YNEDT-02698; No of Pages 5 Nurse Education Today xxx (2014) xxx–xxx

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Developing an understanding of research-based nursing pedagogy among clinical instructors: A qualitative study Nazik M.A. Zakari a,⁎,1, Hanadi Y. Hamadi b, Olfat Salem a a b

Nursing Administration and Education Department, College of Nursing, King Saud University, P.O. Box 642, Riyadh 11421, Saudi Arabia Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, United States

a r t i c l e

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Article history: Accepted 17 March 2014 Available online xxxx Keywords: Research-based teaching Clinical instructor Pedagogy Nursing teaching strategies Qualitative study

s u m m a r y Background: Effective instruction is imperative to the learning process of clinical nursing instructors. Faculty members are required to provide high-quality teaching and training by using new ways of teaching pedagogical methods to clinical instructors, which have transformed pedagogies from an exclusive clinical model to a holistic model. Purpose: The purpose of this study was to explore clinical instructors' use of planning, implementation, feedback loops, and reflection frameworks to apply research-based teaching and to examine the pedagogy used during field experience. Method: Data for the qualitative study were obtained from twenty purposefully sampled clinical teachers (n = 20) via lists of questioned instructional practices and discussions, semi-structured interviews, observational notes, field notes, and written reflections. Data were analyzed by using a triangulation method to ensure trustworthiness, credibility, and reliability. Findings: Three main themes emerged regarding the use of research-based teaching strategies: the need for learning about research-based pedagogy, support mechanisms to implement innovative teaching strategies, and transitioning from nursing student to nursing clinical instructors. Conclusion: It has been well documented that the nursing profession faces a serious shortage of nursing faculty, impacting the quality of clinical teaching. Developing clinical instructor programs to give students opportunities to select instructor pathways, focusing on knowledge promoting critical thinking and life-long professional development, is essential. Nursing colleges must collaborate by using a partnership model to achieve competency in planning, implementation, feedback loops, and reflection. Applying research-based clinical teaching requires the development of programs that integrate low-fidelity simulation and assisted instruction through the use of computers in Nursing Colleges. © 2014 Elsevier Ltd. All rights reserved.

Background Globally, nursing education has undergone a significant transformation whereby a humanities and holistic approach has replaced the traditional clinical model of teaching and training. At the college level, the goal of nursing programs is to provide students with both theoretical and practical education to ensure their competency when delivering health care services (Zakari, 2011). These college-level programs face challenges due to a worldwide shortage of nurses and especially qualified nursing instructors (Potempa et al., 2009). Therefore, there is a great need for national clinical nursing instructors who can effectively deliver dual approaches to future nursing students. ⁎ Corresponding author. E-mail addresses: [email protected] (N.M.A. Zakari), [email protected] (H.Y. Hamadi), [email protected] (O. Salem). 1 Tel.: +966 11805135; fax: +966 114693625.

In response to this challenge, many college of nursing strategic plans focused on the improvement of the academic and developmental services of nursing education (King Saud University, 2012). From this perspective, the responsibility of the nursing faculty encompasses three issues: teaching, research, and community service (Zakari, 2011). In addition, the nursing faculty members are required to provide highquality teaching and training of new clinical instructors and demonstrators. New graduate nurses who are employed as nursing demonstrators or clinical instructors need to transition from the role of student into the role of clinical instructors. In colleges of nursing, faculties are exploring new ways of teaching pedagogical methods to clinical instructors in order to facilitate the training of clinical nursing instructors. The term “pedagogy” is associated with teaching. According to Chinn (1989), pedagogy is the actions the teachers take in the learning environment, the materials they use, how they use them, and the attitudes they communicate (Chinn, 1989). Therefore, pedagogy includes both ways of thinking and behaviors in

http://dx.doi.org/10.1016/j.nedt.2014.03.011 0260-6917/© 2014 Elsevier Ltd. All rights reserved.

