 146 
4.4 Synthesis 148 
xi 
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS 
5.1 Introduction 154 
.. 
5.2 Summary 154 
5.3 Conclusion 157 
5.4 Recommendations 158 
5.4.1 Recommendations for further research 158 
5.5 Guidelines to create a caring environment in nursing education 160 
5.6 Reflection 173 
REFERENCES 174 
xii 
LIST OF APPENDICES 
Appendix A: Permission to conduct research 186 
Appendix B: Invitation to participate in the research study 187 
Appendix C: Consent form 188 
Appendix D: Protocol for the registration of narrative sketches -.. 189 
Appendix E (1): Definition for data gathering: narrative sketches 190 
Appendix E (2): Data gathering: Narrative sketches 191 
Appendix F: Protocol for qualitative data analysis: Independent 
coder 193 
Appendix G Confirmation that language editing was done 194 
xiii 
LIST OF ACRONYMS AND ABBREVIATIONS 
CHE: Council on Higher Education 
ETQA: Education and Training Qualification Assurance 
HSRC: Human Sciences Research Council 
NCHE: National Commission on Higher Education '-. 
NQF: National Qualifications Framework 
NWP: North West Province 
NWU: North West University 
OBE: Outcomes-Based Education 
RPL: Recognition of Prior Learning 
SAQA: South African Qualifications Authority 
xiv 
LIST OF TABLES 
Table 1: Categorising of participants 93 
Table 2: Narrative sketches and audio-tape recorded focus group 
interview session transcripts retrieved 93 
Table 3: Data saturation and the achievement of referential adequacy 99 
Table 4: Combined data analysis of results presented as responses, 
themes and participants' statements 114 
Table 5: Final categorisation of results derived from combined 
data analysis 119 
LIST OF FIGURES 
Figure 1: Framework with special features for guidelines for 
a caring environment 161 
xvi 
CHAPTER ONE 
ORIENTATION TO THE STUDY 
1.1 Introduction and background 
This study provides background detail on the entire study. It begins by focusing on the 
introductory background to the problem pursued, followed by formulating the problem 
statement and outlining the purpose of the study. The study makes it clear that its 
underlining focal point is to demonstrate how a caring environment could be created in 
the nursing education context. It proceeds by delineating its objectives based on the 
research questions including the delimitations and limitations identified in the study. The 
significance, key concepts and the ethical considerations of the study are also highlighted. 
The Chapter reserves the review of the related literature to Chapter Two, the research 
design and methodology to Chapter Three, data analysis and interpretations to Chapter 
Four. The summary, conclusions and recommendations were highlighted in Chapter Five. 
It ends by briefly highlighting the organisation of subsequent Chapters Two to Five. 
Highlighted at this juncture it is therefore appropriate to put into perspective the research 
problem pursued in order to guide the research process of this study. Furthermore, to 
ascertain what impact does nursing education have on the lecturer-student interaction 
with specific reference to a caring environment. A caring environment in nursing education 
necessitates a paradigm shift in the educational and health care settings or situations 
where nursing students acquire specified learning outcomes such as knowledge, skills, 
values and attitudes essential in the nursing profession. This paradigm shift poses a great 
challenge to the lecturer-student interaction in nursing education. The creation of a caring 
environment in the educational setting should not only accomplish personal growth, 
professional development and career prospects for nursing students, but should have 
positive teaching and learning outcomes to effect meaningful and significant chan~e in the 
nursing profession in general and in nursing education specifically. In addressing the 
1 
problem pursued adequately it is therefore crucial at this point in t ime to investigate 
whether or not nursing education, as presented at the North West University, Mafikeng 
Campus, provides a caring environment to the nursing students .. 
The nursing education structure in essence as pointed out by Cohen (1981:139-142), is 
sound enough to produce professional nurse practitioners but such a structure is 
undermined by the nursing culture. This implies that throughout the education and 
training, nursing students internalise traditional values of obedience and submissiveness 
inherent in the nursing culture. These values are learned, partly through deliberate 
instruction, but mostly by incidental observation of the behaviours and attitudes of 
professional members including lecturers and through interaction with other health care 
team members. The author furthermore explains that nursing students are always 
expected to be perfect, fully responsible and self-confident in their everyday working life. 
They are also expected to be able to communicate in the kindest possible manner without 
appearing to be making suggestions, irrespective of their feelings or level of readiness. 
Likewise, they are expected to assess, make judgements and to be competent in carrying 
out assignments without questioning. Those failing to do so could be labelled as 
troublemakers. These powerful contradictions inherent in the climate of the nursing 
culture cause role conflicts, thus resulting in professional disillusionment brought about by 
professional members' expectations of obedience and perfection in the nursing students. 
Mokwena (1990:93) indicates that nurses are expected to be caring towards consumers in 
the health care system. However, such a behaviour and attitude is not displayed between 
themselves. Instead humiliation, ridicule and embarrassment are used to maintain 
acceptable codes of conduct. What prevails amongst them is remorse or insensitivity or 
fear. Remorse, insensitivity or fear result from the inhibiting effects of the nursing culture 
on the development of close personal and supportive ties amongst nurses in general, and 
nursing lecturers specifically. They always portray to the outside world the ideal image of 
perfection by creating the impression that they are capable of coping with any .s ituation 
they are exposed to. In addition, Nelms (1991:5) affirms that nursing lecturers avoid 
2 
knowing nursing students on a personal level for fear of losing their "objectivity". Both 
nursing lecturers and nursing students view nursing education as preparing for life instead 
of life itself. Such a situation is not unique to nursing, but nursing lecturers could perform 
better by caring for nursing students, for themselves, for the profession and for the -
consumers in the health care system. 
In view of the highlighted perspective, Tanner (1990:70) proposed that nursing lecturers 
should come to grips with the ways in which they can assist intelligent, caring nursing 
students to become knowledgeable and compassionate professional nurses. The author 
further suggests that caring should become a core value in both health policy and nursing 
education which would constitute a paradigm shift. The content-driven, overloaded and 
centrally prescribed curricula with emphasis on disease care (where 70% of graduates are 
employed) as articulated by Tanner (1990:72) should be replaced by the ones that: 
► Reflect the fostering of caring practices through lecturer-student and lecturer-
lecturer relationships that are equal and marked by co-operation and community 
building; 
► Fortify caring as a core value in the way or style in which nursing students are 
taught to think and feel as nurses; and 
► Underpin reform in lecturer-student relationships that nurture caring practices 
pivotal to nursing. 
It is alarming that nursing, as reported by Hoover (2002:80) is generally recognised as a 
caring profession, yet little is known about how to teach and enhance caring practices. 
Nevertheless, the author encouragingly anticipates that comprehension of how caring 
practices are taught and enhanced would improve future education of nursing students to 
be more caring nurse practitioners. In line with this perspective, Wade and Kasper 
(2006: 162) propose that if caring is the core of nursing, then the centre of attention 
should be on the practice of caring, the study of caring and the teaching of caring. They 
further report that the study of caring is frequently elusive since the concept of ~aring is 
difficult to comprehend and complex to put in practice. 
3 
Noddings (1988:216) finds it surprising that experts continually demand that 
educational institutions may do only one thing well which is the direct teaching of basic 
skills. Such basic skills capture only a small portion of the truth, while disregarding the 
moral priority or the core to which this component belongs. The author therefore, 
strongly emphasises that caring relationships deserve first priority in the teaching and 
learning environment. Caring should be regarded · as a moral conduct and attitude 
enlightened by the complex expertise of interpersonal relations. It fs neither without its 
own kind of rigour nor somehow less professional than the calculated expertise of 
formal judgement. Caring is both a moral direction t6 teaching and a moral educational 
endeavour. However, teaching moral education from a caring perspective is not 
dependent on a set of ethical principles to be learned but on the essence of conditions or 
circumstances perceived by both the lecturer and the student. Each student should be 
guided and nurtured towards an ethical life meaning an ethical ideal that is relationally 
constructed. In the final analysis, in order for social relationships as vital sources of 
caring to be realised in the teaching and learning settings, a caring environment in 
nursing education should be established. 
In the present culture as aptly pointed out by Noddings (2005: 1) not only is there a great 
and fast growing desire for care-giving great, but the desire for caring relationships is 
strongly felt. The urge is to identify and answer these needs technically through formulaic 
approaches, which are unrealistic in nature. Caring cannot be achieved by such 
approaches, but requires address and response, and also various behaviours and attitudes 
from situation to situation, and from person to person. It occasionally calls for toughness 
or tenderness. Cool, formal people respond caringly with deference and respect, while 
warm, informal people react caringly with hugs and open affection. Some situations 
require only a few minutes of attentive care, while others need continuous effort over long 
periods of time. 
Nursing education according to Western University of Health Sciences (2006:2), is 
viewed as the teaching-learning process by which lecturers and students team-up to 
4 
create a nurturing and caring environment to achieve the educational goals of 
competence in professional nursing practice. Students are thus empowered to develop 
caring relationships with clients and others by being actively involved and participating 
in their ongoing educational process. 
The preparation for the nursing profession as expounded by Mokwena (1990:6) is viewed 
as a socialisation process as well as an educational process whereby nursing students 
acquire knowledge and skills by developing values, attitudes and beliefs supportive of their 
roles as nurse practitioners. Part of the professional socialisation task in nursing education 
is directed towards lessening the discrepancy between the students' idealistic views of the 
nursing profession and the actual reality. However, the successful achievement of 
professional socialisation, according to standards laid down by the profession, is not 
always possible for nursing students, largely because of the following: disillusionment with 
the profession; the attrition rate among nursing students; the temporary career 
commitment of many nurses; and the limited participation of many nurses in professional 
matters. 
In support, the study on "Professional socialisation as a curriculum component ... ,, 
conducted amongst 64 nursing students as reported by Mokwena (1990:136), revealed 
that 69.8% of respondents indicated that they could leave nursing due to poor 
interpersonal relationship, while 73.7% of the respondents indicated being humiliated by 
superiors as one of the reasons for leaving nursing. 94.9% of the respondents stated that 
their expectations of the nursing profession have not been realised due to discouraging 
attitudes of ward sisters towards nursing students. 77% of respondents indicated that 
discipline is too strict, while 94.8% stated that there is too much emphasis on respect of 
seniors without free expression of opinions, ideas or feelings. In the. final analysis, this 
situation reflects an environment in nursing education as non-caring. 
Usually, within the context of the South African education system, knowledge ~~s been 
treated as isolated historical facts presented to students with less emphasis on social 
5 
change and community development (Mulenga, 1994:1). The development of curricula 
within such a system, including the nursing education system, has long been dominated 
by a highly bureaucratic system based on obsolete philosophical foundations and 
assumptions. Because of this, according to the Department of Education: South Africa 
(1996:28), learning took place through pre-packed "teacher-proof', rigid, formula-driven, 
behaviouristic, time-based, prescriptive, descriptive and content-driven curricula which 
structured attitudes on what constituted knowledge. They are also filled to capacity with 
knowledge pursuit incongruent to the needs of students and that of the nation at large. As 
such, learning becomes static as a result of rote learning. What contributes to this problem 
is that assumptions inherent in educational and training environments are mostly 
unchallenged because the emphasis is on "gathering facts" while playing down the 
concept. 
Various studies conducted internationally by nursing researchers (Falk-Rafael, 2001; 
Persky, Nelson, Watson & Bent, K. 2001 Thomas, Finch, Schoenhofer & Green, 2009) 
focus on caring - in nursing practice. These studies examined nurses' and patients' 
perceptions of effective caring and nurse-patient relationships. However, there is no 
evidence of research that directly ·e xamines whether or not nursing education, as 
presented at the North West University, Mafikeng Campus provides a caring 
environment. 
Although numerous nursing research studies have been conducted in South Africa on care 
and caring, they are generally based on a bio-medical disease-care-oriented paradigm. An 
example of such a disease-care-oriented research was undertaken by Du Tait (2003: 4) 
aimed at developing a lifestyle adaptation programme to enhance the quality life of 
coronary artery bypass patients and their families after surgery. However, literature also 
reveals that in 1992, Van der Wal conducted a study on "Caring in nursing education". The 
research question posed was: What does caring entail in nursing education from the point 
of view of both the tutor and the student? The researcher inferred that caring in . nursing 
education is an extension of prosocial behaviours. Also caring as a means to an end 
6 
cannot be detached from caring as an end in itself. In 1996, Van der Wal conducted 
another study on "Maintenance of a caring concern" to address the following question: 
How is caring concern maintained by the student nurse as a caregiver? Both studies 
conducted by Van der Wal do not address the problem under current study which seeks to .. 
investigate whether or not nursing education presented at the North West University, 
Mafikeng Campus, provides a caring environment. 
As a contribution towards the democratic transformation agenda of the Higher Education 
Quality Committee (HEQC), this study may provide some insights into implicit outcomes or 
extra-curricular outcomes envisaged by the HEQC. Therefore in order to achieve the 
objectives of the transformed South Africa's Higher Education and Training system, the 
perceptions and expectations of nursing students regarding a caring environment in 
nursing education should be elicited, explored and described. 
It can be determined that a caring environment in nursing education . is both an 
international and a national problem. It should be noted that although there has been 
reference to the concepts of care and caring in nursing literature internationally and 
nationally, nothing has been done to conduct an in-depth analysis of the perceptions and 
expectations of nursing students regarding a caring environment in nursing education. 
Also the meaning and significance of such an environment on the lecturer-student 
interaction has not been addressed. It is therefore fitting at this point in time in nursing 
education to consider the impact of a caring environment from the nursing students' 
perspective. Understanding the realities and potential difficulties and challenges these 
nursing students encounter may assist in raising the levels of awareness to their needs. 
Therefore, this study is a bold move towards filling an existing research and literature gap 
as there is no comprehensive research evidence validating the problem under study and 
above all, a reasoned statement on this perspective is lacking. 
7 
1.2 Problem statement 
While working as a lecturer in the Department of Nursing Science, at the North West 
University, Mafikeng Campus, the researcher encountered a number of problems ·-
regarding the provision of a caring environment in nursing education within the Higher 
Education Institutions. Despite government strategies to improve throughput among 
students within Higher Education Institutions, poor student-lecturer relationships still 
prevail, that also leads to poor academic performance. References has been made from 
various national and international studies that there has been a deficiency_i n academic 
development related to knowledge and practices of a caring environment in the nursing 
educational system and health care system respectively (Fransman, 2003:203; Fischer, 
1997:139; Schaap & Buys 2005:129). It should be remembered that when nursing 
students commence their training, they enter a complex situation. They are expected to 
meet the tertiary education requirements (universities) as well as to fulfil the expectations 
in the clinical nursing situations. 
According to Fransman (2003:203), in order to plan effective teaching and learning 
opportunities for nursing students, it is essential to compile a profile of the student, as well 
as to ensure proper caring environment in nursing education. This is the most important 
aspect determining nursing students' success in mastering the theoretical components of 
their programmes (Fischer, Boshoff & Ehlers, 2001:67). In education, in general, and 
nursing education, specifically, the focus is on the student and on learning as a unique 
experience. A South African study by Fischer et al (2001:67) also revealed that, the central 
thrust of education has been the fullest development of student's character and 
understandings; a holistic formation of individuals. While Bennett (1999:44) emphasises 
that interactions between the lecturer and student(s) provide the context for this 
transformative experience wherein the purpose and process of education could be 
understood and achieved. The provision of a caring environment in nursing education is 
therefore regarded as being important prerequisites for effective, respqnsible, 
independent professional practice as well as best academic achievements. The researcher 
8 
witnessed that less time is allocated on how lecturers should interact with students and 
how students interact with each other. Furthermore, how lecturers arrange or organise 
student-student interaction styles reflect how favourably students study,_h ow students feel 
about one another, education system, and how much self-esteem they have (Johnson & 
Johnson, 2001:1). 
The Ministry of Education in the Republic of South Africa (RSA) :on the .- other hand, 
recognises the importance of promoting conducive environment for students even in 
Higher Education. The government therefore, warn by encouraging the educational 
system that if students are to be healthy in all spheres also in achieving best performance 
as well as to be responsible citizens, a caring environment in which interaction between 
lecturers-students relations has to be created and practiced (South Africa, 1996:17). It is 
in this light that the researcher embarked on this study to investigate the extent to which 
a caring environment is created and practiced in nursing education particularly in the 
North West University, Mafikeng Campus where the study focused. 
The most pertinent aspect of this deficiency is the lack of a caring environment in nursing 
education which often results in designing learning programmes which others may 
perceive as relevant, appropriate and of quality for the attainment of the educational 
outcomes. In reality, the programmes do not address the needs of recipients in the health 
care system. Furthermore, they do not provide students with appropriate and adequate 
opportunities for meaningful caring and interaction learning experiences to attain their full 
potential which would contribute effectively in the health care system and towards the 
nation at large. The academic staff members in the department of nursing have the 
responsibility to ensure quality in nursing education by ensuring a caring environment 
within the context of the current educational and professional policies and legislative 
frameworks. Also inherent in their responsibility is the need to fulfil the goals and mission 
of the department and that of the institution as well. 
In the light of the problem statement, the following question arose: 
9 
Does a caring environment for lecturer-student interaction in nursing 
education exist at the No,th West Universit;r✓ Mafikeng Campus, in the NoJth 
West Province? 
The research question as articulated by Burns and Grove (2003:87) is a concise and 
interrogative statement worded in the present tense and mostly with one or more 
variables. In order to address the broad research question as stated above, the following 
sub-questions are formulated to guide the study: 
► What are the perceptions of students regarding a caring envi_ronment in nursing 
education? 
► What are the expectations of students regarding a caring environment in nursing 
education? 
► What guidelines can be formulated to ensure a caring environment in nursing 
education? 
1.3 Purpose of the study 
This study seeks to investigate whether or not nursing education, as presented at the 
North West University, Mafikeng campus, provides a caring environment to nursing 
students. 
1.4 Objectives 
Three objectives that guided the scope of this study are: 
► To elicit the perceptions of students regarding a caring environment in nursing 
education. 
► To explore the expectations of students regarding a caring environment in nursing 
education. 
► To formulate guidelines against which a caring environment in nursing education 
10 
can be judged. 
1.5 Significance of the study 
This section provides the significance of this study. The significance of the study as 
observed by Polit and Beck (2004:70) relates to its potential for contributing substantially 
to the scientific knowledge base. The research outcomes of this study have'the potential 
to develop a strong theoretical description of a caring environment in nursing education. 
The description may lay the conceptual framework for further studies on such a problem 
with the ultimate aim of improving nursing education and the nursing practice. Therefore, 
a strong theoretical description of a caring environment in nursing education requires 
construction, if nursing researchers are to comprehend and improve such a practical 
enterprise as nursing. A caring environment is an example of such a conceptual problem. 
It is envisaged that the research findings may serve as groundwork for the formulation of 
guidelines for a caring environment in nursing education. In addition, the guidelines may 
also provide foundational knowledge which could guide policy makers in nursing education 
and nursing practice as well. Scientifically portraying its significance, the guidelines may in 
turn advance nursing education while concurrently improving the quality of health care 
outcomes. 
The new Democratic Government of National Unity in South Africa, which came in 
operation in 1994, introduced "The White Paper on Transforming Public Service Delivery in 
1997, which set out the eight transformation imperatives or priorities and The Higher 
Education Act No. 101 for South Africa. Both documents targeted improving quality service 
delivery as one of the priority problems to be tackled. The Bathopele (People first) 
principles show a shift in emphasis from poor service rendering to quality service 
promotion and provision. There is, however, debate on the right strategies to achieve 
such goals. This study is therefore in line with the Democratic Government of ~ational 
Unity policies, and comes at the right t ime to make a substantial contribution to the 
11 
debate and to policy recommendations and to put forward how the educational and health 
care systems problems can be alleviated on a sustainable basis. 
This study may also be useful to the health care delivery system including educational .. 
system authorities and planners towards understanding of and appreciating the meaning 
and significance of a caring environment on lecturer-student interaction as a need and 
also the extent to which it is a problem. It is the hope and desire of the researcher that 
this study may be used alongside similar studies as a basis for further research on the 
subject not only in the North West Province, but also in other provinces of South Africa, 
and internationally as well. 
1.6 Delimitations and limitations of the study 
This section focuses on two items, namely the identification of the delimitations and 
limitations of the study. The sample size of the research was two groups of Bachelor of 
Nursing Science degree students at the North West University, Mafikeng Campus in the 
North West Province. Both groups were at the fourth year level but in different years of 
their study. One group comprised of twenty seven (n=27) nursing students registered in 
2002 who had completed eight months of the fourth year level of their study in 2005 at 
the time of the study. Another group was made . up of forty (n=40) nursing students 
registered in 2003 who were three months into the fourth year level of their study in 2006 
at the time of the study. 
In this study the researcher identified limitations which are stated as follows: 
► The participants of the study were limited to one University Campus in the North 
West Province. Therefore, the findings of this study will not be generalised to 
other institutions of higher learning. 
► As the research was a cross-sectional study done once only at the Mafikeng 
Campus, North West University, using African nursing students, such a highly 
specialised sample might have influenced the research outcomes; 
12 
► Initially, the research was intended to include nursing students from two 
University campuses in the North West Province that would have resulted in 
diverse cultural groups participating in the research. Unfortunately that could not 
happen due to conflict of interest and intellectual thinking regarding the format 
of the data collection instrument to be employed at that point in time. The 
researcher decided to withdraw from the second campus since the data 
collection instrument suggested was too prescriptive and did not allow room for 
creativity and flexibility. Also a change of data collection instrument was not in 
accordance with the researcher's plans thus it clashed with her vision; 
► Some of the participants did not answer the questions of narrative sketches 
utilized in the study explicitly, but gave the meaning of what a caring 
environment should be. This could then be interpreted as shortcomings that 
students are experiencing in the current nursing education environment. The 
data was purely what the nursing students perceive as a caring environment and 
is not specific to the Mafikeng Campus of the North West University; 
► The findings of this study will not be generalised to other institutions of higher 
learning. 
1.7 Definition of key concepts 
The study proceeds by briefly presenting key terms/concepts as a way of contextualising 
their usage. Conceptualisation of the key concepts is put into perspective in order to guide 
the research process of this study. For the purpose of clarification, specific concepts used 
in this study are defined as follows: 
1.7.1 Caring 
The term 'caring' is crucial for this study hence attempts to contextualize its usage. 
According to Booyens (2001:223), caring is a highly developed competence, b?sed on 
psychosocial, spiritual and physiological comprehension of self and others. It is a human 
13 
attribute, a moral imperative, an affective competence, an interpersonal interaction and a 
therapeutic intervention. Therefore, for this study, caring refers to an essence of nursing 
which is symbolised by mutual interaction and interpersonal relationships between the 
lecturer and student. This is imperative for the attainment of . the physical, social, 
psychological, emotional, intellectual and spiritual wellbeing of a student in nursing 
education. This concept is further elaborated on in section 2.4.2.1:52. 
1.7.2 Caring environment 
Caring environment refers to a most extensive teaching and learning setting that cultivates 
and nurture substantial and meaningful relationships and growth amongst people at all 
levels. It is a climate or an atmosphere that offers the growth and the development of 
potential, while permitting one to select the best action for herself or himself at a given 
point in time (Booyens, 2001:220). A caring environment in this study is the lecturer's 
interaction through participation and involvement with the nursing student to ascertain 
or establish the unique meaning and significance which the nursing educational 
experience has for that particular nursing student. This concept is further discussed in 
section 2.2.2:24. 
1.7.3 Environment 
An environment is the sum total of internal or external conditions influencing the life and 
development of a living creature e.g. human being (Young, Van Niekerk & Mogotlane, 
2004:14). Additionally, an environment as articulated by the Western University of Health 
sciences (2010:2) is both internal and external contexts of the person. It entails 
multidimensional forces which impact on the person1s health and well being. Therefore, an 
environment in this study is the North West University, Mafikeng Campus in the North 
West Province that is approved by the South African Nursing Council (SANC) for education 
and training of Bachelor of Nursing Science degree nursing students. The co~cept is 
further highlighted in section 2.4.1.3:42. 
14 
1.7.4 Interaction 
Interaction is any contact or communication between an individual and other human 
beings (Beck, 2004:1). It is a collection of processes occurring amongst human beings 
that cannot be detached into segregated parts (Maurer & Smith, 2005:281). Interaction 
in this study is an encounter or a contact and communication the lecturer and nursing 
student have with one another in the nursing educational setting. This concept is further 
highlighted in section 2.4.1.1:37. 
1.7.5 Nursing education 
Nursing education is the process whereby nursing students are guided, assisted and 
provided with the means which empower them to learn the art and science of nursing so 
that they can apply it to the nursing care of people who need such care (Mellish, Brink & 
Paton, 2001:7). Nursing education according to the Western University of Health 
Sciences (2010:2), is the flexible teaching-learning process that provides opportunities 
to expand and extend knowledge for continued growth and competency of the person 
and the profession. Through this process, lecturers and students collaborate to establish 
a caring environment for the students to develop professional nursing practice 
competences. Therefore, nursing education in this study is the professional socialisation 
process whereby nursfng students acquire and understand specified learning outcomes 
such as knowledge, competences, values, norms and attitudes essential in the nursing 
professional practice. This concept is further highlighted in section 2.2.3:25. 
1.7.6 Nursing student 
Nursing student is a person registered with the South African Nursing Council (SANC) 
under regulations R425 of 22 February 1985 as amended relating to the approval of and 
the minimum requirements for education and training of a nurse (General, Psychiatric and 
Community) and Midwife leading to registration (South African Nursing Council, 1985:1). 
15 
Nursing student is a person who receives education and training at North West University, 
Mafikeng Campus in the North West Province ·that is approved by the South African 
Nursing Council (SANC). This student meets all requirements for accreditation according to 
the National Qualifications Framework (NQF) and is accredited on the National Learner 
Records Database (SANC, 2008: 1 & 9). 
Nursing student means a person registered as a "learner nurse" under Section 32 of the 
Nursing Act No. 33 of 2005 and receives education and training at the North West 
University, Mafikeng Campus in the North West Province that is approved by the South 
African Nursing Council (South Africa Nursing Council, 2005:5). 
Nursing student is a unique human being with diverse differences such as culture, 
interests, psychological needs, personality, self-concept, intellectual expertise, previous 
knowledge, motivational level, preferred learning styles and expectations about what is to 
be learnt (Mellish, Brink & Paton, 2001:63). Therefore, a nursing student in this study is at 
the fourth year level of his or her study and is registered for the Bachelor of Nursing 
Science degree at the North West University, Mafikeng Campus in the North West 
Province that is approved by the South African Nursing Council for education and training. 
1.8 Ethical considerations of the study 
The proposed research observed the ethical standards for nurse researchers as outlined 
by Brink (2002:51-53). The following components were included: the quality of the 
research, confidentiality and anonymity, privacy, informed consent and prevention of 
harm. 
1.8.1 The quality of the research 
The researcher and the researcher's promoters complied with the highest possible, ethical 
standards by ensuring the quality of the research process is adhered to. The researcher 
16 
and the promoters have substantive expertise such as knowledge, competences and 
experience with regard to the scope of this study. The researcher approached the study 
with integrity and took cognisance of personal biases and values by engaging the 
independent coder in the data analysis open coding process. The research was conducted 
honestly and without fraudulent acts or misconduct at any stage of the research process. 
All findings were fully reported, without the omission of significant data (Brink, 2002:51). 
1.8.2 Confidentiality and anonymity 
Confidentiality according to Brink (2002:51) means that any information disclosed by 
participants should not be made accessible to any other person. When participants agree 
to participate in the research study, they waive such a right, since the generated data 
should be incorporated in the research report. The confidentiality and anonymity of 
participants and institutions as observed by Brink (2002:51) and Polit and Beck (2004:711, 
714) should however be protected and guaranteed by making it impossible to link 
generated data with the participants and institution and are never publicly divulged. 
Hence, the confidentiality and anonymity of participants in this study was ensured seeing 
that their identities were not linked with their responses. 
When the completed narrative sketches were received from participants, the covering 
letter a_nd signed consent form were removed from each narrative sketch to ensure 
anonymity of participants. Throughout the focus group interview sessions, participants 
were requested not to call each other by name but rather to say "my brother" or "my 
sister" to each other so as to ensure confidentiality and anonymity. Also focus group 
interview sessions were audio-tape recorded and transcribed verbatim. Therefore 
participants were kept nameless without any identification and all raw data for both 
narrative sketches and focus group interview sessions were destroyed after the 
compilation of the final version of the thesis. 
17 
1.8.3 Privacy 
Privacy is the autonomy a person has to determine whether to divulge or withhold private 
information from others. Privacy means a participant may behave, believe and think 
without such private behaviour, beliefs or thoughts being used to dishonour her or him. 
The privacy of participants in this research was protected and guaranteed and no privately 
disclosed behaviour, beliefs or thoughts were used to humiliate them (Brink, 2002:52). 
Data collection for both narrative sketches and focus group interview sessions were 
conducted in a quiet and private classroom. Each participant was requested to sit at a 
single table with a chair, free from any distractions to create a calm environment in which 
he/she could relax and participate freely in the study. 
1.8.4 Obtaining permission to conduct the study 
The researcher submitted a letter to the Mafikeng campus Research Committee of the 
North West University, Mafikeng Campus seeking permission to undertake this study. The 
purpose and objectives of the study were clearly spelled out in the letter (Appendix A) . All 
participants were invited with a written letter to take part in this study (Appendix B). 
1~8.5 Informed consent 
Written informed consent was obtained from all participants, and the purpoSe, objectives, 
methods and procedures were explained to participants before distribution of narrative 
sketches and the conducting of focus group interview sessions (Appendix C). The 
researcher also sought permission from participants to record each focus group interview 
session with two tape-recorders including taking field notes during each session. 
1.8.6 Prevention of harm 
. 
The researcher ensured that no physical or psychological harm was experienced by 
18 
participants since the nature of participation was self-reporting in a narrative sketch form. 
Also during focus group interview sessions no harm was experienced by interviewees 
(Brink, 2002:53). The researcher allowed free expressions of perceptions, ideas and also 
used probes and paraphrases which were neutral to avoid biasing the participants' 
responses. In support, Burns and Grove (2003:276) affirm that probing should be done 
within reasonable guidelines to prevent the participants feeling that they are being 
interrogated. 
1.9 Organisation of the study 
This section gives a preview of how this study's chapters are to be organized. This is done 
as follows: 
Chapter One: Orientation to the study 
This chapter describes the introductory background to the problem, formulates the 
problem statement, research questions, purpose of the study and objectives based upon 
research questions. The delimitations and limitations of the study, rationale for the study, 
definition of key concepts and ethical considerations of the study are also discussed. 
Included also in this chapter is the outline regarding the organisation of the chapters for 
the study. 
Chapter Two: Literature review 
In this chapter, the researcher aims to clarify and describe how a 'caring environment' in 
the nursing education context could be created. In order to achieve that, this chapter 
reviewed the national and international literature extensively until a clear comprehension 
of the problem to be pursued was acquired. The ultimate aim is to put the study in the 
context of the general body of scientific knowledge with the view of minimisiflg the 
likelihood of an unintentional duplication and misconception of conceptual definitions thus 
19 
reducing biases in the study. 
Chapter Three: Research design and methodology 
An overview of the research design and methodology used in the study to elicit the 
perceptions and explore the expectations of nursing students regarding a caring 
environment in nursing education at the North West University, Mafil<eng ca'mpus in the 
North West Province is presented. In this chapter, an explicit description is provided of 
how a sample was chosen from the population. The methods on how data collection and 
analysis were conducted are outlined. Measures to ensure trustworthiness _a nd ethical 
considerations are also highlighted. 
Chapter Four: Data analysis and interpretation 
In this chapter, analysis and interpretation of data is done through the application of 
descriptive data analysis open coding process which is qualitative in nature. The research 
findings serve as the groundwork for the formulation of guidelines for a caring 
environment in nursing education. 
Chapter Five: Summary, conclusion and recommendations 
This chapter provides a summary, conclusion as well as recommendations arising from 
the research findings of the study. A summary, conclusion and recommendations of the 
study are based on the outcomes of the study. 
1.10 Summary 
This chapter laid the foundation for the study. It poses the research questions that define 
the scope of the study. Any other envisaged landmark contributions, the study propounds 
a high quality of student-lecturer interaction and caring relationships with special 
20 
reference to a caring environment in nursing education. The chapter states that this study 
seeks to understand the reality of how a caring environment in the nursing education 
context could be created. It highlighted the purpose of the study, three objectives based 
on the research questions that define its scope. Toe issues related to the literature review, ~ 
research design and methodology, data analysis and interpretation, have been left for 
Chapters Two, Three and Four respectively. Toe next chapter deals with literature review. 
21 
CHAPTER TWO 
LITERATURE REVIEW 
2.1 Introduction 
This section undertakes a literature review that seeks to identify what literature says about 
the present scope. It adopts an approach that allows it to start by focusing on 
conceptualisation of the key concepts. This is followed with an in-depth review of key 
policies and legislative frameworks before an overview of the theoretical perspectives is 
done. This is done in an attempt to properly situate this study in the context of the 
general body of scientific knowledge. In order to achieve the purpose of the study, the 
researcher reviewed the national and international literature extensively until a clear 
comprehension of the problem pursued was acquired. Furthermore, a more rigorous 
literature review was conducted adhering to Rogers and Knafl (1993:80) evolutionary 
method of concept analysis. The approach increased the rigour of the study (Rogers & 
Knafl, 1993:82). 
Mouton (1998:110) articulates that theoretical validity is guaranteed if the theoretical 
definition is drawn from a substantiated conceptual and theoretical framework that has 
been favourably appropriated to account for similar phenomena previously. It is thus likely 
to strengthen the conclusions that could be derived from the research. Mouton (1998:117) 
further reflects that theoretical concepts are rich in connotation. This implies that within a 
specified field of meaning, certain dimensions or aspects of meaning are more intimately 
connected than others. To arrange concepts logically implies that logical rules of correct 
classification and rules of mutual exclusion and exhaustiveness should be adhered to. A 
concept is viewed by Babbie and Mouton (2004:111, 113) as a term that ideally outlines 
and names a phenomenon, consequently supplying it with a separate identity or meaning. 
Therefore, the definition of a concept is more comprehensive and includes ass9<=iated 
. 
meanings the term or word may possess and also yields consistency in the utilisation of 
22 
such. Brink, Van der Walt and Van Rensburg (2006:86-87) indicated that conceptual 
definition expresses the general theoretical meaning, and for it to be considered effective, 
it should : 
► indicate the exceptional attributes of that which is defined; ...  
► not outline something by employing the same concept; 
► be explicit and clearly constructed or expressed to avoid diverse interpretations; 
► encompass all aspects of the impression the researcher wants to put across; 
► be meaningful and possess meaning within the specific theoretical context; 
► reflect the theory employed in the study, 
► be suitable to and for the study; and 
► be consistent with the universal usage, literature and practice. 
