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LIVED EXPERIENCES OF FACE-TO-FACE LEARNING IN NURSING STUDENTS
A DISSERTATION
SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
IN THE GRADUATE SCHOOL OF THE
TEXAS WOMAN'S UNIVERSITY
COLLEGE OF NURSING
BY
BARBARA J. GRUENDEMANN, B.S .. M.S.
DENTON, TEXAS
AUGUST2010
TEXAS WOMAN'S UNIVERSITY DENTON, TEXAS
To the Dean of the Graduate School:
April 29, 2010
I am submitting herewith a dissertation written by Barbara J. Gruendemann entitled "Lived Experiences ofFace to Face Learning in Nursing Students." I have examined this dissertation for form and content and recommend that it be accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy with a major in Nursing Science.
We have read this dissertation and recommend its acceptance:
Associate Dean
Accepted :
Dean of the Graduate School
Copyright 1D Barbara J. Grucndemann, 20 I 0 All rights reserved.
Ill
DEDICATION
To the eight nursing student research participants who made this study come alive
with meaning, who shared experiences with verve and originality, and who spoke vividly
and honestly about how they learned face-to-facc---my kudos!
Thank you! You were an inspiration to me and you give great promise for the
future of nursing!
iv
ACKNOWLEDUMENTS
I wish to acknowledge those who have cantributed to this dissertation through
their encouragement. helpfulness. and support. My sincere thanks go to my dissertation
committee members. Dr. Jane Grassky. chairperson. Dr. Gail Davis, and Dr. Stoerm
Anderson, for their knowledge, guidance. and expertise along the way. Special thanks go
to Dr. Grassley for her thoughtful advice at every step of the dissertation process.
A special word of thanks goes to my husband, Warren L. Rutherford. who
provided valuable, ongoing support throughout my graduate study. My family members
have been behind-the-scene cheerleaders. whose presence was always felt. even though
they were physically far away. This dissertation could not have been completed without
mentors. family members. and friends. I am also grateful to Carol Blazewicz for her
valuable technical assistance and support for this study.
V
J\13STRACT
13ARBJ\RJ\ J. GRlJ EN DEMANN
LIV ED EXPERIENCES OF FJ\CE-TO-FJ\CE LEARNING IN NURSING STUDENTS
AUGUST 2010
Nursing education is undergoing translormation. llistorically, face-to-face
learning has been the mainstay of student nurse learning, but faculty and nurse shortages
are leading to rapid adoption of Web-based on line education. In spite of moves to online
learning, face-to-face learning continues to persist. This study focused on how nursing
students experienced face-to-face learning and why this mode of karning not only
survives, but thrives. Online learning, however, was also valued by most of the
participants primarily because of flexibility, convenience, and accessibility .
This study was anchored in a hermeneutic phenomenological approach, with
Gadamerian concepts, and van Manen's four lifeworlds as frameworks to understand
student lived experiences and meanings of face-to-face learning. Face-to-face interviews
were conducted. Patterns and themes were extracted from the tape-recorded interviews. J\
cohort of eight volunteer RN-BS/MS nursing students from one southern U.S. university
confirmed that face-to-face learning continues to be valued as a strong methodology in
nursing education. Their experiences focused on, for example, humanism, the importance
of "presence," physical proximity, classroom as "the real thing," learning through the
senses, immediacy of ft:edback, and learning and knowing by human connections and
VI
interaction. Additional research is needed to explicate valuable outcomes of learning in
nursing. exploring the relationship of humanism in the classroom versus humanism in
patient care. A study of the effect of multi-tasking by nursing students is sorely needed.
Blended learning in nursing must continue to be studied. At this point in time, is blended
learning a compromise of both online and face-to-face or is it the educational wave of the
future? ls blended learning superior, in outcomes, to face-to-face and/or online learning'!
Also, the particular research of this study needs to be replicated in another part of the
country, using similar frameworks.
The findings of this study were a rich source for understanding how students
process their learning experiences. "Being present" was the primary essence of facc-to
lltce learning. Raising the consciousness of the importance of face-to-face learning for
nurse educators, nurse practitioners, schools of nursing, and healthcare executives was a
goal of this research study.
Vil
TABLE OF CONTENTS
Page
COPYR IC,HT ............................. ..... ... ...... ........... ....... ...... .......................................... iii
DEDICATION .. .......... ............................. ... .. ....... .. .. ............. .... ....... ....... .. ... .. ....... ...... iv
ACKNOWLEDGEMENTS ....... .... .. .... ... .... .......... ...... ........ .. ...... ... .. ............. .. ..... ........ v
ABSTRACT .... ............... ........... .. .......... .......... ... ... ..... ...... .. ... .......... ... .... .................. ... vi
LIST OFT ABLE ............................................. .. ....... ......... .. ...... ........... .... .................. xi
Chapter
I. INTRODU CTION ......... .. .... ... .. ......... .. ..... .. ....... .. ............... ........... .. .... ........ .......... I
Focus of Inquiry ....... ........ ..... ...... ....... ........................... ........ .. .............. ... .. ...... I Purpose .... ................. .. ...... .... .. ..... ........ ............ .... .......... ................ .... .... ........... 4 Detinitions ............................ ....... .......... ... .. ................ ....... ..... .. ........ .... ... ......... 4 Rationale .............................. .. ..... ... .... .. ................ .......... ........ .... .......... ........ .... 7
Literary Context .......................... ......... ... ..... .......... ..... ...... ............ ............. 8 Significance .................................................................. ..... ..... .. ..... ............. ... . 12 Researcher's Relationship to Topic .......... ..... ... ... ....... .. .... ..... .. ..................... . 15 Assumptions ...................................................... .. ... ..... .. ................... ........ ...... 17 Philosophical Framework ..... .... ... ... ... ................ .. .... ... ...... ............................. 17
Interpretive Phenomenology ............. .... ... ....... ...... ........... .. ...................... 18 Lived Experience and Lifeworld .......... ......... ........................................... 19 Gadamerian Hermeneutics .. ..... .... ........ ..... ..... .......................................... 2 1
Summary ...... ................... ... ......... ... ..... ............ .. ......... .. .... ......... .... .. ........... .... 25
II. REVI EW OF THE LITERATURE ...... ....... ... .. ..... ... ....... .............. .............. ......... 26
Introduction ...................................................................... .. ............................ 26 First Research Question ................ ... ......... .. .... ..... ... ... ...... ........ ..... ..... ... .. ..... .. 27
Comparative Studies .......... .... ........... ... ...... .... .......................................... 28 Nursing Literature ...................................................... .. ..... ................. 28
Summary of nursing comparative studies ............. ... ... ......... ........ 36 Professional Education Literature .................... ................ .. ...................... 37
viii
Summary of educational comparative studies ..................... ........ 43 Researcher comments ................................................. ........ .. ....... 44
Critiques of Comparative Studies .................... .. ..................... .. ...... ......... 44 Constructivism ............. ...... .......................... ......... .. .... ...... .. .... ....... .. ..... .. . 46
Second Research Question ....... ............ ......... ........ ......... ... ....... ...................... 51 Comments of Essence ..... ...... ... ...... .. ... .. ... ... .. ... ...... ..... .... ....... ....... ........... 62
Summary ........ ....... ...... ........ ..... ...... ...... .. ...... ....... .. ....... .... ...... ...... .. ..... ... ...... .. 64
Ill. RESEARCH PLAN ..................... .. ..... ...... .. ....... ........ ........ ..... ..... ....... ...... ........... 68
Study Design ...... ... ......................... ... ... .... ..... .... ............ .. ............ ....... ............ 68 Methodology ............................................................... .... ..... .. ..... ...... .... ... ...... 69 Methodological Structure of Max van Manen ................ ..... .. ..... .... .. .... ......... 70
Research Setting .... .... .... .... ... .... ... ............ ...... .. ...... ... .. .... .. .... .... ... ....... ...... 73 Participants ................................... ........... ... ... ........ ......... .. ........... .. ....... .... 73
Data Collection .......... ......... .............. .. .. ..... ...................... ............. .... .. ....... .. .. 73 Interviewing ..... ........... .. ....... ... ... .... .. ... .. .... .................... .. ..... ...... .. ....... .... . 74
Data Analyses ........ ... ...... ................. .......... ..... ... ........ ................ .. .................. 77 Language ........ .... .......... ....... ...... .. ........ .. .... ... ..... ... ......... .. .... ...... ... ............ 81
Methodological Rigor ..................... .......... .. .. ... .. ........ ..... .... .. ..... ... ..... ............ 83 Protection of Human Participants ..... ......... ..... ........... ..... ... .. ....... .. ..... ............ 86 Pilot Study ......... ........................................ ...... .............. ... ... ..... ... ...... ............. 87 Summary ...... .... .............. ..... ...... ...... ........ ................................... ... ........ ......... 91
IV.ANALYSIS OF DATA ... ..... .... .. ................... ... .. ............ .. ...... ............. ................. 93
Research Process ... .......... .. ... ..... ..... ........ .... .......... .. ... ...... ... ........... ... .. ...... ...... 93 Description of the Sample ...................... .. ................ ..... ... .. ........ ...... .......... .... 94
Participants and Permissions ... .. .. ....... .... ............. .... ..... ............... ............. 94 Consents .... ........... ................................. .... .......... .... .. ... ....... .... .... .. ........... 95
Interviewing ........... .. .. ... .. ... ... .. ... ........... ........ .. ........ ...... ... .. ............... ........... .. 96 Data Analysis ... .. .............. ..... ........ .. ...... ...... ............ ... .. .. .... ............. ......... .. .. I 00 Methodological Rigor ................... .. ........... ........ .. ...................... ...... .. .......... IO I Findings ............ ................... .. ................ ...... ............ ........... ..... ... .................. 102
Patterns and Themes ...... ... ....................... .... ..... ... .... .. ... .. .............. ......... I 03 Four Lifeworlds ... .... ........................................ .. ...... .. ........... ............... .. . 104
Summary ........... ................ ............................ .. ......... ... ....... ... ....... ................ 108
V. SUMMARY OF THE STUDY ..................... .. ..... .... ....... ... .. ... .. .. .... .... .... ........... 111
Review of the Problem ......... ......... ..... ........ .... ............. .. ..................... .... ..... . 111 Discussion of Findings ............ .... ... .... ..... .......... .. ...... .. ... ...... ....... ... ...... .. 113
Framework and Meanings ... ........ ... ............... ... .. ................. ............. 113
IX
Research question one ....... ...... .. .... ............... ... .. ..... ... .... ............ 115 Research question two ................... .. ........ ................... .. ........ .... I I 6
Partic ipants and Interviews ..................................... ............. .. ...... .... 116 Patterns and Themes ................... ... ..... ........... ......... ..................... .... I 1 7
Lived space .......... ................. .... .. ... ......... ..... .. ......... ..... ........ .. .... I 17 The teacher .............. .............................. ....................... .............. I I 8 Lived body ............. .............. .... .... ......... ....... .... .................... .... .. 122 Lived time .............. .............. ........ ... ............. .... .. ... ..................... 124 l.ived other ................... ........ ....... ..... .... .. ..... .......... ... ............ ... ... 126
Constructivism ........ ..... ...... ....... ........ .. ....... ....... ..... ..... .. .. ... ...... ........ 128 Conclusions .................. ..... .. ..... ...... ......... ........ ........ ..... ... .. ...... ....... ........ 131 Assumptions ........... ... ... ..... ...... ....... ......... ...... ......... ..... ... .. ....... ...... .. ..... .. 133 Significance .................................................... ........ ... ..................... .... .... 135 Recommendations ......................... ................. .. ...... ........... .. .......... .... ..... 13 7
Nursing Education and Research ............ .. ...... .. ... ..... ....... ...... ......... . 137 Nursing Practice ...................................................................... ........ . 140
Summary ...................................... ..... .. ................. .. ...... ................. .. ... .... ...... 140 Purpose ................ .. ..... ..... ...... ................ ....... ......................................... 140 Methodology ....... ........ ..... ...... ..... ..... ...... ........ .... ........ .................... ........ 140 rin<lings .............. .. ........... ....... .. ... .......... ................ .. ... ..... ...... ........ ......... 141 End Notes .......... ......... ........... ... ... ...... .... ...... .............. ............. ..... ........... 142
REFERENCES ....... ...... .......... ..... ...... .. .... ...... ......... ...... .... .......... ...... .. .... ... .... .... 145
APPENDICES
A. Recruitment Flyer# I and #2 ....... .. ........................... ....... ...... .............. ... 161
B. University Approval Letters to Conduct Study .............. ...... ...... .. .......... 164
C. Informed Consents ......... .......................... .... ............. ............ .. ............... 168
D. University Approval Letter~Pilot Study ....................... .............. ......... 175
E. Interviewing Guide ... .... ..... ................. .. .... ... ...... ............ ....... .... .... ......... 177
F. Li feworlds ....... .............. ............ ...... .... .. ...... .. ............ ...... ....... ....... ......... 179
X
LIST OF TABLE
Table I. Lived Experiences of Faci;-to-Facc Learning-Patterns and Themes .. ... ...... ................................. ..... ....... ..... ......... ... I 04
XI
CHAPTER I
INTRODUCTION
Focus of Inquiry
Historically, nursing education has been characterized by face-to-face learning.
However, a critical nursing faculty shortage coupled with the current nursing shortage
has been a factor in the growth and rapid adoption of Web-based technologies supporting
online learning by many educational institutions. To address the access barrier, nursing
programs are offering increased distance learning options, which are becoming a
common method to obtain a nursing education. This is an especially valuable option for
those who require doctoral degrees to qualify as faculty but cannot travel to an institution
of higher learning (Halter, Kleiner, & Hess, 2006).
According to an American Association of Colleges of Nursing (AACN) Report,
almost 50,000 qualified applicants from baccalaureate and graduate nursing programs
were turned away in 2008 (AACN, 2009). Faculty shortages were a prime concern. In
discussing the nursing shortage, Roman (2008) interviewed nursing leaders who spoke of
the lack of faculty but also discussed the use of Web-based (online) courses, primarily for
subjects that do not require direct supervision of care. In addition, an AACN White Paper
stated that technological advances were enhancing quality and access to nursing
education, expanding the capacity of educational institutions far beyond their own
geographic areas. Technologies could also be used to complement traditional face-to-face
classroom teaching and as tools to enhance education (J\J\CN. 1999). In promoting
technology in student learning. the National League for Nursing (NLN). in their position
papers, advocated evidence-based curricula that were responsive to students ' needs.
collaborative. and with an integration of current technology (NLN, 2003, 2005).
The literature. however. reflected contradictory views of the efficacy of face-to
face and online educational environments in enhancing student learning and providing
the space for professional growth and excellence in nursing practice. Davis (2006). atier
calling online education a disruptive technology, stated that online learning in nursing
was rapidly becoming the norm. Speziale and Jacobson (2005) noted that technology
would have an important role in the future of nursing education and on line learning
would continue to grow in quality and use in the future. Some saw it as an opportunity for
nursing to prepare students across geographic boundaries (Oermann. 2006). Oermann
questioned whether nursing was moving too quickly into implementing online learning
and stated that some faculty were concerned that distance education has initiated the
demise of the traditional classroom. After examining the role of technology in
transforming nursing education, Simpson (2003) cautioned that virtual reality Web-based
technologies were unlikely to solve all the issues that currently confront nursing
education, no matter how promising and exciting they might be. He also argued, " . .. the
imminent demise of the traditional classroom (face-to-face) may have been greatly
exaggerated" (p. 86).
As discussions of the efficacy of on line learning in nursing grew, the dynamics of
face-to-face learning remained an unresolved issue in nursing education. Diekelmann
2
(2000) translated the meaning of face-to-face into ·'physical presence" as she argued that
in online learning, the teacher cannot see or read faces; thus. n;ading students' faces can
no longer be used to influence the hreadth and depth in content. Buckley (2003) noted
that face-lo-face communication contained nonverbal cues that convey overt, as well as
unspoken. meanings that could contribute to learning. The AACN ( 1999) posed questions
regarding the traditional relationship of technology to the humanistic practice-oriented
care that is the hallmark of nursing. Hall (2009) noted that as more nurse educators turned
to online teaching. students continued to value traditional face-to-face approaches.
Neuman (2006) captured two legitimate questions that need to be considered
when discussing the future of nursing education. She asked, "What is the future of human
touch and face-to-face contact in the impersonal technological world? What impact will
technology have on the historically valued, interpersonal relationships in nursing?" (p.
15). This research study, therefore, was anchored against an ever-changing framework for
nursing education and acknowledged the above dilemma. The phenomenon of face-to
face learning, as one perspective, was the pivotal chosen focus of this study. There was a
need to explore what students found valuable in face-to-face learning and how human
interactions related to the learning process and possibly, to patient care. Qualitative
phenomenological inquiry, with a goal of understanding an experience and its meaning
by listening to those who have lived it (van Manen, 1990), offers a methodology to
inductively investigate face-to-face learning in nursing education from the perspective of
students.
3
Purpose
Therefore, the purpose of this interpretive phenomenological study was to put
ltmvard a scholarly understanding of the meaning of face-to-face lived experiences in
karning, among registt:red nurse (RN) students who are pursuing a Bachelor"s or
Master's degree in Nursing. Such a study was needed to enhance our understanding of
the phenomenological attributes and elements of face-to-face learning as it affected
students ' personal and professional development in an atmosphere of continuing growth
of today 's wired educational world. The following research questions flowed from this
purpose. What are the lived experit!nces and meanings of face-to-face learning among
RN nursing students? What is the essence of face-to-face learning?
Definitions
As a preface to a discussion of the study's rationale, it was obligatory to define
the three terms that permeate the literature and language of educators and learners.
Descriptions ofjc1ce-lo:fi1ce learninx incorporate embodiment, somatic body,
corporeality, presence and '·being" before or in front of others on site (Hawley, 2002).
Face-to-face also means physical presence which has several definitions including the
sense of being physically located somewhere, and being there in physical proximity, "in
the flesh," and " real" and not virtual. Diekelmann (2000) approached physical presence
as a human endeavor that relies on visual embodied cues, the ability to "read faces ." and
knowing and connecting with other humans. Kaiser (2004) stated that the physicality of
human presence implies two or more fleshy, embodied people. Physical presence is body-
4
to-body presence which includes movement. touching, ··being there:· and experiencing
one place or one environment ([aster. 2000).