Please cite this article as: Zakari, N.M.A., et al., Developing an understanding of research-based nursing pedagogy among clinical instructors: A qualitative study, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.03.011

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education. Pedagogical approaches commonly blend learning and application. These approaches include participating in seminars, discussing and critiquing qualitative research reports, engaging in fieldwork activities, presenting findings to the class, and writing reports (Kawashima, 2005; Laframboise and Shea, 2009). Nursing faculty members and clinical instructors work collaboratively to illustrate and extend these pedagogies in order to reform their courses. Effective instruction is imperative to the learning process. In general, teachers experience conflict between what they learned in their courses and the real world of their teaching jobs (Clift and Brady, 2005). This is also true in the nursing field. The nursing faculties monitor new clinical instructors and facilitate their integration of theory and practice. Furthermore, faculty members work with instructors in the college to make connections among theory, research, and practice. Although clinical instructors work under faculty supervision, they have few opportunities to acquire the means to implement the research-based methods taught in their shared courses, with faculty members teaching the clinical portion of the course. Research Study Context Nursing education within a university setting has transformed through the implementation of different pedagogies from the exclusive clinical setting model to the holistic model. This study describes how clinical instructors use planning, implementation, feedback loops, and reflection frameworks to apply research-based teaching, and it examines effective pedagogy used during the field experience. Research Methods Design A qualitative interpretive and explanatory instrumental case study design was used. This design was used to gain a deeper understanding of the issue. This method was preferred due to the questions that were asked (Yin, 2009). Thus, the case selection was simple and involved subjects who were willing to participate. Sampling and Participants Demonstrators and clinical instructors in their first semester of teaching were assigned courses based on scheduling availability and were evaluated on their instructional performance strategies by a faculty mentor. According to the human resource policy and college of nursing requirements, teaching staff can be hired as demonstrators, for academic ladder, clinical instructors or nonacademic ladder. The demonstrators are nursing graduates who have bachelor's degrees with average Grade Point Averages (GPAs) of 3.75 and above out of 5.00, who are employed for the academic ladder, and who teach both theory and clinical nursing courses. Consequently, these demonstrators advance their education by earning master's and doctoral degrees in nursing with full scholarships. Conversely, clinical instructors are nursing graduates who have bachelor's degrees with average GPAs of 3.0 and above, who are employed for the clinical ladder, and who teach only clinical of nursing skills. The college policy allows for both types of instructors to practice clinical teaching under faculty supervision until they have advanced their education. In this study, twenty subjects agreed to participate (n = 20). Participants were sampled based on purposeful sampling of those who were attending the preparation and clinical teaching training workshop. The workshop was conducted for both demonstrators and clinical instructors. The aim of this workshop was to train and prepare participants to instruct and to familiarize them with selected methods of clinical teaching and instructing at a mastery level so that they can acquire competencies in teaching clinical sessions. Furthermore, participants who could convey the issue, attempt challenging teaching strategies, and

instruct small groups of nursing students in different clinical settings were invited to participate.

Setting and Procedures During the first week of the semester, both demonstrators and clinical instructors attended a 1-week preparation clinical teaching workshop. The workshop activities included an overview of clinical practice and bedside teaching that involved applying pedagogical approaches and using planning, implementation, feedback loops, and reflection frameworks to apply research-based teaching. The preparation includes guidelines for developing instructional plans and clinical courses and the ability to circulate feedback and suggestions with other faulty members. This preparation enabled the demonstrators and clinical instructors to identify instructional strategies. In addition, the research team inspects the study's feasibility and willingness of the participants to participate. Furthermore, the open-dialog approach encouraged them to reflect and ask what strategies could be performed in clinical teaching. They began their clinical teaching during the third week of the semester under faculty supervision and mentoring. Each participant attended 3 days per week for 15 weeks per semester, for a total of 45 days of clinical teaching. Five faculty mentors were assigned, two demonstrators and two clinical instructors. Each faculty mentor taught at least four nursing courses and was responsible for a weekly seminar connected to their clinical courses and conducted by their trainees. In the seminar, students reflected on their experiences and discussed different instructional strategies that were used. It was required of faculty during the seminar to complete observational notes with illustrations of questions and concerns that were articulated in discussions by trainees. In addition, each trainee was required to adapt at least two instructional strategies incorporating research-based teaching and using the planning, implementation, and feedback loop framework. A semi-structured interview question guide was developed to guide the interview process in a flexible manner. In-depth interviewing of ten demonstrators and ten clinical instructors was conducted at a private meeting room in a nursing college. The question “How and what do you do to manage your teaching strategies for clinical teaching?” was used to start the conversation. Facilitator techniques such as “Could you please describe that further?” and “Do you mean…” were used to elicit more detailed information. The guide questions allowed the research team to focus on the purpose of the study and encouraged participants to express detailed information. Interviews were conducted in the interviewees' native language and averaged 45 min in length. In the beginning, the participants did not feel comfortable enough to record the interview. Therefore, interviewing was completed in writing. The principal investigator of the research team conducted the interview rather than the course faculty, in an effort to help the participants speak openly regarding their complaints, recommendations, and accomplishments. Participants were asked to keep field notes and two sets of written reflections.

