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Clinical instructor's behavior: Nursing student's perception toward effective

clinical instructor's characteristics

Article in Journal of Nursing Education and Practice · November 2015

DOI: 10.5430/jnep.v6n2p96

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www.sciedu.ca/jnep Journal of Nursing Education and Practice 2016, Vol. 6, No. 2

ORIGINAL RESEARCH

Clinical instructor’s behavior: Nursing student’s

perception toward effective clinical instructor’s
characteristics
Lamia Mohamed-Nabil Ismail ∗, Reda Mohamed-Nabil Aboushady, Abeer Eswi
Faculty of Nursing, Cairo University, Cairo, Egypt

Received: May 3, 2015 Accepted: September 7, 2015 Online Published: November 8, 2015
DOI: 10.5430/jnep.v6n2p96 URL: http://dx.doi.org/10.5430/jnep.v6n2p96

A BSTRACT
Background and Aim: Clinical training as the core of nursing education is a significant and essential component for develop-
mentof professional nurses. The quality of clinical instructor’s behavior plays a significant role in the learning process of the
students, especially in clinical practice. The aim of the study was to assess the clinical instructor’s behaviors and nursing students’
perceptions toward effective clinical instructor’s characteristics that facilitate learning process.
Methods: Setting: The current study was conducted at Faculty of Nursing, Cairo University. Design: Descriptive, correlational
design was utilized for the current study. Sample: A convenient sample of 333 was drawn from nursing students in different
levels of baccalaureate nursing programs who had finished at least two clinical rotations with patient care. Tools: The Nursing
Clinical Teacher Effective Inventory (NCTEI) was used for data collection.
Results: Findings of the current study revealed that the highest ranked clinical instructor’s behavior as reported by the student’s
was teaching ability category followed by evaluation and nursing competence respectively. Regarding effective clinical instructor’s
characteristics as perceived by students, the highest ranked one was teaching ability category followed by nursing competence and
evaluation respectively. The personality and interpersonal relationship among nursing student set as the fourth and fifth factors
that affect learning process in the clinical settings.
Conclusions: Effective clinical instructor’s characteristics that affect learning process as perceived by nursing student include
matching clinical teaching abilities, nursing competence and evaluation to student understanding and experience. Also, the
nursing students considered the personality and interpersonal relationship is very important characteristics to provide support and
encouragement to the student during clinical practice. Recommendation: Workshops/seminars should be organized and also
orientation program for all newly clinical instructors on their roles in clinical teaching. These findings may help faculty to be
pleased about students’ views and acknowledge the areas of success as well as areas that needs improvement.

Key Words: Clinical instructor’s behaviors, Nursing student, The nursing clinical teacher effective inventory

1. I NTRODUCTION who are knowledgeable and skillful within health care sys-
tem, deliver safe quality nursing services to all categories as
Clinical instructors have the opportunity to greatly influence
patients, families and communities to attain, maintain and
the students’ learning who eventually graduate and shape
recover optimal health.[1, 2]
nursing practice. The behavior of clinical instructors plays a
significant role in the development of professional nursing So, clinical instructors must possess effective teaching char-
∗ Correspondence: Lamia Mohamed-Nabil Ismail; Email: lamia.m1971@gmail.com; Address: Faculty of Nursing, Cairo University, Cairo, Egypt.