The following key concepts which are the thrust of the study are further highlighted in the 
next section: guidelines, caring environment and nursing education. In examining them, it 
is necessary to define their meanings. Conceptual meaning as articulated by Chinn and 
Kramer (1995:79) enhances the researcher's knowledge of the range of possible uses and 
meanings of the concepts. 
· 2.2 Conceptualisation of the key concepts for the study 
2.2.1 Guidelines 
A guideline is conceptualised by Wikipedia (2010:1) as any document that seeks to 
streamline or make more cost-effective specific practices according to a set of standards. 
It implies that following a guideline is never mandatory. Guidelines according to Wikipedia 
(2010: 1) are a fundamental component of the substantial process of governance. They 
may be issued by and used by any organisation (governmental or private) to make the 
actions of its employees or divisions more predictable, and presumably of higher quality. 
In this study the researcher considers guidelines as standards or statements systematically 
developed to assist in determining how a caring environment in nursing education can be 
23 
most effectively and appropriately created during the lecturer-student interaction 
relationship. 
2.2.2 Caring environment 
By way of building on section 1.7.2:14, a caring environment according to Booyens 
(2001:220), is a climate or an atmosphere that offers the development of one's potential, 
while permitting one to select the best action for himself or herself at a given point in 
time. This implies that a caring environment is a climate that provides moments and 
opportunities for the growth and development of an individual's potential and in the 
interim, granting him or her opportunity to make the best choice for himself or herself at a 
given point in time. 
In many instances, lecturers, according to Darling-Hammond and Bransford, (2005: 117), 
will discover that . the educational systems in which they teach are not planned to be 
supportive of students and their healthy growth and development. In such iastances, 
lecturers have to comprehend what characterises a healthy and caring environment. 
Furthermore, they have to understand how to work collaboratively with colleagues to 
establish and develop changes that permit their operation and interaction with students to 
be a success. 
A caring environment is a most extensive teaching and learning setting that cultivates and 
nurtures substantial and meaningful caring and interactive relationships among all 
stakeholders including nursing students and their growth at all levels. In creating a caring 
environment, the lecturer participates and is actively involved with the nursing student 
in ascertaining or establishing the unique meaning and significance which. the nursing 
educational experience has for that particular student. This occurs through professional 
socialisation of nursing students into the nursing profession amongst all involved in the 
process. In turn nursing students acquire and understand specified learning outcomes 
such as knowledge, competences, values, norms and attitudes essential in nursing 
24 
professional practice. When the proper caring interaction opportunities are accessible 
and nurtured, the student can gradually perceive his or her own individual and human 
existence, its contradictions, and become conscious of his or her perception of existence 
and meaning, and critically and creatively handle that. 
2.2.3 Nursing education 
In order to build on section 1.7.5:15, nursing education as articulated by Western 
University (2010:2), is the flexible teaching-learning process whereby lecturers work in 
partnership with students to help them in attaining academic and professional goals. 
Consequently, lecturers cultivate and nurture a caring environment to optimise learning 
experiences empowering students to develop caring relationships with others and 
consumers in the health care system. In turn students develop competences in 
professional nursing practice by being actively involved in their ongoing educational 
process for the self-directed pursuit of knowledge. Students also supported and developed 
personally, socially and intellectually. Ultimately they become creative, independent and 
critical thinkers. 
In nursing .education, caring and interactive relationships between the lecturer and the 
student involve giving and receiving caring from each other, while allowing discerning 
and their related aspect to influence their consciousness. This is manifested in an act of 
love, respect, commitment, attachment, inclination, interest, reasoning, understanding, 
openness and reflection. It also symbolises caring which is enriching, illuminating, 
nurturing while cultivating and fostering the development of caring behaviours and 
attitudes in both the lecturer and the student. Furthermore, through their unique 
interactions, both the lecturer and the student enter into a relationship participating 
equally as partners in educational settings and growing and learning from the encounter. 
In principle nursing education works hand-in-hand with education. Therefore the nursing 
education will be outlined in the context of education. 
25 
Freire (1977:45-46) views the education and the use of education as a strategy for 
awakening social consciousness in the students. Of particular significance are his 
standpoints of the dichotomy embedded in the lecturer-student roles occurring in an 
educational environment created for empowerment and liberation. Hence, he advocates 
that a solution be achieved wherein the relationship between lecturer and students is 
no longer domineering, but where "both are simultaneously lecturers and students." 
Education according to Noddings' (1992:173; 2005:2) observation should be arranged 
in centres of care rather than the liberal education which is a set of traditional 
disciplines. The author therefore proposes that students should learn to care for 
themselves and others, as well as ideas. Noddings (1992:174) further asserts that the 
ultimate aim of education should be to produce competent, more caring, loving and 
lovable people which is a moral priority disregarded by the educational system. In 
addition, Noddings (2002:283) perceives education as being pivotal to the cultivation of 
caring in society. The author defines education as a set of encounters, both planned 
and unplanned, that promotes growth through gaining knowledge, competences, 
comprehension and appreciation. Noddings (1992: 14) strongly contends that lecturers 
should take a shared responsibility to develop healthy, competent and content students 
with the mainstream education system playing a pivotal role in this task. Simply put, 
students cannot achieve their academic goals if they do not feel as if lecturers care for 
them or if they themselves do not show caring for others. Therefore, nursing education 
in this study is the professional socialisation process whereby nursing students acquire and 
understand specified learning outcomes such as knowledge, competences, values, norms 
and attitudes essential in nursing professional practice. Key policies and legislative 
frameworks that have a bearing on the environment in nursing education are discussed in 
the next section below. 
26 
2.3 Key policies and legislative frameworks 
Within the South African context, various factors influence an environment in nursing 
education, and the most pertinent influence is the effect of key policies and legislative 
frameworks on institutions of Higher Education and Training. Those key policies and 
legislative frameworks which have the most pertinent influence on environment in nursing 
education are discussed. This section reviews six related factors namely: brief historical 
overview of the nursing education curriculum in South Africa, key Higher Education 
policies and legislative frameworks, The South African Constitution Act No. 108 of 1996 as 
amended, The South African Qualifications Authority Act No, 58 of 1995 as repealed by 
National Qualifications Framework Bill, 2008, Higher Education Act No.101 of 1997 as 
amended and The White Paper on Transforming Public Service delivery. Based on these 
related factors that influence an environment in nursing education it is therefore, timely 
for this study to ascertain or determine whether or not nursing education, as presented at 
· the North west University, Mafikeng Campus provides a caring environment. 
2.3.1 Brief historical overview of the nursing education curriculum in South 
Africa 
This section reviews the nursing education curriculum in South Africa with the intention of 
gleaning what it says about the provision of a caring environment. In 1981, the De Lange 
commission, established to examine the provision of education in the Republic of South 
Africa (HSRC, 1981), aimed at restructuring South African Colleges, Technikons and 
Universities. The attempt was to enhance the student mobility across those institutions for 
the production of high level competencies. For the production of high level of 
competencies to be realised in those institutions, a caring environment should be created. 
Also without a caring environment, the production of high level of competencies could not 
be evident. The restructuring in nursing education became evident in 1986 when the 
South African Nursing Council {SANC) introduced a four year comprehensive basic course 
comprising Nursing (General, Psychiatric and Community) and Midwifery under the SANC 
27 
regulations R425 of February 1985 as amended (SANC, 1985:4). This basic 
comprehensive programme is offered both at nursing colleges and university departments 
of nursing education. The programme constitutes extensive preparation conforming to 
sound educational principles and standards to meet ongoing expanded national needs. 
The SANC as a statutory body in South Africa under the South African Nursing Council Act 
No. 50 of 1978 as amended by Act No. 33 of 2005, defines nursing education and 
educational standards for the nursing profession and regulates nursing education and 
nursing practice. In a discussion document (SANC, 1999a:1-8), on the "Transformation of 
Nursing Education and Training in SA", SANC affirmed that such transformation should be 
in accordance with core competencies and learning outcomes. The development and 
implementation of nursing education programmes should be in line with the principles of 
the National Qualifications Framework (NQF). The SANC according to Isaacs (2000:7) has 
been accredited by the South African Qualifications Authority (SAQA) as one of the 
Education and Training Qualification Assurance (ETQA) bodies to monitor and audit the 
provision, assessment and achievement of nursing education and nursing practice 
standards and qualifications in accordance with National Qualifications Framework (NQF). 
In order for the SANC's aspiration to be realised together with that of SAQA, this study 
should therefore be undertaken to investigate whether or not nursing education as 
presented at the North West University, Mafikeng campus provides a caring environment. 
In line with the SANC's perspective, the Bachelor of Nursing Science degree at the North 
West University, Mafikeng Campus in the North West Province aims to develop an 
independent, caring and compassionate nurse practitioner and midwife, who should 
render comprehensive and scientific health care services to recipients throughout their 
working lives. To realise its mission, the nursing department, through its teaching-learning 
process enhances personal and professional maturity of nursing students. As a result, 
students acquire knowledge, skills, attitudes and values that lead to independence and 
commitment to work. It is only through the creation of a caring environment in nursing 
education that the Department of Nursing Science could real ise its mission. As a way of 
28 
concluding this segment, it emerges that caring issues are pertinent and where they are 
not observed, measures should be put in place to redress the anomaly. 
2.3.2 Key Higher Educational policies and legislative frameworks 
This section reviews the key Higher Educational policies and legislative frameworks 
introduced since 1994 with the intention of identifying what they say ·about the provision 
of a caring environment in education. These policies and legislative frameworks introduced 
by the Democratic Government of National Unity in South Africa are continually changing. 
They are developed and implemented in accordance with the cultural, political, social and 
economic transformation and developments comparable to global best practices and 
credible standards. These key policies and legislative frameworks are geared to promote 
lifelong education and training of high quality and a flexible career~path for all citizens to 
be self-directed. In turn, they impact greatly on nursing education and nursing practice 
and also constitute a major thrust for this study. 
Key policies and legislative frameworks for the transformation of the Higher Education 
system in South Africa to be more flexible and open are highlighted. The South African 
Qualifications Authority Act No. 58 Of 1995, and the National Commission on Higher 
Education (NCHE, 1996:2, 89) proposed that institutions of Higher Education and Training 
should be under a single national unified regulatory framework in order to be more 
responsive to national socio-economic priorities. Further, to promote articulation, mobility 
and effective and efficient evaluation of quality in Higher Education and Training system. 
The White Paper of 1997 (Department of Education: South Africa, 1997:9) also echoed 
the same sentiments by indicating that this transformation is a component of the wider 
process of political, social and economic reconstruction and development. 
The Higher Education Act No. 101 of 1997 and the National Plan for Higher Education of 
the Ministry of Education: South Africa (Ministry of Education, 2001) recognised and 
supported meticulous standards of academic quality as one of the principles in the 
29 
transformation of Higher Education and Training system. For the meticulous standards of 
academic quality to be recognised and be evident in Higher Education and Training 
system, a caring environment in nursing education is mandatory since caring is a yardstick 
of quality. For that reason, quality cannot occur without caring. Therefore, the focus . of ~ 
this study is to ascertain whether or not nursing education, as presented at the North 
West University, Mafikeng Campus provides a caring environment. 
2.3.3 The South African Constitution Act No. 108 of 1996 as amended · 
Toe review of the South African constitution is done here. Among other things, this 
constitution enshrines the ideals the South African people aspire for. It is within this 
context that this review seeks to establish what the constitution says about the provision 
of a caring environment in nursing education. The South African Constitution (Act No. 108 
of 1996:6, 25) has mandated that all the governmental departments (departments of 
nursing education included) should be open to transformation based on democratic values 
such as human dignity, equality, freedom, human rights, loyalty, mutual trust, respect, 
support and transparency. It implies that everyone's (nursing student included) inherent 
dignity should be respected and protected. In the context of this study, the South African 
Constitution Act is the most crucial legislative framework the nursing practice and nursing 
education specifically, have to comply with. 
In this context, the paradigm shift is towards investigating whether or not nursing 
education, as presented at the North West University, Mafikeng campus in the North West 
Province, provides a caring environment. This is crucial if the nursing education and 
nursing practice are to: 
► Fit within the context of the South African Constitution Act mandatory to the 
transformation based on democratic values; 
► Be viewed as part of the strategy that substantially contributes towards global 
social and economic development; and 
30 
► Be appropriate, relevant and of quality in the 21st century. 
2.3.4 The South African Qualifications Authority Act No. 58 of 1995 as 
repealed by National Qualifications Framework Bill, 2008 
The review of this section implies that the South African Qualification·s Authority (SAQA) 
Act No. 58 of 1995 introduced in October 1995 as repealed by the National Qualifications 
Framework Bill, 2008, is a major step in the provision of a caring environment by the 
government of South Africa. This is said in the context of the Recognition of Prior Learning 
specifications. The South African Qualifications Authority (SAQA) Act No. 58 of 1995 
introduced in October 1995 as repealed by the National Qualifications Framework Bill, 
2008, was envisaged to develop and implement a National Qualifications Framework 
(NQF) and forthrightly to establish the South African Qualifications Authority. SAQA, 
according to Isaacs (2000:2, 4) ensures that the development and implementation of a 
NQF in South Africa reflects a flexible, coherent and integrated approach which addresses 
both students' and national needs. It implies that NQF contributes to the full development 
of every student as a critical, reflective, analytical and creative thinker and to the national 
social and economic development. NQF is also a register for nationally and globally 
acceptable credible standards defined as learning outcomes relevant to personal and 
national socio-economic development. 
The transformational approach to Outcomes-Based Education (QBE) amongst others 
includes critical cross-field outcomes such as effective communication, decision making, 
problem solving, teamwork, lifelong and self-directed learning. It also allows access, 
mobility and progression through the articulation and portability of credits and 
qualifications and also recognition of prior learning. All these attributes as envisag~d and 
set up in these policies are caring traits fundamental to the development of every student 
31 
·, 
to fulfil his or her full potential. Therefore in addressing or meeting the envisaged caring 
attributes as spelled out in these policies, it is then proper to determine or ascertain 
whether or not nursing education, as presented at the North West University, Mafikeng 
Campus, provides a caring environment. 
Recognition of prior. learning (RPL) according to SAQA (2002:3) means the comparison 
of a student's previous learning and experience, howsoever acquired, against the 
learning outcomes required for a specified qualification, and the acceptance for 
purposes of qualification of that which meets the requirements. It implies that 
recognition of prior learning is to ensure that a student is accorded an opportunity to 
demonstrate the knowledge, skills, values and attitudes he/she has already acquired in 
different ways and match these with proposed standards and qualifications. The student's 
experience is also to be considered in relation to standards and qualifications and awarded 
such should he/she be found competent during assessment. In the final analysis, it is 
imperative that this study's point of departure is to investigate whether or not nursing 
education, as presented at the North West University, Mafikeng Campus, provides a caring 
environment as deemed necessary by these policies and legislative frameworks. It is 
therefore, appropriate for all stakeholders in nursing education and nursing practice to be 
proactive and responsive to the South African professional, Higher Educational and 
Training policies and legislative frameworks which are comparable to those in use globally. 
2.3.5 Higher Education Act No. 101 of 1997 as amended 
This section aims to discuss issues raised by the Higher Education Act that pertains to the 
provision of a caring education environment. Education and training are fundamental 
components of human resource development and are considered the highest priority by 
the Democratic Government of National Unity. By 1997 the government had introduced 
the "Higher Education Act No. 101 of 1997" for South Africa. Though amended several 
times, the Act has, as its essence, the raising of standards of academic quality. The Act 
32 
specifically amongst others, addresses the provision of optimal opportunities for learning, . 
knowledge creation, academic freedom, the pursuit of excellence, and the full 
development of every student. Values such as tolerance, appreciation of diversity, 
freedom of speech, expression of creativity, equality, freedom through the fostering of an , 
open and democratic society based on human dignity are also addressed by the Act. It 
implies that the overarching goals of the Act, is to make it possible for all citizens to have 
equity of access to and to succeed in lifelong education and training of quality and also to 
be self-directed. The values as explicitly laid down in the Act are caring attributes 
reflecting a caring environment. However, for these values to be evident in nursing 
education and nursing practice they must be embedded in the nursing education 
programmes at all levels. Consequently, all stakeholders including nursing students will 
internalise and assimilate these values in their inner being. Therefore, for these set values 
to be attained, it is important to examine whether or not nursing education, as presented 
at the North West University, Mafikeng Campus, provides a caring environment. 
The Department of Education: South Africa (2001:11) also holds this view that everyone is 
responsible for and challenged to establish a humane and caring society for all South 
Africans. In developing a higher education and training system for the 21st century, all 
South Africans have a special responsibility to implement these values and ensure that all 
students, with and without disabilities, pursue their learning potential to the fullest. 
In order to realise the goals of the Act, the Council on Higher Education (2002: 1, 5) 
asserts that the Higher Education Quality Committee's (HEQC) quality assurance system 
aims to be responsive and proactive in promoting and improving standards of academic 
quality aligned with, and sustained by other national and institutional initiatives associated 
with planning, standard setting and quality assurance. It also ensures that amongst 
others, increased equity of access, curricula and other higher education transformations 
are accompanied by satisfactory standards of service provision. Further, that the interests 
and needs of various stakeholders including students are considered. Such impe~atives, 
together with the increasing higher education globalisation, have led to the HEQC shaping 
33 
a perspective of quality based on purpose, value for money, and transformation regarding 
individual students as well as social and economic development. In support, Pretorius 
(2003: 13) indicated that perspective of quality may lead to value and meaning for 
students, and empower them to become lifelong and self-directed students. On this • 
account, it could be noted that for nursing education to meet the challenge of the Higher 
Education Act, a caring environment in nursing education should prevail. 
The Higher Education system in South Africa has built-in mechanisms not only to facilitate 
equity of access, but also to ensure that the quality of education and training programmes 
are attuned to national development needs and are comparable internationally. For 
nursing education that quality should be acceptable to all stakeholders including nursing 
students. The values and competences expected of nursing students should be integral to 
the nursing education programme. Because health care is changing and globalisation is a 
reality worldwide, nursing students should develop the value of lifelong learning and be 
self-directed. If this is a value of nursing education programme, then its students will be 
empowered to become lifelong and self directed students. In order for nursing students to 
render quality care, they should be provided with greater depth of teaching in cultivating 
caring and interaction styles in their inner being. Also they should be presented with 
interaction and caring opportunities, including interpersonal skills for diverse and 
meaningful learning experiences in nursing education and nursing practice settings. 
Equally important, it should be noted that providing a caring environment in nursing 
education is a professional responsibility of all stakeholders and is also a nursing student's 
expectation. 
2.3.6 The White Paper on Transforming Public Service Delivery 
This section devotes time to the review of what the White Paper on Transforming Public 
Service delivery says about the provision of a caring environment in nursing education 
system. The legislative framework introduced in 1997, should be adhered to in nursing 
education and nursing practice for a caring environment to be realised. Among the 
34 
contents of this paper are eight transformation imperatives referred to as Bathopele 
(People first) principles, envisaged to improve quality service delivery. This study also 
comes at the right time to make a contribution to the debate and policy recommendations 
put forward on how the problems in higher educational and health care systems can be -
alleviated on a sustainable basis. In line with these views, it is evident to ascertain 
whether or not nursing education, as presented at the North West University, Mafikeng 
campus, provides a caring environment. Therefore it is crucial to undertake this study if 
nursing education is to be viewed as part of the improved quality service delivery. Also 
attributed to the Bathopele Principles is that they are predetermined to meet the basic 
needs of all South Africans by moving away from poor service rendering to good quality 
service promotion and provision. For the Bathopele Principles to be recognised, it is crucial 
that these principles be embedded in the nursing education learning programmes at all 
levels. In turn, nurses in general, and nursing lecturers in particular, may be empowered 
to deliver a quality nursing education, based on consultation, service standards, access, 
courtesy, information, openness and transparency and value for money underpinned by a 
caring environment resulting in customer satisfaction. 
These Higher Education system scenarios that are emerging world-wide, and in South 
Africa specifically, are making new and far-reaching demands on the nursing profession 
generally and nursing education in particular. Such scenarios also have significant 
implications for the teaching-learning process with specific reference to a caring 
environment in nursing education. As such, nursing lecturers are presented with an 
opportunity to play a significant role in meeting the challenge. Thus they need to reflect 
on major changes that should occur in nursing education if they are to remain proactive 
and responsive to these emerging scenarios. For this to be realised, Romyn (2001:1) aptly 
asserts that nursing lecturers are to embrace an emancipation paradigm that will free both 
lecturers and students from the authoritarian coercion of behaviouristic models of 
education, and empower them to be social change agents. Foremost among these 
changes are to: 
► Rethink definitions of teaching and learning (Romyn, 2001: 1); 
35 
► Reconceptualise lecturer-student relationships ( Romyn, 2001: 1); 
► Shift the locus of care from the biotechnical, disease-oriented model (Frankel & 
Rosenblum, 2004: 1). 
As a way of winding up this section, it became apparent that Higher Education policies 
and legislative frameworks within the South African context have the most pertinent 
influence on the environment in nursing education. Where these policies and legislative 
framework are not adhered to, built-in mechanisms should be in place to restore 
incongruity. The next section focuses on an overview of the theoretical perspectives 
significant to this study. 
2.4 Overview of the theoretical perspectives 
In this section, the theoretical perspectives that provide a framework in terms of which 
the research problem, the nature of the study and the findings can be understood are 
discussed. These theoretical perspectives form the core of a theoretical framework in this 
study, and involve both interaction and caring perspectives. Both theoretical perspectives 
are pertinent and relevant to this study since they: 
► Highlight the significance of the socio-cultural environment in the formation and 
comprehension of human behaviour or social conduct and attitudes; 
► Focus on how that which is perceived or anticipated within specific interaction and 
caring contexts impacts on human experiences and functioning. 
The theoretical underpinning of this study is grounded on the interaction and the caring 
perspectives. Both theoretical perspectives are interrelated and highlight the fact that 
people are social, living beings (individual personalities) consistently judging themselves. 
They are also managing their behaviour and attitudes to ensure that the perceptions of 
self and others are recognised and that the expectations of self and others are 
accomplished. According to these perspectives, a person's level of self-esteem, self-
36 
factors in developing their respective responses. However, they are directing, checking, 
bending and altering their actions in the light of what they encounter in others' 
conducts and attitudes. All these seem to have an impact on the meaning and 
significance attached to the experience of the encounter. 
Symbolic interaction ism, as defined by Nelson (2005: 1) is a theory about human 
behaviour, and also a perspective on the study of human behaviour or conduct including 
social group life. It is concerned about how people define events or situations or 
circumstances or reality and how they act or behave in relation to their beliefs. This 
perspective is also regarded as an interaction process for the establishment of meanings 
to people. The starting point of meaning is central in human conduct. Therefore attaining 
meaning plays a pivotal role in the overall human functioning resulting in good physical 
health as well as positive mental health. The author further indicates that people are best 
understood in relation to their environment. It implies that a symbolic interactionism 
perspective focuses on the meaning and significance of events, situations or 
circumstances of people in a natural setting and is therefore related to phenomenology. 
With this background of the description of an interaction, it is imperative that the 
construction of meaning through interaction be outlined. 
2.4.1.2 Formation of meaning through interaction 
Meaning as expressed by Bezuidenhout (2002:35) is shared mental images of possible 
associations between things, circumstances or situations and relationships between 
people. It is an enlightenment of sequence and coherence and purpose in a person's life. 
Meaning is also viewed as a quest for and an achievement of worthwhile goals with a 
sense of fulfilment. In addition, meaning is perceptual, cognitive and emotional frame of 
reference upon which a person's symbolic code or system is built. It also values human 
beings attach to their own being including life experiences. Therefore, the for~ation of 
meaning through interaction is a fundamental element of the development of self and 
identity. In turn, the formation of meaning is persuaded by the challenges of life and 
38 
these challenges are created in environmental expectations. 
According to Sarantakos . (2005:37), meanings are not permanent but emanate from 
human beings' interaction with the world they create. Meanings do not come into , 
existence before they are connected or linked to a mind. Sarantakos (2005:39) further 
postulates that the degree to which human beings construct meanings in interaction with 
objects differs. However, human beings attribute such meanings each time .they interact 
with each other. The formation of meanings during an interaction is supported by 
socialisation process which is a .c ultural means where human beings learn to recognise 
and appreciate meanings in others. At this point, the formation of meanings is based on 
culturally characterised and historically situated comprehensions including individual 
experiences. In the light of that, the socialisation process expresses or puts across such 
meanings and teaches individuals where, under what conditions, and how to assign them. 
Such skills and practices generate or establish the competence to challenge the world 
wisely and consistently and establish meanings in accordance with intellectual standards 
and principles. Furthermore, these skills attribute such meanings to people and so make 
sense of the world. However, the formation of meanings is more complex than it seems, 
and definitely not without consequences. 
It implies that the social constructionist as indicated by Sarantakos (2005:39) recognises 
and accepts the strong contribution made by human beings in the formation of meanings. 
The social constructionist also highlights and accentuates that culture and society play a 
pivotal role in constructing meanings through the socialisation process. Meanings are 
generated collectively and are readily accessible. They are already formed by and 
articulated through culture. Meanings also are shared and socially constructed, maintained 
and reconstructed through interaction. 
Human conduct as observed by Blumer (19969:132) arises from huge interpretative 
process in which individuals personally or collectively, guide themselves by defining the 
objects, occurrences and situations they encounter. Symbolic interactionism focuses on 
39 
the meanings of occurrences to individuals and symbols utilised to convey those 
meanings. Meanings are formed through experience or interaction. Fundamental to the 
formation of meanings according to Blumer (1969:5), is the human competence to 
possess a self-concept and to communicate with self. 
Similarly, human beings according to Wong's (2005:2) perspective are competent in rising 
above biological, environmental and historical influences. They are autonomous and 
accountable to choose their own futures and are the biographers of their own life stories. 
Furthermore, they are capable of interpreting their own experiences by assigning unique 
meanings to each situation. People are meaning-making and meaning-searching creatures 
who are inspired to make sense of the world and discover meaning for their existence and 
behaviours. Thus they exist in a world of meanings. Their views of events frequently 
impact them more than events themselves. 
The symbolic interactionism perspective according to Sarantakos (2005:43), focuses on 
people and everyday social interaction processes between them. In dealing with social life 
at a personal or collective level, this perspective places importance on human symbolic 
processes. Symbolic interaction means ari unusual and exceptional attribute of the 
interaction that occurs between people and their environment. The peculiarity comprises 
the fact that people as social beings are involved in defining and interpreting each other's 
behaviours and attitudes instead of simply and only reacting to each other's behaviours 
and attitudes. Such response is not made directly to the behaviours and attitudes of one 
another but instead is founded on the meaning attached to such behaviours and attitudes. 
Thus, social interaction is negotiated by using symbols, by interpretation, or by 
ascertaining the meaning of another's behaviours and attitudes. Such negotiation is equal 
to adding an interpretative process between stimulus and reaction in the case of social 
behaviours and attitudes. 
As noted by Blumer (1969:55), symbolic interactionism relies on the belief that a human 
being is not merely and just responding to the play of factors from one's environment 
40 
or from himself or herself but acts to cope with and handle such factors, in so doing has 
to shape one's conduct and attitudes. The building blocks of symbolic interactionism as 
outlined by Blumer (1969: 2) are as follows: 
► People behave toward others on the ground of the meanings others have for ~ 
them, or towards circumstances one encounters in everyday life; 
► The meanings of those people originates from the social interaction the person 
has with others; 
► These meanings are dealt with and reformed through an interpretative process 
utilised by the person during the encounter with others; 
► People in interaction are not just giving expression to such determining factors in 
developing their respective responses, but are selecting, directing, checking, 
bending and transforming the meanings in the light of what they encounter in 
the actions of others; 
► Meanings are employed and amended as devices for guidance and behaviour 
formation. 
According to the symbolic interactionism perspective, meaning guides behaviour or 
conduct and is a stage of deliberation for the formation of meaning which is attached to 
events or situations or circumstances. The meaning of events or situations or 
circumstances is created by people and leads to behaviours and attitudes. Therefore, all 
meanings are ultimately negotiated and integrated through interactions between 
people. People attach meanings to situations with resultant of an action and its 
consequences. 
One of the primary styles or practices human beings explore and learn as observed by 
Beck (2004:4) is through interaction with others. By interacting with friends, peers, 
partners, family members, significant others and people (lecturers and students included) 
in a social environment, people at that moment focus and concentrate on one another and 
adjust their behaviours and attitudes to one another. Through such interacti.o. n with 
others, they learn how to adapt, adjust, care, nurture, communicate, confide, co-
41 
operate, forgive, give, receive, share, trust, understand, support, and be responsible 
and accountable. These attributes are also applicable in the teaching-learning settings. 
In the final analysis, an interaction perspective is characterised by social interaction which 
is a moving process whereby human beings involved are interpreting or defining each . 
other's behaviours and attitudes instead of sheer reaction founded on meaning. However, 
all meaning is decisively cultivated and negotiated through experience or interaction and 
not readily accessible or in one's own mind, but it integrates or blends through one's 
interactions in the environment with others. An environment as a determinant of an 
interaction is then explained in the next section. 
2.4.1.3 An environment as a determanant of an interactaon 
In order to build on section 1.7.4:14, an environment of interpersonal interaction fostered 
by a trust relationship between the lecturer and student encourages learning. It is vitally 
important according Darling-Hammond & Bransford (2005: 116) that lecturers take 
cognisance that educational settings have cultures which can themselves be 
developmentally healthy or unhealthy. The lecturers' work in the classroom can be much 
more helpful if it signifies shared values and norms throughout an entire educational 
system. The authors assert that an educational environment that is nurturing, challenging 
and supportive provides the nourishment that students require to be healthy, whole and 
successful. This environment is accomplished provided lecturers engage their students as 
partners in education and as a result will be able to learn how to embed child 
development principles in every aspect of their work. Furthermore, treating the 
educational setting as an environmental system, establish a powerful context in moulding 
the students' behaviours, attitudes and achievement. Such behaviours and attitudes 
include not only those directed toward the students in the classroom but among all the 
members in the educational setting. 
Varying interactions in the educational system as aptly pointed out by Darling-Hammond 
. . 
and Bransford (2005:117) are fundamental to modifying the outcomes for students. The 
42 
educational environment becomes a powerful support for students' growth, development 
along all of the growth and developmental pathways provided all adults work together to 
establish norms of support and expectation. They also model and teach students a 
coherent set of respectful and responsible behaviours and attitudes that support positive , 
self-identities. Additionally, when adults are more diverse, supporting mutual values, goals 
and hopes for students, it is more likely that students will internalise and assimilate that 
into their own personal identity. 
Darling-Hammond and Bransford (2005: 117) assert that those who apply an 
environmental framework must also look at the environment to see what should be 
altered to support healthy growth and development instead of expecting the student to 
adjust to the environment. They further report that countless problems encountered in 
adolescence are actually the consequence of the educational setting not being conducive 
to the students' developmental needs. Mostly adolescents require intellectual challenge, 
opportunities to express ideas, be involved and participate in decision making processes. 
Additionally, adolescents need caring relationships, and affirmation in developing 
competence and identity. Many are placed in large, impersonal, departmentalised 
structures where rules are more rigid, their participation is less sought, teaching and 
learning is less engaging. They are less attached to adults (lecturers included), and their 
sense of identity is undermined. On the contrary, more personalised educational settings 
that permit more participation, involvement and responsibility taking, generate immense 
achievement and wonderful caring relationships. Furthermore, they are attached to adults 
(lecturers included) and to the academic enterprise. 
In the final analysis, as recommended by Darling-Hammond and Bransford, (2005:117), 
effective lecturers require a good foundation in normal development within diverse cultural 
contexts. Preparing a lecturer to be a substantial contributing member of a supportive 
educational setting also means assisting that lecturer to comprehend how students' 
development is moulded by the overall environment, and how that environment should be 
deliberately moulded by the joint efforts of all academic staff members. The emergence of 
43 
self, self-concept and self-esteem is highlighted in the next section. 
2.4.1.4 Emergence of self, self-concept and self-esteem 
• Self or identity 
Self, according to Huitt (2005:1), is the conscious reflection of one's personal identity, as 
an object detached from other or from the environment. Doyle (2005:1) views self from 
the pragmatic philosophy as a complex process of gaining self-consciousness. Through 
interaction with others, one develops _a concept of who he or she is and accomplishes a 
sense of self. A person is capable of being a recipient to self, and fulfils a sense of self 
through role taking. As the person assumes the role of others, the ability to reflect self, an 
incomparably social potential, is learned. Such social potential to perceive and to 
anticipate self from the perspectives and perceptions of others enables a person to hold 
an image of self. This self-image is learned during childhood and through social 
interaction. This implies that people learn who they are and what they expect of 
themselves by communicating with one another. The author further indicates that 
according to post-modem self, a sense of self is a relational perspective that is defined 
and negotiated in relational communities. 
One's sense of self or personal identity according to Doyle (2005:2) is developed and 
established through communication and interaction with others and at the same time 
determines such interaction. Social experience is vital to one's sense of self. Self is both 
the object (the 'me') derived from other people's behaviour and attitudes while the subject 
(the 'I') is the person's inner reaction to other people's behaviours and attitudes. Hence, 
the self is not fundamentally a fixed and rigid self, but the one that is frequently adjusting 
and adapting to others. The self is one that emerges not just from the individual, but with 
how others view the person and how that person reacts to and develops his or her own 
responses to this. This implies that people respond in terms of feelings or an idea i.e. the 
meaning behind the behaviours and attitudes that are involved in the system of mutual 
44 
expectations, as being present in the interacting situation. Whenever people come into 
contact, a certain mode of interaction transpires. Furthermore, the ways people behave 
towards each other convey the message about or determine the types of people they are 
with the result that personal identity continually changes. 
According to Mellish, Brink and Paton (2001 :33), from a humanistic perspective, a man or 
a human being, is a holistic being with physical, social, mental and emotional dimensions. 
A human being possesses feelings, attitudes and values and has a natural need to 
accomplish her or his own potential. This perspective stresses the relationship between 
the lecturer and the student including the development of the student's full potential. 
Therefore, it is imperatively fundamental for a lecturer to take cognisance of the fact that 
a student is a holistic being with learning needs which are her physical, social, cultural, 
spiritual, mental and emotional dimensions or traits, and these are to be nurtured and 
cultivated during teaching and learning processes. In this way, the student's potential may 
be accomplished. The acquisition of knowledge should not be an end in itself but rather 
a means to improve oneself and finally the environment in which one lives. 