··Physical" is the corporeal and also the somatic body (Urry, 2002; Merriam
Wcbster' s Collegiate Dictionary, 2007). The phenomenon "presence" means in front and
to be present before others and also means "being."' as in phenomenology. Face-to-face
communication is considered the epitome of nurse-patient relationships in nursing. a
necessary presence in relationship with others- teachers, colleagues, patients, and
families (Dickclmann. 2000; Parse, 1992). Traditional face-to-face instruction implies
classes in which students and faculty physically interact, purvey both verbal and
nonverbal messages, engage with the teacher and other students, question and learn.
primarily through lectures, discussions, case studies, demonstrations, and return
demonstrations. Diekelmann describes these face-to-face activities in the classroom as
lived experiences.
Online learning is also known as electronic-based learning (e-based learning),
Web-based learning, e-learning, e-tutoring, distance learning, distributive learning. and
technology-mediated instruction. As a pioneer in distance education. Billings (2005) also
labels distance, or online. learning as mobile learning (m-learning) and just-in-time
learning. The overarching definition of online learning is education that takes place in an
environment where student and teacher are separated and receiving Web-based
instruction in a location other than in the physical presence of faculty . This separation of
student and teacher can be minimal , as within the same community or campus, or across
states or the world. Web-based interactive technology communication systems are
5
employed and cun be accessed any lime and in any place. In synchronous learning,
teacher und student interact remotely in real time. When individuals access the
cc.Jucational materials indepenc.Jently and at times and places of their choosing,
asynchrono us k aming occurs (Clark & Ramsey, 2005; Novotny & Wyatt. 2006).
Quoting Moore and Kearsley ( 1996), Thurmond (2002) stated that distance
education is planned karning that normally occurs in a different place form teaching;
special technologies and methods of teaching and communication are used to deliver the
course through a distance. The technology provides students with opportunities to learn,
share information , and collaborate with colleagues who are located anywhere . Distance
students are forced to take active roles in their learning, possess independence and se ll~
motivation, and prepare assignments without the discipline or a classroom with teacher
and other students (Thiele, 2003 ).
The term "distance learning" is frequently used in the literature but is not
consistently used in this study because not all distance learning takes place at a distance;
some on-campus students register for distance learning. Also. correspondence courses of
yesteryear could have heen labeled distance learning because the teacher and student
were operating at distances. Thus, "distance learning," a fairly recent descriptive term.
can be deceptive. The origin of on line instruction, however, argued Lim. Morris, and
Kupritz (2007), is distance education. Therefore, the term "distance learning" is used in
this study only when the term is used by authors to describe their programs. "Online
learning" is the preferred terminology in thi s research study.
6
Blended /earninx is the convergence ofonline and resident, traditional face-lo
lc1cc instruction. and lhe combination of computer technology and Internet components
with traditional classroom teaching. The aim of blended. or hybrid. learning approaches
is to lind a harmonious. pedagogical balance between online access to knowledge and
face-to-face interaction. promising the best of both worlds (Young. 2002; Mortera
Gutierrez, 2006). The balance in dimensions ofbknded learning is also described by
Verkroosl. Meijerink. Lintsen. and Veen (2008): ··Blended learning is delined as the total
mix of pedagogical methods. using a combination of different learning strategies, both
with and without the use of technology" (p. 499).
Osguthorpe and Graham (200J ). pioneers in blended learning. retcrenced the
construct of personal agency and learner control as important components of this learning
modality, saying that control offered to students a means of directing their own learning.
t\ didactic approach of combining face-to-face blocks with online tutorials seemed to
cater to the majority of learners (Lewis & Price, 2007). Blended learning is a fairly recent
educational strategy that is widely used today in many higher educational institutions; in
add ition. these courses have lower dropout rates than do fully online courses (Welker &
Berardino, 2005; Young, 2002). A variety of academic disciplines including nursing
(Leppa, 2004; Salamonson & Lantz, 2005) and business education (Hockberg, 2006)
utilize the blended learning approach.
Rationale
The rationale for this study first encompassed a literary context that examined the
educational dilemma of online versus face-to-face learning and how each affected student
7
karning. Even though my research was focused on face-to-face learning, it seemed
ohligatory to provide context to today·s educational environment. and thus to present
studies that included and contrasted these two modalities of teaching/learning hecause
lace-to-face karning dues not take place in a vacuum.
The fairly recent advent of on line and blended learning has forced educators to
reassess tead1ing/lcarning strategies. especially of Web-based online education. Also ,
educators have had to face the thorny problem of"what to do" with enduring, long
lasting face-to-face learning, and to critically determine if one or both arc technically and
philosophically aligned with today 's educational landscape, technological developments.
aml pedagogical precepts. My primary interest in this study was to examine one piece of
the educational puzzle, face-to-face learning, to enable enhanced understanding of this
hasic modality, especially with the surge and competition ofonline programs occurring
today. Discussion follows of the significance of this study to various entities that include
nursing education and practice, nursing theory development, participants, and
society/policy.
U!erary Contexl
Following are selected literature pieces that examined face-to-face human
learning in the context of various educational milieus. Each article highlighted questions
concerning learning and some authors proposed tentative answers. For example. Connors
(200 I) chronicled an e-leaming trend that was spreading like wildfire. Even though she
spoke of pedagogic principles of teaching-learning needed in on line courses, the
principles applied to face-to-face as well (e.g. , design of courses to support active and
8
selt~dirccted learning, rich feedback and a fostering of connectedness with faculty).
Missing in online education were the face-to-face intcractions with faculty and peers.
The missing puzzle piece was how to improve the learning process so that the focus was
on teaching and learning (both face-to-face and online) and not the technology (of
online). When asked what it was about face-to-face interactions that students missed in
online courses. a pervasive question. Connors responded by saying that there were no
answers. She did state. however. that students tended to miss face-to-face interactions
with faculty and peers. Connors advocated the need for pedagogic principles of
teaching/learning when using technology. The focus, she said. must be on teaching and
learning and not on the technology .
.Johnson (2008) voiced similar concerns of a lack of knowledge of the pedagogy
ofonline learning, a greater problem than lack of technological skills. 1-kr
phenomenological research study explored the experiences of faculty who made the
transition from traditional face-to-face instruction to Web-based teaching. Faculty
experienced a marked shitl in the nurse educator role, as well as increased collaboration
in faculty development (e.g. , developing effective models of classroom interaction for
their Web-based courses). Several students and faculty members spoke of the difficulty in
online education with the absence of visual cueing, present in face-to-face contact, but
some felt that lack of face-to-face contact was offset by more intellectual and stimulating
student discussions in the Web-based environments. Johnson concluded that nurse
educators still upheld traditional educational principles of graduate nursing education.
Conceptual frameworks, program outcomes, and student learning objectives did not
9
change in Web-based education. New knowledge could be ac4uired and synthesized in
online as well as face-lo-face modalities.
Questions were also posed by Streibel ( 1998) as he analyzed technology and
physicality in community, place. and presence: " Why <lo we need to deal with people
!'ace-lo-face rather than at a virtual distance?" (p. 36). His answer related to greater
understanding of sell; co-creating a lifeworld with other people, and opening oneself lo
the experience of our physicality in learning. leaving open the mandate to li.trther
understand this physicality by exploring lived experiences, new concepts, and
understandings. The Internet. he said, allowed new levels of abstraction and abstract
representations of interactions. Sln:ibel 4uestioned what we need to attend to as we move
into a cyber ti.tture. We need. he said, to attend to our physical bodies, settings. and
communities. Our physicality is embedded in a physical matrix of human and more-than-
human beings. Meaningful human connections were required as were personal
relationships to places. The problem with the Internet was that it was primarily a means
for technical information exchange. How do we sa lvage the primacy of personal
relationships in a depersonalized soeiety? The following question then remains. How do
we sa lvage and further understand face-lo-face encounters so that we can "survive" the
Internet? Streibel challenged us to reflect on our physical selves and construct meanings
that help us gain insight into physical face-to-face encounters. Not fully understood are
meanings in face-to-face learning and physical presence in human interactions.
In a qualitative constmctivist inquiry using a community of inquiry framework,
Stodel, Thompson, and MacDonald (2006) identified learners ' perceptions of what was
10
missing from online learning that would assist in improving the online learning
experience. Answers from IO learners, framed within the three areas of presence (social.
cognitive, and teaching) included the absence of non-verbal cues; face-to-face contact:
energy; robust dialogue, the "dynamic" that is present in face-to-face; and body language.
Also included in this absence were expressions, spontaneity and improvisation, insight.
reassurance, and informal conversations with professors. Implications for practice and
further study of online learning included: enhancing spontaneity. communication. and
social presence; coaching learners how to learn online (a conflict between form and
function that might surface if we expect that the text-based medium of on line discussions
would serve the function of face-to-face interaction): and understanding learners in on line
learning environments. Presence, in its many guises, was significant. The authors
reminded us that as technology magnifies and reduces, it draws attention to what is
present as well as what is missing.
In a phenomenological research study, Halter, Kleiner, and Hess (2006) explored
the lived experiences of five doctoral students, capturing themes and the essences of the
on line mode of content distribution. Most notable were the themes of considering, liking,
and making it fit (online doctoral education). Participants described the lack of
collegiality they experienced from not seeing facial expressions and hearing tone of
voices. However, they were thankful that the online program was available as their only
opportunity to pursue a doctoral degree . Face-to-face interaction was a reasonable price
to pay for the benefit of the convenience of on line education. These findings support the
11
positive aspect of on line programs in providing access to doctoral nursing education
when other options are not available.
In her treatise, McDonald (2002) discussed the pros and cons of on line and face-
to-face learning processes. the commonalities and differences. using the criteria of
asynchronicity, dlicient information access. and increased social distance. Importance
was given to understanding face-to-face learning. she said. because answers to this
resean.:h would expand understanding of the processes of communication. group
dynamics. and teaching/learning. McDonald suggested that a goal of karning research
should be identifying and understanding the most important clements of face-to-face
group meetings.
In spite of massive steps forward in online learning. what was it about face-to face
learning that still permeates, in various ways. the nursing and general education
literature? Does the "lemming-like rush into the technological sea" (Mallow & Gilje.
1999. p. 251) overshadow the need to step back and investigate a phenomenon that
threads itself through many studies, but is not folly understood? I believed, yes. Face-to
face learning was a perplexing phenomenon that was in need of further study.
Significance
The significance of this study to mining educalion and practice encompassed an
identification of what is most valuable and meaningful in students ' lived experiences in
face-to-face learning and thus, that could augment the existing knowledge ofteaching
learning strategies. The most valuable insights of how students learn were best articulated
by students. in their own language. The interpretive phenomenological approach was
12
most appropriate in unearthing these gems of knowledge from those who experienced
them. Furthermore. this study could identify further interpretations of f:.1ce-lo-face
interactions through research that may lead to enhanced curricula and methodological
alterations. Similar experiential studies of on line. as well as face-to-face , learning might
be undertaken to advance the science of nursing education. A model or theory of face-to
face learning may emerge. I anticipated that study results would be disseminated in
nursing/education peer-reviewed literature as well as communicated through nursing and
educational conterences.
Another significance of this study for nursing education and practice is that it
would be. to my knowledge, the first study of lived experiences of face-to-face learning
among RN nursing students, to be developed around qualitative, interpretive
(hermeneutic) phenomenological, Gadamerian interpretation. and framed around van
Manen' s ( 1990) lived experience methodology and interviewing concepts. Studies based
on this particular grouping of theoretical and interpretive concepts were not found in the
literature. Literature does exist, however, that incorporates ''pieces" of the above
framework (Diekelmann, 1993, 2001; Kohn & Truglio-Landrigan, 2007; Magnussen &
Amundson, 2003 ; and Poorman, Webb, & Mastorovich, 2002).
Participants may also benefit from the thinking, interaction, and rich, thick
verbalizing that evolve in the interviews. Participants discover new insights into their
own learning. Being a part of legitimate research by thinking, communicating, and
analyzing is energizing and educational for those who participate. At the least,
participants learn more about their modes of learning by having to think deeply and
13
communicate meaningfully. They need to know how signiticant their input into research
is and how important it is that they have contributed to enhanced understanding of how
learning takes place.
Significance also refers to svcivpo/itica/ benefits. The research may add to the
extant body of knowledge regarding The Concern/ii/ Practices o(Schooling Learning
Teaching (Diekelmann & Ironside, 1998) to the end that students would be educated
belier and that patients can receive consistent professional nursing care based on
experiential learning. Medical practitioners may also be influenced by best practices of
teaching-learning with students and interactions with patients. Nursing care could be
enhanced for patients and families in the community by teaching improved methods of
interacting, communicating, and learning, in neighborhood and community conferences
and small group work. Finally, the results of this study could be used to educate policy
makers and legislators of the need for adequate funding that highlights teaching and
learning in nursing and healthcare.
One additional aspect of significance is in order. Significance is paramount when
considering that nurses are not only educators but also caregivers to patients, as well as to
their students. Therefore, it seemed obligatory that we pay marked attention to the human
component of learning that also becomes the primary mode of caring for patients. Face
to-face learning and interaction seem to be akin to face-to-face interaction with patients.
As we learn more about face-to-face learning, we may enhance caring communications
and respect the primary of caring (Benner, 1994).
14
The signiticance of this study, then, with its in-depth analysis or feeling, "being.'"
experiencing, may lead us, as teachers, to sensitize students to '" be.'" to feel , and to
connect interpersonally with patients, just as they feel and connect with their learning and
prolcssional devdopment. In this sense, unique and enhanced knowledge of face-to-face
learning is truly significant when the concept is placed in concert with humanistic
practice-oriented care that is, according to the AACN ( 1999), the hallmark of nursing.
Researcher's Relationship to Topic
My relationship to the topic had many aspects. I am a registered nurse and am
obviously influenced by the nature of the nurse-patient relationship, having spent many
years in various roles of a caring professional nurse. Thus, I knew and !cit that face-to-
face interactions with colleagues, teachers, and patients were of distinctive value, not
only in learning, but in life.
My personal experience with face-to-face and online learning has been both
positive and negative. I enrolled in several correspondence courses in college during a
period of time when I was caring for my ill mother; these experiences were positive. Also
positive was the blended learning that I experienced in my doctoral studies. A negative
aspect was my involvement in writing an online perioperative nursing course that was
inappropriately altered by the publisher, forcing me to withdraw from the project.
I am intensely interested in "what happens" in face-to-face interaction. This
comes from my various teaching experiences in which I was always intrigued with how
students processed information and experiences, and learned or didn ' t learn, especially in
clinical areas. I was never able to do any such research on learning. This idea was further
15
entrenched in my mind when online learning came into being and I began to see face-to-
foce learning mentioned more in the literature but never anything that I could describe as
ddinitive. I still have questions about learning and its human attributes and this study
will assist me to better understand the process and the phenomenon, enabling me to
.. know" in an epistemological way.
13iases could influence my role as a researcher. I questioned and evaluated myself
regarding biases, especially during interviewing and data collection processes. As this
sdt~retlection occurred, I concentrated on exploring the essence of face-to-face
interaction, but only in the context of learning by this method. I made every effort to be
as neutral as possible, when talking, thinking, and writing. My personal notebook and
rellections on thoughts, conversations, newspaper clippings, and selected journal articles.
have , along the way, made me very sensitive and have had a positive impact on me and
my study.
Munhall (2007a) spoke of decentering and "unknowing" as clearing both our
vision and thinking from assumptions, and from prior knowledge and belief systems. I
practiced listening with the " third ear" free of preconceptions and other '·noise·· that
could have prevented me from hearing clearly. Decentering and unknowing achieved a
condition of openness, and I found myself clicking my brain to bring about openness, and
thus reducing, to a reasonable point. my biases and preconceptions. These activities
brought wonderful insights to my thoughts and conversations.
Conversations about my research with peers, family, and friends encouraged, and
at times. forced me to bring to reality my evident and not so evident influences. But my
16
lifelong nursing actions have occurred in intense face-to-face caring experiences with
patients and with stu<.lents where I know that I have made an impact and a difference.
Therefore. I was influenced by my experiences but was also capable to place my
experiences, as a researcher, into proper context.
Assumptions
The assumptions of this study that I, the researcher, acknowle<.lge are:
I. Face-to-face learning is important and valuable.
The dynamics of face-to-face learning are not fully understood.
3. The present wired world, with its online learning, presents a challenge to
further study face-to-face learning.
4. Face-to-face interactions with patients are valuable components of nursing
responsibilities and are a hallmark of the nursing profession.
5. Nurse-patient relationships are closely relate<.! to face-to-face learning
that most students experience in becoming a nurse.
6. Nursing students will want to talk and reflect on their face-to-face learning
experiences.
7. This study will contribute to learning pedagogy.
Philosophical Framework
Interpretive phenomenology and Gadamerian ( 1960/2004) hermeneutics were the
primary philosophical frameworks of this research study. Layered under a qualitative
research methodology, interpretive phenomenology inclu<.led the concept of"lived
experience" and the understanding of meanings, so relevant to a study of learning.
17
(iadamerian hermeneutics captured the essence of languag.: and text (both inherent in
lace-to-face learning).
Interpretive !'henomenu/ogy
'·Becoming phenomenologic is not only hearing language and believing
something is being revealed that might be valid, but it is hearing and also contemplating
what might be concealed in responses" (Munhall , 2007c, p. 149). The goal ofa
phenomenological inquiry is to identify, appreciate, and explain meanings but also
critique these meanings. Critiquing interpretations has implications !or nursing and
healthcare, as well as the individual (Munhall).
Phenomenology is primarily ontologic, a study of the modes of ''being in the
world" of human being; it is also a study of essences and offers accounts of experienced
space, time, body, and human relations (the lifeworlds) as we live them. The lifeworld ,
the world of lived experience, states van Manen (1990), is the source and the object of
phenomenological research. The term "phenomenology" is derived from the Greek word
phainomenon meaning appearance (Holloway & Wheeler, 2002), an observable fact or
event, or an object or aspect known through the senses rather than by thought or intuition
(Merriam-Webster's Collegiate Dictionary, 2007). The aim of phenomenology and
phenomenological research is to gain a deeper understanding of the nature of our
everyday experiences (van Manen). Phenomenological research is a caring attunement,
and a wondering about living and being human. Phenomenological descriptive examples
help to see the deeper significance or structure of the lived experience (Munhall, 2007b),
and thus the relevance to nursing education and the associated face-to -face phenomenon.