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acteristics such as professional knowledge, role modeling that clinical instructors’ knowledge, giving immediately feed-
and clinical competence.In addition, the teacher’s personal- back on students’ performance, remain accessible, having
ity is essential because experiencing the proper pattern of active listening to students and demonstrating a breadth of
clinical instructor’s behavior is a motivation for educating knowledge in nursing are efficient clinical instructors’ char-
students. Furthermore, student-teacher communication af- acteristics to change nursing education.[9] Therefore, the
fects students’ attitudes. Researchers have reported different purpose of this study was to assess the clinical instructor’s
views on the characteristics of a good teacher as teaching behaviors and nursing students’ perceptions toward effec-
skills, communication skills and effective teacher’s charac- tive clinical instructor’s characteristics that facilitate learning
teristics.[13] process.
Exploration of effective clinical instructor’s characteristics The finding of the current study will provide base for all
provides insight into enhancement of educational programs clinical instructors to examine and change their own clinical
for developing professional nurses. Nursing students’ per- instructor characteristics regarding clinical practice and to
ception and experiences is the method of measuring effective realize teaching behaviors that are effective in clinical prac-
clinical instructors’ characteristics in nursing education. Ev- tice. Consequently, it could help to establish reciprocal and
idence suggested that student ratings can be reliable and clear expectations among the students and clinical instructor
valid indicator of effective teaching.[4, 5] Critical incident which could help to create a healthy academic atmosphere
research about clinical teaching behaviors of faculty began contributing to effective learning. This will give evidence
with Barham’s (1965) and Jacobson’s (1966). The behav- that the body of knowledge related to clinical instructor’s be-
iors that the researcher identified were deemed actions that haviors and effective clinical instructor’s characteristics. As
equated with effective teaching. Over the next four decades, well, they will add grounds for looking at clinical teaching
studies of clinical teaching effectiveness focused primarily in a new glow.
on the clinical instructor’s characteristics.[6]
Nursing education administrator must examine orientation
On the other hand, clinical instructors’ characteristics play a programs for newly clinical instructor regarding effective
crucial role since clinical instructor not only enables students clinical instructor’s characteristics to improve the learning
to integrate the knowledge and skills associated with caring process. In addition, it will maximize opportunities for nurs-
for patients, but also gives learners the opportunity to inter- ing students to learn, and succeed in becoming professional
nalize the role of the nurse as caregivers.[7] To achieve high nurses throughout learning process.
quality in clinical nursing education, variables as the relation-
ship of clinical teaching behaviors to student learning must 1.2 Aim of the study
be identified. Also, nursing students’ perception of effec- The aim of the current study was to assess the clinical in-
tive clinical instructor behavior is an important indicator to structor’s behaviors and nursing students’ perceptions toward
modify and facilitate effective clinical instruction.[8] So, the effective clinical instructor’s characteristics that facilitate
researchers were interested to assess the clinical instructor’s learning process.
behaviors and nursing students’ perceptions toward effective
clinical instructor’s characteristics that facilitate learning pro- 1.3 Research questions
cess by undergraduate nursing students at Faculty of Nursing To fulfill the aim of the current study the following research
–Cairo University. questions are formulated: (1) Which clinical instructors’ be-
haviors used frequently among nursing students? (2) What
1.1 Significance of the study is the nursing student’s perception toward effective clinical
Clinical practice remains a significant component and critical instructor’s characteristics? (3) What is the relationship be-
part of nursing education which considered as the “heart” tween clinical instructors’ behaviors and nursing students’
of professional practice and bridging the theory-practice di- perceptions toward effective clinical instructor’s characteris-
vided. The quality clinical practice delivered through clinical tics?
instructor is dynamic to the success of clinical education and
has direct impact on the quality of nursing to ensure students 1.4 Definition of terms
achieve positive outcomes in the clinical settings as well as • Clinical instructor behaviors: Differential behav-
in future practice. Therefore, the clinical instructors as a iors demonstrated by the clinical nursing instructor
cornerstone of nursing education plays an essential role in that facilitate learning process as delineated on the
preparing nursing graduates for their role as competent, capa- NCTEI.[10]
ble and caring nurses. In nursing, several research recognized • Characteristics: A distinguishing trait, behaviors per-
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ceived by a nursing student as contributing to a positive completed at Medical-Surgical I. Students plan and manage
learning experience in the clinical setting. care for 1-2 patients every week, completing health histories,
• Perception: An individual’s awareness, understand- physical assessments, and performing specific nursing skills.
ing, opinionor insight. The second clinical rotation of the curriculum is Medical-
Surgical II, completed concurrently with Medical-Surgical II
theory over 15 weeks. Also, pediatric, obstetric, emergency,
2. S UBJECTS AND METHODS
critical care, mental health and community health clinical
2.1 Design
over 15 weeks for each clinical rotation.
A descriptive correlational design was utilized. The current
study was focus on clinical instructor’s behavior and nurs-
2.4 Sample size
ing student’s perception toward effective clinical instructor’s
A convenience sample of 333 based on a power analysis. A
characteristics. Descriptive designs are useful to gain addi-
Power of .95 (β = 1-.95 = .5) at alpha .05 (one-sided) with
tional information about characteristics within a particular
medium effect size (0.3) was used as the significance level,
area of study.[11] A correlational study determines whether
because these levels have been suggested for use in the most
or not two variables are correlated. This means to study
areas of research. Although the minimum number of 302 stu-
whether an increase or decrease in one variable corresponds
dents was required by power analysis, the researcher will aim
to an increase or decrease in the other variable.[12]
to obtain 333 students in this study because ten percent of
2.2 Setting non-response rate was expected to be lost from the students.
The current study was conducted at Faculty of Nursing; Cairo
University. It was established in 1963, the main purpose of 2.5 Tools for data collection
establishing to start the study of nursing at the university To collect data pertinent to the study one tool was constructed
level in order to graduate a qualified professional nurse who and used by the researcher after reviewing related literature.
is competent and capable to work among the health care It entails three main sections: (1) The first section included
team at different health and educational organizations in the personal data such as age, gender as well as academic year in
community. Faculty of Nursing, Cairo University obtained program. (2) The second section consisted of two part: the
national accreditation from the National organization of qual- first part “Clinical instructor’s behavior” using the Nursing
ity improvement and accreditation. There are 130 clinical Clinical Teacher Effectiveness Inventory (NCTEI) that was
instructors who are responsible for clinical training of 1,000 developed by Knox and Mogan (1985).[10] It consists of
students in different academic levels. 48 important instructor characteristics divided into five sub-
scales as following: (a) Teaching ability (TA): the process
2.3 Sample of transmission of skills and attitudes and the creation of an
A convenience sample of 333 was drawn from nursing stu- atmosphere that facilitate learning process; (b) Nursing com-
dents in different levels of baccalaureate nursing programs in petence (NC): the clinical teacher’s theoretical and clinical