A human being's calling as observed by Freire (1977:12) is to be a person who acts 
upon and changes his or her world and to progress individually and collectively towards 
ever new possibilities of a fuller and richer life. Each person, whether uninformed or 
immersed in the "culture of silence", has the capacity to critically perceive his or her 
world in a dialogical encounter with others. When one is provided with proper tools for 
such an encounter, one can gradually perceive one's own personal and human 
existence including the contradictions in it, become aware of one's perception of that 
reality and meaning, and deal critically with it. In this process the old, paternalistic 
lecturer-student relationship is overpowered. This implies that in the teaching and 
learning settings, both the lecturer and the student, whether unenlightened or 
immersed in the "culture of silence", have the ability to critically perceive their own 
world in a dialogical interaction with others. When the proper interaction oppo~unities 
are accessible and nurtured, the student can gradually perceive her or his own 
45 
·individual and human existence, its contradictions, and become conscious of his or her 
perception of existence and meaning, and critically handle that. Thus the obsolete and 
rigid lecturer-student relationship is co,nquered. 
Furthermore, when an uninformed person is engaged in the educational experience, he 
or she starts to see self differently, have a different picture of self, develops a new 
sense of dignity and becomes motivated by a new vision. Therefore, education either 
domesticates or liberates people to deal critically and creatively with reality, and 
discover how to participate and be involved in changing their world (Freire, 1977:13). 
Finally, each person is unique (lecturer and student included), needs to be accepted, 
appreciated, and respected and to feel free to learn, reflect, change, grow and develop 
personally and professionally. He or she should have the opportunity to share 
·a ppropriately his or her insight, experiences, ideas and feelings fully in any encounter. He 
or she also should have the opportunity to know others personally, including their 
experiences, opinions, ideas, expectations, issues and challenges considered vitally 
important in life and in educational circumstances. One's personal identity is developed 
and established through communication and interaction with others and simultaneously 
determines such interaction. The development of personal identity is dynamic and 
continually adjusting and adapting to others' behaviour and attitudes. 
• Self-concept 
Self-concept according to Potter and Perry (2001:541), is a subjective sense of self and 
a multifaceted blend of conscious and unconscious thoughts, feelings, attitudes and 
perceptions. It provides one with a frame of reference that influence one's management 
of situations and relationships with others. Self-concept is developed through a very 
intricate process that entails many variables and comprises four elements such as 
identity, body image, and self-esteem and role performance. It is the psychic image of 
. a human being, the fundamental part of "I" around which all perceptio.ns and 
46 
experiences are sorted out. The authors further describe self-concept as a dynamic 
blend formulated over years and based on: 
► Reactions of others to one's body; 
► Continuous perceptions of the responses of others to the self; 
► Relationships with self and others; 
► Spiritual identity; 
► Personality structure; 
► Perceptions of stimuli that have an influence on self; 
► Prior and new experiences; 
► Present feelings about the physical, emotional, and social self; 
► Expectations about the self. 
A positive and healthy self-concept as viewed by Potter and Perry (2001:541) gives one 
a sense of stability, wholeness and consistency with a high degree of continuity and 
generates optimjstic feelings toward the self. In addition, Huitt (2005: 1) describes self-
concept as a cognitive or thinking element of self, pertinent to one's self-image. It is the 
common idea one possesses of oneself. The author further describes self-concept as the 
sum of a complex, orderly, and dynamic system of learned beliefs, behaviours, attitudes 
and opinions that each human being regards to be true about his or her personal 
existence or personality. It is the underpinning of all motivated behaviour and attitudes 
and gives rise to possible or potential self that create and develop the motivation for 
behaviours and attitudes. Furthermore, one's paradigm and the .r elationship to that 
perspective provide the limitations and circumstances within which one develops one's 
vision of possibilities. The self-concept leads to meaning and self-directed behaviours and 
attitudes, and is unique to people. A person has a self-concept and also acts towards self 
as towards others and communicates with self. The person's ability to hold a concept of 
self and for self-interaction is a foundation for the formation of meaning and experience in · 
everyday life. 
47 
The person develops the concept of self through a gradual and complex process that 
continues throughout life. Doyle (2005:1) speculates that one's life and a sense of self are 
in a process and as one grows and changes over time, the quality and substance of one's 
communications with others also change. One's concept is the image that he or she builds ,_ 
only with the assistance of others whose efforts are appreciated and rewarded. If this 
assistance is consistent and repeated frequently, one will develop a feeling of acceptance 
and self-confidence. It is through the responses of others that one decides whether he or 
she is intelligent or stupid, worthy or worthless, depending on whether the responses of 
others are positive or negative. The assessment of the self thus depends on people's 
perception to others; people's judgements; and people's feelings about these judgements. 
Furthermore, the perception of the reactions of others gives an image of the social self, 
the way a reflection in the mirror portrays an image of the physical self. 
In support of the given description of self concept, Huitt (2005:2), expounds that one's 
self-concept is developed and sustained through action taking and reflective processes on 
what one has done and what others tell him or her concerning what he or she has done. A 
person reflects on what has been done and could be done in comparison to one's 
expectations, and that of others, including their attributes and achievements. The self-
concept is continually changing and is not hereditary, but is developed or evolved -by the 
person through interaction with the environment, and reflecting on that interaction or 
encounter. The author further indicates that there is growing research evidence that self-
concept changes i.e. self-change which does not come by choice but is dependent on the 
self-reflection process. Through such a process, one frequently perceives oneself in a new, 
more powerful way and it is through such perception of the self that a person can develop 
potential self. In addition, Mellish, Brink and Paton (2001:99), contend that reflection is a 
thinking process associated with a learning experience. The outcome of such a 
deliberation is to attach meaning to the experience and to incorporate the experience into 
one's perception or assessment of self. As a result, reflection has the potential to provide 
for personal growth and development. 
48 
According to Huitt (2005:2), there are several elements of self-concept - physical, social, 
transpersonal and academic. Physical self-concept is associated with that which is 
concrete or real e.g. what one looks like, one's gender, while social self-concept is 
concerned with one's relationship to others, and transpersonal self-concept describes 
one's relationship with the supernatural or the unknowns. The academic self-concept on 
the other hand, is associated with how one does in school or how well one learns. It 
comprises a general ·a cademic self-concept which denotes how good one is.- as a whole, 
and includes a set of specific content-related self-concepts that is associated with how 
good one is in a particular subject. The author further indicates that there is a very specific 
relationship between self-concept and school achievement. General self-concept and non-
academic self-concept are not associated with academic work. General academic 
achievement measures are moderately associated with academic accomplishment, or 
success, but specific measures of subject-related self-concepts are highly associated with 
success in that content area. The author indicates that the level of self"'.esteem does not 
predict the level of school success. This implies that lecturers need to focus on the 
academic successes and failures of their students. It is the student's history of success and 
failure that provides lecturers with the data to assess themselves (lecturers). 
• Self-esteem or self-worth 
Self-esteem as articulated and expounded by Leary and Baumeister (2000: 1-2) is an 
inner, psychological monitor of social belongingness which is extremely significant to 
human beings. It is one's view of one's value. Fundamentally, self-esteem is an 
individual's personal perception of how one is coping about being a valuable, viable and 
sought-after member of the groups and relationships which one belongs and aspires to 
belong. Similarly, it is a personal view and, consequently, may or may not directly 
reflect one's objective talents or accomplishments. In reality, it is associated more 
strongly to perceptions of others' appraisals of oneself than apparently objective 
indicators of one's ability or goodness. In support, Huitt (2005:1) describes self-esteem 
as the affective or emotional element of self that denotes 'how one feels about oneself or 
49 
how one value oneself which is one's self-worth. Self-concept is concerned with the 
general idea one holds of oneself while self-esteem means specific measures on elements 
of self-concept. The author indicates that these concepts are used interchangeably by 
other authors. Self-esteem is associated with self-concept since an individual with good _ 
self-esteem or self-worth, has a clearly d!fferentiated self-concept. When an individual 
knows herself or himself, he or she can maximise outcomes since he or she knows her or 
his capabilities and limitations. , · 
On the contrary, Potter and Perry (2001:452) point out that an individual who feels 
worthless and who receives little respect from others, typically has low self-esteem. 
Self-esteem is a person's sense of self-worth and is based on both internal and external 
factors. It is affected by both self-assessment which is a continuous mental process of 
one's own worth and the reactions of others. An individual who values himself or herself 
positively, despite weaknesses and limitations, and who feels valued by others generally 
has a high self.:esteem. Potter & Perry (2001:453) hold a view that a positive sense of 
self-worth or self-esteem is an essential human need. One's self-esteem influences how 
one operates in the world and also influences one's self-concept. 
Human beings as observed by Leary and Baumeister (2000:11) seem to be mostly 
inclined to pursue and preserve interpersonal relationships that depict stability, affective 
concern, ongoing contact and persistent expectations. Additionally, stable, caring and 
enduring relationships that engage persistent interventions are more valuable to 
people's everyday contentment and wellbeing. Therefore, even though individuals shun 
being disgraced or rejected by others, they are mainly concerned with maintaining 
certain kinds of close interpersonal relationships. 
The concept is the image that one builds only with the assistance of others whose efforts 
are appreciated and rewarded. If this assistance is consistently and frequently repeated, 
one will develop a feeling of acceptance and self-confidence. It is through the responses 
of others that one decides whether he or she is intelligent or stupid, worthy or worthless 
50 
depending on whether the responses of others are positive or negative. Social interaction 
involves contact or encounter. It is not mere physical contact that counts, but meaningful 
or symbolic contact. Social behaviour of people comprises acquired responses to 
meaningful responses by others. 
As a student masters various skills, his or her self-confidence grows and so does his or 
her desire to attempt new challenges. Through personal and social deielopment, a 
student discovers his or her responsibilities in the teaching-learning settings. Balanced 
relationships through social interaction are dependent on a positive self-image from the 
student. In enhancing and nurturing such self-image in the student, Huitt (2005:3) 
urges that the lecturers and parents should provide experiences through meaningful 
dialogue for appropriate social behaviour and attitudes in a variety of teaching and 
learning settings. Through interpersonal activities the student learns to respect others 
and is sensitive and responsive to their needs. The lecturer's goal is to provide 
opportunities whereby a student can build a comprehension of self-worth, develop 
leadership qualities, foster good character and nurture an appreciation of the rights of 
others. Each student is encouraged to grow and develop personally and acquire skills 
necessary to participate professionally; to recognise his or her gifts and talents and to 
share them with one's community. 
As a way of concluding this section on theoretical overview of interaction perspective, it 
emerged from the literature reviewed that a person is not merely acted upon but he or 
she also acts. All meanings are decisively negotiated and integrated through social 
interactions between people. Pe<?ple attach meanings to situations resulting in behaviour 
and attitudes and their consequences. Furthermore, it should be noted that people are 
social beings consistently judging themselves and managing their behaviour and attitudes 
to ensure that the expectations of self and others are accomplished. According to the 
related literature reviewed, a student's level of self-concept, personal identity, self-esteem 
(self-worth), and self-respect, are dependent predominantly on the positive or . negative . 
feedback received or anticipated from significant others, including lecturers. The student 
51 
develops the concept of self through a gradual and complex process that continues 
throughout life. 
Toe interaction perspective is relevant and appropriate to this study because it highlights • 
that through interaction with people, situations,1and events and self, people, situations, 
events and self are defined, and meaning is attached to them. This framework can be 
used to understand the perceptions and expectations of students regarding.'the meaning 
and significance of a caring environment in nursing education. 
The theoretical overview of a caring perspective is highlighted below. 
2.4.2 Theoretical overview of a caring perspective 
2.4.2.1 Caring as a concept 
By way of building on section 1.7.1:13, caring as viewed by Potter and Perry (2001:102) is 
a general phenomenon that affects human beings' styles of thinking, feeling and behaving 
in relation to each other. It is having a constructive regard for another person and is 
essential to a helping relationship. Furthermore, Potter and Perry (2001:327) indicate that 
nursing scholars (researchers) have developed theories on caring because of its 
importance not only to the nursing practice but also to the existence people. 
Caring is one of the nursing care domains essential for its effectiveness. When a person 
interacts with another according to Booyens (2001:212) caring is suppose to occur and is 
demonstrated by tenderness, thoughtfulness, compassion and respect. It should daily 
saturate the work, behaviour and attitudes of nurses in general and lecturers specifically. 
In addition, Booyens (2001:221) points out that caring is articulated through commitment, 
compassion, confidence, conscience and competence. Caring as described by Potter and 
Perry (2001:104) is a sustainable means of connecting .to a significant person towards 
whom one experiences a personal sense of commitment and obligation. It is also a pivotal 
52 
nursing phenomenon but not essentially unique to the nursing practice. Such caring is 
denoted by: 
► Knowing - striving to compre~end an event as it has meaning in another person's 
life; -· 
► Being with - being emotionally present , to the other, experiencing with, being 
available and involved; 
► Doing for - concern and love for others i.e. doing for another person.'as he or she 
would do for herself or himself if it were feasible; 
► Enabling - facilitating another person's journey through life changes and unusual 
events; 
► Maintaining belief - nurturing and instilling faith in another person's potential to get 
through change or an event and face a future with meaning. 
Therefore, caring as highlighted above can then be viewed as: 
► A general phenomenon that impacts one's thought process,. sensitivity, conduct and 
attitudes in relation to others; 
► A sustaining means of connecting to a significant person towards whom one 
experiences a personal sense of being with i.e. presence, concern and love for 
others, commitment, consideration, doing for, expression of compassion, 
interpersonal valuing and involvement, knowing, obligation, nurturing faith and 
hope, respect, tenderness, actualisation, confidence, conscience and competence; 
► A humane and mutual caring process for both the lecturer and the student through 
interactive, comprehensive, reflective and retrospective relationships resulting in 
discovery of personal essence. 
Such attributes of caring are also applicable in the teaching learning contexts as they 
depict a caring environment. In line with this perspective, the researcher therefore 
affirms that a broader, more appropriate, relevant, and clear understanding of what a 
caring environment is, is a necessity. Furthermore, the significance caring has _on the 
lecturer-student interaction, and how caring reveals itself, is required. It is also 
53 
imperative for all participants in the educational settings, to create the type of 
environment for caring that they require in those settings. 
2.4.2.2 Caring relationship perspective 
Caring as expressed by Smith (2005:2) is feministic in essence and is a part of ethics 
and moral education. Therefore, it should be a basis for ethical decisions.':The lecturer 
practising the "caring ethic" should uphold preparedness to care and focus on the 
wellbeing (interest), protection, or support of the student(s). Caring is an essential part 
of human life and it is to act with love and respect. Caring and caring relationships 
encompass feelings for another, receiving another unto oneself, reasoning with and 
understanding another, and also a commitment to the service of another person. 
Basically caring is ascribed by relatedness, connectedness, engrossment, motivational 
displacement, reflectivity, and receptivity. When a person cares for others and is cared 
for by them, ca~ing for oneself is also feasible. 
In nursing education, a caring relationship implies that both the lecturer and the 
student are involved in giving and receiving caring from each other, while allowing the 
discerning, relating aspect of themselves to encroach on their awareness. That is 
demonstrated by an act of love, respect, commitment, attachment, inclination, interest, 
reasoning and understanding, openness, motivational displacement, and reflection. It 
also symbolises caring which is enriching, illuminating, nurturing, while cultivating and 
fostering the development of caring behaviours and attitudes in both the lecturer and the 
student. Furthermore, through their unique interactions, both the lecturer and the student 
enter into a relationship participating equally as partners in educational settings, and 
growing and learning from the encounter. As such, all participants quest for greater self-
consciousness and greater spiritual awareness with appreciation for people. 
Smith (2005:8) indicated that caring can be viewed as an essential principle ~hereby 
human beings at all times act so as to create, sustain and enhance caring relations . The 
54 
lecturer, conversely, does not refer to such a principle when he or she reacts to the 
student. The principle is descriptive and not prescriptive. The conducts and attitudes of 
lecturers are well outlined by such a principle, but the motivation crops up either naturally 
or through deliberate reflection on an ideal of caring that has become part of their • 
character. It implies that while a person becomes content with a personal caring 
relationship, caring then becomes a component of his or her fundamental principle of life 
and inner being. In the researcher's view, in order for social relationships as;.vital sources 
of caring to be realised in the teaching and learning settings, a caring environment in 
nursing education should be established. Similarly, Noddings (2005:3) proposes that 
lecturers and students should spend more time together to establish trusting relations. 
Mellish, Brink and Paton (2001:73) assert that it is advisable for lecturers to reflect on 
their own general feelings, thoughts, behaviours and attitudes towards students. A 
virtuous lecturer-student relationship originates from lecturers who accept their role as 
lecturers, and who possess expertise, attributes and commitment to facilitate learning. 
In support of Mellish, Brink and Paton (2001), Beck (2004:8) articulates and expounds 
that when the lecturer is with the student, the lecturer can appreciate the student as a 
valuable and unique person. It is significantly essential in human relationship not to 
ignore the importance of love and joy by treating people as objects instead of as the 
divine essence. Human relationship teaches people a lot abo~t themselves. No -r:ierson 
can irritate someone unless one permits that to happen within oneself. Personal 
interaction and communication provide ongoing lessons in self-awareness and the art of 
loving. With a friendly attitude and conduct toward all people one interacts with, these 
experiences are more pleasurable and uplifting. People are inclined to treat one another 
according to the treatment they receive from one another. Thus they learn creativity, 
responsibility and justice through interaction. Furthermore, social situations as 
expounded by Beck are ascertained by people in how they regard or consider or 
experience or perceive the situation. People portray their roles and relationships by 
their attitudes and conduct. 
55 
From the caring perspective, the personal and professional growth of students is vitally 
important as observed by Smith (2005:9). Lecturers are responsible for support, and to 
foresee, assess and encourage worthwhile activities by students. Students, lawfully, are 
to pursue activities mutually constructed and approved by both lecturers and students. , 
Noddings (1992:174) postulates that lecturers,• like mothers, should attempt to raise 
individuals and students who are acceptable, admirable, compassionate, loving, 
productive or competent, respectable, trustworthy, and not obsessive but committed to 
caring. However, this moral priority is disregarded by the educational system. In 
facilitating .the professional development of such individuals and students, lecturers 
require both intellectual capabilities and a knowledge base regarding those particular 
individuals and students with whom they are interacting. 
Caring relationships should be cultivated by encouraging students to share ideas, 
potentials, competences in response to each other's learning needs; to recognise 
personal strengths and weaknesses; to exhibit mutual respect, acceptance and 
cooperation in developing a caring environment. 
2.4.2.3 Lecturer-student relationship 
Freire (1977:45-46) renders a careful analysis of the lecturer-student relationship which 
reveals its critically narrative character. This relationship consists of the lecturer as a 
narrating subject with the student as a patient, receptive, listening object. The student 
is a passive receiver of facts, and education is reduced to "an act of depositing," in 
which the students are the depositories and the lecturer is the depositor. It means the 
'banking' concept of education in which -the scope of action allowed to the students 
extends only as far as receiving, filing and storing deposits. On the contrary, Freire 
advocates for the pedagogy of liberation for both the oppressed (students) and the 
oppressors (lecturers). His focus is on education and the use of education as a strategy 
for awakening social consciousness in the students. Of particular significance are his 
views of the dichotomy embedded in the lecturer-student roles occurring in an 
56 
educational environment created for empowerment and liberation. Therefore, the 
author advocates that a solution be achieved wherein the relationship between the 
lecturer and students is no longer domineering, but where "both are simultaneously 
lecturers and students." 
Students, according to Noddings' (2005:2) observations are not usually as close or 
intimate to lecturers as children are to their parents but the relation'ship is.still ideally a 
close or intimate one. However, for some students, lecturers are more significant than 
parents. The author reflecting back on her experiences indicates that a series of 
lecturers she came in contact with while she was a student, played an instrumental and 
pivotal role in her life. She cannot think what her life would have been like without such 
lecturers. She further states that human beings learn from those they love. The 
lecturer-student relation or bond is, inevitably unequal since lecturers have distinct roles 
students cannot undertake. A possible remedy for the situation according to Noddings 
(2005:3) is that lecturers should: 
► Practice inclusion by assuming a dual perspective i.e. their own and that of their 
students; 
► Perceive the world from their students' perspective in order to reposition them from 
a lesser to a more satisfactory outlook; and 
► Remain aware that the relation or connection is unequal. 
Therefore, virtuous lecturers, according to Noddings (2005:3), do not reject or cast-off 
what students perceive and experience, but, somehow operate with what is directly _and 
forthwith perceived and experienced so as to build a stronger position for each student. 
For this to be realised and accomplished, the establishment and sustenance of a 
trusting relationship is needed. Good lecturers strive to liberate their students to pursue 
their own growth without being held back by their lecturers own personal and professional 
needs. 
57 
Mellish, Brink and Paton (2001:73) indicate that according to research evidence, 
lecturer1s personal traits are fundamental to involving students in the teaching-learning 
process and motivating them to learn. The lecturer1s personal traits fundamental for 
successful learning are: 
► Demonstration of self-confidence in self ar.,d students; 
► Being dynamic and zealous; 
. 
► Being open-minded and non-judgmental; . ' . 
► Displaying a sense of humour; 
► Admitting mistakes and limitations; 
► Being co-operative and patient; and 
► Being flexible when the situation calls for it. 
In the light of the given explanation of the lecturer-student relationship, Noddings 
(2005:3) expounds that the lecturers can both see students and see with them. While 
students on the other hand, by definition, cannot see in the same manner as the lecturers, 
nor should they be expected to. When a lecturer-student relationship takes this route, the 
relationship becomes one of mature friendships and the authoritarian and overbearing 
relationship disappears. Students are set free or liberated by their lecturers1 attempts at 
inclusion so that they can pursue their own personal and professional growth and 
development. This is precisely what the virtuous lecturer strives at or quests for. Lecturers 
do not desire their students to be coerced or compelled by their lecturers' personal or 
professional needs. The responsibility and accountability is just tremendous and great. 
Students also have a part to play as care-recipients by responding positively to their 
lecturers, attempts. Frequently this occurs in an evidently natural way. 
Beck (2004:7) regards friendship as an art of loving those we know. It is a mutual 
relationship that is ideally sound, harmonious and free derived from friendly conduct 
and attitudes. Furthermore, it is characterised by being honest, courageous and 
communicating how one feels and what one thinks pertaining to issues and situations. 
This principle is also applicable in one's relationship with others when one is honest in 
58 
expressing one's feelings and thoughts about others. Another attribute of friendship is 
openness and sharing oneself and acknowledging one's own doubts and inadequacies. 
From the encounter, there is a lesson learned on how to resolve one's doubts and fears 
and to work on one's weaknesses to strengthen them. Therefore, one grows in ~ 
awareness, instead of concealing and repressing one's faults. In addition, should one 
have a problem with someone that is to be resolved, one could discreetly, 
conscientiously and lovingly be honest regarding how one feels ,-so that a two-way 
communication can occur and the problem solved as amicably as possible. No other 
person is compelled to do what another person desires, but someone can communicate 
his or her standpoints so that another person may know his or her ideas and feelings, 
and be free to make an informed decision. 
According to Noddings' (2005:4) observation, children who have been cared for at home 
will spontaneously respond positively towards lecturers. But if lecturers conduct 
themselves in strange ways, students may have a problem in discovering caring 
endeavours. Students may also encounter a problem in perceiving care if it comes in 
forms they have already conceived and assessed as non-caring. If lecturers rationalise 
abusive conduct on the basis that it is for the student's own good, a student may well 
distrust all attempts to improve his or her condition. This places an enormous weight on 
lecturers to listen, receive, and respond to what is actually prevailing. Therefore, lecturers 
must bear in mind that students are from different backgrounds and cultures but are 
unique human beings, each in need of a special relation with his or her lecturer. They 
strive to feel safe in their relationships with lecturers. It must be acceptable to admit error, 
confusion or even a dislike of a particular subject. 
Noddings (2005:4), further points out that the students should also take responsibility. in 
communicating their needs to their lecturers. They should also comprehend that their 
behaviour and attitudes or responses invigorate and vitalise or dampen their lecturers' 
enthusiasm. Students have an immense impact on their lecturers and these probabilities 
should be openly discussed . Lecturers' and students' contributions are unequal, but they 
59 
are however mutual and dispensable. The relationship is characterised by reciprocity that 
implies that caring is a relation or connection involving dialogue and exchange. Both can 
learn and gain from the experience and can also appeal to that principle. However, 
students cannot be expected to teach their lecturers. They can be expected to respond 
with growing sensitivity to their lecturers' endea\/ours to foster and enhance their own 
personal and professional growth and development. Similarly, they can promote their own 
. ' 
growth in acquiring academic knowledge and a relation that might yield a lifetime of 
friendship and wisdom. In unequal relationships by way of illustration, things can become 
complicated since time, intensity and situational variations also have to be considered. 
One of the greatest challenges lecturers are facing, is to assist students to learn how to be 
'care-recipients'. 
Positive or incontestable lecturer-student relationships as evidenced through some 
research reports, according to Mellish, Brink and Paton (2001:72) are most significant and 
substantial in successful learning. A meaningful component in establishing such profound 
lecturer-student relationships is the lecturer's commitment to teaching in a caring way, 
since teaching demands an enormous amount of caring for others, and giving of self. 
Therefore, in helping and caring relationships, a lecturer: 
► Is approachable, available, friendly, genuine and honest; 
► Fosters mutual respect; 
► Provides support and encouragement; 
► Listens attentively; 
► Exhibits profound respect for students as human beings and 
► Harmoniously endeavours to handle them at their level of comprehension; 
► Is conscious that each student is a unique being with biological, psychological, 
social and spiritual needs and has the right to dignity, worth and autonomy; 
► Accepts each student's individual differences; 
► Respects learners' rights to challenge, question and to express own standpoints; 
► Fosters independence in each student; 
► Displays empathetic understanding; 
60 
► Responds to students' experiences and feelings; and 
► Is capable of communicating understanding warmth to them. 
2.4.2.4 Moral education from an ethical caring perspective 
Ethical caring from the feministic perspective according to Noddings (2002:11) is a state 
of being in the relation or connection of individuals ascribed by unspecified affective 
awareness of each other. Ethical caring arises out of natural caring and is found in 
receptivity, relatedness, engrossment, reflectivity, motivational displacement and 
responsiveness. Caring should be a foundation for ethical decision-making. The author 
views care as basic in human life, implying that all people want to be cared for. What 
caring actually means and entails is not that easy to establish. However, according to 
Noddings (2002: 13) in caring encounters people discover things about themselves since 
they are receptive and are attentive in a special way. Natural caring, similar to that of a 
mother for a child, appears prior to ethical caring and is preferable to it. It is that 
relationship or connection in which people react as 'one-caring' out of love or natural 
inclination. Natural caring is the social condition or state that people consciously or 
unconsciously perceive as good. It is the state which people desire and quest for that 
unique relationship that grants motivation for people to be moral. People desire to be 
moral in order to stay in a caring relationship and to heighten the ideal of them as 'one-
caring'. 
On the contrary, ethical caring according to Smith (2005:5) has to be pursued. People 
should not need to turn to a principle. More effectively and substantially people turn to 
their memories of caring and of being cared for and a picture or ideal of _themselves as 
caring for others. The essential contribution of ethical caring is to guide action or 
behaviour long enough for natural caring to be restored or invigorated and for people 
once more to interact with mutual and spontaneous or candid respect. Therefore, it 
may be inferred that ethical caring is contributory to the establishment or resto. ration of 
natural caring. Moral education from an ethical caring perspective comprises core 
61 
elements of modeling, dialogue, practice and confirmation as articulated by Smith 
(2005:5). Modeling as one of the core elements of moral education from an ethical caring 
perspective is now outlined. 
• Modeling 
Modeling is expressed as an enactment of behaviours and attitudes displayed by the 
lecturer to the student. According to Smith (2005:5), lecturers are interested in and 
concerned with human beings' growth and development as caring for others and those 
cared for. Lecturers are also to display or demonstrate in their conducts and attitudes 
what it means to care. They do not merely inform the students to care and offer them 
texts to read about the subject. Instead they display caring in their relationships with 
them. Lecturers model caring behaviour and attitudes when they faithfully and steadfastly 
cultivate and nurture self-affirmation in their students. They are not only concerned with 
the students' academic achievement but endeavour to develop fully moral individuals. 
Lecturers from the social relationship perspective model not only exclusively commendable 
and praiseworthy styles of intellectual activity, but they also model fascinating and 
appealing approaches in interacting with people. Such lecturers treat students with 
respect, (esteem) and consideration and encourage them to do likewise with one another. 
They utilise teaching moments as caring opportunities. 
It implies that the lecturer who is caring also strives that students have practice in 
caring. In a classroom dedicated to caring, students are encouraged to support one 
another. Opportunities for peer interaction are provided or created, and the quality of 
that interaction is vital to both the lecturer and the student as academic outcomes. 
Through the teaching of caring relationships, coupled with lecturers' modeling and 
constant reinforcement of humanness, the student develops a well-grounded inner 
being. Through interaction with lecturers, students also acquire and internalize values 
and morals essential in the teaching and learning settings to meet the challen9es of a 
dynamic and complex life. For this to be realised, a meaningful dialogue between the 
62 
lecturer and student should prevail. 
• Dialogue 
Dialogue is viewed by Freire (1977:61) as a process of naming the world. It is a process 
that opens the opportunity for participants to pose problems, to critically reflect and to 
perceive solutions not previously realised. This process as observed by ·Noddings 
(1995:191) transpires within a caring relation where the lecturer and the students show 
evidence of receptivity that is depicted by openness, accessibility, interest and 
approachability. Receptivity simply means a willingness to "receive the other in an open 
and genuine way." Noddings (1995:191) further perceives openness as engrossment 
implying a non-selective way of attention that permits the other to establish a frame of 
reference and invites him or her to enter it. Dialogue among lecturers and students is 
critical to learning the roles of the lecturer and the student. It encourages and brings up 
discussion or discourse about meanings of caring and fosters personal reflection about 
expressions of caring that might be confusing for students as they enter into the roles 
of lecturer and student. As dialogue unfolds, lecturers share in a mutual construction of 
the frame of reference that engages total receptivity, reflection, invitation, assessment, 
revision and further exploration. 
During dialogue or discourse as articulated by Freire (1977:53), the 'lecturer-of-the-
students' and the 'students-of the-lecturer' ceases and instead the lecturer-student with 
students-lecturers surface or emerge. Both lecturers and students are engaged .i n a 
dialogue where the lecturer no longer only teaches but is also taught while the student is 
taught and also teaches. In this process, both the lecturer and the student are jointly 
responsible and they both grow personally and professionally. Thus dialogue or discourse 
is a powerful tool in Freire's conceptualisation of education and it has important 
implications for successful teaching-_learning outcomes. In problem-posing education as 
observed by Freire (1977:56), both the lecturer and students develop their P?wer to 
perceive critically the way they exist in the world with which and in which they find 
63 
themselves. They come to see the world not as a static reality, but as a reality in 
process, in transformation. 
Freire (1977:61) presents dialogue as more than an exchange of words. It imposes 
itself as the way by which people achieve significance as human beings. Dialogue is 
thus an existential necessity. Lecturer-students facilitate the dialogue of the students-
lecturers; they pose problems that help move the students-lecturers.to further dialogue. 
The outcome of this is critical reflection on the part of all participants on the students-
lecturers' reality and identification of action(s) that the students-lecturers are now 
empowered to name. Only dialogue as articulated by Freire (1977:65), which requires 
critical thinking, is also able to generate critical thinking. Without dialogue there can be 
no communication and without communication there can be no true education. 
Dialogue according to Smith (2005:5) is fundamental to moral education. It is an honest, 
open and reciprocal interaction between the lecturer and student to share mutual 
perspectives, thoughts and experiences, or the search for enlightenment or means to 
problem solution. Engaging in such dialogue does not mean that those involved should 
give up any principles they have and submit to the relationship. It implies that caring is a 
relationship engaging dialogue and exchange. Both the lecturer and student can learn and 
gain from the experience and can appeal to the principle. Evidently, more time is needed 
for that dialogue to occur. 
Smith (2005:7) further indicates that both the lecturer and the student are to know each 
other very well for trust to develop. The purpose is to engage both lecturer and students 
in dialogue about caring. Dialogue is such a fundamental element of caring that the 
lecturer and students cannot model caring without engaging in it. Furthermore, in 
involving them in dialogue it is essential to talk directly about and explore one's caring 
since it may be demonstrated in various ways. Such involvement in dialogue might assist 
them to critique and better comprehend their own relationships and practice. I!1 other 
. 
words, dialogue permits people to examine their caring efforts. As they practice caring, 
64 
they are also assisted in their endeavours by the feedback received from the care-
recipients. Essentially, dialogue contributes substantially and significantly to the personal 
and professional growth and development of students. 
In the final analysis, education is a mutual teaching learning process whereby everyone is 
both a lecturer and student through genuine and authentic dialogue for discovery of valid 
solutions to problems. A caring environment in nursing education needs to be created in 
which an ongoing dialogue can take place so that each participant: 
► Shares learning experiences; 
► Shares own perceptions and expectations of a problem; 
► Listens to; 
► Offers own opinions and ideas; 
► Have the opportunity to make decisions and/or recommendations; 
► Learns from each other or others; and 
► Feels respected and accepted. 
For the aforementioned to be realised, the lecturer should also: 
► Be sensitive to the dynamics in the group; 
► Fosters openness of self and trust in self and others; 
► Allow confrontation to facilitate a culture of learning and teaching; and 
► Recognise and appreciate each student's uniqueness, experiences and insights. 
It is the responsibility of each lecturer to create and avail caring opportunities through 
engaging students in dialogue. Also during such engagement, the environment should 
foster respect, acceptance, freedom to learn, to reflect and rethink one's own views, 
ideas, values, to change and grow, to share fully one's thoughts and feelings and 
experiences. As lecturers practice caring, students as care-recipients will also copy and 
imitate such practice and as a result grow and develop personally and professionally. 
65 
• Practice 
Practice is required to learn the processes of receptivity and engrossment that are 
described by Noddings (1995:191) as critical aspects of effective dialogue. Practice is 
accomplished through experiencing relationships as both lecturer and student(s). Over 
time, the student has the opportunity to develop an appreciation for the presence and 
effects of caring. Both the lecturer and the student view the world with a caring 
. outlook. The lecturers who are caring also strive for students to have practice in caring. In 
a classroom or in teaching-learning settings dedicated to caring, students are encouraged 
to support and assist each other. Opportunities for peer interaction are accessible. 
Students are given opportunities to practice caring and to reflect on such practice. 
In ensuring that good caring practices are enhanced and sustained, appreciation, 
recognition and acknowledgement of such should be confirmed. 
• Confirmation 
Confirmation, according to Smith (2005:6) is an act or behaviour of affirming or 
confirming, promoting and supporting the best in others. This implies that the person to 
be affirmed or confirmed must be reasonably well known to others so that the better 
image or identity of her or him is discovered and his or her growth and development is 
promoted and supported. Otherwise, what that person is questing for, or what ideal he or 
she may actually desire cannot be noticed or observed by others. Instead something 
commendable or acceptable, striving to surface in each person encountered should be 
recognised and appreciated. An attribute must be viewed or perceived as valuable, 
meaningful and significant both by the person attempting to attain it and by others. 