18
Phenomenology, the study of consciousness as experienced from the first-person
point of view, is the study of phenomena, things as they appear in our experience (Smith.
2003 ). I believe that face-to-face learning is consciously experienced from this first
person viewpoint. Smith, ii 14, said:
Conscious experiences have a unique feature: we experience them. we live
through them or perform them . . . This experiential or first-person feature- that of
being experienced- was an essential part of the nature or structure of conscious
experience. This feature was part of what it is for the experience to be
experienced (phenomenological) and part of what it is for the experience to he
(ontological).
Lived E~perience and Lifewor/d
The notion of " lived experience" is a fundamental precept of interpretive
phenomenology. Lived experiences were " those experiences that reveal immediate, pre
reflective consciousness one has regarding events in which one has participated''
(Kleiman, 2004, p. I 0). Recalling these lived experiences, in specific contexts,
transformed them into objects of consciousness. Ironside, Diekelmann, and Hirschmann
(2005). even though speaking of practice educational experiences, identified a key
component that served as a common denominator for my study related to nursing
education: ·'One place to begin reforming practice education is with explicating the
common experiences of nursing students in these environments" (p. 49). Here, the
importance of "experience" became a beacon and evoked, for me the researcher, the
significant meaning to students of experiences in learning the art and science of nursing.
19
Not only were these just "experiences;" they were '"lived" cxperiences. Lived experience.
said van Manen ( 1990). is both the starting point and the end point of phenomenological
research.
In a treatise on nursing education and pedagogies, lronside (200 I) pointed to
phenomenological pedagogies as understanding of lived experiences of teachers and
students. The strength of these pedagogies (e.g. , narrative pedagogy), she said, lay in
reflective dialogue, explorations, shared meanings. and interpretations of the stories of
schooling, teaching, and learning. I wished to describe lived experiences with
relationships to pedagogy, since the pedagogy of learning. along with the lifeworlds of
students' experknces. is what I explored.
The lifeworld is the world of lived experience, the world of immediate
experiences, the world as already there. Four lifeworld existentials (van Manen, 1990)
were guides for reflection in the phenomenological research process:
(a) lived space (spatiality}-the felt space in which we find ourselves that affects
the way we feel. (b) lived body (corporeality)- indicates that we are always
bodily in the world; our physical or bodily presence reveals, and can also conceal ,
some things about ourselves, (c) lived time (temporality}-subjective rather than
objective time; constitutes dimensions of past, present, and future, and (d) lived
human relation (relationality or communality}-the relationships that we have
with others in the interpersonal space that we share (van Manen, 1990, pp. 101-
105).
20
Munhall (2007a; 2007c) stated that we need to hear situated context. Thoughts,
tcelings, emotions, and questions are deeply imbedded in the context of the participant's
Ii fe , or lifeworld. Contextual processing of lifeworlds helped to clarify and reflect
awareness of the experience. In my study, contextual processing took place as
experiences of face-to-face learning were voiced through textual language, constructed,
and given meaning. Gadamerian hermem:utics provided a framework for illuminating this
context of language and text in face-to-face learning.
Gadamerian HermeneU/ics
Hans-Georg Gadamer ( 1900-2002), one of the most influential and important
thinkers of the twentieth century, transformed the art of hermeneutics by making it
philosophical. He was a German scholar who was greatly affected by the philosophy of
Martin Heidegger, but who went on to conduct research that led to a model of how
understanding leads to interpretation (through dialogue or conversation). This
hermeneutic phenomenon, said Gadamer, was not concerned as much with a method of
understanding than with knowledge and truth (Gadamer, 1960/2004; Malpas, 2005 , ~ I).
The word "hermeneutics" pointed back to the task of interpreters, which was
communicating something that was unintelligible because it was spoken in a foreign
language, such as the early Bible. The interpreter of what was written, like the interpreter
of divine or human utterance, had the task of overcoming and removing the strangeness
and making its assimilation possible. Hermeneutics consisted of understanding,
interpretation, and application; interpretation was also an explicit form of understanding,
21
interpretation, and application; interpretation was also an explicit form of understanding
(Gadamer, 1960/2004).
Writing was central to the hermeneutic phenomenon; writing had the
methodological advantage because " it presents the hermeneutic problem in all its purity.
detached from everything psychological" (Gadamer, 1960/2004, p. 353). The art of
writing, like the art of speaking, was not an end in itself and therefore not the
fundamental object of hermeneutic effort. The understanding was entirely taken up with
what was being written about. Understanding itself had a fundamental connection with
language. Language was the medium and universal horizon of hermeneutic experience
(Gadamer). Gadamer's principles of tradition, dialectics of interpretation, and dialectic of
question and answer, could be used to develop a style of hermeneutic interviewing
(Geanellos, 1999). These methods of interviewing and dialectic understanding were
grounded in my study.
Hermeneutics, wrote Gadamer (1960/2004), was the proper method to recover
meaning and make explicit the basic ontologic mode of understanding-essentially a
matter of exhibiting or " laying-bare" stmctures of"situatedness." In addition, however,
all understanding and meanings inevitably involved some prejudice that gave the
hermeneutical problem a real thrust. Not until the Enlightenment did the concept of
prejudice acquire the negative connotation known today. ··Prejudice" essentially meant a
judgment that was rendered before all the elements that determine a situation had been
examined; it was interpreted by Gadamer as neither neutrality nor the extinction of one's
selt'. but the foregrounding of one 's own fore-meanings and prejudices, being aware of
22
one·s own bias. so that the "text can present itself in all its otherness and thus assert its
own truth against one·s own fore-meanings" (Gudamer. pp. 271-272).
Two concepts important to Gadumerian hermeneutics are the hermeneutic circle
and the fusion of horizons. The hermeneutic circle represents the circular structure of
understanding. The circular movement of understanding runs backward and forward
along the text, and ceases when the text is understood. This circular understanding is not
a " methodological" circle, but rather an element of the ontological structure of
understanding (Gadamer, 1960/2004). The circle is a metaphor; this hermeneutic circle
represents a process of repeatedly returning to a text, or to the world, and finding new
interpretations of it each time we see it. Understanding is achieved by our interpreting in
a circular process, moving from a whole to the individual parts and then from the
individual parts to the whole through the hermeneutic circle. This "circle" reveals context
within which we must interpret and reason. The way that understanding leads to
interpretation is dialogue, or conversation (Debesay et al., 2008; Dombro, 2007).
Understanding, in Gadamerian tradition, appears through the fusion of the
hori zons of participants and researchers . The concept of"horizon" expresses the superior
breadth of vision that the person who is trying to understand must have. To acquire a
horizon means that one learns to look beyond what is close at hand- not in order to look
away from it but to see it better, within a larger whole and in truer proportion (Gadamer.
1960/2004). Horizon is the field of vision, a lens, each individual ' s perspective, which
comprises everything that can be seen from one' s perspective or vantage point. It is also
our background of assumptions and meanings. Horizons are temporal and a person does
23
not have a closed horizon because it is always in motion. Gadamer used the metaphor of
a hori zon to depict the range of cultural , historical, and linguistic preconceptions that we
all bring to bear as we try to understand. As the hori zon of the present is in continuous
development, understanding of the participants and researcher merge into a new
understanding. This is where " fusion '' of horizons takes place. The task of understanding
is to show how a fusion has occurred; this task can be achieved in research writing.
Interviewing can also lead to a fusion of horizons (Cassidy, 2006; Fleming et al. 2003;
Koch, 1996; Phillips, 2007). An additional Gadamerian thought, relevant to language in
learning, is that language is the communicative mediation which establishes common
ground (Gadamer, 1960/2004).
Gadamer ( 1960/2004) provided a structure that incorporated what it was that
seemed relevant to increased knowledge of learning, especially face-to-face learning. My
interpretation of this structure included:
(a) situated context (all learning in this day and age, focuses on online versus
face-to-face, two contexts of prime importance), (b) language (all learning is
about language and its textual components), (c) hermeneutic ontologic philosophy
(all about "being" and lived experiences), (d) hermeneutic circle and fusion of
hori zons (valuable metaphors for envisioning the thoughts of both the learner and
me, the researcher), and (e) lifeworlds (the four contexts surrounding face-to-face
interactions).
The structure gave benchmarks by which I could frame and explicate themes and
patterns from students ' lived experiences in learning. My search consisted of unearthing
24
the lived experiences of nursing students who were learning or have learned in face-to
face modalities.
Summary
This is a transformative era of many changes in education, most notably, nursing
education. The processes of learning were subjects of discussion in many journal articles.
Face-to-face learning, however, was the justified focus of this study. The identified
problem was a lack of scholarly understanding of what this phenomenon contributed to
learning and the knowledge of nursing. What do students find valuable in face-to-face
learning'? As context, the definitions of face-to-face, online, and blended learning were
put forth. The rationale, significance, and subsequent worth of this study were presented.
A synopsis of the philosophical framework was a roadmap by which this study
proceeded. The philosophical framework for this study was interpretive phenomenology
enhanced by Gadamerian hermeneutics. Gadamer ( 1960/2004) was chosen as an
appropriate philosopher who furthered the understanding of ontologic meanings as
related to learning.
25
CHAPTER II
REVIEW OF THE LITERATURE
Introduction
This literature review provided an overall picture of where we were in face-to
face learning. The review was complex because the phenomenon that I was studying was
complex. Its complexity is related to history, antecedents, and a present-day view of the
enigma of which learning modality is superior for students. As I stated in chapter I, the
dynamics of face-to-face learning remain an unresolved issue in nursing education.
My focus was on face-to-face learning because I believed this mode of learning
represented what is of importance to students, especially nursing students. The nursing
profession, with its mandate for superior caring for patients, relies primarily on face-to
face human interaction with those we serve; however, one can perceive that how we
learn to serve is equally important. Therefore, this study purported to enhance our
understanding of the experiences and essences of face-to-face learning as it affected
students in the atmosphere of today's growing wired educational world. The gap in the
literature was in the illumination of phenomenological attributes, lived experiences, and
human essences of face-to-face learning. This illumination, one piece of the educational
puzzle, was the crux of this study.
The overall framework for the literature review came from the two research
questions: first, "What are the lived experiences and meaning of face-to-face learning
26
among nursing students?" and second, " What is the essence of face-to-face learning'1"
This framework was chosen because: (a) it directly targeted the gap in the literature. and
(b) it gave strncture to the organization of the review. The overall purpose of the study
was to put fo11h a scholarly understanding of the meaning of face-to-face lived
experiences in learning. The literature was primarily related to the two questions and shed
light on and put forth views of the topic, stimulated thinking, and prompted dialogue.
Face-to-face learning was addressed as a significant issue in education. A summary of the
literature review completed this chapter.
First Research Question
In line with the first research question, the literature review encompassed a broad
view of experience---including student and teacher views of learning in nursing. First,
were research studies in nursing and professional education that compared face-to-face
with online learning (the two most paired teaching-learning methodologies}, and also,
with blended learning. These comparative studies comprised a majority of the learning
literature and provided context to the present state of the teaching-learning environment:
a critique of comparative studies was also included. Based on my knowledge and a search
of the literature, there were no studies based solely on face-to-face methodologies in
nursing.
The inclusion of professional education comparative studies was significant
because the general higher educational milieu is inherently related to what takes place in
nursing education. Nursing is part of the larger academic educational world. Objectives,
teaching methods. problems, and research approaches are similar in nature for both
27
disciplines. Non-nurse educators have brought forth a myriad of lucid thoughts and
expressions on learning that add value and enhance understanding of how students
process information. Constmctivism, the building of new knowledge which is inherent in
face-to-face learning, was addressed in relationship to the first research question. A
qualitative study from the professional education literature that used constructivism as its
framework illuminated students ' experiences of face-to-face learning (Stodel, Thompson,
& MacDonald, 2006).
Comparative Studies
Nursing lilera/ure
Representative comparative nursing research studies provided insights into
student evaluations of their learning, both in face-to-face and online methodologies.
Studies that incorporated blended learning were also included.
These studies incorporated questionnaires, examinations, Likert Scales, chi
square, I testing, Fishers' Exact Test, and ANOVA as evaluative tools. The studies
compared the outcomes of face-to-face with on line learning and included student
perceptions, experiences, and satisfaction indices; examination and course grades, as
dependent variables. No significant differences in scores or satisfaction indices for face
to face versus online modalities were found in these studies.
Bata-Jones and Avery (2004), in a Web-based graduate Pharmacology course,
compared student outcomes with those in the face-to-face course; both were taught
simultaneously. The Web-based course, however, included three face-to-face sessions,
required for online courses by the university. Students self-selected the mode of learning:
28
18 students chose the Web-based course and 52 chose the face-to-face section. The same
instructor taught both courses and the same examinations were administered to both
groups. The results indicated no significant differences between the mean midterm and
final examination scores of students in either course. One research question dealt with the
experience of students in the online course; the students voiced "positive comments" (i.e .,
"high quality interaction") about their experience. No student comments from the face-to
face course were included. The authors stated that "evaluation of online courses should
continue, with particular attention to interaction among faculty and students and overall
student satisfaction" (p. 186), and "technical problems and adequate communications
between faculty and students and among students remain unresolved issues" (p. 186).
In like manner, Leasure, Davis, and Thievon (2000) compared student outcomes
between Web-based distance learning and technology with traditional face-to-face
pedagogy. They reported no significant differences in grades of 66 undergraduate
students in a nursing research course. These researchers, however, also found no
differences in satisfaction indices in both student groups; both groups were satisfied. An
interesting finding of this study is that students chose which section they wanted, but
early in the semester, eight students transferred from the online to the face-to-face course;
no students switched from the traditional to the online course. Online students also had
the option of meeting in person; no information was available about this. Student
comments about what they liked in Web-based learning included improved writing ski ll s,
flexibility, cost, and convenience of the course. Positive aspects identified by the
traditional face-to-face students included more interaction with both faculty members and
29
peers. "can ·1 procrastinate.' ' immediate feedback and clarification. more self contidence.
and more meaningful learning activities.
Perceptions of classroom teaching versus Web-based course deliveries were
evaluated by Rayn, Carlton, and Ali ( 1999), using a questionnaire given to 96 graduate
nursing students in a graduate nursing course; this course was a combination of on-
campus classes and online modules. Three open-ended questions were added to the
questionnaire to obtain unstructured feedback. For live dependent variables (e.g., content,
interaction, participation, faculty preparation, and communications), perceptions yielded
higher scores for classroom than for Web-based delivery.
The respondents in the Ryan et al. ( 1999) study agreed that in the classroom
setting, when compared to Web-based delivery, content was·covered better, interactions
and participation were increased, and faculty preparations and expertise gained in
importance. Increased communication skills were required. The immediacy of interaction
and feedback, the facilitation of face-to-face interactions and increased speaking ability
were also reali zed. The use of critical thinking skills and time required for completing
assignments yielded no significant differences among the two delivery methods.
Saving time, convenience, and facilitation of communications were positive
comments about the online experience for students in this study. They thought that
technical skills were required at a higher level in the Web modules than in classroom
learning. Use of the Web modules, however, did not facilitate the same feeling of
connectedness as the classroom method. Other negative comments about the online
experience included feeling disconnected and isolated, not enough interaction, missing
JO
value of shared ideas, not liking computer learning, and missing seeing faces that go with
names. The researchers stated, however, that although distance learning had both positive
and negative effects, the benefits of distance learning (e.g .. increased access. resources.
and opportunities for diversity) far outweighed the problems. This blended learning
method was labeled a new paradigm in higher education but the researchers argued that
systematic evaluations of learning methodologies were needed (Ryan et al., 1999).
The purpose of an exploratory study by Jeffries, Woo It: and Linde (2004) was to
compare the effectiveness of an interactive, multimedia CD-ROM with traditional face
to-face methods of teaching the skill of performing a 12-lead ECG. A randomized
evaluative pre/posttest experimental design was used with a convenience sample of
baccalaureate nursing students, 45 in the technology group and 32 in the traditional face
to face group, who were randomly assigned. Two methods were compared: (a) a
traditional method utilizing a self-study guide, brief lecture and demonstration by an
instructor, with hands-on experience using a manikin and an actual 12-lead ECG machine
in the learning laboratory; and (b) a technology method which delivered the same content
using an interactive. multimedia CD-ROM embedded with virtual reality, and a self
study module. Randomization, a blinded evaluator, inter-rater reliability established by
duplicating evaluations of three student learners, were all instrumental in controlling
variables and enacting accuracy in the results. The researchers compared differences in
cognitive learning, student satisfaction, performance skill, and perceived self-efficacy in
learning between the two groups, using a researcher-developed questionnaire that was
divided into two areas: satisfaction with the instructional methodology and perceived
31
sdl~erticacy in relation to the karning context. The results yielded no significant
di fforcnccs by group in cognitive gains, student satisfaction with their learning method,
or perception of sdl~efticacy in performing the skill. The authors concluded that the use
of a CD-ROM might be an excellent and efficient alternative or supplement to traditional
teaching of basic skills since setting up laboratory equipment and doing repeated
demonstrations took a great deal of instructor time.
Salyers (2005) conducted a quasi-experimental study that compared Web-
enhanced and face-to-face classroom instructional methods in a Contemporary Issues in
Health Care and Health Care Policy graduate level nursing course, taught in two
sections. Similar to the studies by Leasure et al. (2000) and Bata-Jones and Avery (2004),
this study also included student self-selection of one of the two sections. Salyers stated
that random assignment of subjects in this study " was not possible." Fifty-five
participants were enrolled, 30 students in the face-to-face delivery mode and 25 students
in the Web-enhanced section. The face-to-face students attended a weekly three-hour
class and the Web-enhanced students completed four instructional modules and met on
campus for four, three-hour sessions throughout the semester. The students were
evaluated on technical ability (computer skills), learning outcomes (accessibility, time
needed, and scheduling) and course satisfaction (flexibility, travel time, quality and
quantity of interactions, comfort level). There were no differences in technical ability and
learning outcomes. Students in the Web-enhanced section, however, were more satisfied
with the course than the face-to-face students, noting greater scheduling flexibility, less
travel , and greater independence due to the selt:pacing of content. Students in the face-to-
32
face section felt more comfortable in a traditional classroom because of their belief that
there was greater interaction between peers and faculty.