faculty of nursing at Cairo University. Researchers select the knowledge used in the practice of nursing; (c) Evaluation
student who met the following inclusion criteria: (a) Nursing (E): the type and amount of feedback the student receives
students had finished at least two clinical rotation with patient from the clinical instructor regarding clinical performance
care in hospital before participate in the study; (b) Nursing and written clinical assignments; (d) Interpersonal relation-
students who exposed to at least five clinical instructors in ships (IR): a state of reciprocal interest or communication
order to have experience to entire the study. The students between student and clinical instructor; and (e) Personality
in first academic levels excluded because they don’t have (P): the totality of the individual’s attitudes, emotional ten-
hospital training experience to assess clinical instructor’s dencies and character traits, which are not specifically related
behaviors in clinical area. to teaching, nursing or interpersonal relationships but may
affect all three. A seven point, Likert-type scale ranging from
Clinical time is important to successfully apply the theo-
1 (Never) to 7 (Always); students ranked how frequently the
retical concepts of nursing to clinical situations. Nursing
clinical teaching behavior was demonstrated.
students complete clinical rotations at appropriate health-
care agencies under the direct guidance of qualified clinical The second part: “Nursing instructor’s perception toward
instructors, in a group of 8-15 students with clinical instruc- effective clinical instructor’s characteristics that influence
tor. Students complete 480 credit hours during 8 rotations learning process”. Using the NCTEI that was developed
(4 credit hours per week over 15 weeks for each clinical by Knox and Mogan (1985).[10] This scale was designed to
rotation). The first clinical rotation of the curriculum is assess nursing students’ perceptions toward effective clini-
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cal instructor’s characteristics that facilitate learning process. 2.8 Ethical consideration
The tool contained a five point Likert scale for each of the An official permission was taken from the authoritative per-
48 NCTEI items; ranging from 1 (Never/No important), 2 sonal in the faculty. The researchers introduced themselves
(Slightly important), 3 (Important), 4 (Very important) to 5 to student who met the inclusion criteria and informed them
(Always/Most important). Students rated how the frequency about the aim of the current study in order to obtain their ac-
of use of the clinical instructor characteristic facilitated their ceptance to share in this study. Written consent was obtained
learning. from students who were willing to participate in the study.
The third section includes additional information as; overall Confidentiality and anonymity of the student were assured
rate of quality of the instructor in clinical setting and the best through coding the data.
student-teacher ratio for clinical instructor.
2.9 Statistical analysis
The collected data were scored, tabulated and analyzed using
2.6 Reliability and validity of the tool Statistical Package for the Social Science (SPSS) program
version 19. Descriptive as well as parametric inferential
The tool designed by the researcher and revised by experts in
statistics was utilized to analyze data pertinent to the study.
the field of medical surgical department and maternity nurs-
Level of significance was set at p < .05. correlatebivariate
ing to content validity. The tool was translated into Arabic by
Pearson test was used to analyze data.
professor experts who were fluent in both English and Arabic.
The Arabic draft was then back translated into English by
another two expert who are fluent in both Arabic and English.
3. R ESULTS
The back translated version was compared with the original Findings of the current study were presented as the follow-
English version to verify that the questions were properly ing sequence: (a) Personal data of the nursing students;
translated. All of the back-translated items were worded (b) Research questions; (c) Additional information.
similarly to the original ones and were comparable in their
meaning. The Arabic draft was then discussed by two med- (a) Personal data
ical surgical nursing and maternity experts who found that The convenience sample consisted of 333 from three differ-
it would aid understanding to rephrase the questions in the ent levels of undergraduate nursing students at faculty of
form of simple statements instead of question format with- nursing, Cairo University. Most of the student were 162
out changing their meaning. Also, reliability and validity of (48.6%) from 2nd level, 95 (28.5%) from 3rd level and about
the NCTEI was established through several methods. Initial 76 (22.8%) from 4th level. Student numbers in each level
reliability coefficients for each item ranged from .79 to .89 represent the majority of students enrolled in this level. All
(Knox and Mogan, 1985). Reliability coefficients for the five students were exposed to at least five clinical instructors. The
categories during instrument development were: teaching age of the nursing student ranged from 19 to 23 years old.
.89, nursing competence .84, evaluation .82, interpersonal With the mean 20.71 ± 0.94 years old. More female were
relationship .86, and personal traits .83. The reliability coef- participated in the research than male. Out of 333 nursing
ficients of both the individual items and the categories have students, 204 (61.3%) were female while 129 (38.7%) were
remained stable during repeated use of the instrument. Test- male (Description of the personal data is displayed in Table
retest reliability was reported to be acceptable (Knox and 1).
Mogan, 1985) with probability ranging from .76 to .93 (Knox
and Mogan, 1987).[10] (b) Research questions
Research questions of the current study were as follows:
The first research question: “Which clinical instructors’ be-
2.7 Procedure
haviors used frequently among nursing students?” are illus-
An official permission was granted from the Dean of the trated in Tables 2-4. Regarding the most clinical instructors’
Faculty of Nursing at Cairo University; all nursing students behavior mean score demonstrated as following: stimulates
from various academic levels were invited to participate in what is important; provides frequent feedback on students’
the current study voluntarily. Data collection was carried out performance; gears instruction to students’ level of readiness
during the second semester of the academic year 2013-2014; and has a good sense of humor. The most clinical instructors’
through interviewing the nursing student and explaining the behavior means score of use were in the teaching ability, eval-
aim of the study. Each nursing student took nearly 10-15 uation, personality and nursing competence category (see
minutes to complete the questionnaire. Table 2).
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Table 1. Frequency and distribution percentage of personal were: is self-critical, recognizes own limitations, does not
data among the studied sample (n = 333) criticize students in front of others, demonstrates commu-
Item No % nication skills and shows a personal interest in students; in
Age (years old) M ± SD the personality, nursing competency, evaluation and interper-
20.71 ± 0.94 sonal relation category (see Table 3).
Gender Regarding teaching categories had the most and least mean
Male 129 38.7
score in use; presented in Table 4. The highest category
Female 204 61.3
mean score among the studied sample was teaching ability
Academic year in program
followed by evaluation and nursing competence respectively.
Second year: 162 48.6
Interpersonal relation and personality were the lowest scored
Male 63 18.92
categories.
Female 99 29.72
Third year: 95 28.5 The second research question: “What is the nursing student’s
Male 31 9.31 perception toward effective clinical instructor’s characteris-
Female 64 19.21 tics?” was displayed in Tables 5-7. The clinical instructors’
Fourth year: 76 22.8 characteristics with the mean score as perceived by students
Male 35 10.51
were: remains accessible to students, is a good role model,
Female 41 12.31
emphasizes what is important, demonstrates clinical proce-
Total:
dures/techniques and directs student to useful literature in
Male 129 38.74
nursing. The clinical instructor’s characteristics with the
Female 204 61.26
highest mean score as perceived by students were in the nurs-
ing competence, teaching ability, followed by personality
Regarding the least clinical instructors’ behaviors mean score
and evaluation category respectively (see Table 5).