Notably, such confirmation entails or embraces trust and continuity. Continuity is required 
as people require knowledge of the other and trust as the lecturer is required to be 
credible. 
66 
With the given core elements of moral education as a background, Noddings (2005:4) 
emphatically proposes that for moral education from an ethical caring perspective to be 
realised, it is crucial for lecturers and students to engage in modelling, dialogue, practice 
and confirmation. Furthermore, strategies to increase and expand the contact or 
interaction between lecturers and students need to be explored to maintain and sustain 
collaborative relationships. 
Noddings (2002:283) perceives education as being pivotal to the cultivation of caring in 
society. It is imperative that lecturers comprehend and nurture this idea in any teaching-
learning environment. For this to be realised, lecturers are to be the role models who 
symbolise caring traits of commitment, trust and competence and endeavours these as 
becoming a benchmark in the educational settings. As a result, students will assimilate 
and internalise such in their inner being and also be empowered to harmoniously display 
caring behaviours and attitudes in any setting they are exposed to. 
2.4.2.5 Caring traits 
• Commitment 
Commitment as described by the University of Indianapolis (2005:6) is a blend of the 
passion, responsibility and an intentional choice to act or perform in congruence with 
them. It is also a quality that grows to be internalised as a value such that responsibilities 
are not considered as burdens. Therefore, a committed nurse (a lecturer included), as 
reported by Mokwena (1990:87) displays compassion, empathy, sensitivity, confidence 
and calmness when interacting with people (nursing student included). That lecturer 
copes in any situation whether new, challenging or unique by maintaining his or her 
individuality, dignity, integrity, and also r_especting the rights of those entrusted to his or 
her care. Compassion is viewed by the University of Indianapolis (2005:6) as a belief that 
begins with an alertness of one's interconnection with all living creatures and prowesses 
towards a sensitivity that empowers one to share with and accommodate others. 
67 
Confidence on the other hand is the belief in one's own sense of power to achieve goals. 
It promotes trust without enslavement, ·rigidity or reaction out of fear. This state of affairs 
is also applicable in nursing education. 
• Trust 
Trust and frankness according to Booyens (2001: 164), are essential' in all relationships. 
Potter and Perry (2001:329) regard genuine caring as a powerful means to gaining trust. 
Consequently, trust is relying undoubtedly or unquestionably on another person and that 
provides the basis for effective communication as one becomes more open in expressing 
feelings, concerns and thoughts. Caring as viewed by Booyens (2001:222) is a process 
whereby one (lecturer included) is assisting another (student included) through the 
provision of opportunities for growth and self-actualisation. This process according to 
Noddings (2005:3) emanates from time spent together to establish and sustain 
incessantly a profound and mutual trust and intensified relationships. Trust as 
articulated and expounded by Potter and Perry (2001:455) is depending on someone 
without reservation or questioning. Being trustworthy denotes assisting others without 
indecision when assistance is required. In cultivating and promoting trust, the nurse 
(lecturer included) communicates warmth and expresses consistency, reliability, honesty 
and competence. Trusting someone entails risk and vulnerability, however it also 
encourages open, therapeutic communication and boosts the expression of feelings, 
thoughts and needs. Therefore, learning is encouraged in an environment of 
interpersonal interaction fostered by a trust relationship between the lecturer and 
student. 
These aspects imply that during any social interaction, both the lecturer and the 
student need to be constantly sensitive and responsive to each other's needs. They 
should be honest and open with each other, including building mutual trust with each 
other. The process of building mutual trust is continuous and requires great ORenness 
on the part of the lecturer. Lecturers are to be open to feedback about how they 
68 
operate and also take time to critically examine their own values, beliefs, behaviours, 
attitudes, knowledge and competences. Being a lecturer therefore implies that he or 
she should be engaged in a continuous mutual trusting relationship to demonstrate 
competence in creating a caring environment when interacting with students. 
• Competence 
Competence according to the University of Indianapolis (2005:6), is the form of 
possessing the knowledge, judgement, skills, energy, experience, expertise and motivation 
needed to respond positively to the challenges of one's professional obligations. The 
capacity to care and to care appropriately and efficiently requires that 'a human being 
(lecturer) possesses the liberty and privilege to learn, and the opportunity to practice in 
his or her respective profession in a way compatible with the dignity and needs of those 
(students) he or she serves. A lecturer can prioritise his or her tasks to encourage caring 
opportunities and model caring behaviour and attitudes by creating time to be with 
students through informal discussions, conversations, meetings and giving feedback 
during consultation. As students notice and experience such caring expressions, the 
caring behaviours and attitudes will be copied or imitated and assimilated into their 
inner being. 
Cultivating a caring environment and relationships in the teaching and learning settings 
requires the lecturers to take time to interact with students informally whenever 
possible. When giving feedback on academic performance during consultation periods, 
lecturers are to create moments and opportunities to interact directly with an individual 
student or a group of students in which caring behaviour and attitudes are displayed. 
Such moments and opportunities for caring interactions and relationships are aimed at: 
► Fostering an environment for sharing successes and identifying learning 
problems encountered in the teaching and learning settings more readily and 
at ease; 
► Creating an environment for identifying learning gaps and give remedial 
69 
teaching at the spot (teachable moments); 
► Improving the student(s) academic performance; 
► Developing a feeling of self-worth in both the lecturer and the student(s); and 
► Nurturing and enhancing the caring behaviours and attitudes in both the 
lecturer(s) and the student(s). 
From the caring perspective, the personal and professional growth and development of 
students is vitally important (Noddings, 1992:174). The author argues that lecturers 
should strive to develop students who are acceptable, admirable, compassionate, 
loving, competent, respectable, trustworthy, and not obsessive but committed to caring. 
In modelling for the students, lecturers require both intellectual competences and a 
knowledge base concerning those students with whom they are interacting. They need 
more time to learn more about those students in order to obtain a level of 
comprehension and a quest to be involved more personally. Therefore, the caring 
relationship may_d evelop into one of understanding and trust. In turn, the lecturer may 
feel ready and competent to contribute to the growth and development of the student. 
Commitment may be made to care for a student. The student who is cared for may be 
receptive and ready to be cared for. 
In the final analysis, lecturers should create a caring environment for meaningful 
dialogue with students by demonstrating appropriate and acceptable social behaviour 
and attitudes in a variety of teaching and learning settings. Through such caring 
environment and relationships the student can: 
► Recognise his or her potential, personal strengths and weaknesses; 
► Develop a feeling of self-worth and self-confidence; 
► Learn to love and -respect others; 
► Become sensitive to others' needs; 
► Nurture an appreciation and respect for others' rights; 
► Develop good caring traits; 
► Develop and grow personally and professionally; and 
70 
► Acquire the caring behaviours and attitudes needed in the nursing profession 
generally and in nursing education specifically. 
2.4.2.6 Caring as a moral perspective in the teaching learning process 
A relational ethic or an ethical caring according to Noddings (2002:11), is commonly 
. . . 
marked by responsibility and response and differs completely from· traditional ethics. A 
relational ethic is firmly established and is dependent on natural caring. The one 
behaving from a caring perspective is forever affectionate and has a sense of obligation 
to invigorate natural caring for both the lecturer and the student, with ethical caring 
being its servant. The most significant contrast is that ethical caring turns the traditional 
emphasis on duty (in conformity to principle) upside down. On the contrary, the natural 
caring prefers behaviours and attitudes achieved out of love and natural inclination or 
preference. An individual behaving out of traditional ethics conforms to a rule or a 
principle, or special responsibility, only when love or inclination fails. The relation of 
natural caring is the social condition that people consciously or unconsciously view as 
good. It is that condition which people desire and quest for. It is their desire for caring, 
to be in that unique relationship that provides the motivation for them to be moral. 
Education is a continuous process and is based on group action throughout the 
individual's lifespan. It is a shared responsibility. In essence, each person has a role to 
play in the education of the individual for optimal promotion, maintenance and 
protection of health, and shaping the environment where they live and learn. Therefore 
the teaching-learning process must take place in the total environment that has 
physical, social, intellectual, emotional and moral dimensions for optimal human growth 
and development. 
Ruddick (1993:369) asserts that all thought or idea originates from human practice or 
custom. In their customs, human beings react to a reality or existence that eme!ges or 
surfaces to them as given, as presenting particular cla ims. The reaction or responses to 
71 
NWu 
IBRAR 
such claims is moulded by interests in or passion for preserving, reproducing, directing 
and understanding personal and group life. Furthermore, such customs or practices are 
marked by specific interests in meeting the claims that some reality imposes on its 
participants. 
The lecturer's role often parallels that of the mother. It is the desire of each mother to 
" \ 
see her child become an adult that she and significant others can appreciate· and also to 
be accepted by peers and others. According to Ruddick's (1993:370) observation, a 
mother's role in raising her child may be supported or violated by the assistance and 
advice of fathers, lecturers, doctors, moralists, therapists and others whose interest is 
to enhance and mould that child's physical, emotional and intellectual growth and 
development. Furthermore, mothers have the same relation to maternal practice as 
lecturers have to educational practice. Mothers are ruled by their respective practices, 
as lecturers are governed by their educational practices. But the style, skill, 
commitment and integrity with which both the mother and the lecturer engage in these 
practices vary greatly from person to person. 
The mother's role (the lecturer's role of educating and training) of raising an 
appreciable child (student) becomes a self-conscious, reflective expression of a 
disciplined conscience that grants and offers her unique opportunity to: 
► Explore, create, asserts and maintains her own values; 
► Train her child (student) for strength and integrity; 
► Develop openness and relationship in regard to her child's (student's) most 
intimidating differences from her, i.e. moral ones (Ruddick, 1993:373). 
Love according to Mokwena (1990:75) is caring and accepting responsibility for another 
person. This implies that in the educational settings, it is the responsibility of each 
lecturer to display caring and acceptable behaviour and attitudes when interacting with 
the student, in order for the student to feel loved and accepted and have a s.e.n se of 
belonging. Loving a child (student) as observed by Ruddick (1993:376) is not 
72 
exclusively profound attachments and affections, but it is a separation, a giving up and 
letting him or her grow. To love a child (student) is to perceive that child's (student's) 
existence with patient, loving attention. The patient, attentive love might appropriately 
outline the detachment of mother (lecturer) and child (student) from the mother's (the 
lecturer's) perspective. In addition, Noddings (2005:2) emphatically asserts that the 
reordering of priorities in the learning environment is fundamental. As such, Noddings 
(2005:4) urges that students should also learn to care for others: · Consequently, the 
outcomes will not only be gaining academic knowledge but: 
► A relation that might harvest a lifetime of friendship and wisdom; 
► A healthy family life: happy and healthy children; 
► Co-operative and considerate behaviours and attitudes; 
► Competence in everyday affairs of life; 
► Intellectual curiosity; 
► Openness and willingness to share; 
► A declar~d interest or passion in existential questions; including 
► A growing capacity to contribute to and prosper in intimate or close relationships. 
According to Beck (2004:5) parents are commonly responsible for caring for their 
children until they are mature and independent. The same applies to lecturers who 
have caring attitudes towards the students by regarding them as human beings. 
2.4.2.7 Fostering a child's or a student's growth and development 
For a mother or a lecturer to comprehend her child or a student, she must undertake 
the reality or existence of a conscious, enduring person whose attitudes and behaviours 
are significant and understandable in terms of perceptions and reactions to a meaning-
filled world. She knows that the fantasies and thoughts of her child or student are 
linked not entirely or exclusively to the child's or student's acting ability but frequently 
are the only foundation for her to understand her child or student and for the child 's or 
student's self-understanding (Ruddick, 1993:373). With the given exposition as 
73 
background, Noddings (2005: 1) asserts that parenting and teaching are situations that 
both require long term time-continuity in relations. Virtuous and moral parenting or 
teaching begins with the establishment of substantial and profound trusting 
relationships and operates incessantly to build on the foundation of trust. 
2.5 Summary 
In this chapter, an extensive and more rigorous literature review was conducted in order 
to obtain effective representation of relevant issues related to the problem under study to 
intensify the rigour of the study thus reducing the researcher's biases. Conceptualisation 
of key concepts such as guidelines, caring environment and nursing education which are 
the thrust in the study were also highlighted. The key Higher Education policies and 
legislative frameworks which have the most pertinent influence on the environment in 
nursing education were also put into perspective. The theoretical underpinning of the 
study which provides theoretical framework in terms of which the research problem, the 
nature of the study and the findings can be understood was explored and described in 
detail. This theoretical underpinning is grounded in both the interaction and the caring 
perspectives which are integrated highlighting that people are individual personalities 
consistently judging themselves. 
74 
CHAPTER THREE 
RESEARCH DESIGN AND METHODOLOGY 
3.1 Introduction 
In this chapter, a detailed account of the qualitative research design a·nd methodology are 
presented and serves as bedrock for the planning and implementation of this study. It 
proceeds by giving an overview of qualitative research and justifies the researcher's choice 
for employing the perspective to elicit perceptions and explore expectations of nursing 
students regarding a caring environment in nursing education. This chapter devotes space 
to the discussion of research design and its type, research strategies and research 
context. It also gives an explicit outline of data gathering tools and data analysis followed 
by the realisation of findings to reflect a coherent way of thinking throughout the chapter. 
Finally, the chapter presents a detailed description of measures to ensure trustworthiness 
in this study. 
3.2 Research design 
Discussed here is the research design that informs this study. Research design is 
conceptualised by Brockopp and Hastings-Talsma (2003:326) as a structure and plan of 
how the researcher intends to answer the research question. In addition, Burns and Grove 
(2003:195) view research design as a blueprint for conducting a study that maximizes 
control over extraneous variables. Such control intensifies the probability that research 
outcomes will be accurate reflections of reality. A research design, according to Babbie 
and Mouton (2004:74) focuses on the study being planned and the end-product. The 
importance is given to the logic of research by a clear presentation of evidence needed in 
addressing the research question satisfactorily. The research design implies an explicit 
structure and systematic plan of how research procedures will be carried out to find 
answers to the research question. 
75 
This study was conducted in a qualitative manner since the researcher sought both to 
explore the meaning of, and describe and promote comprehension of human experiences 
-
regarding a caring environment in nursing education from the participants' own frame of 
reference and context. Toe analysis and interpretation of findings were not, by and large, 
dependent upon the quantification of observations as expounded and articulated by Burns 
and Grove (2001:56; 2003:357) but entailed the gathering, integratfon and :synthesis of 
nonnumeric narrative data. Consequently qualitative research design is a more pertinent 
and effective approach of investigating human emotions since they are not easy to 
quantify (Brink, 2002:119). 
3.2.1 Type of research design 
This segment focuses on the type of research design that was chosen. In this study, the 
researcher utilised a qualitative research design which concentrated on qualitative 
elements such as meaning, experience and comprehension. Such a design also studies 
human experience from participants' perspective and in the context where the research is 
conducted (Brink, Van der Walt & Van Rensburg, 2006:113). 
Qualitative research according to Brockopp and Hastings-Talsma (2003:328) is an 
inductive paradigm through which the researcher seeks to discover and build or expand 
knowledge base by identifying the meaning or relevance of a specific phenomenon to the 
individual. Toe analysis and interpretation of findings focus on comprehending the whole 
by exploring the depth, richness and complexity inherent in phenomena (Burns & Grove, 
2003:357). The findings lead to understanding a phenomenon in a specific situation and 
are not generalised in the same way that quantitative studies are. It implies that 
qualitative research is descriptive and comprehending rather than explaining and 
predicting human conduct. Hence the qualitative researcher constantly attempts to 
examine human behaviours from the participants' perspective by gaining access to them 
in their natural setting. 
76 
A qualitative research paradigm as observed by Creswell (2003:181) is emergent, 
humanistic, interactive, sensitive and essentially interpretative in nature. Additionally, a 
qualitative research refers to inductive, orderly, process-oriented and subjective . 
procedures employed by the researcher for comprehension, interpretation, description and 
development of a theory on a phenomena or setting (Burns & Grove, 2003:356-357). 
Consistent to this perspective, this research approach is the most appropriate design to 
capture insider perception which means seeing through the eyes of participants 
themselves. It is also referred to by anthropologists as the "emic" perspective. Hence, the 
theoretical frameworks are not predetermined (Babbie & Mouton, 2004:270) since the 
rules and procedures are not fixed, but are rather open and emerging. The researcher 
employed this approach to comprehend fully the research problem by exploring and 
describing the depth, richness and complexity inherent in the meaning of a caring 
environment (Burns & Grove, 2003:357). This was done through eliciting the perceptions 
and exploring tt,e expectations of nursing students regarding a caring environment in 
nursing education from their perspective where the research was conducted (Brockopp & 
Hastings-Talsma, 2003:328; Sarantakos, 2005:45; Brink, van der Walt & Van Rensburg, 
2006:11 & 113). The researcher gained an insight from these processes which were 
supported by exploratory, descriptive research strategies which formed the bedrock for 
the formulation of guidelines for a caring environment in nursing education. Therefore, in 
order to complement and to reflect a coherent way of thinking, it is imperative to give a 
detailed account of research strategies which in essence are fundamental in this study. 
Qualitative research strategies according to Brockopp and Hastings-Talsma (2003:328) are 
valuable for developing facts and concepts about an area of interest that is less 
researched, or for exploring an area that has not yet been explored from a qualitative 
perspective. The perceptions and expectations of nursing students regarding a caring 
environment in nursing education have not been studied previously. Therefore, the focus 
of this study is to ascertain whether or not nursing education, as presented at the North 
West University, Mafikeng Campus, provides a caring environment. 
77 
3.2.2 Research strategies 
The aim of this study is to investigate whether or not nursing education, as presented at 
the North West University, Mafikeng Campus, provides a caring environment. To achieve 
the identified aim, exploratory and descriptive research strategies with a qualitative 
orientation were applied as detailed under section 3.2.2.1:78 and section 3.2.2.2:79. 
3.2.2.1 Exploratory research strategy 
In the qualitative research design, the rules and procedures are not fixed, but are rather 
open and emerging. In this study, the research ·problem had to be explored since no 
substantial evidence has been documented in the literature on the research problem or 
the sample under study. The important variables as observed by Creswell (2003:22) are 
unknown to the researcher. Therefore, the research aspired to focus on the context that 
might shape the comprehension of the phenomenon studied. 
An exploratory strategy is a means of gaining more understanding of a situation or 
phenomenon when there is limited or a lack of basic information in a new area of interest 
(Sarantakos, 2005:137; Bless, Higson-Smith & Kagee, 2006:47) . The research also sought 
to construct and highlight a level of comprehension based on the nursing students' 
perspectives that is their frame of reference. In this study, the perceptions and 
expectations of nursing students regarding a caring environment in nursing education 
were elicited, explored and described through narrative sketches and focus group 
interview sessions since no substantial evidence has previously been reported in the 
literature. As a result, the research took an exploratory approach in an attempt to collect 
new data in areas where little or no previous research has been done into a caring 
environment in nursing education (Brockopp & Hastings-Talsma, 2003:328; Creswell, 
2003:22; Bless, Higson-Smith & Kagee, 2006:47). Literature was explored to gain insight 
on the perceptions and expectations of nursing students regarding a caring environment 
: 
in nursing education . 
78 
3.2.2.2 Descriptive research strategy 
Qualitative research is descriptive in nature since it seeks to give a precise account of 
attributes of specific individuals, events or groups in real-life situations for discovering new 
meaning. It describes what exists, determines' the frequency with which something 
happens, and categorises data (Burns & Grove, 2003:27). In this research strategy, the 
researcher aims to gain more insight into phenomenon of interest through exploration and 
description of phenomenon in real-life situations without the manipulation of variables. 
Consequently, concepts are described, relationships are identified and assumptions are 
developed thereby providing a basis for future qualitative research. The researcher 
carefully described participants' behaviours, comprehending these in the contexts that 
were clear to participants themselves. The researcher also applies categories and concepts 
used by the participants themselves as a further attempt to describe, interpret and 
explicitly develop the social interaction in terms of the meanings that the participants 
themselves attach to it. 
The descriptive research strategy allows for the compilation of new, complete, accurate 
and current data on a phenomenon (Brink, 2002:11) by simply describing the 
phenomenon (Brink, Van der Walt & Van Rensburg, 2006: 104). The research according to 
Babbie and Mouton (2004:53 & 271) invariably endeavours to investigate human 
behaviour from an emerging perspective for descriptive and comprehensive purposes 
rather than to explain and predict such. During data collection, the fourth year nursing 
students were asked to describe their perceptions and expectations regarding a caring 
environment in nursing education. Based on their descriptions of the perceptions and 
expectations, the researcher was able to understand and comprehensively describe new 
emerging data for inclusion in the formulation of guidelines for a caring environment in 
nursing education (Babbie & Mouton, 2004:271-272). The research context is discussed. 
79 
3.2.3 Research context 
A study is contextual when the phenomenon is studied for its intrinsic and immediate 
contextual significance (Mouton, 1998:133). Additionally, Creswell (2003:18_1) indicates 
that qualitative research is conducted in natural settings where human conduct and events 
take place. The researcher enters the participants' natural setting and through continuing 
interaction and involvement, pursues the participants' perspectives and meanings 
holistically, reflectively and sensitively. The researcher actively involved participants in the 
study and sought to build rapport and credibility with them. Furthermore the researcher 
utilised both inductive and deductive reasoning appropriate from data collection and 
analysis to problem reformulation. 
A contextual strategy according to Babbie and Mouton (2004: 272) is conceptualised as the 
holistic research strategy of qualitative research. In applying such a strategy, the 
researcher acco~ding to Meyers and Sylvester (2006:3) is always interested in the rich and 
detailed descriptions and interpretations of the participants' conducts as they happen. 
Furthermore, to comprehend such conducts in relation to their own beliefs, narrative or 
account within the concrete, natural context in which they took place. It is only, as 
· observed by Babbie and Mouton (2004:272), if the researcher understands events against 
the background of the whole context and how such a context gives meaning to the events 
concerned, that she can actually claim to have comprehended the events. 
The context in this study was the North West University, Mafikeng campus, in the North 
West Province where two groups of fourth year nursing students but at different year of 
their study had registered for the Bachelor of Nursing Science degree programme (see 
sections 3.3.1 & 3.3.2:81-83 for more detail). Each group described their perceptions and 
expectations regarding a caring environment in nursing education through narrative 
sketches and during the focus group interview sessions respectively. These two groups 
were capable of disclosing actual information in a specific context (Babbie & tiouton, 
2004:272). 
80 
While the research design represented the research plan, the research methodology 
indicated the 'how' of the implementation. The research methodology is highlighted below. 
3.3 Research methodology 
The methods utilised to determine the population, sample, data ·gatheri~g and data 
analysis are discussed in detail. Firstly, the research describes the population, sample, and 
then the data gathering and data analysis processes. Measures to ensure trustworthiness 
are also highlighted. 
3.3.1 Population 
A population includes all components that meet certain criteria for inclusion in a study 
(Burns & Grov~, 2003:43). Hence Bless, Higson-Smith and Kagee (2006:98) viewed 
population as the complete set of individuals who are the research focus and possess 
specific attributes the researcher is interested to investigate. The population at the time of 
the study included all registered nursing students in the North West University, Mafikeng 
campus, in the North West Province. The population was two hundred and twelve 
(n=212) nursing students (from first year to fourth year level of study) registered for the 
Bachelor of Nursing Science degree programme at the North West University, Mafikeng 
campus, in the North West Province. 
3.3.2 Sample and sampling technique 
Accessible sample for this study are all registered fourth year nursing students in the 
North West University, Mafikeng Campus, in the North West Province. Sampling is the 
process of choosing the sample from a population in order to obtain data pertaining to a 
phenomenon in a manner that symbolises the population of interest (Brink, van d.~ r Walt 
& Van Rensburg, 2006: 124). A sample is then a component of a population chosen by the 
81 
researcher for inclusion in the study (Burns & Grove, 2003:43). The sample for this study 
was sixty seven (n=67) fourth year nursing students registered for the Bachelor of 
Nursing Science degree programme at the North West University, Mafikeng Campus in 
North West Province. Both groups were at the fourth year level but in different years of 
their study. One group comprised twenty seven (n=27) nursing students registered in 
2002 who had completed eight months of the fourth year level of their study in 2005 at 
the time of the study. Another group of forty (n=40) nursing students registered in 2003 
and was three months into the fourth year level of their study in 2006 at the time of the 
study and were chosen from the population by a non-random sampling technique that 
was convenient and purposive (Sarantakos, 2005:164; Bless, Higson-Smith & Kagee, 
2006:106; Brink, van der Walt & Van Rensburg, 2006:132). 
A convenient sampling was employed in the sense of geographical availability and ready 
access to nursing students (Polit & Beck, 2004:305; De Vos, Strydom, Fouche' & Delport 
2005:202). A purposive sampling on the other end is judgemental and involves the 
conscious selection by the researcher of certain subjects for inclusion in the study (Burns 
& Grove, 2003:255; Polit & Beck, 2004:306). Participants were purposively chosen since 
they had been in the undergraduate degree programme for a long time and had acquired 
profound experiences, comprehensive knowledge base, competences, attitudes and values 
both in nursing education and professional nursing practice. For that reason, the 
researcher believed that those nursing students were more able to share some specialised 
insights on their perceptions and expectations regarding a caring environment in nursing 
education because of being in the programme for a longer period than the first, second 
and third year nursing students. Furthermore, both groups would therefore have similar 
characteristics in order to increase the theoretical understanding of a caring environment 
within the context of nursing education as a concept under investigation (Babbie & 
Mouton, 2004:109). The core aim of qualitative research paradigm is the comprehension 
of meaning hence a rich descriptive version of the phenomenon was sought (Creswell, 
2003:196; Meyers & Sylvester, 2006:3). 
82 
Babbie and Mouton (2004:287) assert that it is vitally important for the researcher to 
vigilantly develop and explicitly stipulate inclusion criteria pertinent to the study 
depending on the nature of the study and the number of times data gathering 
techniques will be replicated with each particip~nt. By specifying inclusion criteria, the 
research was narrowed down to a smaller and comparatively focused number of potential 
participants. As such, participants were selected in accordance with the following inclusion 
criteria which defined their eligibility for this study: 
► Nursing students registered for the Bachelor of Nursing Science degree programme 
at the time of the study at the North West University, Mafikeng campus in the 
North West Province in: 
- 2002 and had completed eight months of the fourth year level of their study in 
2005 at the time of data collection; 
2003 and were three months in the fourth year level of their study in 2006 at 
the time of data collection. 
► Both groups of nursing students had also registered with the South African Nursing 
Council (SANC) under regulations R425 of 22 February 1985 as amended relating 
to the approval of and the minimum requirements for education and training of a 
nurse (General, Psychiatric and Community) and Midwife leading to registration 
(South African Nursing Council, 1985:1). 
A detailed account of data gathering is outlined. 
3.3.3 Data gathering 
Data was gathered through qualitative research methods. A detailed outline of the 
qualitative data collection methods is discussed in accordance with the research 
plan/strategy of this study. Clear and consistent qualitative data collection procedures 
were used in order to ensure rigour. 
83 
The two primary open-ended questions used for data collection aimed to elicit perceptions 
and to explore expectations of students regarding a caring environment in nursing 
education. Open-ended questions, as indicated by Brink, Van der Walt and Van Rensburg 
(2006:148-149), are not founded on preconceived answers, and yield richer, more diverse 
data, thus are appropriate for exploratory studies. 1 
The two primary questions asked for narrative sketches and focus group interview 
sessions were constructed as follows: 
For you personally: 
1. What are your perceptions regarding a caring environment in nursing education at 
the North West Universi(Yt Mafikeng Campus, in the North West Province? 
2. What are your expectations regarding a caring environment in nursing education at 
the North West Universi(Yt Mafikeng Campus, in the North West Province? 
The above-mentioned questions asked in the narrative sketches and also used for focus· 
group interview sessions were tested in a pilot study prior to the main study. The sample 
realisation for the pilot study was as follows. 
3.3.3.1 Pilot study 
A pilot study, as conceptualised by Brink (2002: 174) and Brink, Van der Walt and Van 
Rensburg (2006:166), is a small-scale study or a trial run that is undertaken on a limited 
number of participants from the same population as that proposed for the main study. 
Narrative sketches were used to collect data for a pilot study to determine the 
congruency, appropriateness and applicability of the two open-ended questions to be 
employed in the main study (see section 3.3.3:84 for more detail). It was also 
undertaken to obtain information for improving the study and assessing the feasi9ility of 
the study. 
84 
The research design and methodology for the pilot study was similar to that of the main 
study. Participants in the pilot study comprised five (n=5) nursing students who recently 
' 
completed their fourth year studies and awaited the undergraduate degree to be 
conferred. They were approached to obtain consent. A covering letter inviting 
participation and providing instructions on how to complete the narrative sketch form 
(Appendix E (2) was given to each one of them. Anonymity and confidentiality were 
assured as no names were to be written on the narrative sketch forms. After they agreed 
to participate in the pilot study, they were given the forms to complete in one sitting as a 
group. No time restraints were set. During the pilot study one of the nursing students 
wanted to know the meaning of a caring environment and nursing education respectively. 
The meaning of both concepts was provided to participants. The meaning was also added 
to the narrative sketches for the main study (Appendix E (1)). After the completion, the 
forms were retrieved immediately. No remarks were received pertaining to the utilization 
of the narrative sketch form, and no problems were discerned from the nursing students 
completing the narrative sketches. Otherwise the two questions were acceptable in their 
original format and were used for the main study through the narrative sketches and 
during focus group interview sessions. 
3.3.3.2 Data collection tools for the main study 
• Narrative sketch 
In this study, a narrative sketch was utilised to collect data. A narrative sketch according 
to Brink (2002: 160), and Brink, Van der Walt and Van Rensburg (2006: 154), is termed a 
'vignette' which is a brief descriptive sketch about a situation or an event to which 
participants must respond. It is a self-reporting technique, the easiest and most effective 
approach to elicit information about participants' beliefs, thoughts, knowledge base, 
perceptions, motives, experiences and attitudes. Utilising a narrative sketch, accor~ing to 
Brink (2002: 161), and Brink, Van der Walt and Van Rensburg (2006: 154) enables the 
85 
researcher to differentiate various perceptions of participants. This method is more likely 
for participants to disclose true perceptions, rather than the answer. Pilot and Beck 
(2004:407, 735) affirm that 'vignettes' are mostly written narrative descriptions of 
/ 
participants' perceptions, opinions and knowledge. The technique as reflected by Bless, 
Higson-Smith and Kagee (2006: 121), involves research participants narrating their own 
experiences honestly and accurately, and thereby reflect the true state of affairs. The 
participants were twenty seven (n=27) fourth year nursing students who registered for 
the Bachelor of Nursing Scien~e degree programme at the North West University, 
Mafikeng campus, in the North West Province (see sections 3.3.1 & 3.3.2:81-83 for 
more detailed description of nursing students). The aim of the narrative sketches was to 
elicit the perceptions and explore the expectations of nursing students regarding a caring 
environment in nursing education (see section 3.3.3:84 for more detail). The outcome was 
to be used to formulate guidelines for a caring environment in nursing education. 
The planning outline of data collection through the narrative sketches was as follows: 
► Written request for permission to conduct the study was sought from the North 
West University, Mafikeng Campus' research committee (Appendix A (2)); 
► Potential participants were approached individually and requested to participate in 
the study in accordance with the inclusion criteria. The scope of the research was 
explained to the potential participants; 
► The researcher requested participants to assemble in a classroom and each to sit at 
a single table with a chair, free from any distractions to create a calm environment 
in which they could relax and participate freely in the study; 
► A covering letter (Appendix B) with detailed instructions including the research title, 
the purpose and objectives of the study as well as an informed consent (Appendix 
C) were handed out to participants; 
► Narrative sketches with two (2) open-ended questions (see section 3.3.3:84 for 
more detail), typed and printed with lines, were distributed to participants only 
after an informed consent was obtained; 
► No time constraints were set. In th is way participants could document freely their 
86 
experiences, feelings and their perceptions and expectations regarding a caring 
environment in nursing education in their own time and in a natural setting; 
► When the completed narrative sketches were received from participants, the 
covering letter and signed consent form were removed from each narrative sketch 
to ensure anonymity of participants; 
► Arrangement was made for follow-up meeting to be held with participants for 
verification of findings after data analysis (Brink, 2002:192; Brink, Van ·der Walt & 
Van Rensburg, 2006: 184-185); 
► A sequential number was assigned to each completed narrative sketch according to 
predetermined system including the date. After the registration procedure, the 
narrative sketches were photocopied and stored to become the basis for data 
analysis; 
► A data analysis coding protocol was developed to ensure that the correct procedure 
was followed with each narrative sketch (Appendix F). 
► The data obtained from the narrative sketches were written as non-quantifiable or 
non-numerical statements (Brink, Van der Walt & Rensburg, 2006: 184) ready for 
analysis which did not require transcription. 
Data collection through focus group interview sessions is outlined. 
• Focus group interview sessions 
The aim of the focus group interview sessions was to elicit the perceptions and explore 
the expectations of nursing students regarding a caring environment in nursing education . 
. The ·f ocus group interview sessions were conducted through two open-ended questions 
asked in the narrative sketches constructed for the main study aimed to elicit the 
perceptions and explore the expectations of nursing students regarding a caring 
environment in nursing education (see section 3.3.3:84 for more detail). The outcome was 
to be used to formulate guidelines for a caring environment in nursing education. 
A focus group is a common qualitative method (Mahoney, 2005: 1) and a multi-sample 
87 
study (Sarantakos, 2005: 195). It is a potentially essential source of collecting qualitative 
data by gaining contact with participants' perspectives (Ryan, Twibell, Brigham & 
Bennett, 2000:402), when their ideas and experiences are simultaneously required (Brink, 
2002:159) and Brink, Van der Walt and Van Rensburg (2006:152). 
Brink (2002: 195) further indicates that participants share their thoughts and ideas with 
each other, thus sparking or igniting new ideas, and encouraging consideration of a scope 
of views prior to answering the researcher's questions. In addition, the richness of 
experiences emerge based on social interactions and shared meanings (Ryan et al, 
2000:402), thus yielding an increased level of participants' involvement (Hoover, 
2002:80). 
The focus group interview is a purposive deliberation on a particular problem occurring 
among participants with the same background and mutual interests. Group interaction 
involves verbal and non-verbal communication including the interchange of perceptions 
and ideas that kindle discussion without altering the views of participants. It also 
empowers the researcher to grow or intuitively develop concepts, reflecting the 
participants' intimate or deep knowledge (De Vos, 2001:314). 