Methods to Assure Rigor In a qualitative study, the trustworthiness of data sources and analyses must be ensured (Leech and Onwuegbuzie, 2007). To assure rigor in this study, steps recommended by Lincoln and Guba (1985) were tracked. Credibility of the data collected was fulfilled by memberchecking and peer debriefing (Lincoln and Guba, 1985). Detailed descriptions from the interviews and reflection probes were used to secure transferability. To provide transparency, the procedures were described in detail, including interview questions and reflections. Furthermore, dependability and conformability were guaranteed by using Polit's (2008) inter-coder approach.

Please cite this article as: Zakari, N.M.A., et al., Developing an understanding of research-based nursing pedagogy among clinical instructors: A qualitative study, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.03.011

N.M.A. Zakari et al. / Nurse Education Today xxx (2014) xxx–xxx

Data Analysis The case study approach presents extensive flexibility in terms of which data are collected and how. Data sources included lists of questioned instructional practices and discussions conducted during the workshop, semi-structured interviews, observational notes, field notes, and two sets of written reflections on each of the teaching strategies delivered to the class. Method and analysis occur simultaneously in case study research. The interviews were transcribed verbatim. Quotations from the verbatim transcripts of interviews and reflection papers were used. The data were analyzed by using open coding, and a triangulation method was used to compare data across all data sources collected. Member-checking, field notes, and observational notes processing were implemented to ensure the trustworthiness of the findings. All transcripts were repeatedly read to obtain an overall sense of the data. Meaningful statements and phrases were highlighted to find the thematic phrases and themes within the transcripts. Interpretations emerged from an understanding of the whole in relation to its parts (Mackey, 2005). Then, themes and interpretations were checked for fitness against the original transcripts. Because interviews were conducted in the interviewees' native language, the extracted thematic phrases and themes were translated back into English. Then, those translations were double-checked by a bilingual research assistant. After this, the comprehensibility and readability of the translations were evaluated. Any questions were clarified and discussed until agreement was reached. Each participant was provided with transcripts of her interview to review for accuracy and to add any additional information as a member check (Creswell, 2009). By using multiple data sources in this study, triangulation was achieved. Triangulating the data gave richness in denotation, thus identifying themes, confirming interpretations, and clarifying meaning. Triangulation is a common strategy for ensuring trustworthiness to support the study finding (Hays and Singh, 2012). Constant comparison methods were conducted to analyze the data. This process was initiated by reading through each set of data, aligning the data into smaller elements, and making descriptive codes. Codes were categorized based on their similarities. Multiple data sources and expert reviewers were used to ensure the consistency of the study's analysis and findings. Ethical Consideration Approval to conduct this study was granted by the ethics committee of the college of nursing, and the dean of the college approved the teaching preparation workshop. The process of the study was described and subjects were asked to give written consent for interviews and participation in the study. Participants were free to complete the workshop and the study. Confidentiality and the rights of the participants were maintained. The initials of pseudonyms were used. No personal information was identified or shared. Research Findings From the series of open-ended questions designed to elicit how clinical instructors use research-based teaching strategies, participant responses were categorized into three main themes: the need for learning about research-based pedagogy, support mechanisms to implement innovative teaching strategies, and transitioning from nursing student to nursing clinical instructors. The Need for Learning About Research-based Pedagogy The participants conveyed their necessity for learning about teaching strategies. Powerful lessons were learned in relation to their teaching experience at the clinical sites. The need for learning can be achieved through providing more modeling from course faculty and other expert clinical instructors.