Table 2. The most clinical instructors’ behaviors mean scorea mong the studied sample (n = 333)
Items Behavioral description Category M ± SD
2 Stimulates what is important. TA 5.29 ± 4.97
28 Provides frequent feedback on students’ performance. E 5.26 ± 3.14
12 Gears instruction to students’ level of readiness. TA 5.07 ± 3.69
46 Has a good sense of humor. P 5.06 ± 5.78
22 Directs students to useful literature in nursing. NC 5.05 ± 4.65
18 Demonstrates clinical skill and judgment. NC 5.04 ± 2.10
5 Demonstrates clinical procedures and techniques. TA 5.02 ± 1.53
31 Communicates expectations of students. E 5.01 ± 5.86

Table 3. The least mean score clinical instructors’ behaviors among studied sample (n = 333)
Items Behavioral description Category M ± SD
44 Is self-critical. P 4.31 ± 1.86
24 Recognizes own limitations. NC 4.34 ± 1.75
34 Does not criticize students in front of others. E 4.42 ± 1.96
19 Demonstrates communication skills. NC 4.44 ± 1.63
39 Shows a personal interest in students. IR 4.45 ± 1.78
40 Demonstrates empathy. IR 4.45 ± 1.82
33 Corrects students’ mistakes without belittling them. E 4.49 ± 1.89
32 Gives students positive reinforcement for good contributions, observations or performance. E 4.52 ± 1.78
41 Demonstrates enthusiasm. P 4.69 ± 1.69