During the focus group interview session, according to Gibbs (2007:2), participants are 
brought together to draw upon their feelings, reactions, beliefs, attitudes and experiences 
in a way which would not have been possible utilising other methods. These feelings, 
reactions, beliefs, attitudes and experiences are more likely to be disclosed through 
interaction. Interaction between participants highlights their perceptions, values and 
beliefs about a situation. Consequently, the researcher is confronted with a whole new set 
of data. The researcher is empowered to generate data that would not otherwise be 
accessible and also discover data that she had not thought about before. It is this 
presentation of opinions and ideas being sought by the researcher. It implies that focus 
group interview sessions promote interaction and dialogue amongst participants. A~ such, 
the sessions brought to the fore issues grounded on interpretations and personal 
88 
experiences, beliefs, feelings, reactions and attitudes that may not have been elicited and 
explored in other approaches to data collection. 
The researcher according to Sarantakos (2005:195-196), utilises focus group interview 
session as a data collection method to provide group discussion, to brainstorm a 
diversity of clarifications and to institute a mechanism of opinion formation. It was 
anticipated that through mutual encouragement, a group environment would promote 
dialogue, intensify the motivation to tackle critical issues. A group environment further 
permits the researcher to serve as a facilitator and to guide and direct the discussion 
towards focal points and topical issues. Additionally, substantial and noteworthy 
perceptions are allowed to be presented in a real, emotional and summated form as 
spontaneous expressions. 
In the final analysis, to achieve the best outcomes when conducting the focus group 
interview sessions, the researcher, as pointed out by Sarantakos (2005: 197), should be 
the leader and a facilitator in the context of group discussion. Such a facilitator should 
possess the following attributes: 
► Adequate theoretical and methodological knowledge base of research theme, 
and general intellectual competence; 
► The competence to develop a warm environment amongst the group members; 
► Experience with group work or group dynamics, including competence in guiding 
and directing discussion effectively; 
► The capacity to establish an environment that will promote involvement and 
active participation, control dominating participants, and keep the discussion 
moving in the right direction; and 
► Leadership qualities. 
Participants for the focus group interview sessions .were forty (n=40) fourth year nursing 
students (see sections 3.3.1 & 3.3.2:81-83 for more detailed description). They were 
divided into four (4) focus groups and each focus group comprised ten (n=l0) fourth year 
89 
nursing students since, according to Mahoney (2005:9), a smaller and more homogeneous 
group allows for more in-depth probing into detailed experiences, feelings and perceptions 
of each participant. Such a group was more likely to generate more intense, detailed and 
fluent discussions on a theme of shared interest. In addition, Mahoney (2005:11) outlines 
that a focus group permits each participant to contribute in discussions while still eliciting 
a range of responses. Furthermore, it encourages active dialogue thus facilitating free 
expression of intense opinions, ideas, memories, feelings, experiences ·and perceptions on 
the theme under study. The researcher employed probes and paraphrases which were 
neutral avoiding biasing the participants' responses. Consistent with this view, Burns and 
Grove (2003:276) affirmed that probing should be done within reasonable guidelines to 
prevent the participants feeling that they are being interrogated on the problem being 
pursued. 
The planning outline of data-collection by the researcher through the focus group 
interview sessions was as follows: 
► Met potential participants individually and requested them to participate in the 
study. 
► Explained the scope of the research; 
► Requested participants to assemble in a classroom and divided into four ( 4) focus 
groups of ten each. Each focus group was given date, time and location for the 
focus group interview session; 
► Met with each focus group according to the specified date, time and location for 
the focus group interview session; 
► Guided participants to sit around a table to ensure maximum eye contact with each 
other including the researcher. Welcomed participants in a way to create a relaxing 
environment conducive to discussion; also permissive and non-threatening (Burns 
& Grove, 2003:286); 
► Sought permission from participants to record each focus group interview session 
with two tape-recorders including taking field notes during each session; 
► Arranged for follow-up focus group sessions for each group to be held for 
90 
verification of data after data analysis. 
The duration of each focus group interview session was not more than two hours as 
suggested by Mahoney (2005: 10) and was systematically recorded through two (2) audio-
tape recorders (battery and electrically operated). The researcher acted as a facilitator and 
read the two open-ended questions verbatim for discussion (see section 3.3.3:84 for more 
detail). The researcher also guided and encouraged such discussion amongst focus group 
members to address the questions posed (Sarantakos, 2005:195). Participants were 
allowed to describe their views freely and openly with probes employed only for 
clarification. During and after the focus group interview session, the researcher took 
detailed, factual, accurate and thorough field notes. The researcher drew on memory to 
expand and clarify field notes immediately after the session. Additionally, the research was 
non-judgmental on what was noticed to be worth noting (Mahoney, 2005:3) such as non-
verbal cues to procure supportive data and also validate the audio-tape recordings. 
Field notes as articulated by Polit and Beck (2004:382-383) refer to the researcher's 
attempts to record, to synthesise and to comprehend emerging sequence of events in the 
study which serves as a rich and thorough narrative of the data for analysis. Polit and 
Beck (2004: 382-383), further postulate that field notes are both descriptive and reflective 
in nature. In this study, the researcher consistently wrote and kept the following 
descriptive and reflective field notes to examine and reflect how these effect data 
collection and data analysis. 
Descriptive field notes: 
► Observational notes as descriptive field notes are objective in-depth accounts of 
occurrences the researcher experienced while watching and listening to 
participants' articulation and interaction during focus group interview sessions with 
slight interpretation (Wilson, 1989:434; Polit & Beck, 2004:382). 
Reflective notes serve multiple purposes and are as follows: 
91 
► Methodological notes are the researcher's instructions, critiques, and reminders 
about strategies that might be successful (Wilson, 1989:435; Polit & Beck, 
2004:382-383); 
► Personal notes are notes about her reactions, reflections, experiences and 
introspection (Wilson, 1989:435-436; Polit & Beck, 2004:383) and 
► Theoretical notes are the researcher's purposeful endeavours to draw and attach 
meaning from observational notes by interpreting, inferring, imagining, and 
hypothesising to construct her logical plan (Wilson, 1989:435; Polit & Beck, 
2004:383). 
Immediately after each audio-tape recorded focus group interview session, the researcher 
independently prepared transcripts according to Ramos (1992:499) as follows: 
► Listened several times to audio-tape recordings of each focus group session to 
gain an adequate insight of discussions and thereafter prepare transcripts 
(transcribed verbatim); then 
► Reviewed all data documents to check for consistency, cross-reference data 
points, and to generate a list of coding units ( combination of ideas and words that 
convey meaning); 
► Formulated categories, placed most appropriate coding units under each category, 
clustered categories and subcategories; 
► Restructured redundant categories to maximise exclusivity; 
► Identified overall thematic content(s); 
► Then constructed a diagram to represent relationships among data categories to 
enhance more abstract organisation of thematic data. 
After the registration procedure, audio-tape recorded focus group interview sessions 
transcripts were photocopied and stored to become the basis for data analysis. A 
sequential number was assigned to each completed transcript according . to the 
92 
predetermined system. 
Participants for narrative sketch were categorised as A while those for focus group 
interview sessions were category B as reflected in Table 1. 
Table 1: Categorising of participants 
Category Participants 
A 27 fourth year nursing students participated in the study 
conducted through narrative sketches 
B 40 fourth year nursing students participated in the study 
\ 
conducted through focus group interview sessions 
A protocol for data analysis open coding process was developed to ensure that the correct 
procedure was followed for audio-tape recorded focus group interview sessions transcripts 
(Appendix F). The data gathering of narrative sketches and audio-tape recorded focus 
group interview session transcripts obtained are described in Table 2. 
Table 2: Narrative sketches and audio-tape recorded focus group 
interview session transcripts retrieved 
Narrative sketches distributed 27 
Number of narrative sketches returned 27 
Number of audio-tape recorded focus group interview 40 
sessions transcripts 
Data analysis was planned and realised as outlined in the following section. 
93 
3.3.4 Data analysis 
The data generated from the narrative sketches and focus group interview sessions were 
combined and analysed simultaneously as the nature of data was similar, thus the same 
method was applied to analyse the data. 
3.3.4.1 Data analysis of narrative sketches and audio-tape recorded focus 
group interview sessions transcripts 
The analysis and interpretation of findings are not dependent upon the quantification of 
observations as expounded and articulated by Burns and Grove (2001:56; 2003:357) but 
rather entail the gathering, integration and synthesis of non-numeric narrative data. The 
data in qualitative research is non-numerical, presented in words as a starting point for 
analysis. Data analysis began at once with data collection, meaning that data collection 
was accordingly merged with data analysis (Burns & Grove, 2003:378; Sarantakos, 
2005:344-346; Brink, Van der Walt & Van Rensburg, 2006:184). Data derived from the 
narrative sketches and focus group interview sessions on the perceptions and expectations 
of participants of how a caring environment in nursing education could be created were 
combined and analysed simultaneously as the nature of data was the same. The 
researcher was capable of boosting the rigour of the analysis by conducting a meticulous 
review of available and relevant national and international literature samples that were 
strictly selected to reduce her biases in the study (Rogers & Knafl, 1993:80). 
The researcher accustomed herself with the data collected by reading and rereading 
narrative sketches, tape recorded transcripts on focus group interview sessions and 
written-up field notes for recalling perceptions and experiences, reflecting on possible 
meaning and relationships of the data. Additionally, the researcher listened repeatedly to 
focus group interview sessions audio-tape recordings until she became deeply immersed 
in the data (Bums & Grove, 2003:378-379; Brink, Van der Walt & Van Re~sburg, 
2006:184). Data was reduced by selecting, organising, focusing, simplifying, abstracting, 
94 
discarding and changing the data that emerged in narrative sketches, transcripts and 
written-up field notes. As data collection proceeded, further incidences of data reduction 
surfaced . specifically writing summaries, coding, teasing out themes, making clusters, 
making partitions and writing memos which proceeded after fieldwork. Final conclusions 
were drawn and verified until the final report was completed (Miles & Huberman, 
1994: 10-11). 
Furthermore, for the purpose and nature of this study, the data generated from the 
narrative sketches and focus group interview sessions were non-numerical statements. 
Toe researcher analysed all data sets immediately, continuously and independently for 
emergent themes and commonalties through application of descriptive data analysis using 
the open coding process of Creswell (2003:192). The researcher studied the data, and 
asked analytical questions to establish essence from participants' perceptions and 
expectations regarding a caring environment in nursing education by doing the following: 
► Carefully reading through all narrative sketches and focus group interview sessions 
transcripts to get the meaning of the whole; 
► Randomly selecting one narrative sketch to identify commonalities and themes and 
writing them in the margin; 
► Compiling a list of all identical themes after completing some narrative sketches. 
Identical themes were clustered together, formed into columns and then arranged 
and organised into main themes, unique themes and leftovers; 
► Taking a compiled list of themes and consulted the data. Abbreviating the themes, 
encoding and writing them next to the appropriate sections of both narrative 
sketches and transcripts of the audio-taped recorded focus group interview 
sessions. Testing this preliminary organising scheme to determine whether new 
categories and codes emerged; 
► Finding the most descriptive wording for themes and turning them into categories. 
Grouping together themes that relate to each other. Drawing lines between 
categories to indicate interrelationships; 
► Making a final decision on abbreviations for each category and placing codes in 
95 
alphabetical order; 
► Gathering data material belonging to each category in one area and performing a 
preliminary analysis; and 
► Recoding the existing data when necessary. 
A data analysis open coding process protocol as outlined above, in accordance with 
Creswell (2003:192) was prepared for the independent coder (Appenaix F). The protocol 
was to serve as guidelines for performing the coding of the raw data of both narrative 
sketches and transcripts of audio-tape recorded focus group interview sessions. An audit 
trial was done by an independent coder to ascertain trustworthiness of the research 
findings (Babbie & Mouton, 2004:276). An audit trial according to Polit and Beck 
(2004:712) is the systematic documentation of data that allows an independent coder to 
draw inferences about the trustworthiness of the data. The independent coding is then 
outlined in more detail. 
3.3.4.2 Independent coding 
The utilisation of an independent coder in qualitative data analysis, as pointed out by De 
Vos (2001:352), is fundamentally important in guaranteeing the trustworthiness of the 
data. Creswell (2003:195) also expounds that it is essential for the researcher to utilize an 
independent coder in tackling the issue of credibility and the accuracy of the data in order 
to identify whether they match reality. Similarly, verification of the findings of data 
analysis by another independent coder (researcher) in qualitative research is crucial. The 
independent coder, as aptly described by Brink (2002: 192) and Brink, Van der Walt and 
Van Rensburg (2006: 185) must meet the acceptable criteria such as expertise in the 
subject under study, and also have extensive experience in coding process of qualitative 
data. 
96 
• Criteria for the independent coder 
The following criteria were set for the independent coder because of the nature and 
purpose of this study: 
► To be proficient and conversant in terms of research with special reference to 
qualitative research and the data analysis coding process; 
► To be geographically accessible for consensus discussions meetings; ' 
► Having completed doctoral studies; 
► Having published in accredited research journals; and 
► To be supervising post-doctoral research activities. 
The researcher submitted the following data documents to the independent coder for data 
analysis: the data set comprised photocopies of completed narrative sketches, transcripts 
of the audio-tape recorded focus group interview sessions, written-up field notes from the 
researcher during and after focus group interview session and each participant's written 
transcript. The prepared data analysis coding process protocol of Creswell (2003:192) was 
also submitted to the independent coder as guidelines for data analysis (Appendix F). The 
coding was open as recommended by De Vos, Strydom, Fouche' and Delport (2005:340) 
since the independent coder was given the raw data without any prearranged themes or 
categories to discover first-order concepts and substantive codes (Sarantakos, 2005:349). 
The outcome of the pilot study, as agreed upon by the researcher and the independent 
coder, was that the two open-ended questions (see section 3.3.3:84 for more detail) were 
acceptable in their original form and they could be used throughout data collection 
process. Hence the two open-ended questions were applied in the main study to collect 
data through narratives sketches and focus group interview sessions respectively. 
After both the researcher and the independent coder completed the data analysis coding 
process independently, the researcher scheduled a meeting with the independe~t coder 
for consensus discussions on the outcome of the data analysis. The discussion centred on 
97 
NWu 
LIBRA-Ry 
the appropriateness of the two (2) open-ended questions (see section 3.3.3:84 for more 
detail), the user-friendliness of the drafted narrative sketch form. Furthermore, the 
discussion focused on the consensus between the researcher and the independent coder 
pertaining to the combined data analysis of narrative sketches and focus group interview 
sessions. The following points emerged during the meeting: 
► Saturation was achieved by both researcher and independent coder; 
► One of the requirements of trustworthiness in an attempt to maintain rigour in a 
scientific inquiry was accomplished; and 
► The outcome agreed upon by the researcher and the independent coder, was that 
the categories and subcategories were well addressed. 
3.3.4.3 Realisation of data analysis 
Data analysis for both the pilot study and the main study were conducted in the same 
manner. According to Sarantakos (2005:45), the study followed an inductive approach by 
first focusing on the natural setting, outlining the events as precisely as possible as they 
occur, or have occurred, with subsequent generation of new categories. 
The data was gathered through two (2) open-ended questions (see section 3.3.3:84 for 
more detail) to elicit perceptions and explore expectations of nursing students regarding a 
caring environment in nursing education. The data was written as non-quantifiable or non-
numerical statements and thus required qualitative data analysis. The photocopied 
narrative sketches, the transcripts of audio-tape recorded focus group interview sessions 
and field notes were submitted to the independent coder with the prepared data analysis 
coding process protocol. The researcher and independent coder independently analysed 
data according to Creswell's (2003:192) descriptive data analysis open coding process 
(Appendix F) to guarantee rigour without relinquishing the relevance of the qualitative 
research. 
98 
Initially, the themes and categories were hand written on both the narrative sketches and 
the transcripts of focus group interview sessions audio-tape recorded were then 
transferred onto the computer spreadsheet. Each category was then numbered on the 
computer spreadsheet. The registration numbers of both the narrative sketches and 
focus group interview sessions' audio-tape recorded transcripts from which the specific 
category emerged or matching categories in the subsequent data sets were listed. In 
this way, the sequence of the development of the initial sixty seven (67) categories of 
both narrative sketches and the focus group interview sessions audio-tape recorded 
transcripts from which the category originated can be retraced (see Table 4:114). Due to 
the need to validate data saturation and to ensure referential adequacy, the pertinent 
information is reflected in table 3 below. 
Table 3: Data saturation and the achievement of referential adequacy 
Number of narrative sketches and focus group interview session 67 
tape-recoded transcripts 
Number analysed with new categories emerging 30 
Additional number analysed with no new categories 15 
Number not analysed 22 
Total 67 67 
Table 3 above, reflects how the descriptive data analysis coding process protocol was 
employed to analyse the initial sixty seven (67) narrative sketches and focus group 
interview session tape-recoded transcripts (see section 3.3.4.1:95 for more detail). 
Referential adequacy was ensured by having 22 narrative sketches and focus group 
interview sessions tape-recorded transcripts ( combined) not analysed as data saturation 
has been achieved after 45 of 67 narrative sketches and focus group interview sessions 
tape-recorded transcripts (combined) were analysed (see Table 3:99). Data saturation and 
referential adequacy were thus accomplished, fulfilling the requirements of trustworthiness 
as determined by Babbie & Mouton (2004:276-277) as well as adhering to the 
recommendation for being auditable by Burns and Grove (2003:258). Data saturation as 
observed by Polit and Beck (2004:57) emerges when themes and categories in .the data 
99 
become repetitive and redundant, such that no new information can be gathered by 
further data collection. Consistent with Polit and Beck (2004:57), Sarantakos (2005:349) 
indicates that data collection ended once saturation was reached with the data, meaning 
that no new or relevant data emerged, the category was well developed, and the 
relationships among categories were well established and validated. 
The narrative sketch, as a self-reporting data gathering tool, allowed participants an 
opportunity to document their own perceptions and expectations regarding a caring 
environment in nursing education. Also focus group interview sessions provided 
participants a forum that allowed group discussion on their own perceptions and 
expectations regarding a caring environment in nursing education. The data from which 
the specific category emerged, or matching categories in the subsequent data sets, was 
realised. 
Data derived from narrative sketches and focus group interview sessions are qualitative in 
nature and should therefore be assessed for trustworthiness. Trustworthiness signifies to 
an audience that the research outcomes are worth paying attention to. Trustworthiness is 
. discussed in detail in the next section. 
3.3.5 Measures to ensure trustworthiness 
Trustworthiness according to Steele (2002:7) is the competence of the researcher to 
motivate the readers that the research findings are acceptable and worth reflecting on. It 
implies that the research findings are trustworthy when they precisely and correctly 
represent the perceptions and expectations of the participants according to their frame of 
reference or from their perspective and context. The researcher utilised narrative sketches 
and focus group interview sessions to generate qualitative data including the verification 
of the data through the utilisation of an independent coder. The data were assessed for 
trustworthiness to guarantee rigour without relinquishing the relevance of the qualitative 
research . Rigour in qualitative research implies that the researcher strives for excellence 
100 
through openness, meticulous adherence and strict accuracy during data collection, also 
giving careful reflection to all data (Burns & Grove, 2003:391, 393). Validity according to 
Creswell (2003: 195) is viewed as strength of qualitative research. However, it is employed 
to determine whether the findings are accurate from the researcher's, the participants' 
and or the readers' viewpoint. The clear and accurate reflection of a good qualitative 
research is discovered in trustworthiness namely neutrality of its outcomes. The study 
employed categories and concepts used by participants as a further attempt to remain 
authentic to the meanings of participants. In this study the researcher ensured 
trustworthiness by adhering to the following criteria: credibility, transferability, 
dependability and conformability. A presentation of the criteria follows. 
3.3.5.1 Credibility or truth-value 
Credibility means the compatibility and harmony between the constructed actualities that 
are in the minds of the participants and those that are ascribed to them. Credibility 
determines how convinced and confident the researcher is with the truth of the outcomes 
of the study grounded on the research design, participants, and context (Polit & Beck, 
2004:430). The study, according to De Vos, Strydom, Fouche' and Delport (2005:346-347) 
is deemed credible when it imparts such precise identification and description of 
participants' experiences and perceptions according to their frame of reference and 
context. This was established through eliciting the perceptions and exploring the 
expectations of nursing students regarding a caring environment in nursing education by 
reaching a comprehensive description in the data collection and analysis. The following 
strategies were employed to ensure that the pieces of evidence have not been mis-
constructed or misconstrued thus increasing and achieving credible outcomes in this study 
(Brink, 2002:124): prolonged and varied engagement, persistent observation, peer 
debriefing, member checks, reflexivity, triangulation and referential adequacy. 
101 
• Prolonged and varied engagement 
In ensuring credibility of the research outcomes, the researcher spent an adequate and 
extended period of time in the research setting to identify and verify persistent patterns. 
The researcher, before collecting data, had a direct interaction with participants to 
establish rapport (Creswell, 2003: 196). As a result, the researcher was able to check 
perceptions and consecutively participants got acquainted with the researcher. As rapport 
and trust increased between the researcher and participants, hidden and sensitive 
information was freely disclosed (Krefting, 1991:217-218). The establishment of good 
rapport and trust between the researcher and participants as pointed out by Mouton 
(1998: 158), defuses initial mistrust, serves as a control for role selection effects and also 
operates as a control for context effects. 
Consistent with Krefting (1991), Polit and Beck (2004:430) affirm that the researcher must 
spend an ample and extended time in the research setting to have a direct and intense 
interaction with participants. In addition, to establish rapport and to gain, build and 
maintain trust. As rapport and trust increased between the researcher and participants, 
close acquaintance is developed with resultant of more and vital, constructive, accurate 
and rich information being revealed. In turn, the credibility of the research findings is 
enhanced . The researcher remained in the research area until data saturation had been 
achieved and also gained a thorough comprehension or insight of the phenomenon under 
study. Data saturation as indicated by Polit and Beck (2004:57) implies that the researcher 
collected data to the point where themes and categories in the data became repetitive and 
redundant, such that no new information could be scraped together by further data 
collection. The researcher was also able to give description with reference to the site and 
the participants that contributed towards the credibility to the narrative account (Creswell, 
2003:196; Babbie & Mouton, 2004:277). 
102 
• Persistent observation 
During the course of the study according to Creswell (2003:181), the researcher enters 
the participants' natural setting, and through continuing interaction and active 
involvement, pursues the participants' perspectives and meanings holistically, reflectively 
and sensitively. She actively involved participants in the study and sought to build rapport 
and credibility with them. The researcher as pointed out by Meyers and Sylvester, 
(2006:3) is constantly interested in the rich and detailed descriptions and interpretations 
of the participants' conduct as they occur, including the comprehension of the conducts in 
relation to their own beliefs, narrative or account within the concrete, natural context in 
which they took place. It is only when the researcher according to Babbie and Mouton 
(2004:272), understands the observed sequence of events against the background of the 
whole context. Furthermore, how such a context gives meaning to the events concerned, 
then the researcher can actually claim to have comprehended the events. That is only 
achievable as postulated by Creswell (2003:189) when the researcher is engaged in 
multiple observations during the research process. In addition, Babbie and Mouton 
(2004:277) echo that during persistent observation, the researcher should constantly and 
harmoniously follow interpretations in various perspectives in combination with a constant 
and provisional analysis. The researcher searched for multiple influences and for what 
counts and what did not count. 
In this study, the researcher embarked on persistent multiple observations which were 
coherent to the problem under study. During and after each focus group interview 
session, the researcher noted and recorded fully and impartially the observed events and 
conversations among participants as they emerged (Polit & Beck, 2004:382) with the 
intention to explore them further as the focus group interview sessions progressed. The 
written-up field notes were in essence descriptive and reflective (see section 3.3.3.2:91-
92) and formed part of the persistent observation. Persistent observation implies that the 
researcher logically and constantly noted and recorded the sequence of events 
fundamentally pertinent to the problem under study (Sarantakos, 2005:228). 
103 
Qualitative data analysis itself requires persistent observation which compels the 
researcher to become greatly and constantly immersed in the data in an attempt to 
preserve each participant's individuality although allowing an understanding of the 
problem pursued. The researcher critically studied through persistent observation the 
data, asked analytical questions to establish essence from participants' perceptions and 
expectations regarding a caring environment in nursing education. During the data 
analysis open coding process, the researcher carefully read and re-read all narrative 
sketches, focus group interview sessions transcripts and written-up field notes to get the 
gist of the whole (Creswell,2003: 192). 
• Peer debriefing 
An external validation is one of the techniques crucial in qualitative research to establish 
credibility of the research findings which could be achievable through peer debriefing. Peer 
debriefing involves sessions with peers to review and explore diverse study prospects. This 
strategy exposes the researcher to the searching questions of others who have expertise 
in both qualitative research methodology and the problem pursued. In peer debriefing 
sessions, the researcher presents written or oral summaries of the collected data, themes 
and categories that are emerging or emerged and her interpretations of the data (Polit & 
Beck, 2004:432). 
In this study, the researcher exposed her research findings to impartial peers who were 
outside the context of the study but who have a general understanding of the nature of 
the study including qualitative research methodology. During this process, peers reviewed 
perceptions, insights, analytically probed the researcher's biases, perspectives, 
assumptions, explored meanings, clarified the sources for specific interpretations and 
performed a negative case analysis by searching for and accounting for refuting or 
counteracting evidence. This implies that the peers took a "devil's advocate" stance, asked 
questions regarding research process and assisted in the decisions regarding which step to 
104 
take next (Brink, 2002:124; Creswell 2003:196; Babbie & Mouton, 2004:277). In peer 
debriefing, an independent coder was also involved in an open coding data analysis of raw 
data and consensus discussions of the data analysis to increase the accuracy of the 
research outcomes. 
• Member checks 
Verification of research findings with participants is a crucial measure in ensuring 
credibility in qualitative research process. It was then imperative for the researcher to be 
vigilant in presenting the findings to ensure that the research does not ask leading 
questions and thus coerce verification (Morse & Field, 1998:117). For this reason, the 
researcher did member checks with the research participants through a follow-up session 
to share, review, validate and verify the preliminary interpretations and conclusions 
generated during data collection and analysis of narrative sketches and audio-tape 
recorded focus group interview sessions. Feedback was sought from participants to ensure 
and confirm whether the findings precisely and completely reflect their experiences and 
perceptions rather than perceptions of the researcher (Polit & Beck, 2004:57). The 
participants confirmed that the research findings were accurately and thoroughly 
documented (Brink, 2002: 124). By taking the final report or specific descriptions or 
themes back to participants and determining whether they feel they are accurate, assisted 
the researcher to uncover and illuminate the accuracy of the findings (Creswell, 
2003:196). Additionally, a follow-up session made with participants also created the 
opportunity for the researcher to assess the participants' intentionality, correct evident 
errors, provide additional volunteer information, abridge and reduce what the initial stage 
of the data analysis should be and to assess the whole adequacy of the data (Babbie & 
Mouton, 2004:277). 
105 
• Reflexivity 
Reflexivity as interpreted by De Vos (2005:363) is the researcher's competence to create 
an integrated comprehension of own cognitive perspective, exceptionally comprehending 
the effect this has in a set of human relations. Polit and Beck (2004:335, 730) view 
reflexivity as implying the researcher's recognition of herself as a component of the data 
collected, and the role played in the study and how it can impinge ori the data obtained. 
Polit and Beck (2004:730) further indicate that the researcher critically reflects on own 
biases, preferences, and preconceptions. 
Throughout this study, the researcher was accustomed to the data collected by reading 
and rereading narrative sketches, tape recorded transcripts on focus group interview 
sessions and written-up field notes for recalling perceptions and experiences. Additionally, 
the researcher reflected on possible meaning and relationships of the data and listened 
repeatedly to focus group interview sessions audio-tape recordings until became deeply 
immersed in the data (Burns & Grove, 2003:378-379; Brink, Van der Walt & Van 
Rensburg, 2006: 184). Similarly, the researcher analytically and continually recorded and 
kept the descriptive and reflective written-up field notes (see section 3.3.3.2:91-92 for 
more detail) to continually reflect and examine how these influenced data collection and 
data analysis. All the way through reflecting and examining these documentations, the 
researcher was able to discover biases. Then the procedures for data collection and 
analysis were modified to enhance the credibility of the study (Krefting, 1991:218). During 
qualitative data analysis, a dynamic interaction emerged between the researcher and the 
data. 
Through the reflexive thought process which required deliberate self-awareness, the 
researcher was able to explore personal feelings and experiences that may impact the 
study and integrated this understanding into the study (Burns & Grove, 2003:379). In the 
same vein, Creswell (2003: 182) asserts that the introspection and acknowledgement by 
the researcher of biases, values and interests, signify honesty and openness to the 
106 
research. Sarantakos (2005:45) views the reflexivity process as the researcher's self-
awareness. 
• Triangulation 
Triangulation as interpreted by Mouton (1998: 156) implies that the researcher employs a 
range of methods and techniques of data collection in the study of the ·same phenomenon 
with a belief that diverse methods complement each other, thus stabilising their respective 
inadequacies. Babbie & Mouton (2004:275) conceptualise triangulation as an action plan 
that raise the researcher above the personal biases that originate from single 
methodologies. Triangulation is basically viewed as one of the best approaches to enhance 
trustworthiness in interpretive (qualitative) paradigm. Triangulation was employed in this 
study with the view to double check data and their interpretations so as to gain insight of 
the problem pursued, consequently enhancing confidence in the research findings. 
Additionally, Polit and Beck (2004:432) affirm that a researcher utilises triangulation as 
groundwork for converge on the truth through employing multiple methods and 
viewpoints, in an attempt to distinguish "true" information from "error" information, thus 
increasing the credibility of the findings. This strategy also assists in illustrating a more 
complete and contextualised picture of the problem pursued. As a result, it is basically 
viewed as one of the best approaches to enhance trustworthiness in interpretive 
(qualitative) paradigm (Babbie & Mouton (2004:275). Therefore, in this study, 
triangulation was achieved by the researcher through generating data from various 
perspectives in order to guarantee credibility: 
► Conducted a pilot study to test the two primary open-ended questions for the main 
study done on five nursing students to detect possible errors; 
► Collected data with two open-ended questions (see section 3.3.3:84 for more 
detail) from two groups of fourth years nursing students who were at different 
years of their study (see sections 3.3.1 & 3.3.2:81-83) for more detailed description 
of nursing students); 
► Administered narrative sketches to twenty seven (n=27) fourth year nursing 
107 
students to elicit their perceptions and to explore their expectations regarding how 
a caring environment in nursing education could be created; 
► Conducted four (4) focus group interview sessions amongst forty (n=40) fourth 
year nursing students registered at a different year to that of a group for the 
narrative sketches; 
► Took extensive descriptive and reflective field notes during and after each focus 
group interview session to procure supportive data and also validate the verbatim 
transcribed audio-tape recordings; 
► Reviewed the national and international literature extensively and repeatedly until 
clear comprehension of the problem pursued was acquired; 
► Conducted a thorough review of existing and relevant theoretical and empirical 
national and international literature samples that were stringently selected to 
minimize the biases in the study thus increasing rigour of the study (Rogers & 
Knafl, 1993:82); 
► Connected interpretation and existing models where applicable consistently with 
the theoretical conceptual framework of the study; 
► Engaged the independent coder in an audit trial to analyse raw data without any 
prearranged themes or categories in an attempt to discover first-order concepts 
and substantive codes thus ascertaining trustworthiness of the research findings; 
► Held consensus discussion meetings with the independent coder regarding the 
outcomes of data analysis; 
► Arranged follow-up meetings with participants after data analysis to review, 
validate and verify her interpretations and conclusions generated during data 
collection and analysis. 
• Referential adequacy 
Referential adequacy means the detailed written documentation of the research findings 
from completed narrative sketches, focus group interview session's audio-tape recorded 
transcripts and written-up field notes. All themes and categories are represented and 
108 
enough data have been collected to ensure data saturation. Data saturation as observed 
by Polit and Beck (2004:57) occurs when themes and categories in the data become 
repetitive and redundant, such that no new information emerges by further data 
collection. Referential adequacy was ensured by having 22 narrative sketches and focus 
group interview sessions tape-recorded transcripts ( combined) not analysed as data 
saturation has been achieved after 45 of 67 narrative sketches and focus group interview 
sessions tape-recorded transcripts (combined) were analysed (see · Table 3:99). Data 
saturation and referential adequacy were thus accomplished, fulfilling the requirements of 
trustworthiness as determined by Babbie & Mouton (2004:276-277) as well as adhering to 
the recommendation for being auditable by Burns and Grove (2003:258). The completed 
narrative sketches, transcripts of focus group interview sessions audio-tape recorded, and 
written-up field notes utilised for data collection were stored in a secure area until a final 
version of the thesis was completely written (Babbie & Mouton, 2004:277) (see Table 4 
under section 4.2:114). 
3.3.5.2 Transferability or applicability 
Transferability is the extent to which the research findings can be applied to various 
participants or in other contexts to serve as concrete frame of reference for comparison by 
other researchers (Babbie & Mouton, 2004:277). The aim of this study was to investigate 
whether or not nursing education, as presented at the North West University, Mafikeng 
campus, provides a caring environment. The responsibility for demonstrating 
transferability as reflected by Babbie & Mouton (2004:277) consequently remains in those 
researchers who desire to apply the research findings to the audience of their study. In 
this study, transferability was achieved through the application of the following strategy: 
• Rich, thick description 
The researcher gave a detailed, rich and adequate descriptive version regar~ing the 
study's focal point, researcher's role, and criteria for selection of participants. Furthermore, 
109 
the research design, context for data collection, data collection and data analysis coding 
procedures were also outlined clearly and accurately so that another researcher could 
determine whether the research findings will be applicable, or could be replicated in 
another context (Brink, 2002: 125). 
The rich, thick description by the researcher according to Creswell (2003:196) could put 
across explicitly to the audience or readers the research context and ·g ive the discussion 
an element of shared experiences. In qualitative study, transferability according to Babbie 
and Mouton (2004:277) relies on relationships between sending and receiving contexts. 
Similarly, the researcher collected adequately comprehensive descriptions of data within 
context and reported them precisely to allow the reader to make judgements regarding 
transferability. 
Furthermore, the researcher emphasised a rich, intense description of perceptions elicited 
and expectations explored from nursing students regarding a caring environment within 
the context of nursing education. It implies that the researcher had constantly been keen 
in describing nursing students' behaviours and comprehending that in the contexts that 
were clear to participants themselves. The researcher utilised categories and concepts 
used by nursing students themselves to describe, interpret and develop as accurately and 
precisely the social interaction in terms of the meanings that the nursing students 
themselves attach to it without manipulation of variables (Burns & Grove, 2003:27). 
3.3.5.3 Dependability or consistency 
Dependability as viewed by Babbie and Mouton (2004:278) means that the qualitative 
research must yield the same results if replicated with the same participants and in the 
same context. The authors further indicate that there can be no credibility without 
dependability and a manifestation of credibility is adequate enough to generate an 
existence of dependability. In this study, dependability was however accomplished 
through the utilisation of an audit trial. An audit trial as described by Polit and Beck 
110 
(2004:435) is the systematic collection of materials and documentation that allows an 
independent coder to draw conclusions about the trustworthiness of the data. In 
determining its acceptability, the independent coder was appointed in accordance with the 
specific criteria to affirm whether the processes and procedures utilised by the researcher 
were acceptable meaning dependable (Brink, 2002: 125). The independent coder explored 
raw data generated through the narrative sketches, and focus group interview sessions 
audio-tape recorded transcripts, and the research outcomes of ·the data analysis, 
interpretations, conclusions and recommendations. The independent coder then declared 
that the research outcomes were sustained, supported and confirmed by the data. The 
independent coder further indicated that there was evidence within the data that served 
as logical validation of the findings. 