Consistent themes arose from both groups regarding perceptions and experiences
of taking the respective courses. Students in the face-to-face section described the
positive student-faculty and student-student interactions, better communication about
course assignments and expectations, and greater course structure. Disadvantages fo r
these students were the increased travel time and time requirements of classes, and less
tlexibility with scheduling. Students in the Web-enhanced section reported greater
flexibility in scheduling, less travel, and the independent and self-paced learning of the
content. They identified disadvantages as decreased student-faculty and student-student
interactions, and difficulties with the technology. Salyers (2005) advocated further
research to examine the balance of face-to-face interactions with Web-enhanced learning
activities in order to optimize learning. Although not a "pure" face-to-face versus Web
based study, the researcher did identify common attributes and perceptions of both modes
of learning. The perceptions were similar to those reported by Ryan et al. ( 1999).
The following two studies were described as descriptive, exploratory, and/or
comparative research. A traditional (face-to-face) course was transitioned, in three
consecutive semesters, to a Web-enhanced course, followed by a Web-based (online)
course, all taught by the same teacher, the researcher (Buckley, 2003). This nutrition
course was taken by 58 undergraduate nursing students, a convenience sample, and
evaluated, using a descriptive comparative study design. The sequenced course allowed
students more flexibility in learning and opportunities to improve computer skills,
33
including the use of the Internet. The measurable outcomes included two examination
scores and tinal course grades; additional evaluation data were selt:reports from the
students regarding instructor preparation, instructor-student interaction, testing, course
objectives and ass ignments, textbooks; and strengths and weaknesses of the course. The
SUMMA survey (SUM MA Information Systems, Inc., 2000) was used for measurement
or instructor and instruction.
No differences were found in examination scores or course grades (outcomes)
among the three learning groups in this study; however, there were significant differences
in student perceptions of sati sfaction with course formats (Buckley, 2003). The Web
enhanced course produced the highest student ratings and the Web-based, the lowest
ratings. Even though the scores of Web-based learning were significantly lower than the
other two modalities, the students' open-ended comments revealed both positive and
negative aspects of online instruction. For the traditional face-to-face course, student
comments related to content, lectures, and discussions. Comments also included positive
attributes of the face-to-face communication: nonverbal cues that conveyed overt, as well
as unspoken, meanings, which may contribute to the learning process. The students in the
Web-enhanced course, on the other hand, commented on the ease of accessing course
materials and instructors. They liked online examinations, which they felt prepared them
for taking board examinations. Students in the Web-based course were divided in their
comments. Some valued the convenience of accessing information, and thought the chat
sessions were helpful. Other students did not like studying completely online nor did they
like not getting to know the teacher. They also commented that nursing included the
34
development of interpersonal relationships and communication and asked how they could
get that over the Internet. Buckley urged. if and when developing on line courses.
activities that foster course structure. instructor interaction. and a feeling of belonging be
incorporated into the course.
The final study had a different approach to evaluation of learning outcomes.
Using an Analysis Mode/jar Social Construction <~/"Knowledge (Gunawardena. Lowe, &
Anderson, 1997), Cragg. Dunning, and Ellis (2008) compared the quality and quantity of
both teacher and student interaction in an online versus a face-to-face learning
environment. The face-to-face section consisted of 18 students; IO students were in the
online section. The same teacher taught both sections of a Master's level Advanced
Nursing Theory course. Knowledge construction was the criterion for assessing students'
abilities to think conceptually; the five levels of knowledge construction included
sharing/comparing, discovery, co-construction, synthesis, and newly constructed
meaning. The goal was to compare the quality and quantity of professor-student and
student-student interactions in both delivery systems. The Analysis Model is based on
analyzing social construction of knowledge where transcripts of the process were
available. Word counts and numbers of interactions were used for analyses. Students in
both environments mastered the higher levels of knowledge construction (i.e., synthesis
and application of newly constructed meanings) and mastered complex, abstract
conceptual material. Students in the face-to-face environment commented that face-to
face allowed for interpretation of non-verbal student communication and identification of
puzzling and problematic areas of learning. A cogent newly constructed meaning came
35
from a student: " In my view, the art and science of nursing are not dichotomous entities:
the art must be informed by and legitimized through sc ience" (p. 123).
Summary of nursinx comparative studies. These studies provided an
understanding about how students processed their learning experiences. Since face-to
face learning was the focus of this study, the student perceptions of this mode of learning,
culled from the seven studies, were extracted for this summary. Student comments were
divided into (a) connecting with others; and (b) the experience of learning. Comments
about connecting with others were: greater interaction with faculty and peers (three
entries); immediate feedback and clarification; more communications; better
communication about course assignments; more participation; and, being face-to-face
allowed for interpretation of non-verbal student communications. Comments about the
experience of learning included: can't procrastinate; increased confidence; more
meaningful learning activities; more preparation of faculty; greater course structure; non-
verbal cues conveyed overtly as well as unspoken meanings which may contribute to the
learning process; and, the identification of puzzling and problematic areas of learning.
Student comments on face-to-face learning provided windows of insights into
how they processed and experienced learning (e.g. , nonverbal cues, unspoken meanings,
identifying problems, receiving immediate feedback, and enhancing confidence). The
comments also highlighted what the students personally desired in learning, plus how
face-to-face methods contributed to their understanding of concepts and also of course
deli very. The seven articles, along with student comments, were valuable for assessing
understanding of their experiences. The value for me, the researcher, was that, first, I
36
planned to incorporate some of these words into my interviewing with a goal of seeking
to unearth lived experiences. Second, when similar words and phrases arose in the
interviewing, I would ask for further meanings and examples of their experiences. Third.
"hearing" the students' words from these studies enhanced my sensitivity and propelled
me to focus, deeply. on what students actually said and meant during interviews. I
anticipated and received rich experiences during collection and analyses of these data
because face-to-face learning is an elusive and intriguing phenomenon about which little
is known. except that it does relate to our "humanness" and our need to learn with others.
Analyzing and reviewing literature in this fashion can be a valuable exercise for any
researcher.
l'rofessiona/ Education literature
Nursing education and higher collegiate education share similar objectives.
methodologies, and frameworks. Nursing education does not take place in isolation.
Therefore it seemed appropriate and necessary, when studying learning experiences, that
professional education research be included. Studies compared face-to-face versus online
learning and also face-to-face versus blended (hybrid) learning. The courses taken by the
students included hu.man resource development, graduate technology, introductory
statistics, master's level accounting, and master's level in education. The objective for
these choices was to present a variety of academic topics from the professional education
literature. These studies incorporated questionnaires and Likert Scales for data collection
and !-tests, ANOV A, and chi-square for analyses.
37
Johnson. Aragon. Shaik. and Palma-Rivas (2000) compared face-to-face with
on line learning outcomes of an instructional design collegiate course in human resource
development course (n = 19 in each cohort). Dependent variables included student
satisfaction ratings of instructor and course quality; assessment of course; and course
projects , grades. and self assessment. 130th courses were taught by the same instructor
and students .. were enrolled" into one of the two courses. Student evaluations showed
that the face-to-face group voiced more positive views than the online group. The face-to
face group perceived that they experienced higher instructor support than the online
group. Online students, however. rated departmental support higher than the face-to-face
group. Grades were equally distributed between both groups (i.e., no significant
differences).
On interactive experiences and social dimensions (e.g., between student and
teacher, and treatment of students in the course), there was a significant difference
reflected by higher ratings by the face-to-face students. Several reasons for this were
posited by Johnson et al. (2000). A possibility was that, because of proximity. online
students did not enjoy the same amount, type. or timeliness of communications about the
course as the face-to-face students. Another possibility was that online students '
expectations were likely based on earlier face-to-face experiences during years of
schooling. The researchers concluded that online instruction may not have been suitable
for courses that required enhanced student interaction and feedback. Better simulation of
real time interaction was needed. Until this is possible, Johnson et al. stated that program
38
developers for online learning may need to avoid courses that require frequent verbal and
behavioral communications between students and the instructor.
The second study ' s focus was instructional quality, which was measured by
students ' overall satisfaction and perceptions of learning in face-to-face versus online
methods (Topper, 2007). Three related graduate level educational technology courses.
spanning three years, were evaluated. The face-to-face group had 148 participants and the
online group had I 50 participants. Students self~selected the learning methods described
as ·'traditional face-to-face (Web-enhanced or blended)," and "'fully online." (Note:
'Traditional face-to-face," " Web-enhanced," "blended," and "fully onlim:" describe
mutually exclusive methods of teaching, which raised the question of which methods
were used. The article's title, however, had reference to " ... comparing the instructional
quality of online and face-to-face." ): Comparison data by the researcher consisted of
written student course survey evaluations. Seventeen of the 18 evaluation items did not
differ significantly across both formats; no significant difference was found based on
media used (face-to-face versus online) for instruction in these courses. Topper offered a
reason for not providing evidence of cause-effect relationships: " ... we were rather
examining what was observed in the data gathered" (p. 686). Survey responses supported
the premise that the online courses were "perceived as comparable" with traditional face
to-face courses. In conclusion. the researcher suggested that. from a student perspective.
online and face-to-face (or blended) courses "are the same" (p. 689).
The following two higher education studies compared traditional face-to-face
instruction with a blended (hybrid) methodology, the blend being a combination of face-
39
lo-face and Web-based instruction. Both studies concluded that student performances in
the hybrid ortering equaled that of the traditional face-to-face method, and final learning
outcomes were similar in both delivery methods. Course composition, discussions, and
subject matter, were, however, different in each study. Both courses in each oflhe two
research studies were taught by the same instructor.
Utts, Sommer, Acredolo, Maher, and Matthews (2003) investigated student
learning in a collegiate Introductory Statistics course. The lead researcher taught both
courst:s in the same quarter at the same time of day. There were 208 students in the face
to-face course and 77 students in the hybrid course. Textbooks were identical , but the
online course also included CyberStats, a commercial online introductory statistics course
in which special attention was paid to interactive applications. Since it was "not possible"
to randomly assign students to a cohort, they were allowed lo self-select. A number of
tests were done to assure comparability, elimination of potential confounding variables
such as grade point average (GPA), class standings, gender, and selt:reporting of basic
computer skills. Dependent variables were student performance, student satisfaction, and
investments in time. Results indicated that student performance, in terms of mean scores
on the final exam, was almost identical for the two student cohorts. No significant
differences were found between the two groups. The hybrid cohort, however, was slightly
less positive in its subjective evaluation of course satisfaction. On time investment. the
instructor time spent in each course was almost identical in spite of the traditional class
having three times as many students as the hybrid class.
40
These researchers (Utts et al. , 2003) also connected the study findings with the 10
principles of learning, developed by Gartidd ( 1995), which strengthened the study.
Examples of three of these principles were: (a) ·'Students learned by cons/rucling
(emphasis mine) knowledge·· (Utts et al., ,r 41 ); rnntext added by the authors included the
observation that students in both the hybrid and face-to-face courses constructed
knowledge with continued guidance; (b) "Students learned by active involvement in
learning activities" (Utts et al., ,r 42); this involvement was present in weekly discussion
sections (face-to-face group) and the use of CyherStat, offering numerous online
interactivities. The authors stated that a combination of both types of hands-on learning
experiences would be ideal. They planned more interactive face-to-face times, to discuss
concepts rather than details and suggested that the instructor should primarily be a
motivator and explainer; and (c) "Students learn to do well only when they practice
doing" (Utts et al., ,r 43). The researchers suggested the provision of two textbooks in
addition to material online because textbooks were more adept at providing details and
in-depth elaboration; al so noted was the claim that extensive reading was more difficult
online than in a book (an intriguing insight [mine]). The researchers argued that the real
value of this study was that it showed how students seemed resilient to the method of
presentation. Ultimately, learning fell to them, but they seemed to adapt to methods
provided to them for accomplishing their learning goals (another intriguing insight).
Blended learning methodology has become popular in both the academic and
corporate worlds. Chen and Jones (2007) argued that because very little research has
examined the effectiveness of blended learning relative to traditional face-to-face
41
instruction. they proposed to assess effectiveness and student perceptions in a graduate
level accounting course. One group of 38 students was enrolled in a traditional in-class
section; another group of 58 students enrolled in a section where the course was blended
with online delivery and face-lo-face class mct:tings. Comparisons of the two methods
incorporated the dependent variables of learning outcomes and perceptions or the
instructor and the course. not unlike the variables in the previous study. Overall learning
and performance on exams and class participation did not appear to be measurably
different between the two groups. There was general satisfaction with both courses.
Students in the blended-learning section, however, appeared to have found the course
more difficult and did not find online course delivery itself to be as effective as the
traditional classroom setting. Describing this difference as intriguing, the authors
projected that online, or primarily online, delivery may be more burdensome for the
learner since the student cannot rely nearly as much on class attendance and the teacher
to clear up their questions. Both groups, however, indicated that they learned how to
solve problems. Based on the results, the authors stated that the traditional classroom
setting continued to add value in terms of instructional clarity.
Learners and teachers, commented Chen and Jones (2007), may have simply been
more comfortable with the classroom environment because it had always existed. Also,
the blended approach may inherently have offered incremental values of learning and
appreciation of concepts in the field , because of using more resources from the Web that
illustrated the concepts. If this was true, then instructors might enhance traditional
classrooms by requiring greater use of the Web. An additional related thought was that
42
online "meetings" may have forced students to be more prepared and to participate more
in the learning process than they might while sitting in a classroom. They were less likely
to become detached and passive in tht: process of learning. The authors believed that
··traditional classrooms will continut: to ofter benetits that arguably cannot fully be
obtained in any other manner, but any gaps in process effectiveness (i.t: .. navigating the
Web) will continue to be narrowed as technology becomes friendlier for both instructors
and students" (p.13). An interesting adjunct to this study was the authors' theorizing that
a phenomenon known as a '·halo effect" ( e.g. , Cooper, 1981) might occur in some aspect
of learning outside of the instruction, atlecting overall rating of an instructor and the
course. For example, the convenience ofa course or the promptness ofan instructor' s
responses to an e-mail question may have outweighed other factors and thus atlected a
student's overall perceptions. The "halo effect" and its subliminal effects on learning
deserve further study.
Summary of educational comparative studies. These studies covered various
academic higher education coursework in which face-to-face instruction was compared
with online and Web-based methodologies. Outcomes that were compared included
examination and course grades, satisfaction and perception indices, time investments. and
overall academic performance. Student study participants were either randomly assigned
or chose their preferences regarding course deliveries.
The researchers reflected on expectations of the student and the courses,
principles of learning, the "halo effect" and its subliminal effect on learning, and
incremental values of learning. No clear-cut conclusions emerged that suggested that one
43
of the three learning modes was superior over the others. 1 lowever, the positiw attributes
of face-to-face learning (e.g., higher instructor support, enhanced interactive experiences
and social dimensions. feedback, construction of knowledge, satisfaction. and
participation) were described in the studies.
Researcher comments. Comparison studies have flaws (e.g .. effects of
confounding variables, learner differences, flawed random sampling for assigning
participants to learning modalities, instructional methods contused with delivery media,
inappropriate instructional designs, and misinterpreting dependent and independent
variables). The literature below contirn1ed these comments. Even so, these studies served
a purpose, that of beginning to incorporate online learning into the nursing and
protessional education literature and attempting comparison with face-to-face learning.
These studies seemed appropriate for the time and we do learn from them. At this time,
online learning was essentially challenging traditional face-to-face learning as to which
mode was the most appropriate learning method for nursing education (e.g., the above
comparison studies). In spite of today's wired world. face-to-face learning continues.
usually in conjunction with online methodologies. My study, then, was built on this
challenge in the sense that human interactions in nursing and learning remained as the
nexus to protessional nursing. In the midst of the Web-based environment of today, I
wanted to know what it was about face-to-face learning that contributed to its tenacity.
Critiques of Comparative Studies
Johnson et al. (2000) spoke of comparative studies, saying that they often are
discounted because of the great dissimilarity between the two learning environments.
44
'·This is a classic example of comparing apples to oranges" (p. 31 ). Also voiced by
.Johnson et al. were observations about studies where learner satisfaction was a variable.
Satisfaction studies were usually limited to one-dimensional post-training perceptions of
learners, where "satisfaction" was too often m.:asured with "happy sheets" that query
learners as to how satisfied they were with their overall learning experiences. Satisfaction
must be explored through a multidimensional analysis of a wide variety of critical
variables, the researchers noted. These statements are not unlike the comments made by
researchers about comparative studies, referenced earlier in this chapter. Comparative
studies are ubiquitous in both the nursing and education literature.
There are controversies about comparative studies of learning. Joy and Garcia
(2000) advocated cautiousness when interpreting results of media comparison studies,
stating that researchers must adhere to time-tested instrnctional design strategies,
regardless of the chosen medium. The authors also emphasized giving attention to
learning effectiveness as a function of effective pedagogical practices and not just the
delivery media, a core mandate for nursing research. Comparison studies, according to
Meyer (2004), were likely to be poorly designed and implemented; they may not have
discriminated specific skills or concepts learned. Such studies, however, are relatively
easy to conduct because they usually ignored requirements for matching student samples
or controlling other variables. The impact of instructional design was often omitted in
comparison studies. Yet, despite criticism of these frequently-seen studies, they continue
to be used.
45
In the media comparison studies cited in this chapter, the delivery medium (online
versus foce-to-face) became the independent (treatment) variab le, and student
ach ievement, grades, indices of satisfaction, the dependent variables. Unfortunate ly, this
approach was usually plagued with problems (Lockee, Moore, & Burton, 2001). The
problems arose because many vari ables usually worked together to create an effective
instructional experience (e.g., media attributes, instructional strategy choices, learner
characteristics, and psychological theories). Instructional methods and pedagogy are not
to be confused with delivery media. Meyer (2004) commented that the effec ts of
confounding variables, such as individual student differences can lead to serious flaws in
comparison studies. Salyers (2005) concluded that further research was needed to
examine the balance of face-to-face interactions with Web-enhanced learning activities in
order to optimize learning (emphasis mine).
Constructivism
Comparative studies have limits. However, other frameworks for learning are
available and appropriate. One of these is constructivism. Constructivism provides an
additional approach for investigating face-to-face learning. Constructiv ism, a
psychological-cognitive and developmental learning theory, was based on the work of
Piaget and Vygotsky, both cognitive theorists. Cognitivists defined learning as an active,
cumulative, constructive process that was goal -oriented and dependent on the learner' s
mental activities. Constructionists believe that learners always interpret what is presented
to them with existing knowledge, history, collaboration, and typical ways of perceiving
and acting. Leaming occurs as an experience incorporated in the learners' existing
46
knowledge base. By making sense of the new experience, the learner com/ruc/.1· new
knowledge and meaning, building on experience and communication. The purpose of
instruction and learning is to support this construction rather than just communicate
information (Broussard, McEwen, & Wills, 2007; Vandeveer & Norton, 2005; Weller,
2004).