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“Technical proficiency or a high GPA alone does not guarantee a novice like me at the clinical site to use research-based teaching strategies effectively with confidence. I need more than just one week of teaching preparation.” Another participant conveyed how she was a little more lost and in doubt. “In the clinical setting, I am wondering how to best enhance my students' clinical learning experience. In college, I learned how to perform the most basic nursing skills, but I did not learn how to teach and supervise students in terms of clinical skills. Although I learned the best clinical teaching methods theoretically during six levels of teaching and learning courses in the college, such as how to asset the learner's need and how to implement my lesson plan and use the appropriate evaluation methods, I still do not have sufficient experience to be a clinical instructor.” Participants explained the need to learn the “how” of a strategy of research-based pedagogy. They learn “what” and “why,” but they need to actually try it out to understand how it works in real life. One participant declared that “There are strategies and practices that I know about because I have learned them, but I am not comfortable with putting them into practice… I know about it, but I am not quite sure how it will work in practicum situations. … I know I have it and it sounds great, but how do I make it work with students at a clinical site …In fact, I need to learn how to apply research-based pedagogy.” Support Mechanisms to Implement Innovative Teaching Strategies Although the participants agreed upon the support they received, they inquired about the type of support and how effective it is to their training as a clinical instructor. One participant clearly said, “In the clinical setting, my supervisor supported me and told me again and again to search for new teaching strategies and to implement them, to give myself space to adapt any method that has been approved that is suitable and to implement that research and that in order to indicate its effectiveness, I will have to judge whether these strategies help my students improve their skill test scores and become more motivated and better able to grasp the materials taught. But I still ask myself is this correct support mechanism to implement innovative teaching strategies?” The difficulties that the participants faced were further expressed as follows: “It is difficult I push myself to the edge to set up my mindset on many occasions and to shift my preparation from giving quality care to the patients as student to providing quality education to nursing students who will one day provide patient care; this is not easy for me as a trainee,” Moreover, the participants conveyed that the faculty shortage has impacted the quality of the support mechanism to implement innovative teaching strategies, as stated by this participant: “For my course, which is maternity care, I searched for the best practice method for teaching the clinical part. I've got my faculty mentor. One time she gave me an evaluation checklist to evaluate the most appropriate teaching methods for our students. But I was not always successful for many reasons. Of course, one of these factors is the scarcity of resource, either human or financial…um, I mean, most of our faculty are old and not familiar with the different research-based teaching strategies, especially using technology, online teaching, virtual classrooms, high-validity simulation strategies…I think the global faculty shortage is the reason, but we should have the best nursing support mechanism to implement innovative teaching strategies.”

Please cite this article as: Zakari, N.M.A., et al., Developing an understanding of research-based nursing pedagogy among clinical instructors: A qualitative study, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.03.011