3.3.5.4 Conformability or neutrality 
Conformability as reflected by Babbie and Mouton (2004: 278) is the extent to which the 
research findings are the end-product of the study and not of the researcher's biases. 
Furthermore, a conformability audit trial, that is a sufficient trial should empower the 
independent coder to ascertain if the research findings, conclusions, interpretations and 
recommendations could be traced to their sources, and sustained and confirmed by the 
study. The audit trial was also conducted to determine if there was correlation between 
the researcher's interpretation and the actual evidence (Babbie & Mouton, 2004:278). The 
audit trial conducted by the independent coder comprised: 
► Material associated with intentions and dispositions - research proposal, personal 
notes and expectation; 
► Instrument development information - two primary open-ended questions 
construction utilised in the narrative sketch form for both pilot and the main study 
including focus group interview sessions; 
► Raw data consisting of narrative sketches, focus group interview sessions audio-
tape recorded transcripts and researcher's written-up field notes; 
► Process notes - methodological notes, trustworthiness notes, and audit trial notes; 
111 
NIIJU 
LIBRARY 
► Data reduction and analysis products - write-ups of field notes, summaries and 
condensed notes, theoretical notes, concepts and intuition; 
► Data reconstruction and synthesis products - themes that were developed, 
research findings, conclusions and a final report. 
On the background of the stated discussions, it is evident that the researcher adhered to 
and applied the criteria of trustworthiness to ensure the rigour witho·ut rel inquishing the 
relevance of the qualitative research . 
3.4 Summary 
This chapter laid the basis for the planning and the implementation of the study. It 
provided a detailed account on the research design and methodology. The chapter 
justified the researcher's choice for employing the qualitative research design which was 
supported by the exploratory and descriptive research strategies to elicit perceptions and 
explore expectations of nursing students regarding a caring environment in nursing 
education. It also gave an explicit description of data gathering tools and data analysis 
followed by the realisation of findings to reflect a coherent way of thinking throughout the 
study. This chapter also highlighted measures to ensure trustworthiness in this study to 
maintain rigour without relinquishing the relevance of qualitative research. 
112 
CHAPTER FOUR 
DATA ANALYSIS AND INTERPRETATION 
4.1 Introduction 
This chapter handles data analysis and interpretation. This is done to establish what data 
says about the existence or otherwise of a caring environment in the nursing education as 
presented at the North West University, Mafikeng campus. The data analysis and 
interpretations are not dependent upon the quantification of observations as expounded 
and articulated by Burns and Grove (2001:56; 2003:357) but entail the gathering, 
integrating and synthesis of non-numeric narrative data. The perceptions and expectations 
elicited, explored and described from the nursing students' frame of reference and context 
regarding a caring environment in nursing education are fundamental in this chapter. 
Thus, it follows that there is not a single reality and that reality rooted on perceptions is 
diverse and distinct for each person and it converts over time. Most notably, also is that 
what is known has meaning only within a given context and since perceptions and 
expectations vary from person to person, many different meanings are possible (Burns & 
Grove, 2003:357). The outcomes of the study are to serve as the foundation for the 
formulation of guidelines for a caring environment in nursing education. 
4.2 Analysis of results 
The results derived from the perceptions and expectations as reported by participants 
through both narrative sketches and focus group interview sessions were outlined and 
clustered as responses, themes and statements. The results are presented in 'direct 
quotes' as a means of giving a living meaning to research participants (Sandelowski, 
1994) and are reflected in Table 4. The table provides a comprehensive summary of 
responses from two groups of participants (see items no. 3.3.1 & 3.3.2:81-83 f~r more 
detailed description). 
113 
Table 4: Combined data analysis of results presented as responses, themes 
and participants' statements 
RESPONSES THEMES PARTICIPANTS' STATEMENTS 
Al, A2, A3, A4, Perceptions • "Most of the time lecturers display 'don't care attitude' 
AS, A6, A7, AS, without compassion when talking to students .. ... this 
A9, Al0, All, behaviour is more observable in the classroom but 
A12, Al3, Al4, mostly during consultation periods" 
AlS, A16, A17, • "Some of them do not have time to listen to a student 
A18, Al9, A20, instead one is cut short or the discussion is terminated 
A21, A22, A23, before the student completes what one intends to say" 
A24, A25, A26, • " ... sometimes a student is desperate for help or for 
A27, Bl, 82, 83, clarity. One will be told 'you cannot see me' even when 
84, 85, 86, 87, one has made an appointment'' 
88, 89, 810, 811, • " ... individual differences are not regarded as valid" 
812, 813, 814, • "prevalence of non-caring incidences of disrespect, 
815, 816, 817, made fun of, ridicule, discrimination and undermining 
B18, 819, B21, of views and feelings among lecturers and students" 
822, B23, B24, • "experienced mixed sense of anger, hopelessness, 
825, 826, B27, misery, frustration and devastation but at the same 
B28, 829, 830, time have a strong desire to intervene, but often felt 
B31, B32, 833, intimidated, helpless and afraid of being victimised in 
834, 835, 836, their role as being just nursing students" 
B37, 838, 839, • "not consulted to be involved and participate in 
B40. decision making regarding academic issues" 
• "these caring role models are uncommon in nursing 
education" 
• "some lecturers interact with nursing students in 
unprofessional, non-caring, degrading and intimidating 
ways as evidenced by outbursts of temper, 
overpowering and inconsistent actions, favouritism, 
unfairness, and failure to observe confidentiality 
regarding students' personal problems and issues" 
• 'If a student does something wrong or something that 
shows disrespect towards a lecturer, that lecturer can 
114 
extremely dislike that student'' 
• "some lecturers are even not approachable, friendly 
and polite and that makes it difficult for students to 
consult if having learning problems". 
• "there is poor relationship between some lecturers 
themselves and with students being inappropriate 
mentors of future professional nurses" 
• "without good guidance, direction, advice, supervision 
and monitoring from the lecturers, problematic 
situations may arise which could have an impact on the 
nursing students' academic performance and progress 
would be indicative of uncaring environment in nursing 
education" 
• "lecturers hardly listen to nursing students' 
complaints" 
• "there is no proper interaction and communication 
between lecturers and students" 
• "The classroom learning environments are not 
conducive to learning, are not comfortable and are 
inadequate" 
Al, Al, A3, A4, Expectations • " .. . lecturers should teach caring" 
AS, A6, A7, AS, A9, • " ... enough t ime for consultation with lecturers should 
AlO, All , A12, be created for personal and academic issues to ensure 
Al3, Al4, AlS, a caring environment that stimulates students to work 
A16, A17, A18, to their best ability'' 
A19, A:20, All, • " ... sensitivity, privacy and confidentiality shou ld be 
A22, A23, A24, observed and maintained when addressing students' 
A:25, A26, A27, problems, complaints and academic issues" 
Bl, 82, 83, 84, BS, • "respect, love and cooperation between lecturers 
86, 87, 88, 89, and students should be cult ivated without 
810, 811, 812, discrimination" 
813, 814, 815, • "each other's human rights should be acknowledged 
816, 817, 818, and respected" 
819, B20, 821, • "student-lecturer meetings should be held on a 
822, 823, 824, monthly basis for effective problem solving" . 
115 
825, 826, 827, • "lecturers should practice democracy at all times 
828, 829, 830, which is characterised by openness, transparency 
831, 832, 833, and cooperation in all dealings regarding academic 
834, 835, 836, issues and activities without dictatorship" 
837, 838, 839, • ". .. identified role modelling and mentoring as the 
840. most crucial professional attribute that exemplify the 
caring and interaction practices the lecturer could 
demonstrate if a caring environment is to prevail in 
nursing education" 
• "lecturers should be more supportive, academically 
and professionally acceptable; giving equal treatment 
to all nursing students without favouritism, thus 
enhancing solidarity; and moulding them to be 
professionally competent" 
• ''the most important task of a lecturer is to provide 
constant and unfailing guidance, direction, advice, 
supervision and monitoring to the nursing students at 
different stages of their study both in the classroom 
and in the clinical learning environment'' 
• ''there should be cooperation between the lecturers 
and nursing students in order to achieve the expected 
learning outcomes" 
• "continuous, harmonious, good and stable lecturer-
student interpersonal relationsh ips should be 
maintained in nursing education to enhance 
academic and spiritual growth" 
• " lecturers should be ready to listen, know and 
understand students' own views, feel ings and needs 
without criticism, discrimination and victimisation" 
• "a commun ication box for complaints and 
compliments should be made available" 
• "an annual assessment of lecturer-student 
interaction and caring relationships should be 
conducted, and nursing students should be actively 
involved" 
116 
• "during their professional education they too would 
be empowered to communicate effectively, and this 
would boost their self-esteem and self-awareness" 
• "good communication between lecturers and 
students should be maintained for continued growth 
in their interpersonal communication skills" 
• " it is the responsibility of each lecturer to serve all students 
equally without discrimination or preferential treatment, 
and to provide support where it is deemed necessary" 
• "support groups should be established in order for a 
caring environment to be rea lised in nursing 
education" 
• "nursing students strongly held this view that support 
groups for personal and academic issues should be 
established" 
• "mentoring groups should be established to give 
support to new students" 
• "a healthy environment that encourages teamwork 
among students should be fostered since is a 
coherent feature of the classroom activities" 
• "Students and lecturers should spend more time 
together for social interaction, bonding and building 
trust with each other" 
• " mutual trust and caring relationships among 
lecturers and nursing students should be perceived 
as the central attribute of the teach ing and learning 
process as well as a key to personal and professional 
growth and development" 
• "a mutual trust and good relationships between 
lecturers and students should be cult ivated" 
• " lecturers should act as or be like mothers and 
behave like parents" 
• "when a lecturer interacts, communicates and relates 
to an individual nursing student or a group of nursing 
students informally or formally, that lectur~r should 
117 
be a role model by demonstrating trust, 
understanding, encouragement, dependability and 
acceptance instead of mistrust" 
• "lecturers should build rapport with nursing students 
to accommodate and know them better in order to 
identify any learning problem" 
• "lecturers should lay foundation to instill into 
students the value of a life-long learning" 
• "effective lecturers should have good knowledge and 
experience in their respective areas of specialisation, 
be accountable, dedicated to their responsibilities, be 
objective in their evaluations, and be competent and 
dependable facilitators of theory and practice" 
• "lecturers should provide remedial teaching for those 
who don't perform well in order to avoid high failure 
rates" 
• " ... identified areas requiring remedy" 
• " .. .t he physical safety on the university campus 
should be promoted and that no student parties 
should be hosted in the campus because these lead 
to crime" 
• " The classroom learning environments should be 
more better equipped and comfortable" 
• "lecturers should accompany students in the clinical 
learning environments for clinical teaching, guidance, 
supervision, monitoring and assistance" 
• "Time for clinical nursing practice should be sufficient 
for them to acquire experiential learning" 
• :". ..t he presence and availability of lecturers in the 
clinical learning environments may also depict that 
lecturers care for them" 
• "clinical hours should be reduced to prevent burn-out" 
The themes and statements that reached a comprehensive description were finally 
summarised as categories and subcategories and are discussed under section.4.3:120. 
118 
The final categorisation of the results is reflected in Table 5 below. 
Table 5: Final categorisation of results derived from combined data analysis 
Theme Categories Subcategories 
Participants' current • Poor lecturer-student • Poor lecturer interaction 
nursing education interaction relationship; • Lack of compassion 
environment is non-caring • Poor role modell ing • Unapproachable 
and mentoring • Poor communication 
• Lecturers' • Lack of respect 
unprofessional • Lack of support 
attitudes and behaviour • Mistrust 
• Inadequate and non- • Lack of supervision 
conducive classrooms 
Participants' expectations • Qual ity lecturer-student • Sensitivity/ com passion 
regarding a caring interaction and caring • Respect 
environment relationships • Cooperation 
• Good lecturer-student • Good communication 
interpersonal • Democracy through 
relationship 0 Openness 
• Lecturer-student 0 Transparency 
collaboration • Mutual support 
• Good role modelling • Support groups 
and mentoring • Mentoring groups 
• Physical safety • Mutual trust and rapport 
• Classrooms adequately 
equipped 
• Lecturers' availabi lity 
and presence 
These responses are discussed in detail in section 4.3 below. 
119 
4.3 Discussion and interpretation of results 
Nursing students in this study highlighted numerous details of their nursing educational 
experiences during their interactions with their lecturers. These interactions became the 
focal point for expressing their perceptions and expectations regarding an environment in 
nursing education. This environment symbolised the relationship between the students 
and the lecturers, whether positive or negative. Thus the relationships were central to 
articulating their lived experiences regarding an environment in nursing education. Two 
themes that emerged are as follows: Participants' current nursing education environment 
is non-caring; Participants' expectations regarding a caring environment. A detailed 
description of each theme will be given in the discussion that follows. 
4.3.1 Participants' current nursing education environment is non-caring 
The lecturer-student interaction relationship is imperative if a caring environment is to 
be realised in nursing education . It was found that poor lecturer-student interaction 
relationsh ip is one of the most critical factors that contribute to this problem as 
highlighted below. 
4.3.1.1. Poor lecturer-student interaction relationships 
Findings of this study revealed that there was no report of a positive caring environment 
in nursing education as articulated by the nursing students. It appears that most of the 
nursing students experienced or perceived lecturers as non-caring and without 
understanding. 
In teaching and learning settings, less time is allotted for lecturers-students' interactions. 
This view is also supported by nursing students who affirmed that: 
"There is no proper interaction and communication between lecturers and students. // 
120 
The perceptions as expressed by nursing students may have an impediment in their 
ability to interact and communicate with one another, significant others, and clients, 
including lecturers. 
Nursing students recalled that caring is lacking and totally unobserved between lecturers 
and students. One nursing student said, 
"Most of the time the lecturers display a 'don't care attitude' without compassion when 
talking to students . . . this behaviour is more observable in the classroom, but mostly 
during consultation periods. " 
The perception expressed above indicates that the nursing students hold the view that the 
lecturers' conduct and attitudes towards them is non-caring and lack consideration. It 
seems that this could have a negative impact on the nursing students' goals, 
aspirations, values, professional conduct and attitudes, including their interaction and 
attachment to others. Therefore, it is of paramount importance that the lecturers acquire 
listening competence, have empathetic understanding, helping and caring behaviour and 
attitudes towards students so as to facilitate and create a caring environment in nursing 
education. 
What also emerged in this study is that attentive listening skills are crucial in order to 
promote a caring environment. However, that is not the case in nursing education . 
Nursing students reported that: 
''Lecturers hardly listen to students' complaints. " 
The perception as reflected above is the main emphasis which seemed to have been 
the core of an environment in nursing education as being inconsistent and evidenced by 
121 
poor student-lecturer interaction relationship. The research findings point to the fact 
that, 
•: .. nursing students' problems and concerns are not addressed amicably and not 
considered as important.  .,., 
If the perception, as expressed by nursing students, is not apparent to the lecturers in 
nursing education, it may have a negative bearing on the academic progress of nursing 
students. 
Another nursing student also noted that: 
''Some of them do not have time to listen to a student instead one is cut short or the 
discussion is terminated before the student completes what one intends to say.  .,., 
The research findings showed that poor communication in nursing education is one of the 
major problems which may have a negative influence on the personal, academic and 
professional growth and development of nursing students. 
Many of the nursing students also reported that: 
•: ..s ometimes a student is desperate for help or for clarity. One will be told 'you cannot 
see me' even when one has made an appointment.  .,., 
One nursing student remarked, " .. .m mm!!! ... I suspect that they are under pressure and 
too much overloaded with work.  .,., 
Lecturers' primary purpose seem not to be the moral one of developing caring nursing 
students who are prospective professional nurses but instead, there is a persistent and 
unfortunate emphasis on academic adequacy. Consequently, nursing students do not feel 
122 
cared for. This state of affairs may have potential negative consequences on nursing 
students' physical, social, intellectual, emotional and moral wellbeing for optimal 
personal and professional growth and development. 
However, learning and teaching process in nursing education may be possible in an 
environment that encourages and nurtures positive communication such as attentive 
listening amongst the lecturers and students. 
By comparison, this state of affairs seems lacking in the learning environment as 
perceived and experienced by the nursing students. They reported that: 
''Lecturers hardly listen to students' complaints'~ 
It is vitally important that nursing education incorporates a caring environment in the 
teaching and learning processes in order to develop caring practices between lecturers 
and students, provided the educational culture supports the mandate of that amongst 
lecturers. This study indicates that this may not necessarily be the nursing students' 
perceptions. From the nursing students' accounts of their perceptions regarding their 
nursing educational experiences, what surfaced is that most of the time the lecturers 
seem to have the sole control of the learning environment in nursing education with 
nursing students being in a conforming role. 
4.3.1.2 Poor role modeling and mentoring 
The caring role models are uncommon in the nursing education experience of nursing 
students in this study. They reported that: 
123 
''. .. some lecturers are interading with nursing students in unprofessional non-caring 
degrading and intimidating ways as evidenced by outbursts of temper, overpowering and 
inconsistent adions/ favouritism/ unfairness and failure to observe confidentiality 
regarding students'p ersonal problems and issues'~ 
When conflict is dealt with destructively, it damages relationships and destroys the 
mutual and supportive system. However, a healthy social develop·ment requires that 
lecturers and students learn how to handle conflicts constructively, in order to derive 
outcomes such as interest, motivation, intensified success, insight, creative thinking, 
problem-solving, intensified healthy cognitive and social development. One may also be 
in a position to clarify one's own and other's identity, commitments, and values, 
including strengthened relationships. 
One nursing student also noted that: 
''If a student does something wrong or something that shows disresped towards a 
ledurer, that lecturer can extremely dislike that student'~ 
The perception reflected above suggests that the nursing students hold the view that 
lecturers may have an attitude of dissatisfaction towards them based on the student's 
negative conduct towards the lecturer. This negative interaction between the student 
and the lecturer may lessen effective communication and may also have a negative 
influence on their relationship. Therefore the student-lecturer interaction may be 
damaged leading to broken relationships and cooperation and trust between the 
lecturer and the student may also be destroyed. 
The nursing students in their responses also reiterated that, 
"There is poor relationship between some lecturers themselves and with students being 
inappropriate mentors of future professional nurses. " 
124 
It can be gathered from this perception that the current ineffective lecturer-lecturer and 
lecturer-student interaction may have an impact on how the student interacts and 
relates with other students in the future. The student may have a negative attitude 
towards mentorship. This conduct and attitudes undermines trust between the lecturers 
and nursing students resulting in communication and relationship problems evidenced 
by poor student-lecturer relationships. 
Another nursing student commented that: 
"Some lecturers are even not approachable, friendly and polite and that makes it 
difficult for students to consult ifh aving learning problems'~ 
It can be inferred from the perception above that students can perceive the lecturers' 
attitude towards them as firm and punitive. This can therefore interfere with effective 
communication between the student and lecturer. The student may fear approaching 
lecturers based on the lecturers' aloof behaviour. 
The research findings also revealed that: 
''Nursing students are not consulted to be involved and participate in decision-making 
regarding academic issues. " 
It appears that some major decisions are taken for the nursing students which might 
not be appealing to them. In line with this observation, it could be noted that this is a 
common practice in educational institutions. When actually on the whole, students 
require intellectual challenges, opportunities to express ideas, to be involved and 
participate in decision making process, caring relationships, and affirmation in developing 
competence and identity. On the contrary, students are placed in outsized, unfriendly, 
departmentalised structures where rules are more inflexible, their participation is less 
sought. Teaching and learning is less engaging with students less attached to lecturers, 
125 
and their sense of identity is damaged. 
It was also discovered that without good guidance, direction, advice, supervision and 
monitoring from the lecturers, problematic situations may arise which could have an 
impact on the nursing students' academic performance and progress would be indicative 
of non-caring environment in nursing education. 
4.3.1.3 Lecturers' unprofessional attitudes and behaviour 
There appear to be poor communication between students and lecturers and this poor 
relationship may have a long history. It also seems that there is an attitude of 
indifference between the student and lecturer which lessens caring towards one 
another. If the attitude is persistent, it may lead to incidents of discrimination, 
disrespect and lowering of human dignity which may have an impact on academic 
performance and progress. 
Based on the following research findings which are interrelated, it could be inferred that-
professionalism and professional relationships are to be cultivated and sustained in 
order for a caring environment in nursing education to be evident. The following 
findings are interrelated and point to the fact that: 
"Nursing students' problems and concerns are not addressed amicably and not 
considered as important. " 
The research results further revealed that: . 
''Nursing students' individual differences are not regarded as valid " 
What prevails according to the nursing students' perceptions: 
126 
" is non-caring incidences of disrespect made fun ot ridicule/ discrimination and 
undermining of views and feelings among lecturers and students/~ 
These inconsistencies were reported by the nursing students in detail, 
" ... as humiliating/ embarrassing/ demoralizing and lowering human dignity as well as 
retarding communication and academic performance and progress. · 
During the occurrence of these incidences, nursing students also reported that they: 
''experienced mixed sense of anger✓ hopelessness✓ misery, frustration and devastation 
but at the same time having a strong desire to intervene/ but often felt intimidate(l 
helpless and afraid of being victimized in our role as being Just nursing students/~ 
Based on the nursing students' descriptions of their perceptions regarding an 
environment in nursing education, it appears that the environment that prevails in 
nursing education is not flexible and positive enough, since most of the time lecturers 
have domineering tendencies and are conceited without taking into consideration 
nursing students' uniqueness in responding to learning environments. Given that, this 
could be a potentially stressful experience for nursing students. Without any doubt, this 
indicates that there are individual differences in response to situations. Therefore 
proper interaction and communication seems to be crucial in order to avoid the 
situations experienced. This, however, seems like an ideal situation as the academic 
nature of higher learning institutions where nursing education is provided lacks the 
necessary resources and caring academic members of staff to provide this service 
efficiently. 
127 
4.3.1.4 Inadequate and non-conducive classrooms 
The university is an organisation with adequate and appropriate facilities to render 
quality services to consumers. The classroom as a learning environment is one of those 
facilities where teaching and learning takes place through interaction, communication 
and building of caring relationships among the lecturers and students. The success of 
the teaching and learning process is dependent on an environment which is conducive 
to teaching and learning, being free from distractions, well-ventilated, adequately 
spacious and comfortable with essential equipment and furniture. 
By comparison, in this study the nursing students reported that: 
" The classrooms as learning environments are inadequate, not comfortable and not 
conducive for learning. " 
The nursing students seem to be of the view that their classroom situations are less 
than perfect. According to the students, the classroom situation seems to be less than 
favourable and do not meet their expected standards. 
The research findings in view of the expectations as advocated by the nursing students 
regarding a caring environment in nursing education, are highlighted and interpreted in 
the following section. 
4.3.2 Participants' expectations regarding a caring environment 
It appears that caring is both a moral direction to teaching and learning and also a 
moral educational effort. In order for mutual support as a vital source of caring to be 
realised in nursing education, it is imperative that a caring environment be purposely 
established. Such an environment should cultivate and nurture substantial and 
meaningful relationships, growth and development amongst participants engaged at all 
128 
levels in the teaching and learning process. 
4.3.2.1 Quality lecturer-student interaction and caring relationships 
In esteeming and appreciating communication for its imminent supremacy, including 
the provision of continuous lessons in self-consciousness and the art of interaction and 
caring, the nursing students had expectations expressed as follows: · 
"Ccontinuou~ harmonious, good and stable lecturer-student interpersonal relationships 
should be maintained in nursing education to enhance academic and spiritual growth. " 
Based on the highlighted expectation, it could be inferred that a harmonious teacher-
student relationships and good and stable teacher-student interaction could promote and 
boost a nursing student's self-concept and self-esteem. It seems that the ability to 
interact or communicate and relate to students, or others caringly is learned. With 
practice the lecturer becomes an effective communicator committed to caring for 
oneself and students for the attainment of emotional, physical, spiritual, mental, 
intellectual and social wellbeing. 
The nursing students also shared this view when they suggested that: 
''Lecturers should be more supportive, academically and professionally acceptable; 
giving equal treatment to all nursing students without favouritism, thus enhancing 
solidarity; and moulding them to be professionally competent. " 
Lecturers need to strive to develop students who can be acceptable, admirable, 
compassionate, loving, competent, respectable, trustworthy and not obsessive, but 
committed to caring. In moulding these students to be professionally competent, 
lecturers require both intellectual competences and a knowledge base with reference to 
those students with whom they are interacting and relating. Furthermore, lecturers 
129 
need more time to be involved more personally with these students in order to learn 
more about them and to fully understand them. 
Hence the nursing students also shared this view when they suggested that: 
"The lecturers should teach caring". 
It appears that a successful teaching and learning process is exclusively dependent on 
the lecturer's effective listening competence, empathetic understanding, helping and 
caring conduct and attitudes. These professional attributes may also be copied by 
nursing students in their inner being as they aspire for greater heights in their career 
paths. Hence, in helping and caring relationships, a lecturer listens attentively and displays 
empathetic understanding, model a caring outlook in any situation exposed to. 
The nursing students shared this view that: 
''Each lecturer should be trained in interpersonal relationship skills to empower 
students'~ 
The lecturers are to listen with empathy, show understanding and facilitate sharing of 
ideas and feelings towards the students. Furthermore, a course on effective 
interpersonal relationship should be offered to lecturers to improve their listening and 
communication competences. Consequently the students will be indirectly and directly be 
empowered during the lecturer-student interaction and communication. 
Nursing students expressed and shared that they expect: 
''Sensitivity, privacy and confidentiality should be observed and maintained by lecturers 
when addressing students'p roblem~ complaints and academic issues'~ 
130 
It is the responsibility of the lecturer to be resilient and sensitive when dealing with 
students' problems, complaints and academic issues. Effective and sensitive 
communication may also assist in developing positive and long lasting student-lecturer 
interaction and caring relationships. It appears that the nursing students' academic and 
personal issues are not regarded as sensitive and not treated confidentially by lecturers 
but they are discussed openly. What also seems to be the norm is the lack of privacy as 
one nursing student remarked, 
''mmm!! ... students' concerns are also to be taken seriously and privately dealt with'~ 
This view is in line with the Constitution of South Africa (Act No. 108 of 1996:6 & 25) 
which safeguards and preserves every person's rights, dignity, equality, freedom, 
security and privacy. It further urges that cooperation should be based on mutual trust 
and good faith by promoting friendly relations, assisting, supporting, informing and 
consulting with one another on appealing issues while adhering to agreed procedures 
Nursing students in their responses also shared this view, 
''Respect, love and cooperation between lecturers and students should be cultivated 
without discrimination'~ 
Therefore, to effectively cope with the student-lecturer caring and interaction 
relationship there is a need for lecturers to be trained and educated on their role in 
nursing education so that they can overcome challenges that are a result of failure to 
recognize students' experiences and expectations. Discrimination should be avoided by 
all means since this sets the stage for negative attitudes and interactions leading to 
suspicion and mistrust. Therefore, it can be argued that a caring environment in nursing 
education is a relationship-based responsibility of both the lecturer and the student. To 
cultivate and nurture positive and productive caring relationships with and within 
students, lecturers need to ensure that they need to be trustworthy, respectful and fair 
131 
in any situation. 
The nursing students further suggested that: 
•~ -- each other's human rights should be acknowledged and respected'~ 
In line with the above observation, the South African Constitution Act No. 108 (1996:7) 
concurs that every person has an intrinsic dignity and the right to have such dignity 
respected and protected and may not be directly or indirectly unfairly discriminated 
against on one or more grounds in terms of subsection (3). Therefore it is the 
responsibility of both the lecturer and student to respect and acknowledge each other's 
human rights and dignity irrespective of their ethnical, cultural, religious, and racial 
background. 
Therefore the research findings reflect what nursing students in this study perceived and 
recognised as an environment in nursing education during their interactions with lecturers 
as caring, as well as what they expect to be a caring environment in nursing education. 
The nursing students reported that: 
'Tt is the responsibility of each lecturer to serve all students equally without 
discrimination or preferential treatment and to provide support where it is deemed 
necessary'~ 
However, when all students are treated equally, fairly and with justice using the same 
rules and procedures, then positive attitudes and relationships are fostered, which may 
facilitate positive interaction between the lecturer and the student. This conduct may 
encourage and motivate students to work together as a team. Within cooperative 
situations, students are inclined to interact, uphold one another's success, qevelop 
multidimensional and sensible impressions of one another's experiences and expertise, 
132 
and offer precise feedback. The interaction is inclined to encourage an essential 
acceptance of oneself as a competent person. One of the most crucial and longstanding 
goals of nursing education is the promotion of constructive relationships, and healthy 
conducts and attitudes among various students. 
For effective communication to be accomplished in nursing education, the nursing 
students are of the opinion that, 
"Lecturers should be ready to listen,, know and understand students" own views,, 
feelings and needs without criticism,, discrimination and victimisation. ,,,, 
In view of the highlighted observation, it could be noted that the lecturers already know 
this but need to identify what is contributing to the communication problem. Many 
nursing texts address communication, so it is not that lecturers are unaware. 
It seems that in any situation one is exposed to, interaction and communication take 
place simultaneously. Therefore, there can be no interaction without communication, 
and the manifestation of interaction is adequate enough to generate an existence of 
good communication. For such a situation to prevail in nursing education, lecturers 
should attempt to interact and communicate caringly with nursing students. It entails 
taking the initiative in creating and sustaining communication, being authentic, and 
responding aptly to one another. Good interpersonal communication also requires both 
the lecturers and students to establish a sense of mutuality. 
4.3.2.2 Good lecturer-student interpersonal relationships 
In making an authentic caring environment in nursing education, nursing students in 
their responses which are interrelated suggested that: 
''.-4 communication box for complaints and compliments should be made available"~ 
133 
They further recommended that: 
':.4n annual assessment of lecturer-student interaction and caring relationships should 
be conducted, and nursing students should be actively involved'~ 
The above interrelated stated research findings are unique and could assist lecturers to 
receive constructive and substantial feedback on teaching and learning issues for self-
evaluation, reflection, correction of mistakes, and working on weaknesses to strengthen 
them; to be resilient when dealing with nursing students' academic and personal issues, 
growing in awareness instead of hiding and repressing faults. Furthermore, such a process 
would provide opportunities for personal and professional growth and lessons to be 
learned. 
The nursing students also expect that: 
"During their professional education they too would be empowered to communicate 
effectively, and this would boost their self-esteem and self-awareness''. 
In view of the expectation held by the nursing student effective communication is a 
critical component of the teaching-learning process. During this process both lecturers 
and nursing students are empowered and enabled to understand themselves and make 
their own choices. With this type of communication, lecturers have great opportunities 
to bring about principles and ideas of high-quality to themselves, their colleagues and 
their students. 
It could be further noted that a mutual caring environment that fosters and sustains a 
healthy communication and mutual interaction relationships between lecturer-lecturer, 
lecturer-student and student-student should prevail in nursing education. 
Hence the nursing students suggested that: 
134 
"Good communication between lecturers and students should be maintained for 
continued growth in their interpersonal communication skills'~ 
Interpersonal communication competences are an essential social interaction most 
commonly employed in the nursing profession with special reference to nursing education. 
Therefore the meaning of messages must be confirmed or mutually negotiated between 
the lecturers and students. A healthy interpersonal communication permits problem-
solving, sharing of ideas, decision-making, expression of feelings, goal accomplishment, 
team building and personal growth and development. Hence the student-lecturer caring 
relationship may succeed when both the students and the lecturers understand their 
roles in the teaching-learning process. They should know where they need to 
complement and to assist one another for ongoing growth in their interpersonal 
communication competences. Failure to acknowledge the specific roles that each one 
has to play may deteriorate into conflict and tension. 
The nursing students were of the opinion that, 
''Lecturers should provide remedial teaching for those who don't perform well in order 
to avoid high failure rates." 
The nursing students' expectation regarding remedial teaching to be offered to those 
who do not perform well to avoid high failure rate is not feasible since usually these 
students are the last to acknowledge and understand their shortcomings. They rarely 
ask for assistance on their own. 
135 
4.3.2.3 Lecturer-student collaboration 
The nursing students advocated that: 
''Sufficient time for consultation with lecturers should be created for personal and 
academic issues. This would encourage the creation of a caring environment that 
stimulates them to work to their best ability. " '-
The expectation reflected above suggests that the nursing students hold the view that 
enough time should be made available for consultation with their lecturers to address 
both the academic and personal issues. In turn, this attempt may have a positive effect 
on student-lecturer interaction and communication thus enhancing and nurturing a 
caring environment in nursing education that motivates them to do their best. 
Nursing students further shared this view when they pointed out that: 
"Lecturers should reward and congratulate students for work well done. " 
The lecturer could make use of encouragement rewards which rest on the principle that 
learning is more effective provided students have feelings of gratification. 
The nursing students reported that: 
''Lecturers should practice democracy at all times which is characterised by opennes~ 
transparency and cooperation in all dealings regarding academic issues and activities 
without dictatorship/~ 
The students perform better in an environment that promotes democracy, active 
participation and collaboration. They prefer to be actively involved in establishing h?w and 
what are to be learned and they also favour active learning experiences rather than 
136 
passive ones. In order for both the lecturers and nursing students to have a more positive 
caring and interaction relationship, they should be actively involved in regular meetings for 
open discussions and the cultivation and promotion of transparency regarding academic 
issues and activities. 
The nursing students proposed that: 
"Student-lecturer meetings should be held on a monthly basis for effective problem 
solving/~ 
It could be noted that student-lecturer monthly meetings may assist both the lecturers 
and students to come together and create a platform to exchange and share ideas, 
articulate feelings, analyse and solve problem situations, take decisions, make an informed 
choices, accomplish goals, build team and grow and develop personally and professionally. 
This discourse could also foster an environment for resolving communication barriers 
and conflict between lecturers and nursing students. 
The nursing students further reiterated that: 
"There should be cooperation between the lecturers and nursing students in order to 
achieve the expected learning outcomes// 
It can be inferred from the expectation expressed by the nursing students that the 
lecturers and students should work together as a team in order to foster caring 
relationships in the teaching and learning setting to achieve the expected learning 
outcomes. This situation has a potential effect on personal and professional growth and 
development of both the lecturers and students. 