Constructivism is in contrast to the traditional view of learning where information
is handed down by experts who transmit their knowledge to passive learners. Learners
become constructors of knowledge rather than teachers becoming disseminators of
knowledge. In constructivism, students share their lived experiences as well as construct
new knowledge from the experiences of others. A constructivist teacher designs learning
experiences that are active, and where the learners are "doing," reflecting, and evaluating
their learning experiences; this enables students to construct multidimensional knowledge
through experience. Constructivism, a holistic social process, implies a foundation for
learning in nursing. The metaphor of construction is used because it portrays an
epistemological view of building new knowledge on existing knowledge (Magnussen,
2008; Peters, 2000). Constructivism informed this study of face-to-face learning.
Vygotsky, a cognitive theorist, promoted learning contexts in which students
actively learned, as in constructivism. Vygotsky also studied the interrelations of words
and sought to understand a concept as a conception of a word' s meaning. His major
theme was the relationship of thought to language ( emphasis mine) ( Vygolsky 's Theory of
Social Cognilive Development, n.d. ). The notion of supremacy of language, from
Vygotsky, was in concert with the philosophical thoughts of Gadamer ( 1960/2004), for
47
whom understanding was inherently connected with language. This relationship of
thought to language is inherent in face-to-face learning.
According lo Bigge and Shermis (2004), learning, in Vygotsky·s view, was
intellectual development, and humans were "taken lo learn" through rngnitive
cxperiences. The conception of a word' s meaning was of great value for the study of
thought and language. It was the internalization of external dialogue that brought the
powerful tool of language to bear upon our stream of thought. The contributions of
Vygotsky are his enduring emphases on the social dimensions of learning whereby
learners construct their meanings within social environments (Mcinerney, 2005).
Constructivist epistemology, the construction of knowledge through experience, was
transformed into words of participants through the interviewing process and also the
analyses of this study.
A constructivist and community of inquiry framework was illustrated in a
qualitative treatise of students ' lived experiences of learning. Stodel, Thompson, and
MacDonald (2006) interviewed 10 students in a master' s level Introduction to Research
in Education course who had indicated that they missed and/or would have liked more
face-to-face contact in their online course.
A caveat: The first sections of the on line course, however, included two face-to
face sessions that provided a course overview and an orientation to the technology, plus
other "additional assistance" (e.g., face-to-face meetings for the students who wanted it:
optional chat sessions with the protessors that allowed for ··real-time communication").
Acknowledging that because of these "additional" face-to-face sessions, the course could
48
have been perceived as a blended course, Studel et al. (2006) argued that it was first and
foremost an onlint: course. Skewing of the findings , based on these face-lo-face meetings
could have been possible, but only if the students analyzed the face-to-face methodology
used in the meetings rather than the actual infonnation given, which does not seem likely.
Skewing in studies such as this one would more likely come from numerous face-to-face
classes which virtually all students have had before entering college, or have previously
taken in college. Studies of learning were fraught with potential biases and variables,
which in many cases were not controllable (e.g., previous schooling, teaching-learning
techniques used, and influences of parents, home atmosphere, and mentors).
The participants in this study were working adult teachers, school administrators,
counselors, and also other full-time students. These learners were interviewed by the co
professor, which may have prevented full disclosure of participants, even though the
interviews were conducted after the learners' grades were submitted. The researchers
argued, however, that the learners were forthcoming and were not reticent in commenting
on the negative aspects of the course, or the professor (Stodel et al., 2006).
Data in this study were analyzed using a constant comparative method. Five
themes were constructed regarding what learners perceived was missing from their online
learning experiences: (and examples of each theme)
I. Robustness of online dialogue: body language and expression; energy and
emotion; physical presence; and conveying fast and in a bigger way
2. Spontaneity and improvisation: the tangent factor, those teaching moments
that are not in the syllabus; the learning that comes with discussion
49
3. Perceiving and being perceived by the other: interactivity; the listening and
talking that is much faster than writing and reading; honesty detected from
looking someone in the eye; shared experiences and interactivity
4. Getting to know others: bonding with others; socialization; sense of personal
caring; informal conversations
5. Learning to be an online learner: human contact; sharing of experiences;
reassurance; a boost of confidence.
A synthesis of"what was missing" included body language, non-verbal cues. and
visible expressions; spontaneity; energy and emotion; shared experiences; a sense of
personal caring, dynamics of discussions, and real-time. This study also highlighted the
negatives of online learning throughout the article, which, when synthesized, were
illustrative of what hindered the ability of these learners to experience superior learning:
disconnect; isolation; technology; misunderstandings; faceless people and learning; and
helplessness.
Also, in my overall analysis of these data, several pallerns (with examples from
participants in parentheses) of face-to-face learning seemed to emerge: (a) physical
presence and human contact ("body language and expression"); (b) proximity to others
(" looking people in the eye"); social presence ("bonding with others"); interactivity
("'shared experiences"); and sense of community ("getting to know someone rather than
knowing about someone"). I wondered, "Are these not the essences of face-to-face
learning?" which was my second research question.
50
The constructivist perspective was used to enable the understanding of a complex
world of lived experiem:es from the points of view of those who lived it. Discovery of
what the learners perceived was a constructivist goal. Stadel et al. (2006) connected
participants' words with themes that portrayed an epistemological view of what was
missing in learning for the IO participants. The researchers' views of constructivism seem
to have added color and intense meaning to otherwise bland words and phrases. For
example, the heading "spontaneity and improvisation" seemed to come to life as
participants spoke-"somebody brings up a point and that leads to another point and you
now have a di scussion that comes out of nowhere" (126) plus "listening and talking is
much faster than writing and reading" (130). Vygotsky 's (Bigge & Shennis, 2004;
Vandeveer & Norton, 2005) notion of the supremacy of language only highlighted the
importance of hearing real words and real feelings from participants, which was inherent
in the Stadel et al. research. " Faceless learning" and "disjointed and disconnected"
instantly portray meanings that "stick." This relationship of thought to language, and to
understanding, is inherent in face-to-face learning.
Second Research Question
The purpose of this section was to extrapolate, clarify, and explain the concept of
"essence," as related to learning, and as associated with one of this study 's two research
questions. The second research question in this study was, '·What is the essence of face
to-face learning?" Understanding essences of learning assisted in formulation of
interviewing questions and comments, but also provided a deeper understanding of the
phenomenon of face-to-face learning. '·Essence" is essentially the fundamental, real , or
51
ultimate nature of a thing (Merriam-Webster's Collegiate Dictionary, 2007); in this
research study. it was applied to the nature of how humans learn and how they express
how they learn. van Manen ( 1990) stated that phenomenological research is the study of
essences. He defined essence as ·'the i;ssential nature of a thing, the true being of a thing.
and what makes a thing what it is, rather than its being or becoming something else" (p.
177). Therefore, the essence of face-to-face learning was the true nature of how that
particular form of learning takes place. This discussion focused primarily on aspects of
presence (e.g., physical , social), proximity, collaboration, and communities of inquiry, all
of which appeared in the literature, and were associated with face-to-face learning. Other
related concepts (e.g., co-presence) were also included. (Note: This concept of essence
was assessed again atier interviewing students and analyzing the data).
A number of literature discussions of essences came from studies of online
learning. However. intertwined in many of these studies were comments on face-to-face
learning, including comparisons, again, of the most studied modes of learning-face-to
face and online. The extraction of essences from the literature was a challenging
endeavor, primarily because it was found that the business and educational literature, and
not the nursing literature, contained some of the in-depth studies of phenomena that were
applicable to this discussion. At times, the literature attributes that were missing in online
learning translated to what were positive attributes of face-to-face learning; these findings
were also discussed in the previous section of this chapter. Also challenging was the
discovery that not one, but several, essences were discussed in almost every piece of
52
literature. Thus. a portion of this review reflected the relationships among several
essences.
A personal commentary on the "essence of teaching., provided an appropriate
introduction to the topic. 8anks ( 1998), a teacher of an African-American Studies course,
spoke of her presence in a traditional classroom. She liked the physical closeness of
herself with her students. " I like standing near students as we engage in thought
provoking discussions, looking into their eyes as they grapple with dense readings and
tough issues ... and see the glee on their faces when I affirm their interpretations .. . their
nods don ·1 tell me simply that they agree, but that they get the point" (p. 1 ). She found
herself paying just as much attention to students' body language and facial expressions as
their spoken comments. She wondered how she could possibly have had this interaction
in online courses because she wanted to engage them with each other, face-to-face. Banks
stated that it was her physical presence in the classroom that conveyed her caring about
the students' learning. "Instead of letting technology drive teaching, we should think
about the ways in which technology could supplement- not substitute for- what we do
in the classroom" (p. 2). Scholars and administrators, she said, should proceed with
caution if consideration was given to dispensing with traditional classroom contact
between students and teachers; more was at stake than superficial technological
advancement.
Physical place and physical presence are important in how we construct meanings
in our lives, especially in how we construct meanings of face-to-face learning. A
university professor of education, Streibel (1998) enlarged on this concept by questioning
53
the consequences of the abstractions of place and presence in virtual. online communities.
This '·technological vision" was contrasted with the "experiential vision" where. in
physical settings, students learn how to construct meanings in learning and where they
develop a personal and public identity. In the technological vision, we could carry out
extensive interactions with others without being fully present or even fully ourselves.
Streibel argued that we needed to attend to our physical bodies, settings, and
communities because we are embodied in a physical matrix of human and more-than
human beings. Deep meaningful work and meaningful life demanded that we experience
meaningfol connections. ·'We are embodied in physical (not virtual) bodies and are
situated in physical (not virtual) locations. All important aspects of working and learning
happen in the here and now of our physical bodies" (p. 32). Strei be I then spoke of the
care that we infuse into the environment and how that changes other people's
experiences of us and our interaction in that place. He wondered whether virtual places
could be infosed with soulfulness, spiritedness, and wisdom, and also whether human
ideals could survive the Internet.
The problem with the Internet, wrote Streibel ( 1998), is that it originated
primarily as a means for technical information exchange. It was not a means of salvaging
the primacy of personal relationships and community in a depersonalized society. The
Internet undermined community. He made a case for the importance of caring for our
physical presence, our physical settings, and our physical communities. Streibel asked
why we need to deal with people face-to-face rather than at a virtual distance. He
answered that he wanted to notice and interact with people, gain a greater understanding
54
ofhimsell~ an<l co-create a life-world with other people in specific places. lfhe were to
ignore his live<l experience, he would deny himself the ability to develop new concepts
and understanding. A virtual world that would not foster physical as well as
psychological and social health was not sustainable. Quoting Moore ( 1992), Streibel
stated that "we nee<l to establish a care for physical place, presence, an<l community
before adding virtual place, presence, and community into learning. Even a virtualized
work world (or learning [mine]) required this ... physicality ifwe wanted people to grow
up having • feelings of attraction, desire, curiosity, involvement, passion, and loyalty in
relation to work"' (pp. 36-37).
Lahaie (2007) did not speak about social health, as Strei be I ( 1998) did, but did
<liscuss another social phenomenon, social presence. Social presence was another essence
of learning discussed in both face-to-face and on line learning literature. The primary
thrust of this article was that social presence could be found in online learning. Teacher
immediacy might be displayed online through affective, cohesive, and interactive
responses (e.g., emoticons [affective dimension], repetitious punctuation, capitalization,
selt~disclosure, and humor). Online intimacy could be conveyed by small discussion
groups, with feedback to students' discussions. Lahaie stated that although there were
limitations and constraints in projecting presence through technology, it could be done
successfully. He challenged nurse educators to continue finding ways to enhance student
learning experiences without " being there." (Note: Are not intimacy, presence,
immediacy, and interaction, also characteristics of face-to-face learning? Yes.)
55
According to Kaiser (2004), in her dissertation commentary, nursing differs from
education and technology in its emphasis on physical presence. In nursing, presence
(social , teacher, and virtual) was viewed as an intervention and in nursing education,
presence was viewed as a teaching strategy. Both professions conceptualized presence as
a professional competency. Clear meanings must be ascribed to presence in online
environments and may allow nursing faculty and students to address this aspect of
professional practice in ways not previously available (i.e. , exploring the meaning of
presence in a faceless learning environment that could also enhance knowledge of the
pedagogy associated with online learning).
Kehrwald (2008), a university educator, in an exploratory case study design
utilizing extended student interviews, argued that social presence played a role in online
learning. In fact, he foreshadowed a role for social presence as a critical element of on line
learning and surmised that research would make online learning "more social." He
de tined social presence as a mediated interaction but also as "an individual's ability to
demonstrate his/her state of being in a virtual environment and so signaled his/her
availability for interpersonal transactions" (p. 94). In online environments, he said, social
presence is conveyed through the use of language, media, and communication tools.
Social presence is a quality of people. Therefore, the emphasis on human activity must
take precedence over the capabilities or limitations of technology.
Collegiate researchers Wise, Chang, Duffy, and del Valle (2004), using an
exploratory research design, studied social presence with 20 students enrolled in a
graduate course, Elementary and Seconda,y School Curriculum. The goal was to test the
56
"1Tects of social presence cues on student interaction, performance. and satisfaction.
Examples of the cues were humor/playful asides, emotions, addressing people by name,
greetings. complimenting another's idea, and allusions of physical presence. Results
indicated that social presence affected the learners· interactions and perceptions of the
instructor but had no causal effect on perceived learning, satisfaction, engagement, or the
quality of the tinal course product. It was determined that it was not the medium alone
that determined social presence but rather what the individuals did in the medium. The
study results suggested, therefore, that social presence was a correlational rather than a
causal variable associated with student learning.
Diekelmann (2005), too, stated that presence could be attained in online learning.
From her Concernful Practices in Narrative Pedagogy, she spoke of teachers becoming
supportive presences in student-to-student knowing and connecting in ways other than
face-to-face encounters. Students were held accountable to their online groups and by so
doing, engendered collaboration. This meant that places for learning that were safe, fair,
and respectful were created.
Collaboration plays a role in learning. Stein and Wanstreet (2003) related
collaboration with interaction and with social presence and learning, using a
constructivist approach. Using a mixed-method design, these researchers assessed factors
that contributed to satisfaction with a gain of perceived knowledge in distance and face
to-face learning environments. Participants were 37 undergraduate and graduate students
enrolled in a course on the role of adult education in American society. The researchers
defined social presence as the ability of people to be perceived as real. three-dimensional
57
beings despite not communicating face-to-face; social presence was also emphasized in
the creation of communities of learners. Stein and Wanstreet surmised that it was
worthwhile to offer collaborative learning methods of interaction with each other and the
instructors in ways that foster learning. The research question assessed the role of learner
choice in selecting whether to collaborate in physical space or cyberspace; collaborative
work was important for completing academic tasks.
The ability to work effectively in small groups was at the heart of social presence
theory and of importance to those involved in creating communities of learners (Stein &
Wanstreet, 2003). Some face-to-face learners expressed strong opinions about the ability
to express emotion on line or carry on a dialogue. Blurbs of thought and blurbs of fact,
were not a dialogue, said one learner. However, online learners countered that the lack of
visual cues fostered an environment free of pretense because they were " really open" in
chat rooms.
Results of this study indicated no statistical differences in satisfaction with the
course structure between the online and face-to-face groups, and no difforence in the
perceived social presence of computer-mediated communication technologies between
the online and face-to-face collaborators; this was an unexpected finding. The researchers
suggested that "it is worthwhile to offer different methods of collaborative learning that
promote the ability for adults to interact with one another and the instructor in ways that
foster their learning" (Stein & Wanstreet, 2003, p. 197). The environment in which
learning took place-whether in online or face-to-face- involved a complex array of
58
factors that influenced learner satisfaction and achievement, an apropos addendum to this
literature rt:view.
Communities of learners were described in a commentary by Hodge, Bosse.
Faulconer, and Fewell (2006) who argued that creating a unity among students with each
other and the faculty was necessary for realizing "community of learners" in online
courses. "Creating unity" meant the creation of physical proximity, active social
interactions, human communication, and connectedness. Forming communities can be
done by mimicking proximity, said the researchers. Creating a social space and
community must be carefully considered in an online environment because most attempts
in creating real world spaces in the virtual world lack authenticity and often fail to yield
results by "education." Social presence. stated the researchers, was comprised of two
recognitions. The student must feel valued as a "community" member, and the
community must accept the individual. Student participation and interaction become
central concerns for learning. A community was formed by making friends, being
accepted, and exhibiting camaraderie.
Physical proximity may be essential for development and solidarity of the concept
of community, noted Hodge et al. (2006). The challenge for educators was to provide
socially negotiated and authentically constructed online learning environments that
mimic proximity. Social and collegial components played a critical role in learning.
Important aspects of technologically mimicking proximity involved allowing students to
socially interact with each other which would engender trust, community building.
collegiality, and socialization. Skills required of developers and users posed barriers but
59
the unJerlying goal was to create technologically sophisticated environments that
facilitate communications, anJ mimic proximity.
The relationships of proximity to physical presence were also highlighted by
l larper, Goble, and Pettitt (2004), researchers in a university department of Compuler
Science, in a treatise describing a multi-disciplinary proprietary platform system named
proXimily. The researchers suggested that the physical and virtual must be conjoined
because, without a physical presence, the virtual world could not reach its full potential.
With the advent of the semantic (e.g., meaning in language) Web, the division between
real and virtual had become more of a hindrance and thus more of a concern. They
argued that we have over-estimated the Web's importance; they envisioned that, in the
future, realities will be augmented by giving the Web a physical presence in the real
world. In effect, the user acquires a real-world centric view of the Web in which the Web
conforms to reality, not reality to the Web. The primary goal of proXimily was to
augment realities by giving hypertext and the Web a physical presence in our real world.
The system included intelligent searching and knowledge management, and links that
could be used to view virtual information related to the physical location or object.
(Note): This is a forward-looking system that, to my knowledge, has not yet been
operationalized in healthcare, but future advancements may prove to carve out a logical
place for proXimily in education and learning.