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Transitioning from Nursing Student to Nursing Clinical Instructor This is the final theme and it illustrated how grateful students were for the opportunity to be clinical instructors in the academic ladder as well as in the administrative ladder. The transition from student-received teaching to provider teaching was not what the students had expected. These students experienced different degrees of stress and anxiety. They are looking for more training and preparation to boost their self-confidence, promote collaboration, and help them to manage and control clinical teaching situations. One participant declared that “When I got the news that my application had been accepted for the college and that I would work as a demonstrator and no longer be a college student, I was so happy for this great opportunity … but at the same time, I was panicked because of the college expectation. I know the role I must fulfil in clinical teaching under faculty supervision and I should be at the clinical site with students… I wish that the college had elective courses to teach us how to become demonstrators or clinical instructors.” Another participant cited that “Well, my age is near my students' ages, so I am motivated jointly to design instructional activities requiring our collaboration, but the time, classroom, materials and technology hinder the accomplishment of this collaboration”. However, the following participant added the concept of sharing among colleagues in the transition process, saying “When I found that I would transition from student to clinical instructor, it was a shock to me. My confidence in my faculty allowed me to speak freely about my feeling and how to control the situation. I wanted my colleagues to know and I didn't want to hide any information. This reduced my nervousness and boosted my confidence.” Furthermore, the clinical instructors acknowledged some reluctance to practice effective research-based teaching strategies and to apply innovative teaching strategies. These reasons were categorized into four major categories. The first related to faculty performance—they still teach by using traditional methods and few used blended teaching in either the theory or in the clinical teaching. Second, the resources available at some clinical sites were limited. The participants declared that some clinical sites hinder the application of clinical education, especially if the teaching methods are blended with technology. Third, the nursing curriculum was not specifically developed for preparing for the role of clinical instructor. The participants stated that only one course in the curriculum taught principles of teaching and learning in nursing. This course introduces the students to the nurse's role as an educator by emphasizing principles of teaching and learning. The course gives special attention to the elevation of health awareness of clients as well as changing their attitudes and health behaviors within the context of their cultural background. Additionally, learning theories, teaching strategies, and evaluation methods are explored (King Saud University, 2010). Finally, a clinical instructor commitment was the major reason. The participants recognized that some clinical instructors showed a lack of commitment toward their duties. Absenteeism and conflict were two factors that contributed to the lack of commitment. For instance, absenteeism interrupted the implementation of clinical teaching strategies and resulted in conflict that prevented the application of new teaching strategies. Discussion The aim of this study was to describe how clinical instructors use planning, implementation, feedback loops, and reflection frameworks to apply research-based teaching and to examine effective pedagogy used during the field experience. Central themes emerged from the

study, including 1) the need for learning about research-based pedagogy, 2) support mechanisms to implement innovative teaching strategies, and 3) transitioning from nursing students to nursing clinical instructors. Teaching clinical nursing is an educational atmosphere for nursing students. Clinical instructors are obligated to provide students with knowledge and with opportunities to practice skills and to demonstrate professional attitudes that are consistent with professional nursing practice. They must continue to provide feedback regarding their students' performance. The requirements for teaching clinical experience included planning for clinical assignments depending on the clinical setting; applying pre-conferences to establish the priorities of clinical experience; conducting observational experiences to provide guidance, answers, and support throughout the clinical experience; and creating a successful post-conference to analyze and synthesize the events of the clinical experience (American Association of Colleges of Nursing, 2003; Andrews and Roberts, 2003; Lewin, 2007). In the college of nursing, the faculties encourage the exploration of uses of technology to deliver effective clinical research-based teaching during their supervision and mentoring. This will enhance demonstrators' and clinical instructors' performance. Clinical research-based teaching is a way to increase the capacity of faculties to teach more novice clinical instructors. The participants expressed fear and anxiety regarding failure in attempting to apply any new methods. Conversely, they received different levels of support in learning and applying new teaching strategies. The clinical instructors indicated that the nursing faculties were reluctant to apply a new strategy because they still used the traditional strategies in teaching. Moreover, a lack of opportunity to apply what had been taught in the preparation workshop increased conflict and elevated problems. Irby and Bowen explained that the time of clinical learning and teaching structure and function have significant changes in the clinical setting. Clinical instructors are under increasing pressure to engage in scholarly activities. Inexperienced clinical instructors' assignments are not without challenges (Irby and Bowen, 2004). The participants of the current study stated that support mechanisms to implement innovative teaching strategies are required to improve the quality of clinical teaching. The implementation of innovative teaching strategies would bring challenges to reform the nursing curriculum. A phenomenological study was conducted to explain the experience of the nursing faculty undergoing implementation of an innovative clinical immersion-nursing curriculum. The study articulated that the structure and philosophy of the program presented numerous challenges, such as integrated learning activities and simulation development (Paulson, 2011). A framework is considered necessary to design, implement, and evaluate innovative clinical teaching strategies. This framework must include best practices, clinical teaching factors, and desirable outcomes (Jeffries, 2005). The current study highlighted participants' concerns toward the issues and provided guidelines to promote and enhance participants' clinical teaching experiences. Consistent with these concerns, clinical instructors obtained lowest mean scores for their clinical teaching experiences in a study conducted to assess nursing students' perceptions regarding their clinical instructors (Al-Kamis et al., 2013). This study reported that clinical instructors described transitioning processes that influenced their ability to apply different research-based teaching strategies. The validation process with faculty improved the transmission process and its ability to identify the appropriate education resources and materials. Casey et al. (2004) confirmed that their study participants experienced stress when transitioning from a familiar educational environment into the workforce. Furthermore, their results articulated that the participants did not feel skilled, comfortable, or confident. They also showed the participants' need for the provision of extended support programs to facilitate their successful entry into the workforce.