The nursing students hold the expectation that, 
137 
"It is the responsibility of each lecturer to serve all students equally without 
discrimination or preferential treatment and to provide support where it is deemed 
necessary. " 
This conduct may encourage and motivate students to work together as a team, and 
accept one another as competent students. One of the most crucial and longstanding 
goals of education is the promotion of constructive relationships, healthy conduct and 
attitudes among various students. Working as a team endorses significantly better liking 
amongst students despite differences in gender, ethnic background, intellectual ability, 
social class or task orientation. Students who collaborate develop significant 
commitment and caring for one another. They also regard the lecturer as being more 
supportive and academically and personally acceptable. 
What further emerged in this study is that support groups should be established in 
order for a caring environment to be realised in nursing education. The nursing 
students strongly held this view that: 
''Support groups for personal and academic issues should be established. " 
Through the establishment of support groups students could share experiences, 
difficulties, and feelings, and learn various coping strategies. They could also gain 
insight into themselves and various issues discussed in those support groups. Students 
could also obtain reliable information regarding academic and personal issues, acquire 
knowledge and access referral and supportive systems. In addition, such support 
groups could foster mutual support for growth, discovering and forming new meanings 
in their personal, academic and professional lives, assisting in maintaining a sense of 
mastery over their lives and questing for self-enhancement and self-fulfillment. 
Furthermore, teamwork amongst students is still uncommon, and what is _evident 
according to research findings, is that a huge number of students perceive the educational 
138 
mainstream as a competitive enterprise where one student attempts to do better than 
others. 
The nursing students are of the opinion that: 
''A healthy environment that encourages teamwork among students should be fostered 
since is a coherent feature of the classroom activities. " 
Trust was perceived as one of the attributes the lecturer could demonstrate when 
interacting with nursing students to establish a positive relationship. It also emerged that 
the success of a relationship should be based on mutual trust, shared responsibility and 
respect amongst lecturers and nursing students involved in such a relationship. 
Cultivating, and maintaining mutual caring relationships between the lecturers and 
nursing students is crucial in the nursing educational settings for nursing students to 
reach their educational goals. For that reason, such attributes of a successful relationship 
to be realised in nursing education, a caring environment fosters teamwork. The value of 
teamwork demands a sense of belonging or developing experiences and expertise in 
which each student is not merely included, but is required. Both inclusion and team-
work are essential for the attainment of the social, professional and a shared life in the 
teaching-learning process. 
The nursing students strongly suggested that: 
''Students and lecturers should spend more time together for social interaction bonding 
and building trust with each othel'. 
The research results also revealed that mutual trust and caring relationships among 
lecturers and nursing students should be perceived as the central attribute of the 
teaching and learning process as well as a key to personal and professional gro~th and 
development. However, most frequently, such attributes are either taken for granted or 
139 
disregarded. It is therefore imperative that mutual trust between lecturers and nursing 
students be built and good relationships be fostered amongst them by spending more 
time together. Mutual trust should also be a component of the commitment to the 
cultivation and sustenance of a caring environment in nursing education. As a result, 
both lecturers and nursing students engaged in the teaching and learning process may 
have opportunities for personal and professional growth and development, including 
self-actua Ii sation. 
The nursing students expressed that they expect that: 
''..4 mutual trust and good relationships between lecturers and students should be 
cultivated'. 
Less time is apportioned to the concept of how lecturers should interact with students; 
how they arrange or organise student-student interaction styles reflect how favourably 
students learn; how they feel about one another, the education system including the 
lecturers, and how much self-esteem they have. Furthermore, teamwork amongst 
students is still uncommon, and what is evident according to research findings, is that: 
''..4 huge number of students perceive educational mainstream as a competitive enterprise 
where a student attempts to do better than others. " 
According to the nursing students' opinion, it can be inferred that the students are still 
ascribing to an individualistic learning style where interaction is attributed to students 
being independent of each other and their achievement depends on their own 
performance in relation to the set criteria. This competitive spirit is counterproductive to a 
caring environment leading to negative consequences such as failure, mistrust including 
hatred. 
140 
4.3.2.4 Good role modeling and mentoring 
Findings of this study revealed that role modeling and mentoring are the most crucial 
professional attributes that exemplify the caring and interaction practices the lecturers 
could display if a caring environment is to prevail in nursing education. These professional 
attributes of caring and interaction practices which emerged in this study, could mould the 
whole nursing students' educational experiences. 
According to the nursing students' expectation, 
"A caring role model and mentor are symbolised as a caring way of existence or life 
expressed as a blend of genuine acceptance, empathy, respect and warmth integrated 
with caring and interaction behaviours and attitudes'~ 
It appears that positive role modeling and mentoring should ideally take precedence in 
the environment for teaching and learning in nursing education. It is imperative to 
highlight that lecturers need to be positive role models and mentors to nursing students. 
If that is to be realised in nursing education, lecturers are expected to be positive role 
models in interacting, relating and communicating with one another and nursing 
students individually and collectively as well. They are also to have a positive reflective 
and resilient effect on nursing students' educational life. Such professional attributes 
portrayed in educational settings are likely to be emulated by nursing students who 
aspire to greater heights in their career. Lecturers are also expected to be mentors who 
guide, direct and coach nursing students for positive and healthy professional growth 
and development. 
141 
The research results also revealed that, 
"The most important task of a lecturer is to provide constant and unfailing guidance, 
direction, advice, supervision and monitoring to the nursing students at different stages of 
their study both in the classroom and in the clinical learning environment'~ 
The guidance and advice relate to direction, clarification, supervision, ·monitoring and also 
involves giving feedback on the academic performance and progress. In line with this 
observation, it was noted that such guidance and direction should be based on nursing 
students' ability and individual differences, since they are not the same, but are highly 
diverse in their attitudes, behaviours, reasoning and motivation. 
The nursing students reiterated that: 
" When a lecturer interacts, communicates and relates to an individual nursing student 
or a group of nursing students informally or formally, that lecturer should be a role 
model by demonstrating trust, understanding, encouragement, dependability and 
acceptance instead ofm istrust'. 
What is necessary or required then is that lecturers establish a caring environment by 
organising their educational activities in a way that allows for more time to interact, 
communicate and relate with an individual student or a group of students informally or 
formally whenever possible. Those moments and opportunities could be utilised for 
informal conversations, discussions, or even giving feedback during consultations. This 
environment could foster and instil enthusiasm in nursing students, build trust and 
acceptance of one another and encourage them to strive for the best performance in 
the teaching and learning process. 
142 
They further suggested that: 
"Lecturers should build rapport with nursing students to accommodate and know them 
better in order to identify any learning problem'. 
It appears that lecturers play a pivotal and instrumental role in creating a mutual caring 
environment in nursing education for nursing students to acquire knowledge, 
competences, attitudes and values required for professional nursing practice. Nursing 
students too are to create this mutual caring environment in nursing education but with 
the leadership from lecturers. Their personal attributes, essential for successful 
learning, could be evidenced through the exposition of competence, honesty, respect, 
compassion, acceptability and dependability. As a result, such attributes may be 
integrated and assimilated by the nursing students into their inner being. In turn the 
lecturer may be in a better position to know them better to identify any learning 
problem by any of these students. 
The research results also revealed that nursing students are of the opinion that, 
''Mentoring groups should be established to give support to new students." 
It can be inferred that the expectation reflected above suggests that the nursing 
students hold the view that the establishment of mentoring groups may benefit both 
the junior and senior students academically and personally. As the senior students 
provide support, guidance and encouragement to juniors during their daily activities, a 
continuous mutual caring relationship develops between them. As a result, senior 
students develop a sense of gratification and fulfillment including life-affirming 
competences that comprise enthusiasm, self-confidence, self-awareness, self-control, 
motivation, empathy, active listening and cooperation. Also through mentorship, 
friendships are established, and successes are shared amongst participants involved. 
143 
The nursing students held the view that, 
''Lecturers should lay foundation to instil into them the value ofa  life-long learning. // 
The expectation highlighted by nursing students affirms that students are expected to 
be self-directed and active participants in their education . The blend of learning 
experiences and caring relationships train them to exhibit caring, competent practice, 
professional conduct, life-long learning and service to communities. 
The nursing students expressed that, 
"Effective lecturers should have good knowledge and experience in their respective areas 
of specialisation, be accountable, dedicated to their responsibilities, be objective in their 
evaluations, and be competent and dependable facilitators of theory and practice// 
It can be inferred that the nursing students hold the view that they expect and envisage 
that the lecturers as facilitators of theory and practice should be helpful, 
knowledgeable, accountable, dedicated, competent, and dependable and be an 
objective evaluators. Furthermore, lecturers should also have expertise in their 
respective areas of specialisation. These professional attributes as expressed and set by 
nursing students reflect high standards and quality of service delivery for achieving 
learning outcomes both in nursing education and nursing practice. In the final analysis, 
a caring environment in the nursing education context may prevail. 
What also emerged is the expectation strongly shared by nursing students who 
suggested that: 
"Lecturers should act as or be like mothers and behave like parents'. 
The expectation as reflected above could have a pertinent influence on the lecturer-
144 
student interaction relationships. It can then be inferred that mothers have the same 
relationship to maternal practice as lecturers have to educational practice. Mothers are 
ruled by their respective practices, while lecturers are governed by their educational 
practices. However the style, competences, commitment and integrity with which both 
the mother and the lecturer engage in these practices vary greatly from person to 
person. 
4.3.2.5 Physical safety 
The university as a higher learning institution for teaching, research and community 
service is established to educate students for life-long and self-directed learning. It also 
provides education and training for professional practices. According to the findings of 
this study, it appears that the nursing students have identified areas requiring remedy. 
They overwhelmingly reported that: 
"The physical safety on the university campus should be promoted and that no student 
parties should be hosted in the campus because these lead to crime'. 
In support of the above highlighted research findings, the Constitution of South Africa 
Act No. 108 (1996:7 & 11), concurs that every person is equal before the law and has 
the right to equal protection including the right to an environment that is not harmful to 
his or her health or wellbeing. The proceeding discussions indicate that an academic 
institution of higher learning should be symbolised by the acquisition of knowledge, 
competences, values and attitudes and their integration and application within educational 
circles. It is the responsibility of such institutions to support and encourage students to be 
involved and actively participate in the academic activities for personal and professional 
growth and development ensuring these occur in a safe environment. 
145 
4.3.2.6 Adequately equipped classrooms 
The classroom is an environment where students can engage in discourse about what 
makes them feel welcome, comfortable and safe in the educational settings. 
The nursing students overwhelmingly held the view that: 
" There should be more better equipped and comfortable classrooms'~ 
The expectation as highlighted by nursing students affirmed that it is crucially vital that 
the institutions of higher education responsible for education and training of nursing 
students provide all the essential resources and equipment to accomplish teaching and 
learning outcomes. Furthermore, those who apply an environmental framework, instead 
of looking only to the student to adjust to the environment, should also look at the 
environment to see what should be altered to support healthy growth and development of 
students. 
4.3.2.7 Lecturers' availability and presence 
The nursing students propose that, 
"Lecturers should accompany them in the clinical learning environments for clinical 
teaching, guidance, supervision, monitoring and assistance. " 
It appears that the nursing students are of the opinion that lecturers should accompany 
them in the clinical learning environments for teaching purpose and also to offer 
guidance when necessary. The lecturers could also supervise and assist students for 
mastery of procedures thus acquiring clinical learning experiences. Students could also 
be monitored for developing and instilling confidence in them while incorpor?ting a 
range of processes, planning and implementing therapeutic interventions which are 
146 
evidence-based nursing accomplishments that contribute to competent nursing care. 
The nursing students may perform roles, and health care technologies under the 
supervision of the lecturers. When caring for the unique needs of diverse individuals in 
clinical learning environments, the nursing students will also be assisted by the lecturers 
during accompaniment. It is important to note that students should be able to monitor 
their own performance and approach their lecturers to seek advice on how to improve 
or maintain the current performance. The lecturers should work very closely with the 
students to inculcate the ability to self-evaluate and to engage in a genuine self 
feedback. The students should be able to actively participate in the process of learning 
and academic development. 
The nursing students were also of the opinion that, 
"Time for clinical nursing practice should be sufficient for them to acquire experiential 
learning. '' 
The conduct and the attitude of the nursing student can only be satisfactory if the 
accompaniment of the student is managed successfully. The student may thus build on 
previous classroom including clinical learning experiences and move from dependency 
to self-directed and independent practice. 
What also emerged from this study is that the nursing students felt that, 
"The presence and the availability of lecturers in the clinical learning environments may 
also depict that the lecturers care for them. " 
It can be inferred that the presence and availability of lecturers in the clinical learning 
environments may alleviate the nursing students' fears and concerns which usually 
occur when one is exposed to situations that demand critical thinking and p_roblem-
solving including major decisions making. The presence and the availability of lecturers 
147 
in the clinical learning environment should be demonstrated by the concern and love for 
students. The presence and the availability could also facilitate students' journey through 
academic life changes. The lecturers' presence may also instil faith in students' potential. 
Likewise a caring environment could be realised through the availability and presence of 
all lecturers and nursing students at that point in time. 
The nursing students were also of the opinion that, 
"Clinical hours should be reduced to prevent burn-out. " 
This expectation, as articulated by the nursing students, is not consistent with the 
requirements for the completion of a four year undergraduate nursing programme as 
stipulated by South African Nursing Council (SANC). However, as highlighted above, 
nursing students are placed in clinical settings in accordance with the South African 
Nursing Council's specifications for acquisition of clinical learning experiences. A four 
year undergraduate nursing programme is a professional programme which has been 
determined by, and approved by the South African Nursing Council (SANC) which is a 
governing statutory body under the Nursing Act No. SO of 1978 as amended. The SANC 
prescribes the theoretical and practical hours. For a nursing student to be competent in 
both the theory and practice, he or she has to comply with such requirements as 
stipulated by SANC. 
4.4 Synthesis 
The research findings represent what nursing students in this study perceived and 
recognised as an environment in nursing education during their interactions with lecturers 
as non-caring or caring, as well as what they expect to be a caring environment in nursing 
education. 
Based on the research findings, it could be inferred that professionalis!11 and 
professional relationships are to be cultivated and sustained in order for a caring 
148 
environment in nursing education to be evident. Therefore, a lecturer who is sensitive 
and caring should give personal support to nursing students, accept them for their 
mistakes, and correct them appropriately. If they have learning problems, these are to be 
attended to, in order to promote the nursing student's personal and academic 
development. 
From the preceding discussions, it appears that creating and sustaining a caring 
environment in nursing education requires a joint involvement and active participation of 
both the lecturers and nursing students in intellectual discourse which is commonly 
equated to mutual caring and interaction relationships between the lecturers and 
nursing students. The active involvement, guidance, and availability of lecturers who 
are polite, friendly, approachable, courteous and consultative on issues affecting 
nursing students were also regarded by nursing students as motivating and helpful to 
them to deal with diverse and challenging situations. Such lecturers also nurture them 
to view their studies as an investment in their future. They are encouraged to recognise 
their' strengths and limitations, accept one another's individual differences without any 
of their viewpoints and feelings being challenged. 
In the final analysis, it appears that an environment in nursing education that fosters 
ongoing, committed, healthy, harmonious and mutual interaction and caring relationships 
between the lecturers and students is ideal. Such relationships could be nurtured and 
sustained for the enhancement of academic advancement including the social, physical, 
spiritual, intellectual and emotional wellbeing of both the lecturer and the student. 
What emerged in this study is that communication is crucial in nursing education. The 
empirical evidence showed that poor communication in nursing education is one of the 
major problems which retard the academic progress of nursing students. However, 
learning in nursing education may be possible in an environment that encourages and 
nurtures positive communication such as attentive listening amongst the lectur~rs and 
students. 
149 
In view of the highlighted observations, it could be noted that the lecturers already know 
this but need to identify what is contributing to the communication problem. Many 
nursing texts address communication, so it is not that lecturers are unaware. For this 
situation not to prevail in nursing education, lecturers should attempt to interact and 
communicate caringly with nursing students. It entails taking the initiative in creating and 
sustaining communication, being authentic, and responding aptly to· one another. Good 
interpersonal communication also requires lecturers and students to establish a sense of 
mutuality 
It could be further noted that a mutual caring environment that fosters and sustains a 
healthy communication and mutual interaction relationships between lecturer-lecturer, 
lecturer-student and student-student should prevail in nursing education.That state of 
affairs permits problem-solving, sharing of ideas, decision-making, expression of feelings, 
goal accomplishment, team building and personal growth and development. 
In line with the nursing students' perceptions, it may be inferred that most frequently the 
importance of caring relationships is taken for granted or even disregarded within 
education circles. This situation has a potentially negative effect on personal and 
professional growth and development of participants involved, meaning both the lecturers 
and nursing students. A support group also allows for more personal empowerment of 
students, since members feel more integrity, are accountable, have personal power, 
can integrate their concerns and will finally be stronger for it. Furthermore group 
processes are dependent on communication, cooperation and shared responsibility. 
Communication competence, on the other hand, enhances the group experience and 
expertise. Members are active participants, collectively accountable for actions taken 
and their consequences. All combined entail the group destiny. Such is operational as 
members share the outcomes, consequences and repercussions of group activities. 
150 
In this study, trust was perceived as one of the attributes the lecturer could demonstrate 
when interacting with nursing students to establish a positive relationship. It also emerged 
that the success of a relationship should be based on mutual trust, shared responsibility 
and respect amongst lecturers and nursing students involved in the relationship. 
Cultivating and maintaining mutual caring relationships between the lecturers and 
nursing students, is crucial in the nursing educational settings for nursing students to 
reach their educational goals. For that reason, such attributes of a successful relationship 
to be realised in nursing education, a caring environment should be imperative. In this 
regard, the nursing students hold a strong view that students and lecturers should spend 
more time together for social interaction, bonding and building trust with each other. 
The research results also revealed that mutual trust and caring relationships among 
lecturers and nursing students should be perceived as the central attribute of the 
teaching and learning process as well as a key to personal and professional growth and 
development. However, most frequently, such attributes are either taken for granted or 
disregarded. It is therefore imperative that mutual trust between lecturers and nursing 
students be built and good relationships be fostered amongst them. Mutual trust should 
also be a component of the commitment to the cultivation and sustenance of a caring 
environment in nursing education. As a result, both lecturers and nursing students 
engaged in the teaching and learning process may have opportunities for personal and 
professional growth and development, including self-actualisation 
It appears that lecturers should play a pivotal and instrumental role in creating a mutual 
caring environment in nursing education for nursing students to acquire knowledge, 
competences, attitudes and values required for professional nursing practice. Nursing 
students too are to create this mutual caring environment in nursing education 
curriculum but with the leadership from lecturers. Their personal attributes, essential for 
successful learning, could be evidenced through the exposition of competence, honesty, 
respect, compassion, acceptability and dependability. As a result, such attribut~s may 
be integrated and assimilated by the nursing students into their inner being. 
151 
Lecturers are to be engaged in caring relationships with students in order to promote 
personal growth and professional development. Each lecturer brings a unique 
personality, specialised education, and practical experiences to the educational 
environment. Lecturers also role-model professional behavior and attitudes, and work in 
partnership with other professionals, students, and others to promote caring and 
competent professional practice. They are also responsible for the constant 
development and implementation of a nursing education curriculum that meets the 
needs of diverse students. The lecturer cultivates and nurtures good lecturer-student 
relationships exemplified by profound respect for students as unique human beings with 
biological, psychological, social and spiritual needs, and the right to dignity, worth and 
autonomy. In addition, the lecturer is to be enthusiastic, non-judgemental, humorous, 
cooperative, patient, and with confidence in self and students and readiness to admit 
errors and limitations. 
From the preceding discussions, it may be inferred that each lecturer has a specific 
teaching role to observe and honour. This role is based on knowledge, experience and 
expertise attained through professional education. As such, lecturers are obliged 
according to their educational practice to assist, direct, guide, teach, coach students 
individually or collectively to acquire knowledge, competences, attitudes and values 
fundamental to professional nursing practice. For such to be apparent in nursing 
education, a caring environment is a key feature of the teaching and learning process. 
The lecturer's educational practice should be characterizsed by dedication, commitment, 
objectivity, trustworthiness, trust, and competence, including the acknowledgement and 
appreciation of each nursing student. 
The preceding discussions indicate that an academic institution of higher learning should 
be symbolised by the acquisition of knowledge, competences, values and attitudes and 
their integration and application within educational circles. It is the responsibility of such 
institutions to support and encourage students to be involved and actively partic~pate in 
the academic activities for personal and professional growth and development ensuring 
152 
these occur in a safe environment. 
It could be further noted that a mutual caring environment that fosters and sustains a 
healthy communication . and mutual interaction relationships between lecturer-lecturer, 
lecturer-student and student-student should prevail in nursing education . Consequently, 
that state of affair permits problem-solving, sharing of ideas, decision-making, expression 
of feelings, goal accomplishment, team building and personal growth and development. 
153 
CHAPTER FIVE 
SUMMARY, CONCLUSION AND RECOMMENDATIONS 
.. 
5.1 Introduction 
This chapter highlights the landmark contributions of this study. It portrays how the 
underpinning research questions, purpose and objectives based on these research 
questions were addressed. Thereafter, consideration is given to summary and conclusion. 
Further research to be done is presented. This study is an important contribution as it 
provides literature that is missing in the existing research and literature nationally and 
internationally. It is also appropriate at this stage to consider the impact the guidelines for 
a caring environment in nursing education would exert on lecturer-student interaction. 
These guidelines may also assist in understanding the realities and potential challenges 
these nursing students encounter thus raising the levels of awareness to their needs. 
Finally, recommendations regarding the guidelines for a caring environment in nursing 
education were formulated and are presented in the format of standards and criteria with 
which the lecturers are to comply. 
5.2 Summary 
This section summarises the study's findings. Out of the nursing students' perceptions and 
expectations elicited, explored and described, it should be noted that the perceptions were 
that the environment in nursing education was less or non-caring than the expectations 
expressed. Nursing students highlighted numerous details of their nursing educational 
experiences during their interactions with their lecturers. These interactions became the 
focal point for expressing their perceptions and expectations regarding a caring 
environment in nursing education. This environment symbolised the relationship between 
the students and the lecturers, whether positive or negative. Thus the relationships were 
central to articulating their experiences regarding an environment in nursing education. 
154 
What emerged in this study is that nursing students felt that they are not actively 
involved to participate in decision-making pertaining to academic issues. It implies that 
chief decisions are taken for them which might not be appealing. In line with this 
observation, Darling-Hammond and Bransford (2005:117) report that countless problems 
encountered by students are actually the consequence of the educational environments 
not being conducive for their academic development. In reality, students require 
intellectual challenges, opportunities to express ideas, to be involved and participate in 
decision making process, caring relationships, and affirmation in developing competence 
and identity. This viewpoint also concurs with Starnes (2006:3) who asserts that lecturers 
should persistently endeavour to intensify students' involvement and participation in 
decisions affecting them. 
The empirical evidence also revealed that poor communication in nursing education is one 
of the major problems which may have a negative effect on the personal, academic and 
professional growth and development of nursing students. The findings revealed that 
lecturers hardly listen to nursing students' complaints. However, learning in nursing 
education may be possible in an environment that encourages and nurtures positive 
communication such as attentive listening amongst the lecturers and students. This 
perspective is consistent with Potter and Perry's (2001:107) observation that attentive 
listening is one of the most effective therapeutic communication competences which 
require complete attention and interest. Through active listening as pointed out by Beck 
(2004:9) an individual is assisted to comprehend what others are saying by giving them 
full attention, clarifying the meaning of their message by communicating what is 
understood, then expressing own perceptions and ideas. 
The research findings further revealed that a successful teaching-learning process is 
exclusively dependent on the lecturer's effective listening competence, empathetic 
understanding, helping and caring conduct and attitudes. These attributes may also be 
copied by nursing students as they aspire for greater heights in their career paths. In 
155 
support, Mellish, Brink and Paton (2001:72), illustrate that teaching demands an 
enormous amount of caring for others and giving of oneself. In helping and caring 
relationships, a lecturer listens attentively and displays empathetic understanding. In 
addition, the nursing students proposed that each lecturer should be trained in 
interpersonal relationship skills to empower students. The view concurs with Van der 
Colff's (2001:183) report that an open communication in nursing education should be 
promoted, implying an accommodating atmosphere in which nursing students can 
approach the lecturer without fear. The lecturers are to listen with empathy, show 
understanding and facilitate sharing of ideas and feelings. Van der Colff (2001: 189) 
further recommends that a course on effective interpersonal relationship should be 
offered to lecturers to improve their listening and communication competence. Since 
communication competence as articulated by Beck (2004:9) boosts group experiences and 
expertise. 
The research findings also revealed that when a lecturer interacts, communicates and 
relates to nursing students or a group of nursing students should demonstrate trust, 
understanding, encouragement, dependability and acceptance instead of mistrust. 
Furthermore, the lecturers should build rapport with nursing students to accommodate 
and know them better in order to identify any learning problem. The findings concur 
with Van der Colff's (2001: 185) report that relationships should be established, based 
on trust and understanding between lecturers and students. Furthermore, mutual 
respect and mutual acceptance of each other should also be considered. The way the 
lecturer perceives a student as a unique person, leads to a relationship built on trust 
and acceptance. The relationship of trust and acceptance is further strengthened by the 
lecturer's knowledge and expertise by which a feeling of security is given to the 
students. Jacquez-Gutierrez (2004:6) also hold the view that students gain knowledge 
from their relationships with lecturers and develop expectations from such relationships. 
Similarly, the lecturer's enthusiasm and high expectations of students can make a 
difference. 
156 
It appears that lecturers should play a pivotal and instrumental role in creating a mutual 
caring environment in nursing education for nursing students to acquire knowledge, 
competences, attitudes and values required for professional nursing practice. Nursing 
students too are to create this mutual caring environment in nursing education but with 
the leadership from lecturers. Their personal attributes, essential for successful 
learning, could be evidenced through the exposition of competence, honesty, respect, 
compassion, acceptability and dependability. As a result, such attributes may be 
integrated and assimilated by the nursing students into their inner being. A'  positive role 
modeling and mentoring should ideally take precedence in the environment in nursing 
education. Lecturers should be positive role models and mentors to nursing students 
when interacting, relating and communicating with one another and nursing st1Jdents 
individually and collectively as well. The findings concur with Noddings (2002: 283) who 
asserts that the lecturers should be role models who symbolise caring traits of 
commitment, trust and competence and endeavours these as becoming a benchmark in 
the educational settings. As a result, ~tudents will be empowered to harmoniously display 
caring behaviours and attitudes in any setting they are exposed to. In support Jacques-
Gutierrez (2004: 1) indicates that lecturers as meaningful role models have an intensive 
reflective influence on students' lives. 
5.3 Conclusion 
Chapter Four discussed the research results which were strengthened by quotations 
from participants. As a result the conclusion is made in this chapter. The chapter 
highlighted the landmark contributions made to the scientific body of knowledge by 
providing the missing literature in the existing research and literature nationally and 
internationa.lly. It demonstrated how the bedrock research questions, overall purpose 
and three objectives of the study were achieved. Reflection was also made on the 
summary pertaining to major research findings of the study. What emerged to a large 
extent is that a caring environment in nursing education at the North West University, 
Mafikeng Campus, is not adequately provided. Furthermore, role modelliQg and 
·157 
mentoring emerged as the most crucial professional attributes that may have an impact 
on the lecturer-student interaction. Further research to be done was presented and then 
followed recommendations that outlined in detail the guidelines for creating a caring 
environment in nursing education. These guidelines are presented in the format of twelve 
standards and criteria that the lecturers are to comply with. Each standard has a number 
of criteria which address the major findings of the research. 
5.4 Recommendations 
Consistent with the research outcomes, a number of recommendations are made 
concerning further research into nursing practice and nursing education. Guidelines for 
creating a caring environment in nursing education will be provided to assist and 
support the lecturers in facilitating a better future education at all levels for nursing 
students to be excellent caring nurse practitioners. 
5.4.1 Recommendations for further research 
The study, however, whilst presenting some answers in the quest for creating a caring 
environment in nursing education, also uncovered diverse areas where further research 
is crucial. Consistent with the outcomes of this research, recommendations for further 
research are as follows: 
► To address the limitation of this study, it will be meaningful to replicate similar 
studies in order to include nursing students from diverse cultural backgrounds 
and a wider population group for comparison; 
► The validation and implementation of guidelines for a caring environment in 
nursing education in a specific context to measure the outcomes of such and to 
determine whether the perceptions and expectations of students were fully 
addressed; 
► An in-depth analysis of the meaning and the significance of a caring environment 
on lecturer-student interaction in nursing education; 
158 
► An in-depth analysis of the lecturer-student interaction in the classroom setting. A 
longitudinal study to allow observations over an extended period; 
► Guidelines for a caring environment in nursing education should be refined; 
► Affective components such as the virtual or practical values of fairness, respect, • 
honesty, approachability and caring need to be explored and tested more in the 
education and training of lecturers since these are critical aspects of the students' 
perceptions and expectations regarding the creation of a caring environment in 
nursing education; 
► More needs to be done in teaching lecturers how to integrate or incorporate 
interaction and caring practices throughout the curriculum; 
► The lecturers' perspective regarding a caring environment in nursing education in 
order to compare with that of nursing students'; 
► The role of students in establishing a caring environment in nursing education; 
► Creating a caring environment during lecturer-student interaction in nursing 
education needs to be rethought and redefined so that teaching and learning 
becomes more authentic and less prescriptive by spending more time focusing on 
interaction and caring practices in nursing education; 
► An in-depth analysis of the meaning and significance of a caring environment on 
lecturer-student interaction in South Africa needs to be conducted in the classroom 
by utilising participant observations during lecturer-student interactions; 
► This study should be replicated in other disciplines at the university, nursing 
colleges and colleges of higher education; 
► A comparative study needs to be conducted in other institutions of higher learning 
to determine the perceptions and expectations of students who were exposed to 
this study and those who were not exposed; 
► Research needs to be conducted to establish whether, and if so, how the 
curriculum facilitates and fosters evidence-based caring practices; and 
► The initiation and sustenance of a culture for healthy interaction and caring 
relationships to determine whether the strategic planning and the current 
curriculum are successful in creating a culture for healthy interaction and caring 
159 
relationships amongst lecturers and students, and if not, which critical factors and 
processes should be applied to attain such a goal. 
5.4 Guidelines to create a caring environment in nursing education ,. 
From the background of the study, it emerged that a caring environment in nursing 
education is crucial with regards to achieving teaching and learning outcomes. In 
accomplishing a caring environment in nursing education, this research affirms that a 
broader, more appropriate, relevant, and clear understanding of what a caring 
environment means, the significance it has on the lecturer-student interaction, as well 
as where and how caring reveals itself is required. It is also imperative for all 
participants in educational settings including the health care setting, to create the type 
of an environment for caring that they require in those settings. The interaction style of 
both the lecturer and the student is very valuable and irreplaceable and it will be 
influenced by what each brings to the teaching-learning situation. 
To ensure that a caring environment is provided in nursing education at the North West 
University, Mafikeng campus, the following guidelines were formulated for a caring 
environment in nursing education. There are no such guidelines available in South 
Africa and even internationally for use in nursing education. The nursing students' 
perceptions and expectations elicited, explored and described guided the researcher to 
construct a framework with essential features to use in formulating guidelines for 
providing a caring environment in nursing education. The perceptions and expectations 
were grouped into three main themes namely relational, departmental and clinical as 
reflected in Figure 1. The findings may assist in identifying, addressing and aiding in the 
creation of a caring environment in the nursing education context to optimise 
meaningful learning experiences in the classroom and clinical learning areas the nursing 
students require. 
160 
Figure 1: Framework with essential features for guidelines for a caring 
environment 
Relationship 
Lecturer attitude 
Communication 
Support 
DEPARTMENTAL 
Lecturer 
The guidelines to create a caring environment in nursing education are presented in the 
format of twelve standards and criteria that the lecturers are to comply with. Each 
standard has a number of criteria which address the major findings of the research. These 
standards and criteria are highlighted and presented below. 
161 
NWu 
LIBRARY 
Standard 1 
Lecturers in nursing education will cultivate and sustain a healthy lecturer-student 
relation. 
Criteria 
Lecturers should: 
• Practice inclusion by assuming a dual perspective i.e. their own and that of their 
students; 
• Perceive the world from their students' perspective in order to reposition them from 
a less to a more satisfactory outlook; 
• Remain aware that the relationship or connection is unequal; 
• Not reject or cast-off what students perceive and experience. 
• Strive to liberate the students to pursue their own growth without being held back 
by their !lecturers' own personal and professional needs; and 
• Take cognisance that students are from diverse backgrounds and cultures but are 
unique human beings, each in need of a special relationship with his or her 
lecturer; 
• Involve students in the teaching-learning process and motivate them to learn; 
• Accept each student's individual differences; 
• Respect students' rights to challenge, question and express own viewpoints; 
• Foster independence in each student; 
• Display empathetic understanding; 
• Respond to students'experiences and feelings and 
• Be capable of communicating that understanding warmth to them. 
162 
Standard 2 
Lecturers will be role mcxfels in the teaching-learning process and encourage caring 
practices. 
Criteria 
In a classroom or teaching-learning setting dedicated to caring, lecturers should: 
• Strive that students have practice in caring and encourages them to assist and 
support one another and also to reflect on such practice; 
• Foster and instils enthusiasm in students to strive for the best performance in 
the teaching and learning process; 
• Be sensitive to the dynamics of the group; 
• Foster openness of self and trust in self and others; 
• Allow confrontation to facilitate a culture of learning and teaching; 
• Recognise and appreciates each student's uniqueness, experiences and insights; 
• Create and avail caring opportunities through engaging students in meaningful and 
ongoing dialogue between them and students; 
• Ensure that good caring practices are enhanced and sustained. Appreciation, 
recognition and acknowledgement of such should be confirmed; 
• Conduct themselves in an acceptable way; 
• Be collaborative and possess the necessary knowledge, competence, integrity, 
empathy, sympathy, neatness, personal bearing, and willingness to help 
wherever their knowledge and competence are required; 
• Be interested in and concerned with students' growth and development as 'carers' 
and 'cared-for'; 
• Display or demonstrate in their conduct and attitudes what it means to care; 
• Exemplify caring in their relationship with students; 
• Model caring behaviour and attitudes to faithfully and steadfastly cultivate and 
nurture self-affirmation in their students; 
• Be concerned with the students' academic achievement; 
• Be interested in the development of completely moral individuals; 
163 
• Model not only exclusively commendable and praiseworthy styles of intellectual 
activity but also model fascinating and appealing approaches of interacting with 
students. 
,. 
Standard 3 
Lecturers will establish a caring environment that fosters trust between the lecturer and 
the student. 