In nursing, being present, or presence, was a gift ofone's self in human
interactions and relationships. Even though Easter (2000), a nurse, spoke of presence
with patients, the concept could be applied to nursing education. Physical, or body-to-
60
body, presence included "being there," in other words, proximity, which according to
Fcenberg ( 1999), is far from being reproduced, that is, to the actual experience of human
proximity in the space of the Web. It was the human interactions and the human contacts
that were critical in higher education.
The value of this essence, physical proximity, was discussed previously. Physical
proximity, as an essence, was highlighted in an ingenious paper by Urry (2002). Urry, a
university sociology professor, was intrigued by business travel and its significant
relationship to physical proximity. He highlighted the value of this essence in a most
unusual way. This researcher asked two simple questions: "Why do (business) people
physically travel?" and "Why is there an increasing amount of physical, corporeal
travel?" (p. I). Because being on the move has become a way of life for many, some
questioned whether computer-mediated communications would overtake the physical and
social travel, where sensing another person became significant. Physical proximity
described a face-to-face encounter, a cu-presence. and a social structure. The desire to
travel physically, argued Urry, stemmed from the significance of corporeal co-presence
and the "socialities" within social life. (On a related personal note, I have long wondered
why people continue to go to movie theaters, even as theater demise was predicted, and
DVDs became plentiful. And, why do people flock to sports arenas to "see" games in
person when they could watch the action on high-definition television in their homes?).
Citing Boden and Molotch (I 994), Urry (2002) wrote that co-present interaction
was fundamental to social intercourse (and the physical proximity of face-to-face
learning [mine]); this "thick" co-presence involved rich, multi-layered and dense
61
conversations (e.g. , not just words, but indexical expressions, facial gestures and access
to the eyes, body language, status, pregnant siknccs. anticipated actions, and tum-taking
practices) that led to the all-important trust. The embodied conversation was a physical
action as well as "brain work." Co-presence involved "facing the moment" in academic
occasions and business meetings. People felt that they "knew" someone from having
communicated with them face-to-face; to "be there" for oneself was critical. Urry
concluded that face-to-face mobility maintained social capital. The face-to-face
conversation appeared crucial for the development of trustful relationships (and crucial
for learning [mine]). Urry described the importance of business travel in establishing co
presence with other humans, plus the highly significant nature of co-presence. "The need
for physical co-presence and corporeal travel would appear to be with us for a long time
yet" (p. 23). The attributes and nature of co-presence, as described by the researcher,
were closely akin to descriptive attributes of face-to-face learning (e.g., physical presence
and place, interaction, and social presence), described in the previously reviewed
literature.
Comments on Essence
This discussion focused on the essential, the real nature, or essence, of face-to
face learning, as reported in the literature. As indicated, some essences ( e.g., social
presence, communities of learning, collaboration) were incorporated into both face-to
face and online learning experiences. These essences were described by Hodge, Bosse,
Faulconer, and Fewell (2006), Diekelmann (2005), and Lahaie (2007). primarily in online
62
courses. Significant essences, described below, were associated primarily with face-to
face learning.
Essences of face-to-face learning were identified as physical and human
proximity, physical space and place, physical and corporeal embodiment, and physical
presence and were described in the literature (Easter, 2000; Harper et al., 2004; Urry,
2002). Physicality, in the studies (Hodge et al., 2006; Kaiser, 2004; Streibel, 1998), was
paramount in face-to-face learning, calling forth intimacy, identity, immediacy, tmst, and
a community of knowledge. Attributes of face-to-face learning, reported in a number of
learning environments, also included human ideals, soulfulness and wisdom (Streibel,
1998); and meaningful connections, curiosity, and body language (Banks, 1998).
Knowledge constructivism, as related to learning, was discussed in several articles
(Broussard et al., 2007; Magnussen, 2008; Peters, 2000).
Co-presence, as described by Urry (2002), was likened to corporeal proximity,
social intercourse, and structuring. Communications were articulated as "dense
conversations." Easter (2000) described physical presence with others, in nursing, as a
gitl of one's self in human interactions and relationships. Both thoughts were profound
and thoughtful in helping to understand what learning really "was."
The nature of face-to-face learning, as articulated in essences, was at the heart of
this study. To my knowledge, there were no research studies of the essences offace-to
face learning, per se, in the literature. The study of human learning is complex, but also
intriguing. There are no ready-made variables by which to pinpoint the impact of face-to-
63
face interaction and how humans karn. Learning is universal but learning face-to-face is
very personal , as revealed in the literature discussed here.
Summary
This literature review provided an overall picture and dynamics of a complex
phenomenon, face-to-face learning. Does human face-to-face interaction in nursing
remain as a crucial connection to learning and professional nursing practice? Yes, from
the review of this literature, I have found that this mode of learning represented what 1
believed is of superior import to nursing education. I wanted to know what it was about
face-to-face learning that contributed to its tenacity. The framework chosen for this
review were the two research questions that undergirded the study. The questions' main
themes were lived experiences and the essences of face-to-face learning. This two
question framework also gave structure and organization to the review. The research
questions were employed in this way because they directly addressed the gap in the
literature which included lived experiences and human essences of face-to-face learning.
To my knowledge, this would be the first study oflived experiences of face-to-face
learning among RN nursing students, that is developed around qualitative. interpretive
(hermeneutic) phenomenological. Gadamerian interpretation, and framed around van
Manen 's ( 1990) lived experience methodology and interviewing concepts.
A review of the nursing literature reflected a preponderance of comparison
studies, comparing face-to-face learning with online or blended learning. Comparison
studies, therefore, became the primary sources for extrapolating meanings of learning.
Several additional researchers outlined methodological flaws and confounding variables,
64
along with a lack of pedagogical principles, present and documented in a number of the
studies (!laws were pointed out in the respective studies). Nonetheless, I gleaned student
perceptions and experiences about face-to-face learning from these studies that included
positive interactions, nonverbal cues, immediate feedback, and unspoken meanings, as
examples.
Face-to-face learning is an active, cumulative, and constructive process.
Constructivism, as a holistic social process, therefore, was a foundation for learning in
nursing and was discussed as such. The metaphor of construction was used because it
portrayed an epistemological view of building new knowledge on existing knowledge.
Most notably applicable to nursing education were the concepts of cognitive experiences,
learning as intellectual development, the relationship of thought to language, and
construction of knowledge through experience. Face-to-face learners then can become
constructors of knowledge.
The education literature included comparative and descriptive studies of higher
education courses. These reviews were significant since nursing will always be a part of
the larger academic educational world. Non-nurse authors compared modes of learning
(with flaws, also) but went further by suggesting application to principles of learning
(Utts et al., 2003) and to the "halo effect" in learning (Johnson et al., 2000), as examples.
The second research question dealt with essences of face-to-face learning. I found
this literature to be relevant, exciting, and highly instructive. Essence was described as
the fundamental, real, or ultimate nature ofa thing; here, it was applied to the nature of
how humans learn and how they express how they learned. Phenomenological research is
65
Lhe study of essences. according to van Manen ( 1990). Studies discussed in this section
included both face-to-face and online kaming.
Social presence, communities of learning, and collaboration are highlighted in
both face-to-face and online learning experiences in the literature. Physicality is closely
related. in face-to-face methods, as calling forth intimacy, identity, immediacy, trust. and
a community of knowledge . "Co-presence" (Urry, 2002) seemed to best describe face-to-
face interaction, even as it was described in relation to physical interactions in business
travel.
The use of the two research questions in the literature review was significant for
me in that they served as valuable guides for my readings and evaluations. The questions
caused me to focus like a laser beam on experiences, meanings. and essences in the
literature and then, prompted me to evaluate exactly what I had read. I believe that the
review demonstrated this intense focus.
The ultimate goal in research should be to provide quality education regardless of
the technology used in teaching and learning (Hadidi & Sung, 2000). Valentine (2002)
pointed out that a goal of distance learning was to offer experiences much like traditional
face-to-face instruction. According to the author, technology should be used, not to
replicate traditional methods, but rather to improve instruction. The issue was not
technology itself, but how it is used in the design and delivery of courses. The need in
educational (and nursing) research is for a guiding philosophy of education and pedagogy
in spite of the reliance on technology (Mallow & Gilje, 1998). Positive learning
experiences require a pedagogical approach and an understanding ofleaming outcomes
66
that create a responsive and creative learning; technology should not come before
pedagogy ( Ladyshewsky, 2004 ). Likewise, according to Gkn (2005). technology has not
produced the quantum leap in improving pedagogy, despite the advances: the focus is still
on content rather than on ensuring that students are fully engaged or learning. What is
needed, Glen said, are sound educational principles and not techno-wizardry or the
agendas of educational pub! ishers.
So, why did we need to hear the voices of nursing students on their experiences of
face-to-face learning? In a study of curriculum as narrative, Olson (2000) said it best:
··When curriculum is understood as narratively constructed and reconstructed through
experience, the stories lived and told by students and teachers of what is important,
relevant, meaningful, or problematic for them are valued" (p. 170). The problem, the
understanding of nursing students' experiences in learning, especially face-to-face, as it
aftects their personal and professional growth, was the primary focus of this research.
67
CHAPTER Ill
RESEARCH PLAN
Study Design
The purpose of this qualitative phenomenological research was to understand the
lived experiences of face-to-face learning among registered nurse (RN) students who are
pursuing a bachelor's or master's degree in nursing. There was a need for in-depth study
of face-to-face learning from the perspective of students' lived experiences. My plan was
to ask the students to reflect on their learning experiences in order to more fully reveal
the essences, meanings, and characteristics of this mode of learning. The appropriateness
of this approach was confirmed by Roberts (2004) who said that the qualitative approach
is based on a philosophical phenomenological orientation and by Rudestam and Newton
(2007) who confirmed phenomenological inquiry as attempts to describe and elucidate
the meanings of human experience. van Manen ( 1990) added to this by writing that, in
phenomenological research, the emphasis is always on the meaning of lived experience.
This orientation focused on human lived experiences and included hermeneutic
interpretations. Hermeneutics was appropriate because, as a general philosophy, it helped
to understand experience and the way that people experienced the meaning of the world
and their place in it (Steeves & Kahn, 1995). Along with this approach were Gadamerian
constructs set against a backdrop of learning methodologies. Hermeneutic interpretive
phenomenology, as conceptualized by Max van Manen ( 1990), was the proposed
68
methodology. The van Manen ( 1990)) conceptualization of interviewing was used for the
purpose of obtaining qualitative data that were words, patterns, and themes, describing
experiences and meanings of face-to-face learning.
This chapter begins with a discussion of the methodology, including the
methodological structure of van Manen (I 990). Following are descriptions of the planned
research setting, recruitment of study participants, interviewing, data collection, and
recording. Data analysis included requisites for methodological rigor as well as means of
protecting human subjects. The Pilot Study is described, followed by a summary of the
chapter.
Methodology
The proposed methodology for this study was hermeneutic interpretive
phenomenology as conceptualized by van Manen ( 1990). Phenomenology, said van
Manen, describes how one orients to lived experiences and hermeneutics described how
one interprets the "texts" of life. A writing or linguistic approach to the method of
phenomenology and hermeneutics includes reflection on the meanings and significances
of phenomena of daily life; this is fundamental to pedagogic research. My study was of
the phenomenon of face-to-face learning, how it was experienced and interpreted by
nursing students, and how it related to the pedagogical texts brought forth by the
participants and me, the researcher. Texts, said van Manen, must be oriented, strong, rich.
and deep. " Depth is what gives the phenomenon or lived experience to which we orient
ourselves its meaning; rich descriptions, that explore the meaning structures beyond what
is immediately experienced, gain a dimension of depth" (p. l 52). Rich and deep texts
69
describing face-to-face lived experiences were a goal of data collection and analysis in
this study.
Methodological Structure of Max van Manen
The van Manen ( 1990) approaches to hermeneutic phenomenological research
and interviewing underpinned and supported this study of lived experiences and human
learning in a face-to-face mode. van Manen described hermeneutic phenomenological
research as a dynamic interplay among six research activities which he labels a
methodological structure of human science research (my study). van Manen's six
research activities were:
(a) turning to a phenomenon which seriously interests us and commits us to the
world; (b) investigating experience as we live it rather than as we conceptualize it;
(c) reflecting on the essential themes which characterize the phenomenon; (d)
describing the phenomenon through the art of writing and rewriting; (e)
maintaining a strong and oriented pedagogical relation to the phenomenon; and (f)
balancing the research context by considering parts and whole (pp. 30-31 ).
In the context of these six activities, van Manen ( 1990) described specific
components of each of the activities (abridged), all apropos to my study (van Manen, pp.
30-34). Examples of how I enacted and interpreted, with sensitivity, each of these
activities in my interviewing, (and later in analyses), are in parentheses following each
activity:
1. Engaged in an abiding concern through the practice of thoughtfulness, a
fullness of thinking, and deep questioning (immersed myself in deep
70
thought and truly observed and listened to participants e.g., ·'real persons,"
their words, non-verbal cues. gestures, and any signs of discomfort and also
com tort).
2. Aimed to concentrate or establish a renewed contact with original
experience; turned to the " things themselves;" and used practical wisdom to
understand and become full of lived experience (constantly concentrated on
the original research question and, where appropriate. used participants'
voiced words as a "nudge" to follow up on their particular experiences).
3. Truly reflected on lived experience in a thoughtti.tl, grasping way that
rendered a special experience its special significance; made a distinction
between appearance and essence; and asked what it was that constituted the
nature of each lived experience (focused on meanings of words, "bringing
into nearness," and was sensitive to emotionally-laden experiences; focused
on words that appeared repeatedly, such as "l felt." "I wanted," " I
understood," " I saw,""[ didn't like," " I wondered it;' ' and"[ think that I
learn best by ... " ).
4. Realized that doing phenomenological research is always a "bringing to
speech" of something; understood that thoughtfully bringing to speech is
usually a writing activity; and knew that phenomenology was the
application of"logos," the language of phenomenon (took care when
observing language used; pondered on themes that arose during the
interview, and how I could capture these in writing; paid attention to
71
personal and unique language used to describe the phenomenon of face-to
face learning).
5. Was demanding of sel f; the researcher. in remaining strong to the
fundamental question and not getting side-tracked and settling for
superficialities and falsities or wandering aimlessly and indulging in wish
washy speculations (brought the participants back to the essence of their
experiences, and not those that appeared to be side-tracking, unless voiced
as pertinent to how they learned).
6. Constantly measured the overall design of the study text against the
s ignificance that parts had in the total textual structure; frequently stepped
back and looked at the total contextual "givens" ( carefully followed up on
significant words or phrases that described feelings and deep thoughts about
specific stories or incidents that had affected their learning; allowed full
descriptions and voicing of the "whole" of their experiences, without
interruptions by me).
My interest in how students learn was intense and my curiosity was ongoing. I
intended to investigate lived experiences of students in a phenomenological manner that
hopefully, would result in new and novel insights into this particular mode oflearning,
enhancing and energizing nursing pedagogy. I carefully analyzed the data and recorded
meanings and every word voiced. A phenomenological approach meant that I was
cognizant of gathering, understanding, and interpreting recollections of face-to-face
72
learning. This included meanings, "a-ha"' moments, and illustrative insights that ensued
for both myself and the participants.
f?esearch SetlinK
The settings for this study were Texas Woman ' s University, Denton, Texas.
campus classrooms, library conference rooms, and other quiet, comfortable, well-lit and
enclosed private areas agreed upon by each participant and me.
l'arlicipanls
Criteria for participant selection in this study were: currently held registered nurse
licensure, currently enrolled as nursing students (i.e. , RN-BS/MS) on TWU/Denton
and/or Dallas campus, had experienced both face-to-face (classroom) and online (Web
based) classes; be 18 years of age or older, English-speaking, and would be available for
individual interviews for no more than two hours in length. It was anticipated that 5 to 15
participants would be sufficient, depending on when saturation began to appear in the
collection of the data (saturation is reached when no new relevant data were discovered
regarding a category. and all of the categories were well developed [Rudestam &
Newton, 2007]).
Data Collection
Sampling consisted of a purposive nonprobability process that incorporated
experiential tit and good informants. Experiential tit involved deliberately selecting
participants who had lived through or were going through the experience of face-to-face
learning. " When we purposefully select according to the best example. the characteristics
of whatever we are studying are easier to identify than in situations that are muted with
73
contextual factors" (Morse, 2007, p. 530). I hoped to and did recruit good informants who
talked. reflected, described, and shared lived experiences of face-to-face learning.
Recruitment was by fl yers (Appendix A, Flyer # I) sent by e-mail to the RN to
BS/MS program instructors at both campuses. I contacted each RN to BS/MS class
instructor beforehand, to discuss the research goals and process, and obtain their
permission and assistance in sending a one-page flyer by e-mail to each student in their
classes. Volunteers were self~identified through e-mailed fl yers and were asked to send
an e-mail to the researcher; my name and e-mail address were posted on the flyer.
Recruitment began afier approval had been obtained from the Institutional Review Board
(IRB) at Texas Woman' s University (TWU). Approval for conducting this study was
received from the !RB, July 2, 2009; an extension for collecting data was received
October 12, 2009 (Appendix B).
lnterviewinx
A hermeneutic phenomenological approach to human science research and
writing was explained by van Manen ( I 990), who viewed conversational interviewing as
a method to reveal the participant's personal stories. The interviewing process must be
disciplined by the fundamental question (i.e., the research question) that prompted the
need for the interview in the first place. I asked the participants to think of a specific
instance. situation, person, or event, and then explore the whole experience to the fullest
(van Manen). Whereas van Manen said that it is impossible to offer ready-made
questions, he did consider the use of questions appropriate in beginning the interview.
·'Often it is not necessary to ask many questions, as pati ence or silence may be a more
74
tactful way of prompting the other to gather recollections and proceed with a story" (p.
68). lfthe participant seemed to be generalizing about the experience, a question could be
inserted that could turn the discourse back to the level of concrete experience. The
lnterviewinK CJ11ide (Appendix E) contained a few questions that I used. Interviews were
number-coded for confidentiality, and audio-taped and transcribed verbatim by me. The
interviews became texts for data analysis. Settings for the interviews were described
earlier in this chapter.
During the interview, I used prompts such as "Can you give me an example?" or
··What was it like?" and " I-low did that make you feel?" and responded, when
appropriate, with comments such as " I' m understanding that .. . " (to clarify) or " What an
experience that must have been ... . " I was perceptive, insightful, and as discerning as
possible to the object (of the response) so that its full richness and greatest depth was
shown or disclosed. Examples of experiences which stood out for vividness were always
desired. I avoided trying to beautify participants' accounts with fancy or flowery words . I
observed the participant, monitored myself, assessed the "emotional comfort"
atmosphere, and throughout, always attempted to make the participant feel relaxed,
comfortable, and eager to be a research participant.