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Table 4. Rank order of teaching categories in frequency use among studied sample (n = 333)
No Categories Min Max M ± SD
1 Teaching ability 17 119 81.38 ± 20.35
2 Evaluation 8 56 67.29 ± 10.66
3 Nursing competence 9 63 42.41 ± 11.63
4 Interpersonal relation 6 42 28.08 ± 8.41
5 Personality 6 42 28.08 ± 8.41
Total score 52.27 ± 2.17

Table 5. The most important clinical instructor’s characteristics as students’ perceptions among studied sample (n = 333)
Items Behavioral description Category M ± SD
4 Remains accessible to students. TA 4.21 ± 0.97
26 Is a good role model. NC 4.21 ± 0.96
1 Emphasizes what is important. TA 4.20 ± 0.94
5 Demonstrates clinical procedures and techniques. TA 4.20 ± 1.05
22 Directs students to useful literature in nursing. NC 4.20 ± 1.01
47 Appears organized. P 4.19 ± 1.03
21 Discusses current development in his/her field. NC 4.19 ± 1.01
34 Does not criticize students in front of others E 4.18 ± 1.10
25 Takes responsibility of own actions. NC 4.17 ± 0.97
23 Demonstrates a breadth of knowledge in nursing. NC 4.16 ± 0.97

The clinical instructors’characteristics with the least mean est in students and is approachable. The clinical instructor’s
score as perceived by students were: communicates expec- characteristics with the least mean score as perceived by
tations of students; provides support and encouragement to students were in the personality and interpersonal relation
students; has a good sense of humor; shows a personal inter- category (see Table 6).