Please cite this article as: Zakari, N.M.A., et al., Developing an understanding of research-based nursing pedagogy among clinical instructors: A qualitative study, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.03.011

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Conclusion and Recommendations Overall, demonstrators and clinical instructors exercised some planning, implementation, feedback loops, and reflection frameworks to applied research-based teaching during their clinical teaching experience. However, novices in classroom management strategies did not develop insightful self-awareness. This showed that there was a need for participants to gain self-confidence, to learn how to apply different teaching strategies, and to master the various stages involved in the development and implementation of class plans. In addition, demonstrators and clinical instructors addressed core concepts that are transferable from one clinical teaching strategy to another. Teaching clinical strategies was determined by the learning goals rather than previous experience and its outcomes. The participants of the study experienced anxiety as a result of feeling incompetent and lacking professional experience in teaching clinical nursing skills and knowledge to implement various teaching strategies in the clinical setting. Trans-disciplinary or inter-professional models of clinical teaching are important for health professionals to educate nurses, physicians, pharmacists, and other health professionals depending on the type of clinical needs addressed. This innovative model may facilitate a better understanding of what each discipline contributes to the overall plan of health improvement and may promote confidence and reduce anxiety (Glasgow et al., 2010). There is a need to create trans-disciplinary simulation centers across the university, where demonstrators and clinical instructors from the health disciplines, nursing, health professions, and medicine will be exposed to the complexities of teamwork within the clinical setting and have the opportunity to enhance their performance. In response to the concerns of the participants, establishing strategies for collaboration between practice and education is recommended. The short-term solutions cannot correct the underlying problems affecting clinical teaching. The college of nursing must present collaboration in a partnership model. Achieving competency in using planning, implementation, feedback loops, and reflection frameworks to apply research-based clinical teaching requires the development of a program integrating low-fidelity simulation and assisted instruction through the use of computers. This program aimed to provide novice demonstrators and clinical instructors with quality and safety clinical teaching processes (Andrews and Roberts, 2003; Sharpnack and Madigan, 2012). Ali (2012) examined the teaching behaviors of clinical nursing instructors in the clinical area. The findings were encouraging for promoting active and diverse methods of learning and high and positive expectations for students as well as for promoting self-confidence and collaborative team-building opportunities (Ali, 2012). It has been well documented that the nursing profession faces a serious shortage of nursing faculty. This shortage has an impact on the quality of clinical teaching. To promote and train new graduate nurses to provide clinical education is highly valued in this environment of nursing shortages in colleges of nursing. Developing clinical instructor programs to give students a chance to select clinical instructor pathways that focus on knowledge and that aim to transfer between the clinical instructor, active experience, and subsequent reflection to promote critical thinking and life-long professional development is essential. The college of nursing has a strategic plan for producing a higher number of master's-level and doctoral-prepared nurses for the academic ladder. However, clinical instructors are looking forward to new policies to support them in advancing their education beyond the master's level. Difficult decisions must be made and the educational setting best supports the preparation of different levels of practice, such as clinical instructors, advanced practice nurses, nurse faculty, nurse leaders, and nurse scientists, who are all in high demand. Furthermore, future research