I believed that the interview must become an enlightened happening for both me
and the participant, not merely a staid conversation that was devoid of feeling or
reflection. Before conducting the Pilot Study ( described below), I spent several hours
pondering how I could allow myself and the participants to fully feel a unique happening
and even unspoken "high" moments during the interviews. I wanted the participants to be
75
as excited as I was in better understanding how humans actually learn; I practiced how I
would start the interview, hopefully creating an atmosphere of anticipation. This was a
personal but very useful exercise for me in preparation for the interviews. Also, since
each of the interviews was unlike the others, I was able to critique some of my own
words and unique and different responses in each of the interviews. leading to valuable
learning on my part.
van Manen ' s ( 1990) precise use of language in describing the interactions among
researcher and participant presented, for me, a beacon of understanding about the
interviewing process: '·We must be sensitive to the undertones oflanguage, to the way
language speaks when it allows the things themselves to speak ... must be a true listener,
attuned to the deep tonalities of language that normally fall out of our accustomed range
of hearing, able to listen to the way the things of the world speak to us" (p.111). The goal
of a hermeneutic interview was to seek understanding and meaning through language and
interpretation. Learning is the most significant thing about language itself; language is the
site of human experiences, and understanding (as in phenomenology) is linguistically
mediated (Hogan, 2000). My conscious processing of words and meanings of experiences
voiced by participants during interviews were the most treasured gi~s I could give to
each person who volunteered to be a part of this study.
van Manen's ( 1990) four existentials of lived body, lived space, lived time, and
lived relations to the other, form a unity called the lifeworld which is our lived world
(discussed later). Reflecting on these existentials allowed me, as interviewer and
researcher. to perceive an immediate immense richness of meaning to what participants
76
voiced. In hermeneutic phenomenological writing, language, again, brought pedagogic
experience into a symbolic form that created a conversational relation: a discourse. van
Manen also stated that the researcher had to be sensitive to the subtle undertones of
language, and also the power in silence, especially during interviewing.
Data Analysis
In van Manen ·s ( 1990) methodological structure of human science research. he
spoke of six research activities. I capitalized on these activities to illuminate how I would
interview participants. I did this because, to me, these activities spoke lucidly to " the
things themselves" that had direct relevance to preparing me to see the "gestalt" of
interviewing. But, the six activities didn't stop there. They were also relevant to data
analysis which, in essence, was a logical progress of interviewing, a component of data
collection.
Following are the six italicized analytic activities (van Manen, 1990, pp. 30-34)
with their relevance to data analysis:
I. Turning to the nature ()f/ived experience was a commitment of dwelling on an
abiding concern, which for me, were the lived experiences of face-to-face
learning. The " fullness of thinking," this mode of learning, was the "whole"
for me; it was real, and it was a golden and rich source for research
experiences.
2. fnvestigaling experience as we live ii was establishing a renewed contact with
original experience. Students "lived" learning every day and therefore. I
believed they would not hesitate to call out what was real and meaningful to
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them; they knew this well. How they learned was the major lorce in their
pursuit to become registered nurses. In the words of van Mancn ( l 990), the
students are full of this world and full of lived experience. I analyzed and
translated their experiences into van Manen 's four life existentials. noted
previously.
3. Reflecting on essential themes was a "thoughtful grasping of what it was that
rendered this or that particular experience its special significance" (van
Manen, 1990, p. 32). This included the essence of face-to-face learning which
was one of my research questions, and was that which grounded the things of
our experience by "reflectively bringing into nearness that which tended to be
obscure" (p. 32). In the data analysis, then, I reflected and interpreted
meanings, sometimes with affirmation from the participants.
4. The art of writing and rewriting was a task where I, as accurately as possible,
transformed texts into words and language that were understood, were "in this
world," and were meaningful.
5. Maintaining a strong and oriented relation meant that the analysis had to be
fundamentally focused and articulate: "To be strong in our orientation means
that we will not settle for superficialities and falsities" (van Manen, I 990, p.
33). As a researcher, it was my goal to sift through the student utterances with
a keen eye and a discerning mind.
6. Balancing the research con/ex/ by considering parts and whole was asking
"What was this phenomenon of face-to-face learning?" and always reflecting
78
on the major question that was the students' perceptions of how they learned
through face-lo-face interaction of this learning phenomenon. 1 did not ignore
language and words used by students to capture their meaningful experiences,
even though I might have thought that they were trite and unrelated to the
main question. This took concentrated work and an analysis that focused on
what they, and not me, thought and verbalized. 1 also remembered that lived
experiences are immediate, pre-reflective consciousness of life, a given
awareness of the experience itself.
Data analysis was an ongoing process. Phenomenological research includes the
analysis of significant statements, the generation of meaning units, and the development
ofan "essence" description. A synthesis of the basic methodological steps for
phenomenological data analysis included the following steps:
1 got a sense of the whole (the gestalt) by reading all of the transcriptions
carefully, decentering and coming to "unknow:" (a) I reflected on personal experiences
and expressions; (b) I read each statement for how well it described the experience; ( c) I
recorded all relevant statements and removed statements that were redundant or
overlapped with others, leaving the key meaning units; (d) I clustered together similar
topics, finding the most descriptive wording for the topics to generate categories; (e) 1
formed a description or identification of categories, or themes; interrelating themes to
show a higher level of analysis and abstraction; (t) I performed a preliminary analysis,
examining the data again and recording if necessary; and (g) 1 made an interpretation or
meaning of the data: "What were the lessons learned?" "What new questions were
79
unearthed?" capturing the essence of these data (Creswell, 2003; Munhall , 2007c; &
Roherts, 2004 ).
I also incorporated van Manen's (1990) four lifeworld existentials as guides to
data analysis, particularly as I reflected on the nature of the data and the emerging
themes. The four lifeworlds are: (a) lived space (,palialily), the space in which we find
ourselves that affects the way we feel. Lived space is the world or landscape in which
human beings move and find themselves at home. Perhaps a classroom surrounded by
people interacting may represent lived space for a nursing student; (b) lived hody
(curpurealily) relers to the phenomenological fact that we are always bodily, or
corporeal, in the world. We reveal, and conceal, things about ourselves that relate to our
physical or bodily presence; (c) lived time (tempurality) is subjective, not objective, time
that may appear to speed up when we enjoy ourselves or slow down when we feel bored,
or when we are anxious; and (d) lived other (relationality) exists in our relation with
others, in a shared interpersonal space. Conversational relations allows us to transcend
ourselves (van Manen, pp. 101-105). These four worlds, can be differentiated, said van
Manen, but not totally separated. The four existentials form an intricate unity called the
liteworld---our lived world.
Data analysis was done with the use of rich, thick descriptions, peer debriefing,
clarification of the researcher' s bias, and all the while, checking and re-checking field
notes and transcriptions for accuracy and establishment of the prominent themes.
Holloway and Wheeler (2002) suggested listening to and reading the collected data over
and over again for general tones of ideas and themes; this was done.
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Rudestam and Newton (2007) said that the general framework ofan analysis can
be specified in advance, although specitics of data analysis may not always be possible in
advance of the study. Qualitative studies tend to produce large quantities of data that
represent words and ideas rather than numbers and statistics. Thus, me, the researcher,
could become the victim of data overload, with no idea of what to present or where to
begin. The thinking process in data analysis was iterative, with a cycling back and forth
from data collection and analysis to problem formulation and back again. Simultaneous
activities, such as collecting, analyzing, and writing up data, occurred. Steps for analysis
of textual data included reducing or transforming the data.
Textual data, brought forth by the participants through dialogue and speech,
represented language with all of its undertones and kaleidoscopic meanings. Language
undergirded and framed this research study and therefore is discussed in greater detail
below.
language
Language, a foundation of phenomenology and hermeneutics, was addressed by
van Manen ( 1990), Gadamer (1960/2004), and Hogan (2000), who analyzed Gadamer' s
philosophy. Language and learning were symbiotic and represented the core ofmy study
(i.e., language as the texts and the speech of learning face-to-face).
Gadamer ( 1960/2004) explained: '"From language we learn that the subject matter
is not an arbitrary object of discussion but rather the path and goal of mutual
understanding'' (p . 180), which was linguistically mediated. Hogan (2000) stated that
learning is the most significant thing about language itself; it is primarily in language that
81
human experiences of the world are expressed and understood. From learning comes
understanding. And the way that understanding leads to interpretation was dialogue, or
conversation, as in interviews. Therefore, I planned, honored, and carefully listened to the
'"language" of my participants, how they spoke, the words that were repeated, and the
nonverbal apperceptions that were disclosed. The outcome was that learning, for both
myself and the participants, took place.
Being sensitive was described by van Manen (1990): "The phenomenological
method consists of the art of being sensitive to the subtle undertones of language, to the
way language speaks when it allows the things themselves to speak" (p. 11 l ). Hogan
(2000) spoke of Gadamer's "the dialogue that we are" as having educational tenor and
language significance. Gadamer's emphasis on teaching and learning was " much more of
an interplay with overt and unseen consequences than a matter of transmission of
cognitive content and values"(~ 14). These understandings can be revealed in language.
van Manen ( 1990) stated that human experience is discovered through language.
My study of lived experience itself, then, seemed to have a linguistic, textual structure
that included meanings of those experiences. "In one sense, the notion oftextuality
becomes a fruitful metaphoric device for analyzing meaning" (p. 39).
I anticipated the inclusion ofGadamerian concepts of the "hermeneutic circle"
and " fusion of horizons" as I analyzed the overall data and recognized the importance of
Gadamer's thinking on language when transcribing and analyzing texts. And
understanding is linguistically mediated, according to Hogan 's (2000) treatise on
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Gadamer. I was struck and awed by descriptions of the power of language, its words and
imagery, portrayed so succinctly by these authors.
Methodological Rigor
Holloway and Wheeler (2002) described rigor in terms of trustworthiness, labeled
as "truth value" and the necessity for research that is credible and valid. Holloway and
Wheeler referred to the alternative terms of naturalistic inquiry of Lincoln and Guba
( 1985) to further describe trustworthiness. Trustworthiness denoted methodological
soundness in four dimensions. Dependability implied accurate and consistent findings in
context which were verifiable patterns and themes (of face-to-face interaction).
Credibility or the "truth of findings" implied precision and accuracy of recording and
interpreting data from learners. Transferability, not necessarily generalizability, would be
applicable because findings in one context may be transferred to similar situations or
participants, such as learners who have experienced face-to-face modalities in either the
traditional, or blended, forms of learning. Cunjirmability meant that findings and
recording of learner data experiences achieved their aims and were not the result of any
of my prior preconceptions.
I planned to use the following methods to ensure trustworthiness in my study: my
constant and persistent goal to listen and to record thick and rich detailed descriptions and
meanings accurately from the interviews and the recordings; use of a detailed field diary
(my journal); member checking, although Holloway and Wheeler (2002) put forth
caveats on this method (member checking may be done at the end of each interview):
peer review of data from colleagues; giving participants the opportunity to receive a
83
summary of the study findings; keeping an audit trail (a detailed record of the research
process through personal responses which described my thought processes and
demonstrated my self-awareness and reflexivity as a researcher); and triangulation
(examining my data in one of several ways, from theory, interpretive phenomenology,
Gadamerian hermeneutics, and constructivism, for example).
In addition to trustworthiness, authenticity was also of high import. Authenticity
meant that there were new insights into the phenomenon under study, including
ontological authenticity in understanding the human condition in learning. "A study is
authentic when the strategies used are appropriate for the true reporting of the
participants ' ideas, when the study is fair, and when it helps participants and similar
groups to understand their world and improve it" (Holloway & Wheeler, 2002, p. 256). It
was anticipated that new authentic insights into face-to-face learning would come forth as
a result of my study, and they did.
The authenticity of this study was framed in fairness, ontological authenticity, and
educative authenticity. Fairness was inherent in my research. By way ofmy demeanor
and utmost desire to treat participants honestly and respectfully, and in a forth-right
manner, they were treated fairly. I was very intuitive in detecting any signs of discomfort
and, if occurring, stopping and talking with the participants about this and making them
comfortable so as to be able to attend to the research conversation itself. The atmospheres
of the interviews were made non-threatening, both physically and emotionally, to be able
to enact true feelings and personal experiences about how the participants learn. For
ontological aulhenlicity, I anticipated that the participants would be helped to understand
84
their social world of learning by their "knowing," and by having to speak about their
learning experiences. By having to think deeply about their learning and put their
experiences "out front," I believe that the study reached educalive au/hen/icily. Being
student nurse participants, these learners should be able to relate understandings that
might help to enhance their care of patients.
Validily did not carry the same connotations in qualitative research as in
quantitative research, nor was it a companion of reliability. However, in a limited way, I
used reliability to check for consistent patterns of theme development. Consistency of
patterns and themes was obligatory. Reliability and generalizability, however, usually
play a minor role in qualitative inquiry. However, according to Creswell (2003), validity
is a strength of qualitative research. It may be used to suggest the determination that the
tindings are accurate from the standpoint of the researcher, the participant, or the reader.
Exlernal validily usually referred to generalizations of study tindings. I closely examined
the data for any possible generalizations.
Qualitative studies emphasize "thick rich descriptions" of a small group of
participants and these descriptions allowed for a bit of transferability to other settings, but
according to Rudestam and Newton (2007), generalizations to other situations and
participants are always modest and mindful of the context of individual lives.
Generalization, however, is the task of the reader rather than the author. Infernal validily
is sometimes referred to as the "trustworthiness" ofreported observations, interpretations,
and generalizations. Because of the data collected from a sample of nursing students from
85
one university, I was cautious about generalizing to other nursing student studies. in other
situations.
In summary, my data analysis included intense iterative analysis. described above.
van Manen ' s ( 1990) concepts of the one-on-one hermeneutic interviewing, Gadamer's
( 1960/2004) philosophy of language, "hermeneutic circle" and "fusion of horizons," were
used to explore the whole experience to the fullest, all the while concentrating, as a
researcher, on being perceptive, insightful , and discerning. Emphasis was given to
assume the stance of decentering and unknowing, while being immersed in the
interviewing and data analyses processes. The assurance of rigor was ongoing and taken
seriously, in order to provide high quality and uncompromised integrity to the study.
Protection of Human Participants
The approval for research studies from the !RB at TWU covered descriptions of
identification of risk. methodology, participant information, setting of the study, and
potential risks with steps to minimize risk. Potential risks identified were fatigue and
physical discomfort during an interview, emotional discomfort, and loss of
confidentiality. This protection included all research participants.
All participants were asked to sign an informed consent (Appendix C. #I) after I
briefly explained the interview procedure, the focus of the study, potential risks. and the
emphasis on confidentiality. I also explained that code numbers would be used for
anonymity of each participant and that all efforts would be made to protect
confidentiality of name and information given to the researcher. Ample time was given to
participants to read the consent form and ask questions. The potential risks in the consent
86
form, listed above, were explained, along with actions that might be taken if. for
example, the participant experienced emotional discomfort during the interview. A list of
four local counseling centers, along with telephone numbers, were listed on the last page
of the consent form. The participant then signed the consent and received a copy for her
tiles.
Informed consent is a significant requirement in qualitative studies. Informed
consent included title, purpose, explanation of the research and procedures, and allowed
the participant to ask questions and be free to withdraw at any time. Protecting
confidentiality and privacy was paramount. The research imperative must never be placed
above the therapeutic imperative (Munhall, 2007b ). I placed high priority and gave
meticulous attention to assure that the participants' legal and ethical rights were always
upheld and never compromised.
Pilot Study
A pilot study was conducted (Fall 2008) following approval from the !RB of
TWU to proceed (Appendix D). Inclusion and exclusion parameters of the IRB were met
by three undergraduate nursing students who consented to participate in an interview.
Two students were in their second year at TWU but had not taken any "real" nursing
courses, only prerequisites; the third participant was a registered nurse and was in the
RN-BS/MS program. Interviews with the participants yielded data apropos to the study
question.
The fnlerviewing Guide was available during the interviews but only minimally
used . It was considered only as a ·'security blanket" for me should it be difficult to begin
87
a conversational interview. I did, however, follow van Manen 's ( 1990) suggestion that it
is acceptable to begin interviewing with a question. The question # I on the Interviewing
Guide was: " What is the first thing that comes to mind when I say face-to-face learning?"
As each intt:rview began, I made a conscious effort to relax, decenter, and then
immerse myself into the conversation. Engaging in "small talk" at the beginning helped
to put the participants, and me, at ease. A comfortable, quiet setting- the Nursing
Dissertation Room on the TWU Denton campus- was used for the first two interviews;
the third was conducted in a Public Library conference room at the participant's request.
Consent forms were explained and quickly signed by all three participants. The
interviews were audiotape-recorded and transcribed verbatim by me.
I began the interviews with a statement about my study and emphasized that my
primary thought was "curiosity" about face-to-face learning and why it continues to have
a presence in learning, even in our wired world. This set up the process of talking about
on line versus face-to-face experiences and all three of the participants centered on that
concept, without my intervention. Therefore, outcomes and comments from them
reflected this mode. My technique in following up on participants' answers was primarily
the use of probes, such as, " What does that mean to you?" and "How did you feel about
that?" All three participants were very forthcoming with their comments, spoke freely
and easily, and actually needed very few questions from me to enlarge on their
experiences. Each interview lasted about one hour.
The most interesting insights occurred for me as I began reading the transcripts.
The first reading was to look for and unearth general patterns and themes. These patterns
88
and themes almost seemed to just "pop out," more so than I had perceived that they did
during the interview itself. The second reading was word-for-word, making notes of the
most uni4ue and "wildly" descriptive terms and words used to describe their experiences.
I came to see that overall general patterns were in two categories: face-to-face learning
and online learning. The third reading was slower because I tried, then, to look more at
phrases, words appearing together that seemed to "drill down" deeper into the face-to
face learning phenomenon. Through all of this reading, I began to "see" things that I had
not consciously observed or heard during the interviews. I believed that I could then
observe the Gadamerian hermeneutic circle that had been in action as we "bantered back
and forth" about certain experiences, and then related several word phrases to the two
categories above. Our "fusion of horizons" appeared to have taken place.