Table 6. The least important clinical instructor’s characteristics mean score asstudents’ perceptionsamong studied sample
(n = 333)
Items Behavioral description Category M ± SD
19 Demonstrates communication skills. NC 4.08 ± 1.07
13 Quickly grasps what students are asking or telling. TA 4.08 ± 1.05
42 Is a dynamic and energetic person. P 4.07 ± 1.10
11 Encourages active participation in discussion. TA 4.07 ± 1.05
27 Demonstrates communication skills. E 4.07 ± 1.08
36 Is approachable. IR 4.05 ± 1.08
39 Shows a personal interest in students. IR 4.05 ± 1.13
46 Has a good sense of humor. P 4.05 ± 1.12
35 Provides support and encouragement to students. IR 4.02 ± 1.11
31 Communicates expectations of students. E 3.99 ± 1.18

Regarding rank order of clinical instructor behavior cate- ation respectively. Personality and interpersonal relationship
gories as perceived by students, teaching ability category were the lowest mean score categories (see Table 7).
rated the highest followed by nursing competence and evalu-

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Table 7. Rank order of nursing student perception of effective clinical instructor characteristics among studied sample (n =
333)
No Categories Min Max M ± SD
1 Teaching ability 17 85 69.98 ± 14.95
2 Nursing competence 9 45 37.39 ± 7.92
3 Evaluation 8 40 32.88 ± 7.21
4 Personality 7 35 28.81 ± 6.74
5 Interpersonal relation 6 30 24.45 ± 5.80
Total score 38.67 ± 1.93