Criteria 
In establishing a trusting relationship with students, lecturers should: 
• Provide students with opportunities for growth and self-actualisation by spending 
more time with them to establish and sustain an ongoing, profound and mutual 
trust and intensified relationship; 
• Be trustworthy in their dealings with students which include assisting them without 
indecision when assistance is required; 
• Be honest and open to one another including building mutual trust with one 
another which cannot be overemphasised; 
• Be open to feedback about how they operate and also take time to critically 
examine their own values, beliefs, behaviour, attitudes, knowledge and 
competence; 
• Develop in students a helping-trusting and human caring relationship; 
• Strive to develop students who are acceptable, admirable, compassionate, loving, 
competent, respectable, trustworthy, and not obsessive but committed to caring; 
and 
• Feel ready, competent and committed to contribute to the growth and development 
of the student. 
164 
Standard 4 
Lecturers will create a caring environment that promotes good communication between 
lecturers and students. 
Criteria 
The empirical evidence showed that communication in nursing education is one of the 
major problems which retard the academic progress of students. For· that to be avoided, 
lecturers should: 
• Take cognizance that a successful teaching and learning process is exclusively 
dependent on the lecturer's good listening competences, empathetic understanding, 
helping and caring behaviours and attitudes; 
• Listen to students since this is one of the most effective therapeutic communication 
competences which require complete attention and interest; 
• Be committed to teaching in caring styles since teaching demands a huge amount or 
pledge of caring for others and giving of self; 
• Be offered training on interpersonal effectiveness to improve their listening and 
communication competences; 
• Be an active listener to comprehend what students are saying by giving them full 
attention, and clarifying the meaning of their message by communicating what is 
understood, so that their own perceptions and ideas could be expressed; 
• Communicate with students in a way that articulates responsiveness or compassion 
and respect for them as human beings, with knowledge and thoughtfulness for their 
explicit needs; 
• Take cognizance that through good communication which is a critical element of the 
healing process, students are empowered and enabled to understand themselves 
and make their own choices. 
165 
Standard 5 
Lecturers will be mentors to the students. 
Criteria 
Lecturers as mentors should: 
• Be a trusted guide, a confidant and a provider of sound counsel to students; 
• Assist students to develop a quest to build friendships, inspire hope, share successes 
including enriching a student's life in general as well as within the educational life 
circle; 
• Be good listeners, experienced, competent and available to assist, teach, guide, 
counsel and give feedback to students for personal and professional growth and 
development; 
• Establish a mentorship training programme that builds the self-esteem of students 
by initiating and encouraging senior students to assume the role as mentors to 
junior students. 
Standard 6 
Lecturers will create a caring environment for the fostering of mutual support. 
Criteria 
In achieving this standard, lecturers should: 
• Demonstrate a caring relationship when interacting with students; 
• Encourage students to share ideas, potentials and competence in response to one 
another's learning needs; 
• Recognise students' personal strengths and weaknesses; 
• Exhibit mutual respect, acceptance, mutual support and cooperation in establishing 
a caring environment; 
• Be meaningful role models with an intense reflective and resilient influence on 
students' lives; 
• Share personal knowledge and provide consistent reassurance implying support and 
166 
encouragement to assist students, both young and old, to deal with diverse and 
challenging situations; 
• Encourage and praise students so that they can enjoy studying and understand that 
achieving certain goals will be applicable and valid; 
• Provide support which varies from rendering technical or practical assistance to 
displaying right conduct and attitude; 
• Establish support groups amongst students to assist one another· in their educational 
activities to achieve their learning goals. 
Standard 7 
Lecturers will create an interacting and caring environment in the clinical learning 
environment during clinical accompaniment. 
Criteria 
During the accompaniment, lecturers should: 
• Support and encourage students in the clinical learning environments; 
• Guide, supervise, monitor and assist students; 
• Not criticise students in front of people nor humiliate them when corrected; 
• Develop students from dependency to independency by acknowledging mistakes as 
part of the learning processes; 
• Encourage students to enable them to try new or diverse approaches; 
• Not humiliate or undermine students when they fail in certain approaches; 
• Teach students how to apply the theory of nursing, so that an integration of 
theoretical knowledge and practical competence in the clinical learning environment 
becomes the art and science of nursing. 
167 
Standard 8 
Lecturers will create a caring environment in the classroom. 
Criteria 
Lecturers should: 
• Create a classroom in which all students feel safe, comfortable and supported, 
challenged and enabled to participate as fully as possible; 
• Deal directly with issues that impact on classroom management; 
• Be transparent in all academic issues affecting students; 
• Be considerate and thoughtful of and when addressing or talking to students since 
they are human beings with feelings, emotions and thoughts; 
• Be friendly, approachable, accommodative and supportive towards students as this 
will build strong and vibrant personal lecturer-student relationships which will 
enhance learning; 
• Practice inclusion of both lecturers and students and apply a collaborative problem-
solving process in which they identify issues, generate possible solutions, screen 
solutions for feasibility, choose a solution/s to implement and then evaluate it or 
them; 
• Let students know that each one of them is good at something and can assist 
others; 
• Encourage students to accept that each one deserves to and can gain from others' 
assistance and support; 
• Create a classroom learning environment for students to proudly claim or profess 
what they are good at and freely and safely solicit the assistance and support they 
require without fear or embarrassment or humiliation, seclusion or even 
victimisation; 
• Encourage students to interact freely with classmates without any form of 
discrimination against racial, cultural, gender and ethnic backgrounds including 
intellectual ability; 
• Reward students for work well done by praising them by word of mouth coupled 
168 
with a round of applause; 
• Establish and maintain open communication where students can approach him or 
her without any fear of intimidation, humiliation, embarrassment or victimisation; 
• Structure the classroom learning activities in such a way that each student is both a 
teacher and student; 
• Create an environment in the classroom where students can identify their strengths 
and competences and be willing to employ such appropriately when the need arises; 
• Foster an environment whereby everyone will feel free to approach one another; 
• Structure both informal and formal moments and opportunities for support, and 
mutual assistance amongst students at all levels of the education and training; 
• Promote friendships amongst students and lecturers; 
• Establish genuine partnerships amongst students and lecturers for students to 
actively participate in decision-making on how their learning experiences will happen 
and be assessed; and 
• Develop a sense of community and shared responsibility amongst students for their 
learning. 
Standard 9 
Lecturers will guide students on how to manage conflict constructively. 
Criteria 
Lecturers should: 
• Establish a cooperative context which starts with cooperative learning and extends 
into the cooperative educational environment; 
• Apply academic debates or discourses to teach students how to manage intellectual 
conflicts and to boost motivation to learn and achieve goals; 
• Establish a peacemaker programme where students learn how to negotiate 
constructive resolutions to their conflicts; and 
• Teach students how to mediate their peers' conflicts. 
169 
Standard 10 
Lecturers will assist students to learn and practice caring and interaction relationships. 
Criteria 
Lecturers should: 
• Teach students how to practice caring and interaction relationships that will ensure 
that future generations are prepared or educated and trained to· practice caring and 
interaction relationships effectively in educational settings, career, family, 
community, and in any other setting exposed to; 
• Prioritise their educational activities to encourage caring and interaction moments 
and opportunities and model caring behaviours and attitudes; 
• Establish a caring environment by organising the education and training activities in 
such a way that allow for more time to interact, communicate and relate with an 
individual student or a group of students whenever possible to foster and instil 
enthusiasm in them; 
• Provide greater depth of teaching in cultivating caring and interaction styles 
between themselves and students; 
• Present students with interaction and caring moments and opportunit ies including 
interpersonal skills for diverse and meaningful learning experiences. 
Standard 11 
Lecturers will foster teamwork and support in a classroom setting. 
Criteria 
Lecturers promote positive outcomes for students to attain higher levels of success in 
their educational pursuits. For this to be realised and high quality education and training 
to occur, lecturers should: 
• Arrange and organise the mainstream of learning pursuits cooperatively; 
• Minimise the utilisation of competitive and individualistic situations to enhance 
motivation for learning; 
170 
• Hold regular class meetings in which students discuss issues, plan improvements, 
decide on changes, and reflect on quality of classroom life including the clinical 
learning environment; 
• Provide explicit moments and opportunities for students to acknowledge and 
appreciate one another's perspective and to practice "perspective taking"; 
• Provide explicit moments and opportunities for students to develop positive caring 
relationships with each other in which there are high levels ofhonesty, openness, 
respect, trust and personal interaction; 
• Recurrently engage all students in academic debates or discourses to stimulate and 
develop their intellectual competence; 
• Teach all students how to engage in problem solving and decision-making regarding 
academic issues; 
• Utilise academic learning units to engage students in academic discourses to 
broaden their horizon of thinking; 
• Role play discussions or discourses which are open-ended rather than merely 
educational; 
• Provide opportunities for students to conduct themselves in ways that encourage 
and endorse values being taught; 
• Structure collaboration in the classroom and the clinical learning environment levels 
for students to care about one another and to be committed to one another's 
success; 
• Provide students with learning opportunities to use their teamwork competences to 
articulate their values in environments beyond the educational settings; and 
• Role model collaboration, transparency and expression of caring relationships when 
interacting and communicating with students and colleagues. 
171 
Standard 12 
Lecturers will promote an environment that boosts the studen~s sense of worth by 
being assertive. 
.. 
Criteria 
For assertiveness to be apparent in nursing education, lecturers should be role models 
in instil ling, cultivating and nurturing these behaviours and attitudes in their students to 
internalise and assimilate that into their inner being. Lecturers should teach and 
encourage students to: 
• Know who he or she is; 
• Know what he or she wants. That drive will compel and propel him or her to focus 
and become motivated to achieve great heights in life; 
• Know how to get what he or she wants. By knowing how to get what he or she 
desires leads to be enthusiastic and inquisitive so as to make an informed decision 
wisely; 
• Believe that he or she can get what he or she wants; 
• Be calm and self-controlled when confronted with an unforeseen circumstance; 
• Maintain comfortable and direct eye contact when faced with difficult situation; 
• Speak clearly with a firm tone when confronting whatever difficult situation; 
• Keep one's body posture straight when dealing with any difficult situation; 
• Use an appropriate gesture and facial expressions for emphasis by using the "I" 
statement to drive the point home; 
• Be sure one's timing is appropriate. Do not act on the spur of the moment without 
having considered the consequences of his or her conduct; 
• Not apologise since such will put him or her in a disadvantaged position; 
• Have a sense of pride and self worth to overcome fear and intimidation; 
• Stand up for himself or herself and let him or her be known to others; 
• Stand up for self and express one's genuine feelings in direct, honest and 
appropriate ways; 
• Know that when one humiliates or degrades others, this is also humiliating oneself 
172 
' NWU 
_LIBRARY 
and each person loses; 
• Share one's true reactions with others and allow them also to share theirs honestly. 
• Act assertively and inform others how their conduct affects one. 
5.5 Final reflection 
Caring is the essence of and superseding, unique and merging attribute in nursing. If 
this is true, the question arises:'What about the teaching-learning environment of the 
nursing students?" The answer lies in the challenge that is put to the lecturer to create 
an environment in nursing education for interacting and caring relationships for nursing 
students to explore and learn how to adapt, adjust, care, nurture, communicate, 
confide, co-operate, forgive, give, receive, share themselves, trust, understand, support 
and to be responsible and accountable (Beck, 2004:4). 
173 
REFERENCES 
Babbie, E. and Mouton, J. 2004. The practice of social research. Cape Town: Oxford 
University Press. 
Beck, S. 2004. Life as a whole: social relationships. [Online].Available at: 
http://www.san.beck.org[Lifel3-Social.html. Date accessed: 10/09/04. 
Bennett, B. L. 1999. Guidance and counselling for tertiary students. Durban: 
Butterworth. 
Bezuidenhout, M. 2002. Psychological wellbeing and meaning in life. Mafikeng. 
Unpublished MSc Thesis. University of North West. 
Bless, C., Higson-Smith, C. and Kagee, A. 2006. Fundamentals of social research 
methods an African perspective. Cape Town: Juta & Co. Ltd. 
Blumer, H. 1969. Symbolic interactionism perspective and method. Englewood Cliffs, 
New Jersey: Prentice-Hall, Inc. 
Booyens, S. W. 2001. Introduction to health services management Lansdowne: Juta & 
Co. Ltd. 
Brink, H. I. 2002. Fundamentals of research methodology for health care professionals. 
Cape Town: Juta & Co. Ltd. 
Brink, H. I., Van Der Walt, C. and Van Rensburg, G. 2006. Fundamentals of research 
methodology for health care professionals. Cape Town: Juta & Co. Ltd. 
174 
Brockopp, D. Y. and Hastings-Talsma, M.T. 2003. Fundamentals of nursing research. 
Boston: Jones and Barlett Publishers, Inc. 
Burns, N. and Grove, S. K. 2001. Understanding nursing research. Philadelphia: W. B. 
Saunders. 
Burns, N. and Grove, S. K. 2003. Understanding nursing research. . Philadelphia: W. B. 
Saunders. 
Chinn, P. L. and Kramer, M. K. 1995. Theory and nursing a systematic approach. 4th 
edition. St Louis: C. V. Mosby, Inc. 
Cohen, H. A. 1981. The nurse's quest for professional identity. Menlo Park, Calif.: 
Addison-Wesley. 
Council on Higher Education. 2002. Higher Education Quality Committee Programme 
accreditation framework. Draft document for comment. Pretoria: Government Printer. 
Creswell, J. W. 2003. Research design qualitative and quantitative approaches. 
Thousand Aoks, California: SAGE. 
Darling-Hammond, L. and Bransford, J. 2005. Preparing teachers for a changing world 
what teachers should learn and be able to do. San Franscisco, CA: Jossey-Bass. 
De Vos, A. S. (Ed}. 2001. Research at grass roots. 3rd impression. Pretoria: Van Schaik. 
De Vos, A. S., Strydom, H., Fouche, C. B. and Delport, C. S. L. 2005. Research at grass 
roots for the social sciences and human service professions. Pretoria: Van Schaik. 
175 
Doyle, T. A. 2005. Self concept. [Online]. Available at 
http://www.novaonline.nw.cc.va.us/eli/spd llOtd/interper/self/self.htm. Date accessed 
4/6/05 . 
Du Toit, C. M. 2003. Lifestyle adaptation of the patient after a coronary artery bypass. 
Unpublished Magister Technologiae Nursing. Technikon Pretoria. 
Falk-Rafael, A. R. 2001. Empowerment as a process of evolving consciousness: a model 
of empowered caring . Advances in Nursing Science, 24 (1):1-16, September. 
Frankel, B. L. & Rosenblum, S. 2004. Teaching a biopsychosocial approach on medical 
attending rounds. [Online]. Available at: 
http: //WWW .science? ob=ArticleU RL& udi = B6T70-C301 NJ 
~& coverDate=12%2F31 %2F1983& alid. Date accessed: 12/20/04. 
Fischer, M. 1997. Improving student learning skills. London: Josey Bass. 
Fischer, M., Boshoff. and Ehlers, V. J. 2001. Student nurses' needs for developing basic 
skills. Curationis, 24 (1):6673. 
Fransman, F. 2003. Teaching for effective study. South African Medical Journal,5 (2): 
198-203 . 
Freire, P. 1977. Pedagogy of the oppressed. New York: Penguin Books. 
Gibbs, A. 2007. Focus groups. [Online]. Available at: 
http://72.l4.235.l04/search?q=cache:BddspeUn4yEJ:sru.soc.surrey.ac.uk?SRUl9.html. 
Date accessed: 4/19/2007. 
176 
Hoover, J. 2002. The personal and professional impact of undertaking an educational 
module on human caring. Journal ofA dvanced Nursin~ 37 (1):79- 86. 
Huitt, W. 2005. Self-concept and self-esteem. Educational psychology interactive. 
Valdosta, GA: Valdosta State University. (Online) available 
http://chironvaldosta.edu/whuitt/col/regsys/self.html Date accessed 4/6/05 
Human Sciences Research Council. 1981. Provision of education in the Republic of South 
Africa: Report of the main committee of the HRSC investigation into education. HRSC: 
Pretoria. 
Isaacs, S. B. A. 2000. The national qualifications framework and quality assurance. 
Pretoria: A publication of SAQA. 
Jacquez-Gutierrez, J. 2004. Teaching "Self concept skills" through mentoring. [Online]. 
Available at: http://www.unm.edu/~abqteach/good go bad/01-08-06.html. Date 
accessed: 3/22/04. 
Johnson, R. T. & Johnson, D. W. 2002. An overview of cooperative learning. [Online]. 
Available at: http://www.clcrc.com/pages/overviewpaper.htm Date accessed: 1/22/02. 
Johnson, D. W. and Johnson, R. T. 2002. Cooperative learning and social 
interdependence theory. [Online]. Available at: 
http://www.clorc.com/pages/SIT.html. Date accessed: 1/24/02. 
Johnson, D. W. and Johnson, R. T. 2002. Promoting safe educational and community 
environments: The three Cs program. [Online] Available at: 
http://www.clorc.com/pages/promoting.htm. Date accessed: 1/24/02. 
177 
Johnson, D. W. and Johnson, R. T. 2002. Teaching students to be peacemakers: results 
of twelve years of research. [Online]. Available at: http://www.clorc.com/pages/peace-
meta.html. Date accessed: 1/22/02. 
.. 
Krefting, L. March, 1991. Rigor in qualitative research: the assessment of trustworthiness. 
777e American Journal of Occupational Therapy, 45 (3): 214-222. 
Leary, M. R. and Baumeister, R. F. 2000. The nature of self-esteem: sociometer theory. 
In Advances in Experimental Social Psychology. Vol 32, ed. Mark Zanna. San Diego: 
Academic Press, 1-62. 
Mahoney, C. 2005. Common qualitative methods. [Online]. Available at: 
http://www.ehr.nsf.gov/EHR/REC/pubs/NSF97-153/CHAP 3.htm. 
Date accessed: 12/14/05. 
Maurer, F. A. and Smith, C. M. 2005. Community/Public health nursing practice health for 
families and populations. St Louis: Elsevier Saunders. 
Mellish, J. M., Brink, H.I.L. and Paton, F. 2001. Teaching and learning the practice of 
nursing. Sandton: Heinemann. 
Meyers, A. B. and Sylvester, B. A. 2006. The role of qualitative research methods in 
evidenced-based practice. [Online]. Available at: 
http://www.nasponline.org/publications/cq/cq345research.aspx. 
Date accessed: 4/16/2007. 
Miles. M. B. and Huberman, A. M. 1994. An expanded sourcebook: Qualitative data 
analysis. 2nd Edition. Calif.: Sage Publications, Inc. 
178 
Mokwena, B. A. 1990. Professional socialization as a curriculum component for training 
of Black nursing students at the University of Bophuthatswana. Unpublished M Arts in 
Nursing Thesis - PU for CHE. Potchefstroom. 
Morse, J. M. and Field, P. A. 1998. Nursing research: the application of qualitative 
approaches. 2nd Edition. Cheltenham, UK: Nelson Thomes, Ltd. 
Mouton, J. 1998. Understanding social research. Pretoria: Van Schailk. 
Mulenga, D. 1994. In from the margins: challenges, possibilities and limitations of 
participatory research. Unpublished Paper delivered in December 1994 as part of the 
HRSC summer school in participatory research: the social science research and 
development forum. University of Transkei. Umtata. 
Nelms, T. P. January, 1991. Has the curriculum revolution revolutionized the definition of 
curriculum? Journal of nursing education_ 30 (1) :5-8. 
Nelson, D. L. 2005. Herbert Blumer's Symbolic Interactionism. [Online)]. Available at: 
http://www.colorado.edu/communication/meta-discourses/Papers/App 
Papers/Nelson.htm. Date accessed: 4/6/05. 
Noddings, N. 1988. An ethic of caring and its implications for instructional 
arrangements. American Journal of education, 96:215-230. 
Noddings, N. 1992. The challenge to care in schools: an alternative approach to 
education. New York: Teacher College Press. 
Noddings, N. 1995. Philosophy of Education. Boulder, CO: Westview Press, Inc. 
179 
Noddings, N. 2002. Starting at Home. Caring and social policy. Berkeley: University of 
California Press. 
Noddings, N. 2005. The challenge to care in schools. [Online]. Available at: 
httQ.://www.fcis.oise.utoronto.ca/~tborczon/class %23 3-noddings.htm. 
Date accessed: 15/04/05. 
Persky, G. J., Nelson, J. W., Watson, J. and Bent, K. 2001. Creating a profile of a nurse 
effective in caring. Nursing Administration Quarterly, 32 (1):15-20/ January/March. 
Polit, D. F. and Beck, C. T. 2004. Nursing research: Principles and methods. 7th Edition. 
London: Lippincott. 
Potter, P. A. and Perry, A. G. 2001. Fundamentals of nursing. 5th Edition. St Louis: 
Mosby. 
Pretorius, R. 2003. Quality enhancement in higher education in South Africa: why a 
paradigm shift is necessary. South African Journal of Higher Education/SATHO, 17 
(3): 129-135. 
Ramos, M. C. 1992. The nurse-patient relationship: themes and variations. Journal of 
Advanced Nursing, 17:496-506. 
Rogers, B. L. and Knafl, K. A. 1993. Concept development in nursing foundation~ 
technique~ and applications. Philadelphia: W. B. Saunders Company. 
Romyn, D. M. March, 2001. Disavowal of the behaviorist paradigm in nursing education: 
what makes it so difficult to unseated? Advances in Nursing Science/ 23 (3):1-10. 
180 
Ruddick, S. 1993. Maternal thinking in Pearsall, M 1993. Women and values readings in 
recent feminist philosophy. Belmont, California: Wadsworth. 
Ryan, M., Twibell, R., Brigham, C. and Bennett, P. December, 2000. Learning to care for 
clients in their world, not mine. Journal of Nursing Education. 39 (9) :401-408. 
Sandelowski, M. 1994. The use of quotes in qualitative research. Research in Nursing 
and Health, 17 (6):479-483. 
Sarantakos, S. 2005. Social research. New York: Palgrave MacMillan. 
Schaap, P. and Buys, M.A. 2005. One to one learning in developing student autqnomy. 
edited by Boud, D. Triptree Essex: Anchor. 
Smith, M. K. 2005. Nel Noddings, the ethics of care and education, the encyclopaedia of 
informal education. [Online]. Available at: www.infed.org/thinkers/noddings.htm. Date 
accessed: 28/01/ 05. 
South Africa. 1995. South African Qualifications Authority Act No. 58 of 1995. 
Government Gazette No.1521 (4 October). Pretoria: Government Printer. 
South Africa. 1996. A framework for transformation. Pretoria: National Commission on 
higher education, July, 1996. 
South Africa. 1996. Lifelong Learning Through A National Qualifications Framework. 
Report of the ministerial committee for development work on the NQF. Pretoria: National 
Department of Education, February, 1996. 
South Africa. 1996. South African Schools Act No. 86 of 1996. Pretoria: Government Print. 
181 
NWu 
LIBRAR) 
South Africa. 1996. Structures for the development of national policy regarding curriculum 
and related issues. Report of the consultative forum on curriculum. Pretoria: National 
Department of Education. February, 1996. 
South Africa. 1996. The Constitution of the Republic of South Africa Act No. 108 of 
1996. Pretoria: Government Printer. 
South Africa. 1997. Draft White Paper on Transforming Public Service Delivery. Pretoria: 
Government Printer. 
South Africa. Department of Education. 1997. Education White paper 3: A programme 
for transformation of higher education. Pretoria: Government Gazette. 
South Africa. 1997. Higher Education Act No. 101 of 1997. Pretoria: Government Printer. 
South Africa. Ministry of Education. 2001. Draft National Plan for Higher Education in 
South Africa. Pretoria: Government Printer, February, 2001. 
South Africa. 2001. Special Needs Education Building an Inclusive Education and 
Training System. Education White Paper 6. Pretoria: National Department of Education. 
South Africa. 2002. SAQA Recognition of prior learning the development, implementation 
and quality as RPL systems, programmes and services by ETQAs, as providers. Pretoria: 
Government Printer. 
South Africa. 2008. National qualifications Framework Bill 2008. Government Gazette 
No.30778 (15 February). Pretoria: Government Printer. 
182 
South African Nursing Council. 1985. Regulations relating to the approval of and the 
minimum requirements for the education and training of a nurse (General, Psychiatric 
and Community) and Midwife leading to registration . Regulation No. 425 and its 
directive as amended. Pretoria: Government Printer. 
South African Nursing Council. 1999a. Transformation of Nursing Education and Training 
for South Africa. Discussion document. 108. 
South African Nursing Council. 2005. Nursing Act No. 33 of 2005. Pretoria: Government 
Printer. 
South African Nursing Council. 2008. South African Council approved nursing education 
institutions. [Online]. Available at: http://www.sanc.co.za/neis.htm. Date accessed: 
7/28/2008. 
Starnes, B. A. 2006. The Foxfire approach to teaching and learning: John Dewey, 
experiential learning, and the core practices. ERIC Digest. [Online]. Available at: 
http://www.ericdigests.org/1999-3/foxfire.htm. Date accessed: 2006/09/22. 
Steele, J. H. 2002. Herding cats: A descriptive case study of a virtual language learning 
community. [Online]. Available at: 
httQJ./72.14235.104/search?q=cache:FSGthSNMvdsJ:netdial.cario_e.ne.t/~jhsteele/<;g_t~. 
Date accessed: 4/16/2007. 
Tanner, C. A. 1990. Caring as a value in nursing education. Nursing Outlook, 38(2) : 70 -
72, March/ April. 
The University of Indianapolis. The University of Indianapolis School of nursing 
graduate nursing program philosophy, mission and goals. [Online]. Available at: 
b.t.t.Q_;j/nursing .uindy.equ/msn/MSN missiQD.!.Q_c;tf. Date accessed: 5/13/2005. 
183 
Thomas, J. D., Finch, L. P., Schoenhofer, S. 0. and Green, A. 2004. The caring 
relationships created for nurse practitioners and the ones nursed: implications for 
practice. Advanced Practice Nursing Journal, 4 (4), 2004. 
The University of Indianapolis School of nursing graduate nursing program. Philosophy, 
mission and goals. [Online]. Available at:.h.ttp://nursing.yj_o.g_y_:.~d-~lm.s.n/MSNmi~sion.pdf. 
Date accessed: 5/13/05. 
Van Der Colff, J. J. 2001. Die verpleegkundedosent as motiveringsfasiliteerder van die 
verpleegkundestudent. Unpublished Magister Curationis - PU for CHE. 
Van Der Wal, D. M. ·1992, Caring in nursing education. Unpublished M A Cur Thesis. 
UNISA. 
Van Der Wal, D. M. 1996. Maintenance of caring concern. Unpublished D Litt et Phil 
Thesis. UNISA. 
Wade, G. H. and Kasper, N. May, 2006. Nursing students' perceptions of instructor 
caring: An instrument based on Watson's theory of transpersonal caring. Journal of 
Nursing Education, 45 (5):162-168. 
Western University of Health Sciences. Mission and philosophy of the graduate nursing 
progam. [Online]. Available at: 
http://www.westernu.edu/xp/edu/nursing/cogn-mission.xml. Date accessed: 
10/7/2010. 
Wikipedia. Guideline. [Online]. Available at: 
http://en.wikipedia.org/wiki/Guidelines. Date accessed: 5/14/2010. 
184 
Wong, P: 2005. Towards an integrative model of meaning-centered counselling and 
therapy. [Online]. Available at 
bttp~J/www.meaning.ca/artic;le.s.Lkt~.Qr.ative model meaning.html Date accessed on 
7/11/05. 
Wilson, H. S. 1989. Research in nursing. Melmo Park, California: Addison-Wesley 
Publishing Company. 
Young, A., Van Niekerk, C. F. and Mogotlane, S. 2004. Juta's manual of nursing. 
Lansdowne: Juta & Co. Ltd. 
185 
I Permission to conduct research Appendix A 
PO Box 658 
MAFIKENG 
2745 
09th February 2005 
Attention : 
The Vice Rector Academic, Prof S N Mashego 
North West University, Mafikeng Campus 
Dear Sir, 
PERMISSION TO CONDUCT RESEARCH 
I am a DEd student in the Department of Curriculum Development and Planning under the 
School of Postgraduate Studies in the Faculty of Education in the North West University, 
Mafikeng campus. I humbly request permission to undertake data collection for my 
research in premises of your institution through narrative sketches and focus group 
interview sessions. 
The research Title: "An investigation into the extent to which a caring 
environment in nursing education is provided at the North West University, 
Mafikeng Campus" 
Research Purpose: The study seeks to investigate whether or not nursing education, as 
presented at the North West University, Mafikeng campus, provides a caring environment. 
Objectives of the study: 
• To elicit the perceptions of students regarding a caring environment in nursing 
education. 
• To explore the expectations of students regarding a caring environment in nursing 
education. 
• To formulate guidelines against which a caring environment in nursing education 
can be judged. 
Your assistance will be highly appreciated 
Yours faithfully 
Researcher: Bothutu Angelina Mokwena 
186 
Invitation to participate in the research study Appendix B 
PO box 658 
MAFIKENG 
2745 
Dear Participant 
Research Title: An investigation into the extent to which a caring environment 
in nursing education is provided at the North West University, Mafikeng 
Campus 
I would like to invite you to participate in a research study. The title of the research study 
is as stated above. I am conducting the study as a doctoral student in the Department of 
Curriculum Development and Planning under the School of Postgraduate Studies in the 
Faculty of Education in the North West University, Mafikeng Campus. The request is for 
you to participate in this study, a qualitative study using exploratory and descriptive 
research strategies. The purpose is to investigate whether or not nursing education, as 
presented at the North West University, Mafikeng Campus, provides a caring environment. 
Your participation will involve writing a narrative sketch about your perceptions and 
expectations regarding a caring environment in nursing education from your personal 
point of view. The research findings with the concepts derived from the study will form the 
framework for guidelines formulation for a caring environment in nursing education. 
Your anonymity will be guaranteed including confidentiality since you need not write your 
name instead the codes will be used. 
Thank you for participating in the study. If you would be interested in further information, 
please feel free to contact me. My work telephone number is 018 389 2566. 
Yours faithfully 
Researcher: BA Mokwena (Miss) 
187 
Consent form Appendix C 
Research Title : 
... 
An investigation into the extent to which a caring environment in nursing 
education is provided at the North West University, Mafikeng Campus 
I have heard the purpose and objectives of the proposed study and was provided the 
opportunity to ask questions and given adequate time to rethink the. issue. The purpose 
and objectives of the study are sufficiently clear to me. I have not been pressured to 
participate in any way. 
I understand that participation in this study is completely voluntary and that I may 
withdraw from it at any time and without supplying reasons. This will have no influence on 
the regular attendance to classes neither will it influence the teaching and learning I 
receive from my lecturers. 
I know that this study has been approved by the Ethics Committee of the North West 
University, Mafikeng Campus. I am fully aware that the research findings will be used for 
scientific purposes and may be published. I agree to this, provided my privacy is 
guaranteed. 
I have read this consent form and I hereby give informed consent to participate in this 
study. 
Statement by the researcher: 
I provided verbal information regarding this study. 
I agree to answer any future questions concerning the study as best as I am able. 
I will adhere to the approved protocol. 
Name of researcher Signature Date Place 
Name of promoter Signature Date Place 
Participant's signature Date 
188 
I Protocol for the registration of the narrative sketches Appendix D I 
The following procedure is to be followed on receipt of the narrative sketches 
and focus group interview sessions data set: 
a) When the completed narrative sketches and focus group interview· session's data sets 
are received, a sequential number will be assigned to the form with the various 
participants as categories. The categories are as follows: 
Category Participants 
A 27 fourth year nursing students participated in the 
study conducted through narrative sketches 
B 40 fourth year nursing students participated in the 
study conducted through focus group interview 
sessions 
b) After the registration procedure, the narrative sketch and the verbatim transcribed 
focus group interview sessions data set will be dated, numbered according to 
predetermined sequential number, photocopied and stored to become the basis for 
data analysis. 
c) The photocopies will be submitted to the independent coder for data analysis coding . 
d) The process of data analysis open coding will be done (De Vos, 2001:272). 
189 
I Definitions for data gathering: narrative sketches Appendix E (1) I 
RESEARCH TITLE: 
An investigation into the extent to which a caring environment in nursing 
education is provided at the North West University, Mafikeng Campus 
DEFINmON OF TERMS: 
• A caring environment is a most extensive teaching and learning setting that 
cultivates and nurtures substantial and meaningful interaction and relationships 
among people and their growth at all levels. 
• Nursing education is a process whereby nursing students are guided, assisted and 
provided with means which empower them to learn the art and science of nursing 
so that they can apply such to the nursing care of people who need such care 
(Mellish, Brink & Paton, 2001:7). 
190 
I Data gathering: narrative sketches Appendix E (2) 
The following procedure is to be followed on receipt of a narrative sketch 
When the completed narrative sketch is received, a sequential number will be assigned to 
the form. Toe questions are as follows: 
For you personally: 
1. What are your perceptions regarding a caring environment in nursing education 
at the North West University, Mafikeng campus, in the North West Province? 
191 
2. What are your expectations regarding a caring environment in nursing education at 
the North West University, Mafikeng Campus, in the North West Province? 
,. 
192 
I Protocol for qualitative data analysis: Independent coder Appendix F 
Data analysis open coding process according to Creswell (2003: 192) will be as follows: 
• carefully read through all narrative sketches to acquaint with expedient direction of the 
analysis and to gain an idea of the entirety; 
• Randomly select one narrative sketch to identify commonalities and them~s and write 
them in the margin; 
• After completed some narrative sketches, compile a list of all identical themes. 
Identical themes should be clustered together, formed into columns and then arranged 
and organised into main themes, unique themes and leftovers; 
• Take a compiled list and consult the data. Abbreviate themes as codes and write them 
next to the appropriate sections of the text. Test this preliminary organising scheme 
to determine whether new categories and subcategories emerge; 
• Find the most descriptive wording for the categories and turn them into subcategories. 
Group together subcategories that relate to each other to indicate interrelationships; 
• Make a final decision on abbreviations for each category and subcategory and place 
them in alphabetical order; 
• Gather data material belonging to each category and subcategory in one area. Perform 
preliminary analysis; and 
• Recode the existing data when necessary. 
193 
I Confirmation that language editing was done Appendix G 
ti!, NORTH-WEST UNIVERSIT'I 
YUNISESITI YA BOKONE-BOPHIRIMA 
NOORDWES-UNIVERSITE!T 
MAFIKENG CAMPUS 
Private Bag X2046, Mmabatho 
South Africa, 2735 
ACADEMIC DEVELOPMENT CENTRE 
Senior Academic Development Advisor 
Tel : (018) 389-2381 
Fax: (01 8) 389-2430 
Web: http://www.nwu.ac .za 
E-mail : Livingstone.Makondo@nwu.ac .za 
Date: 23 June 2010 
TO WHOM IT MAY CONCERN 
RE: CONFIRMATION THAT LANGUAGE EDITING WAS DONE 
The above refers. 
This communication confirms that I have language edited the doctoral thesis "An investigation into the extent to 
which a caring environment in nursing education is provided at the North West University, Mafikeng 
Campus" for Bothutu Angelina Mokwena. 
Yours 
Makondo Livingstone (Dr) 
194