Caring and compassion are integral to the nursing profession, in academia as well as clinical practice. Understanding how caring and compassion can be utilized in an online nursing environment (ONE) will help faculty teach effectively and enable administrators to accurately assess for these components within nursing education programs. Innovative ways to convey caring and compassion to students are important for overall student engagement as well as continuity between traditional and online programs.
A contemporary definition of caring includes connecting through rapport with and embracing the spirit of the other through dialogue, attention of presence, and the conveyance of concern for the life and meaning of the other person (Sitzman & Watson, 2014). Crawford, Brown, Kvangarsnes, and Gilbert (2014) define compassion as being aware and/or sensitive to the pain or distress of others, which involves being able to remove the source and impact through verbal, nonverbal, or physical action. There is disagreement as to whether compassion can be taught or whether it develops after one reaches complete competence as a nurse.
Empathy is a cognitive skill that includes the ability to understand a person's experience and communicate in a manner that conveys a recognition of individual concerns and perspectives. Empathy and compassion are not synonymous. Empathy is the known precursor for the later development of compassion. According to Klimecki, Ricard, and Singer (2013), empathy can lead to burnout, whereas compassion can aid in fostering resilience. Students and novice health care professionals who experience emotional fatigue in the early stages of their career may face burnout if they cannot transfer those feelings to compassion.
In the ONE, the interaction of caring and compassionate behavior between faculty and students should be fully assessed and measured so changes can be made to foster these traits. Combining the two terms to compassionate caring in an ONE is an idea that merits further exploration.
BEST PRACTICES IN ONLINE ENVIRONMENT
Sacred Heart University (SHU), a traditional private Roman Catholic university, offers onsite undergraduate programs as well as hybrid and fully online programs within the College of Nursing (CON). These programs include the master's of science in nursing (MSN) in four specialty tracks, the doctor of nursing practice (DNP) degree, and RN-to-BSN and BSN-to-DNP tracks. The CON recently adopted a caring model and academic practice philosophy developed by the dean that includes a conceptual framework and guiding principles on how faculty and students interact and engage in a mutually beneficial environment (Donius, 2013): "Nursing is caring with compassion, empathy, altruism with the intention of healing the body, mind, and spirit" (SHU, 2016). The goals are to engage in caring-healing encounters that transform participants and create a caring-healing environment for transformative nursing education and practice.
Although faculty are applying caring behaviors and philosophies onsite and in the online environment, application of the model is currently not measured in student or faculty evaluations. Some behaviors, considered best practices, include instructor presence in classroom discussions; meaningful and timely feedback; demonstrating flexibility; and individual personal contact via email, office hours, and web conferences. These behaviors can be linked to the CON core values and the foundation for the eclectic conceptual framework.
The theoretical framework of caring and compassion are evidenced within the curriculum at SHU, but the actual concept of caring and how to express it with students may vary across programs while still adhering to best practice. In a complete ONE, the role-modeling of compassionate caring educational behaviors may not be fully evident and may be muddled if not introduced early within the program, specifically within the initial curriculum. Faculty must employ unique methods to model compassionate caring behaviors to students with the ultimate goal being that they perceive these measures as caring actions.
Sitzman (2015, 2016a, 2016b) and Welch, Wilson, and Needham (2015) offer best practice teaching strategies for an ONE, but few studies have evaluated student perceptions of caring (Gabbert, 2008; Sitzman, 2010). A recent study by Welch, Wilson, and Needham (2015), which involved RN to BSN students, found the development of a caring relationship online to be reciprocal between student and faculty, supporting findings by Sitzman (2010, 2015). In Sitzman's 2010 study, respondents identified explicit preferences regarding instructor behaviors perceived to support a caring ONE as the following:clarity/expertise, timeliness, empathetic, presence, and full engagement/accessibility. Clarity/expertise was expressed as the expectation that the instructor will communicate course content and objectives in a clear and consistent manner and outline what the students must accomplish to successfully complete the course. Timeliness was the expectation that the instructor will respond to posts and emails within 48 to 72 hours. Empathetic presence was evidenced by showing compassion, providing insight, and extending support and engagement in terms of being consistently visible and accessible during the online course.
DEMONSTRATING COMPASSIONATE CARING
In ONE courses at SHU, methods employed to role model, convey, teach, and develop compassionate caring include regular and close communication between faculty, student advisors, and students by email and phone, which allows faculty assessment of student status. There is an immediate opportunity for students to have a more personal forum in the first week of each eight-week, three-credit course. Faculty teaching in the ONE have students write an introduction describing themselves, their work, and their families, as well as their professional goals. Many techniques to illustrate caring in this way can be utilized with different technological modalities, such as video interaction, the use of pictures, and icebreaker activities to engage learners to participate with peers and faculty.
In this particular forum, faculty read each student's contribution and respond individually to recognize and acknowledge each student. Having students read and respond to each other is a means of encouraging students to interact with their peers. This activity helps create a personal relationship between students and faculty and between students and classmates. Whether students perceive this approach as caring can be addressed in questions added to the evaluation students complete at the conclusion of the course.
For students identified as at risk related to course performance or external factors, SHU offers supportive services such as one-on-one virtual appointments with faculty instructors and/or advisors and tutors. Online writing support is also offered. In most instances, this kind of caring and compassionate recognition of individual students and their personal circumstances may be enough to alleviate their distress and encourage student success.
Despite overall declining enrollments in education, the growth of online education continues (Allen, Seamen, Poulin, & Strout, 2016). Nurse faculty are responsible for fostering knowledge, skills, and behaviors of professional nurses. The isolating and often emotionally sterile nature of the online environment challenges faculty to teach abstract behaviors like caring and compassion. The goal of all faculty is to make sure that students feel comfortable and confident, no matter the type of class setting. The literature reviewed points to the need for further research to discover the presence of caring in ONE classrooms and provide further information about how nursing students and faculty experience caring. The ONE at SHU is ripe with examples of how faculty engage students in caring and compassionate behaviors. However, further research is needed regarding the perceptions of such behavior to help educators develop best practices for professional practice and beyond.
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