The third research questions: What is the relationship be- This study was designed to assess the clinical instructor’s
tween clinical instructors’ behaviors and nursing students’ behaviors and nursing students’ perceptions toward effec-
perceptions toward effective clinical instructor’s character- tive clinical instructor’s characteristics that facilitate learning
istics? Regarding correlation between clinical instructor process. The discussion of this current study is two fold:
behavior in use and as perceived by students that influencing (1) Research Questions; and (2) Additional Information.
learning process, a liner relationship was found. Positive cor-
Research questions of the current study were as follows:
relation at p < .0001 was found between clinical instructor
behaviors in use and influence on learning for all categories The first research question: Which clinical instructors’ behav-
(see Table 8). iors used frequently among nursing students? In the current
study, the teaching behaviors with the most frequency use
Table 8. Correlation between clinical instructor behavior in were: stimulates what is important; provides frequent feed-
use and as perceived by students among studied sample (n = back on students’ performance; gives instruction to students’
333)
level of readiness and has a good sense of humor. This study
Categories Pearson r Significant (2-tails) finding confirms results from studies conducted in Jordan.[4]
Teaching ability 0.37 0.000 A number of researcher suggested that clinical instructors
Nursing competence 0.36 0.000 strive to create positive learning experiences for their stu-
Evaluation 0.24 0.000 dents and to provide them with ongoing feedback on their
Interpersonal relation 0.23 0.000 clinical accomplishments and progress. This may be related
Personality 0.23 0.000 to continuous feedback is intended to assess the extent to
which clinical objectives are met and to motivate students
to make desired behavioral changes over time. Clinical in-
(c) Additional information
structors need to develop innovative ways to overcome these
Overall rate quality of the clinical instructors from student
considerable challenges and continue to make an effort to
perspective was 6.69 ± 1.95. In relation to the best student-
develop partnerships with students that promote effective in-
teacher ratio for clinical instructor, from student’s perspective
terpersonal relationships.[15] The findings of another research
a 5:1 ratio of student.
verified that student nurse perceived clinical instructors more
frequently demonstrated caring behaviors highest in the fol-
4. D ISCUSSION lowing ways: (a) show personal interest in patients and their
The clinical nursing instructor is responsible for managing, care; (b) create a climate of mutual respect; (c) acknowledge
educating and supporting the student nursing during clinical the limitations or mistakes; (d) realistic in expectations of
practice that is most effective for facilitating learning process. students performance; and (e) promote student awareness of
Clinical instructor behavior and skills that enhance effective the professional responsibilities; especially for the future.[2]
clinical instruction include: clinical teaching skills, having
Regarding the clinical instructors’ behaviors in the current
experience, having good communication skills, providing
study with the least frequency use were captured an aspect
constructive feedback, facilitating a student-centered envi-
of: is self-critical, recognizes own limitations, does not criti-
ronment and give student chance for training during clinical
cize students in front of others, demonstrates communication
practice. Correspondingly, students propose that supportive
skills and shows a personal interest in students. In addition
clinical settings have clinical instructors who provide con-
to knowledge, some researcher confirmed that the teacher’s
structive feedback, use good communication skills and help
personality is important to give positive reinforcement for
students develop self-confidence.[14]
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good performance during clinical practice. Furthermore, stu- Similarly, researcher founded that five qualities rated by stu-
dent–teacher communication affects students’ attitudes.[3] dents as effective clinical instructor characteristics as: give
The findings of this study differed from Western studies specific suggestions for improvement honestly, enjoy teach-
where students rated communication skills as the most im- ing, active listening and having good communication skills,
portant domains.[26] In the clinical practice environment, supervising students efficiently and being constructive role
faculty may interpret these behaviors to have potential to be model.[1] In medicine, Irby[19] reported that lack of clear
less well received by students than in a classroom environ- expectations for student performance, insufficient feedback,
ment and therefore may have used them less frequently. and inappropriate role models as obvious problems of ef-
fective clinical teaching. In nursing, Kelly[9] recognized
The clinical teaching categories are a function of the clin-
that teacher knowledge, giving immediately feedback, active
ical teaching behaviors and provide a broader view of the
listening to students and availability of teacher as effective
overall use of the teaching behaviors than do the individual
clinical teacher characteristics.
response items. In the current study, teaching ability category
rated the highest mean scored category followed by evalu- In the current study, the clinical instructor’s characteristics
ation and nursing competence respectively. Interpersonal with the least mean score as perceived by students were:
relation and personality were the lowest mean scored cate- communicates expectations of students, provides support
gories. a few researcher illustrate that according to nursing and encouragement to students, has a good sense of humor,
students, respecting students’ personality by giving attention shows a personal interest in students and is approachable, this
and understanding, respecting time of the nursing students is in the personality and interpersonal relation categories. In
and supporting them are ethical characteristics of academic the same line, Naji[20] concluded that clinical instructors’ ex-
clinical instructorsin nursing practice.[3] These findings are perience, knowledge and personality have a vital role and an
consistent with previous studies, which revealed that closed influence on successful achievement of any clinical practice.
relationship and supportive behavior with students encour-
In the current study, regarding rank order of clinical instructor
age their motivation, their work in clinical practice, increases
behavior categories as perceived by students, teaching ability
criticism acceptance, better adaptation to stress and giving
category rated the highest followed by nursing competence
attention to the educational content obtainable by the clinical
and evaluation respectively. Knowledgeable, competent and
instructor.[16, 17] Therefore, it is noted that the items in the
fairly evaluator clinical instructors’ characteristics is the most
teaching ability, evaluation and nursing competence respec-
importantcomponent for efficient clinical practice; this may
tively,interpersonal relations, and personality categories are
make nursing student feel more secure and comfort in their
nurturing actions consistent with the overall nursing principle
ability to perform learned skills during the clinical practice.
of caring.
The study done on associated degree nursing students regard-
The second research question: What is the nursing student’s ing their perception emphasized that teaching ability and
perception toward effective clinical instructor’s characteris- nursing competence categories are themost effectiveclinical
tics? The clinical instructor’s characteristics with the most instructors’ characteristics to be a good clinical instructor for
frequency as perceived by students were: remains accessi- students in the clinical settings.[21]
ble to students, is a good role model, emphasizes what is
Regarding rank order of clinical instructor’s categories as
important, demonstrates clinical procedures/techniques and
characteristics perceived by students, personality and inter-
directs student to useful literature in nursing. The clinical
personal relationship ranked as the lowest mean scores. This
instructor’s characteristicswith the highest frequency as per-
was disagreement with Ali mentioned that students perceive
ceived by students were in the nursing competence, teaching
this characteristic as the second most effective teaching char-
ability, followed by personality and evaluation. Awad[18]
acteristic.[2] Also, Awad reported that huge differences in
founded that the students perceived their instructors as hav-
scores between effective and ineffective teachers were ob-
ing effectiveclinical instructors’ characteristics as creating
served in the interpersonal relationship category. Therefore,
environment with mutual respect, giving immediate feed-
teachers’ attitudes rather than their professional abilities
back, motivating the students, being accessible all times for
make crucial difference between effective and ineffective
answering carefully and precisely questions raised by stu-
teachers.[18] The study findings was supported by many re-
dents, giving good instructions to student according to level
searchers, reported that the mosteffective clinical instructors’
of readiness, create a constructive learning environment, ap-
characteristics was personality traits which considered as the
plication of theoretical knowledge to clinical practice and
highest rating; such as provide immediate feedback and cor-
demonstrateexcellent role model.[18]
rect students mistakes without criticizing them, well ready