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is needed to explore clinical teaching frameworks and competency among nursing faculty. Limitation of the Study A limitation associated with qualitative study is related to reliability, validity and generalizability. In addition, language translation process may limit the explanations. Acknowledgment This research project was supported by a grant from the “Research Center of the College of Nursing”, Deanship of Scientific Research, King Saud University. The sponsoring agency was not involved in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. References Ali, W.G., 2012. Caring and effective teaching behavior of clinical nursing instructors in clinical area as perceived by their students. J. Educ. Pract. 3, 15–26. Al-Kamis, N., Salem, O., Zakari, N., 2013. Nursing students' perception regarding their clinical instructors and preceptors: a questionnaire survey. Nurs. Sci. Ser. Data Rep. 5, 85–93. American Association of Colleges of Nursing, 2003. Building capacity through university hospital and university school of nursing partnerships: joint task force report of the university health system consortium (UHC) and American Association of Colleges of Nursing (AACN). White paper. Andrews, M., Roberts, D., 2003. Supporting student nurses learning in and through clinical practice: the role of the clinical guide. Nurse Educ. Today 23, 474–481. Casey, K., Fink, R., Krugman, M., Propst, J., 2004. The graduate nurse experience. J. Nurs. Adm. 34, 303–311. Chinn, P.L., 1989. Feminist pedagogy in nursing education. In: National League for Nursing (Ed.), Curriculum revolution: Reconceptualizing nursing education. National League for Nursing Press, New York, pp. 9–24. Clift, R.T., Brady, P., 2005. Research on methods courses and field experiences. Studying Teacher Education: The Report of the AERA Panel on Research and Teacher Education, pp. 309–424. Creswell, J.W., 2009. Research design: qualitative, quantitative, and mixed methods approaches, 3rd ed. Sage, Los Angeles. Glasgow, M.E., Dunphy, L.M., Mainous, R.O., 2010. Innovative nursing educational curriculum for the 21st century. Nurs. Educ. Perspect. 31, 355–357. Hays, G., Singh, A.A., 2012. Qualitative Inquiry in Clinical and Educational Setting. The Guilford Press, New Yourk. Irby, D.M., Bowen, J.L., 2004. Time-efficient strategies for learning and performance. Clin. Teach. 1, 23–28. Jeffries, P.R., 2005. A frame work for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nurs. Educ. Perspect. 26, 96–103. Kawashima, A., 2005. The implementation of narrative pedagogy into nursing education in Japan. Nurs. Educ. Perspect. 26, 168–171. King Saud University, The College of Nursing, 2010. Bachelor of Science in Nursing Program Curriculum Bulletin. King Saud University, Riyadh, Saudi Arabia. King Saud University, The College of Nursing, 2012. Strategic Plan 2011–2016. King Saud University, Riyadh, Saudi Arabia. Laframboise, K.L., Shea, K., 2009. Developing understanding of research-based pedagogy with preservice teachers: an instrumental case study. Qual. Rep. 14, 105–128. Leech, N.L., Onwuegbuzie, A.J., 2007. An array of qualitative data analysis tools: a call for data analysis triangulation. Sch. Psychol. Q. 22, 557. Lewin, D., 2007. Clinical learning environments for student nurses: key indices from two studies compared over a 25 year period. Nurse Educ. Pract. 7, 238–246. Lincoln, Y.S., Guba, E.G., 1985. Naturalistic inquiry. Sage Publications, Inc., Beverly Hills, CA. Mackey, S., 2005. Phenomenological nursing research: methodological insights derived from Heidegger's interpretive phenomenology. Int. J. Nurs. Stud. 42, 179–186. Paulson, C., 2011. The experiences of faculty teaching in an innovative clinical immersion nursing curriculum. Nurs. Educ. Perspect. 32, 395–399. Polit, D.F., 2008. Nursing Research: Generating and Assessing Evidence for Nursing Practice. Wolters Kluwer Health. Potempa, K.M., Redman, R.W., Landstrom, G., 2009. Human resources in nursing education: a worldwide crisis. Collegian 16, 19–23. Sharpnack, P.A., Madigan, E.A., 2012. Using low-fidelity simulation with sophomore nursing students in a baccalaureate nursing program. Nurs. Educ. Perspect. 33, 264–268. Yin, R.K., 2009. Case Study Research: Design and Methods, 4th ed. Sage Publications, Thousand Oaks, Calif. Zakari, N.M., 2011. The impact of nurse role ambiguity and role conflict on nursing faculty commitment in Saudi Arabia. Life Sci. J. 8, 179–186.

Please cite this article as: Zakari, N.M.A., et al., Developing an understanding of research-based nursing pedagogy among clinical instructors: A qualitative study, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.03.011

Developing an understanding of research-based nursing pedagogy among clinical instructors: a qualitative study.

Effective instruction is imperative to the learning process of clinical nursing instructors. Faculty members are required to provide high-quality teac...
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