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www.sciedu.ca/jnep Journal of Nursing Education and Practice 2016, Vol. 6, No. 2

for teaching, a good role model, and create a climate of mu- Some researcher recommended that teachers should have the
tual respect, all of them create positive relationships with highest standards in education, research and management.
students that provide students with interpersonal support.[22] Exploration of effective clinical instructors’ characteristics
provides insight into improvement of educational programs
The third research questions: What is the relationship be-
quality for developing nurses.[3]
tween clinical instructors’ behaviors and nursing students’
perceptions toward effective clinical instructor’s character-
istics? Regarding correlation between clinical instructor 5. C ONCLUSION
behavior in use and as perceived by students on learning. Clinical practice is a crucial role in undergraduate nursing
The findings indicated there was a positive correlation was education. So, there was a demand for highly skilled nurses
found between clinical instructor behaviors in use and fa- with in depth knowledge that extended beyond mere techni-
cilitating learning for all categories. The findings of this cal competence. This contributed to the need for change in
study provide initial confirmation that use of the clinical the clinical practice of nurses. Therefore, instructors during
teaching behaviors facilitates learning. Further, the results clinical area must be effective clinical instructor’s character-
indicated that as the frequency of use of behaviors went up, istics if they want to facilitate student’s learning in clinical
so too did the facilitation of learning. This result supported practice. So, assessment of clinical instructors’ behaviors
by a number of researcher, concluded thatthe correlations and nursing students’ perception toward effective clinical
between frequency of use of the clinical teaching behaviors instructors’ characteristics are important issues in improving
and influence on learning were highly significant.[1, 23] As nursing education to facilitate learning.
well, another researcher indicating that it is the most effective
clinical instructor’s characteristics that students like to see in Recommendation
the clinical instructor.[24] Based on the result of the present study, it was concluded
Additional information: Overall rate of quality of the instruc- that: (1) Set up an orientation program for newly clinical
tor in clinical setting; mean of the student perspective of rate instructors regarding effective clinical instructors’ character-
quality was 6.69 ± 1.95. In relation to the best student - istics; (2) Routine teacher evaluation to incorporate unused
teacher ratio for clinical instructor in student’s perspective a behaviors, into their practice; (3) Nurse educators should
5:1 ratio of student. In the study of students’ perceptions of use the NCTEI as a self-assessment and seek to incorporate
effective clinical teaching in dental hygiene education, the behaviors not previously used, or used infrequently, into their
researchermentioned that individual rapport was the most practice; (4) Graduate programs curricula for nurse educators
effective clinical instructors’ characteristics; this involves a should include courses on clinical education; (5) Workshops
closer physical proximity of instructor to student and much should be organized for clinical instructors on their roles in
smaller and potentially intimate teacher-to-student ratio.[25] clinical teaching; (6) Exploring teachers’ views; (7) Further
research should compare clinical instructor characteristics
The clinical practice is the lifeblood of nursing education
with student success in mastering entry-level skills and com-
where students are allowed to provide selected aspects of
petencies; and (8) Replication of this study with a broader
care for patients. Clinical instructors are paramount in the
student demographic and geographic area is needed to con-
process of clinical practice. The use of effective clinical
firm and generalized the findings.
instructors behaviors would facilitate learning. Therefore,
the study results could help initiating change in the faculty ACKNOWLEDGEMENTS
staff regarding the teaching process, teaching methods, clin- We would like to thank all students who participated in the
ical practice, clinical setting and students evaluation. Also study and helped us to shed light on how they perceived
could help to establish mutual and well defined expecta- effective clinical instructor behavior as an important issue on
tions among the students and faculty administrators and aca- learning process.
demic staff, which could help to create a healthy academic
atmosphere conducive to learning. The information gained C ONFLICTS OF I NTEREST D ISCLOSURE
from this study can assist in improving clinical education. The authors declare that there is no conflict of interest.

R EFERENCES Nursing. 2013; 3(63). http://dx.doi.org/10.4236/ojn.2013.

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