Themes that seemed to emerge from the pattern of face-to-face learning were:
The " real thing," " Knowing" by human interaction, and Socialization in "real time"
learning. A sample of sub-themes that emerged included, " It's a human in face-to-face,"
and " Immediate gratification when you 'get it,"' "Gives confidence," and " I learn caring
from seeing teachers care." "Being" and "knowing" were phenomenological verbiage
that just seemed to emerge.
The emerging theme from the pattern of on line learning was "Being on my
own." A sample of sub-themes that emerged included, "It' s teaching yourself:" "Have to
read between the lines," " ls deciphering," "Don't take as seriously as face-to-face," and
" I don't hear it." All of the words and phrases, with the exception of "socialization" came
directly from the participants, which I believed was important when generating patterns,
89
themes, and sub-themes. "Being" and " knowing·· are phenomenological verbiage that
seemed to just emerge!
I examined the transcriptions to study any pre-understandings that came out. I
wanted to be sure that there was no voiced or subtle indication from me that might have
implied that I "liked" face-to-face better than online learning. I did relate to all three
participants that my curiosity was with face-to-face and maybe that colored their
responses. My "gut" sense of these interviews is that all three participants actually
believed that they learned more and better in a face-to-face environment. Their body
language and behaviors during the interviews were spontaneous and not of a nature that
pre-thinks what "she wants for her study." I continued to study, monitor, and tried to
account for these data revealing themselves the way that they did. However, when I
reflected on my original research question, I was actually more interested in the data on
face-to-face learning than on online learning, and was only using the data on online
learning as context and as a way to consider all contingencies in the common learning
environments of today.
Doing a pilot study was very instructive. Not only did I experience my plan in
action but it also enabled me then to do a sel t~critique and, as noted above, I made some
changes as a result of the critique. The major change was requiring that participants be
registered nurses who were students at TWU. It became obvious during the pilot study
that the caliber of responses and thought processes of the registered nurse participant,
versus the two students who had not taken nursing courses, was at a higher level of
understanding that included richer descriptions, data, and an in-depth finely-tuned
90
appreciation of teaching-learning in nursing. Based on this finding in the Pilot Study, a
decision was made to only recruit RN-BS/MS student participants. The two pre-nursing
students did relate significant thoughts on learning but did not possess the level of ability
to be able to analyze or evaluate interactions about how one learns nursing. Their
responses, however, were valuable and descriptive, and certainly in concert with their
educational level.
Summary
This chapter described the planned process for data collection and analysis, as
well as a description and analysis of the Pilot Study. A reason for change in the Pilot
Study flyer to only recruit RNs was given. The study design, built on qualitative research
protocols, was explained, along with related hermeneutic and interpretive
phenomenological approaches. The stated methodology added dimensions to
phenomenological research, such as interpretation of human existence. van Manen ' s
( 1990) six research activities were utilized to give structure to interviewing and analysis
of lived experiences. Methodological rigor was described in terms such as
trustworthiness, authenticity, and validity.
Hermeneutics was explicated as the theory and practice of interpretation. Max
van Manen's ( 1990) methodological structure gave direction to the interviewing of
participants and the interpretation and analyses of the collected data. Gadamerian
hermeneutic phenomenology and the beliefs and works of van Manen assisted in
deciphering the meanings of face-to-face learning among nursing student research
participants.
91
In this chapter, the plans for the collection and analyses of the data were
disrnssed, along with the planned recruitment of participants, and incorporation of the
theoretical framework of the study. The emphasis was on van Manen's ( 1990)
methodology of interviewing and analyzing the findings, anchored by Gadamerian
concepts. Chapter 4 li.trther describes and interprets the methodology, outcomes, and
specific findings of the proposed research process. Chapter 4 also includes a description
and analyses of the phenomenon of face-to-face learning, the primary focus of thi s study.
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CHAPTER IV
ANALYSIS OF DATA
Research Process
This chapter is about data collection, analyses, and findings of this research, an
integrated approach to the research story. Because I simultaneously collected and
analyzed the data as the study progressed, it seemed appropriate to report these together.
Interviewing was the underlying process. The chapter became meaningful and seamless
with a convergence of data collection, data analysis, and the findings. van Manen's
( 1990) lifeworlds were the choice for interpretation of patterns and themes voiced by the
participants. The essence of Gadamer's (1960/2004) focus on language was crucial for
the phenomenological interpretive and hermeneutic approach underpinning this study.
The purpose of this research study was to put forward a scholarly understanding
of the meanings of face-to-face lived experiences in learning in nursing students. The
study illuminated the attributes and elements of face-to-face learning as experienced by a
cohort of these students. The two research questions were: What are the lived experiences
and meanings of face-to-face learning among nursing students? What is the essence of
face-to-face learning? Face-to-face learning was defined as learning that takes place in a
··real" traditional classroom where both students and teachers are physically present.
" Lived experiences" are experiences that reveal immediate, pre-reflective
consciousness regarding events in which one has participated (Kleiman. 2004). The
93
primary philosophical frameworks of this qualitative research study were interpretive
phenomenology and Gadamerian henneneutics. Interpretive phenomenology includes the
concept of ·•lived experience" and the understanding of meanings, relevant to this study
of learning. A hermeneutic phenomenological approach to human science research and
writing was explained by van Manen ( 1990) who viewed conversational interviewing as a
method to reveal participants ' personal stories; conversational interviewing was the
approach used to elicit lived experiences of participants.
Description of the Sample
Parlicipant.1· and Permissions
The criteria for participants were: currently-held registered nurse licensure,
currently enrolled as nursing students (i.e. , RN-BS/MS) on TWU Denton and/or Dallas
campuses, experienced both face-to-face (classroom) and online (Web-based) classes, 18
years of age or older, English-speaking, and available for individual interviews for no
more than two hours in length. All of the participants met these criteria. With permission
from the professors of the RN to BS/MS courses, flyers (Appendix A, Flyer # 1) were sent
by them, through e-mail, to students in these classes. Participation was voluntary. It was
anticipated that 5 to I 5 participants would be sufficient in gathering data needed for the
study. A $ I 5 Target gift card, which had been given to each participant in the Pilot Study
(reflected in the consent form [Appendix C, # 1], appeared to be non-sufficient for
collection of data in this second group of interviewees; only two students responded
initially. Therefore, with permission from the TWU/Denton Institutional Review Board
(IRB), the giti card amount was increased to $50 and again reflected on the original fl yer
94
(Appendix i\ , Flyer #2) and in the consent form (Appendix C, #2). This flyer response
yielded ten interested female students from which eight were chosen. Saturation began to
appear at about the sixth interview. Thus, interviewing eight students proved to handily
gain the information needed. The interviews ranged in time from about 50 minutes to 70
minutes.
Settings for the interviews included the ASB Dissertation Room (TWU/Denton
Campus) and conference rooms of three hospitals and one public library, all reserved
with permission beforehand from the facilities, and the students. The criteria of well-lit,
comfortable, and quiet venues were met with these settings. Approval to conduct this
study was obtained from the TWU IRB on October 12, 2009 (Appendix 8).
All of the participants came to the interviews well-dressed, on time, eager to
contribute, well-informed, and erudite. They had obviously thought about their learning
experiences both before and after coming to the interview. One student even mailed me a
note, following the interview, thanking me for "selecting" her for my study. Another
student said that she would contribute her honorarium to charity. A third student said she
would recruit more participant friends, because her experience had been "so good." All
had their stories and anecdotes and were ready to talk. All worked as RNs, some full
time, in addition to their studies, and many had children and other home duties. These
nurses knew how to multi-task.
Consents
Before proceeding to the interview, ample time was allowed for each participant
to read the consent form, first explained by me. Time was allowed for questions and
95
comments on the form, but few had any questions. I then asked each participant to sign
the consent form and gave each a second copy for their keeping. High priority and special
attention were placed on assuring that each participant's legal and ethical rights were
upheld and not compromised.
Participants were informed that their personal identity was strictly confidential
and that code numbers and pseudonyms would be used in the dissertation and in
conversation with others. Each student appeared to be comfortable with the consent and
had tew comments. This protection of contidentiality was judiciously adhered to by me,
and is a personal priority that I revere and uphold, always.
Interviewing
The purpose of qualitative research interviewing is the discovery of informants '
feelings, perceptions, and thoughts. One-to-one interviews (used in this study) are the
most common form of data collection. Kleiman (2004) spoke to the need of dialogical
openness in obtaining descriptions of lived experiences from the participants. She said
that interviewing must be face-to-face meetings because the nature of lived experience
depends, in part, on the manner in which it was experienced; the meaning it has for the
participant can only be revealed in face-to-face encounters. These encounters enable the
revealing of"nuances of participants' experiences conveyed through, for example, facial
expressions, blushing gestures, tears, sounds, silences and other vocal dynamics" (p. 13).
Reflective experiences, as described by participants, came to life during face-to-face
encounters. This "coming to life" definitely was experienced by me, the researcher, as the
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participants revealed how best they learned and also, the many profound revelations they
experienced with that --a-ha" moment when they knew that they had learned.
The interviewing process was grounded to the fundamental research question:
--what are the lived experiences and meanings of face-to-face learning among nursing
students?" I explained that the interviews were flexible but would include a few pre
determined questions. van Manen ( 1990) did consider questions appropriate in beginning
an interview and viewed conversational interviewing a method to reveal participants'
personal stories.
The interviews began with the first question from the Interviewing Guide
(Appendix E): What is the first thing that comes to mind when I say "face-to-face
learning?" Most of the participants said that this learning is in a classroom with the
teacher and other students, and minus most technology. From there, the interview was
guided, but not strictly determined, by the main question but was not allowed to wander
into obscure or non-relevant territory. Frequently, 1 followed a comment by a participant
with " How did you feel about that?" or "Can you give me an example?" When Judy
(pseudonym) discussed her experience with face-to-face learning as including "a voice
tone, the way their eyes look, their body motions, and their ears listening for emotions," I
queried if she could share other examples of her descriptions. Her subsequent comment
led to several examples of how "tillering," giving attributes to someone based on your
feelings that are very personal and could be biased, often takes place in learning,
especially when you can't see or hear one another. She then said, "It's just fun talking
face-to-face with someone, without any filters."
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With other participant comments, as examples, I would say, for example. "That's
very interesting; tell me more," "Can you describe what you thought about that?" "So a
facial expression makes a difference?" " I-low does that affect learning?" " How important
do you think it is to have face-to-face courses when learning about nursing?" " I' m
interested in what you said- human interaction. Can you expound a bit on that?" "What
does that feel like as a learner?" The Gadamerian ( 1960/2004) concepts of "hermeneutic
circle" and "fusion of horizons" were strikingly evident, for example, when participants
described how hearing, seeing, and being there were all vital to learning, and I would ask
for more and more examples- we had meaningful "circular" dialogues by which we
reached a "fusion" of our mutual understandings.
I believe that the questions and comments above helped to illuminate this
hermeneutic phenomenological research, as described by van Manen 's ( 1990) six
research activities. These activities gave structure to this study which was human science
research. For example, I purposely immersed myself in observing and listening to each
word of the participants; I also watched body language, tone of voice, and eye contact.
Concentrating deeply on the original research question was always uppermost in my
mind. I could tell through body language and the eyes when a participant was describing
a meaningful experience; I would then ask them to further describe. Following through
like this always yielded deeper and more meaningful experiences of learning; I
considered this as mirroring van Manen ' s ( 1990) "bringing to speech," in which valuable
thoughts are brought to bear. Side-tracking (e.g., participants' talk of unrelated events)
was gently handled by bringing participants back to the essence of their face-to-face
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experiences. van Manen's voicing of the "whole" of their experiences was primarily done
by asking each participant to summarize their thoughts and ask for their meanings of their
learning experiences. van Manen 's ( 1990) six research activities were discussed in depth
in Chapter 3; they served as a valuable guide for me, especially in preparation for each
interview.
During the interviews, participants contextualized vivid stories and dwelled, with
some direction from me, on face-to-face learning. They gave meanings that were real and
" full of the world" lived experiences. For example, Nancy described her experience with
a face-to-face teacher drawing pictures on the board of fetal tracings, and discussing the
normalities and aberrations of the tracings: "l can still see those pictures on the board.
Now that I've had experience in it, that helped a lot,just remembering the teacher
showing that information to us, how she presented it to us, versus just reading about it
and looking at it in the book. I now can remember it and why." Nancy found meaning in
the lived experience of learning tracings by the way the teacher taught and how she
(Nancy) remembered; the teacher connected with her by her positive teaching attributes
which included the pictures she drew. Yes, there was reflection on essential themes
(discussed in Findings) during the interviews that maintained a strong and oriented
relation to the research question.
There also was the strong context of Gadamer's (1960/2004) interpretation of
" language," a belief that all learning is about language and its textual components.
Gadamerian hermeneutics captured the essence of language and text (both inherent in
face-to-face learning). One example of the essence of language was the above comment
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on ·' filtering;" it seemed easy to visualize what, in terms of learning and language, the
word .. filtering" meant. When Alice, another participant, stated that "The main thing
about face-to-face learning is immediate gratification in answering questions," her
language use of both "gratification" and " immediate" left little doubt in my mind as to
what she meant- she portrayed the satisfaction of getting answers to questions instantly,
paramount in the context of her learning. This was a stellar use oflanguage by Alice; she
brought out words that are not commonly used to describe learning. This caught my
attention and alerted me to how significant language, used appropriately and in context,
can enhance our perceptions and heighten our alertness to language. Textual data,
brought forth by participants through dialogue and speech, represented language with all
of its undertones and kaleidoscopic meanings. Language undergirded and framed this
research study.
Data Analysis
Data analysis for this face-to-face learning research study was carried out as
described in Chapter 3; Concentrating on the nature of lived experiences and the
experience as lived; reflecting on essential themes; writing and rewriting to accurately
transform texts into words and language that are "in this world" and are meaningfol in
discovering key meaning units; clustering similar topics together; and accurately defining
and interpreting patterns and themes. The analysis was conducted, first, by carefully
reading each of the transcriptions at least four times, the readings sometimes punctuated
by one or two days for perspective; writing thoughts, themes, feelings, and impressions,
in the transcript blank spaces; listening again to particular audio recordings for
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darification; and then categorizing and re-categori zing experiences by patterns, themes.
and subthemes, using van Manen 's ( 1990) lour lifcworld existentials as the categorical
compass. Peer debriefing of sample transcripts provided verification ofa sample ofmy
assignments of patterns and themes.
Methodological Rigor
Trustworthiness, labeled as "truth value" was necessary for credible and valid
research. My plan was to assure consistent findings in verifiable patterns and themes that
directly related to the research question. Patterns and themes were chosen that directly
related to the thick, rich, and detailed descriptions from the participants; these were taken
lrom the answers and lived experiences, as voiced by them. Recordings yielded exact
language from the interviews.
Authenticity meant being alert to new insights of the face-to-face learning
phenomenon. Adherence to true reporting of the interviews was a mandate for me; actual
words were used consistently. The use of actual words of the participants brought stark
and colorful meanings to learning that were original and even added to my
understandings found in the literature (See "Findings" for a sample of these illustrative
and meaningful words). Recordings and transcriptions were reviewed several times for
accuracy and truthfulness of words used by the participants. Transcripts were matched
word-for-word from the recordings. I believe that intense iterative analyses led to
accurate and comprehensive reporting of the study. Authenticity is also framed in
fairness. of the interviews, and of the physical and psychological atmosphere in which
interviews took place. Every effort was made for comfortable venues that were quiet and
IOI
well-lit; this was accomplished. I was continuously watchful for any discomfort in the
participants, did not detect or hear of any, thus "appropriate action" was not needed
because of the preparation of the surroundings before the interviews.
Validity and reliability were assured by consistency in accurate and appropriate
pattern and theme development. Caution was taken regarding generalizing of this study to
other venues, since my research participants were from only one university.
Findings
This study encompassed a human science research approach, the pedagogical
reflection on how student participants lived as learners, and how teachers influenced
these learners. van Manen ( 1990) stated that when we, as researchers, raise questions.
gather data, describe a phenomenon, and construct textual interpretations, we do so as
researchers who stand in the world in a pedagogic way. Pedagogy, said van Manen,
"requires a phenomenological sensitivity to lived experience" (p. 2). Phenomenological
research is the study of lived experience and phenomenology is a human science.
Furthermore, the writing of human research must produce "oriented, strong, rich, and
deep texts" (p. 21) and is a search for what it means to be human.
Discovering insights, meanings, and lived experiences of face-to-face learning
from rich and deep texts, was the goal of this phenomenological study. In a newly
discovered Canadian hermeneutic study of student engagement in learning, methodology
and meanings were similar to my study and helped to confirm the value of studying lived
experiences (Wilkinson et al., 1998). The authors noted that meanings of learning
emerged out of students' lived experiences. Students needed to have a sense of context in
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which experiences occur. Most of the students clearly needed to feel that they were
actively interacting and fully engaged in the learning situation. My study, too. was about
context, engagement. and interactions, as exemplified by lived experiences.
Pallerns and Themes
A pattern was the first heading for the liteworld existential findings of this
research. The word "pattern" was chosen because it exemplifies a broad structure or a
category (Woll: 2007) and is a discernable coherent system based on intended
interrelationships of component parts (Merriam-Webster' s Collegiate Dictionary, 2007).
Theme, then was the subheading of each of the four liteworld existentials. Theme, said
van Manen ( 1990), gives control and order to research and writing; theme is a
phenomenological structure of experience and a reduction of a notion. Theme is the form
that captures the phenomenon one tries to understand. Peer debriefing of sample
transcripts provided verification of a sample of my assignments of data to patterns and
themes.
Patterns and themes emerged while the data were carefully analyzed. Each of van
Manen' s ( 1990) four existentials, or experientials, comprised a face-to-face category
(Table I).
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Table I
lived Experiences o/Face-/o-Face learning- l'allerns and Themes
Description
Pattern
Theme
Four lifeworlds
Lived Space
Human t2f classroom
The learning space
The real thing
Lived Body Lived Time
Revealing Time affecting ourselves to learning others through our bodies
In-person Immediacy presence
Learning Timely through the feedback senses
Lived Other
The "other" relationality
Learning dynamics
Lived relation to the other
Lived space (spatiality), van Manen 's ( 1990) first existential , is the felt space in
which we find ourselves and is also the space that helps to determine how we feel. This
space has a semblance of a home, a home where we can be what we are and feel
protected. It is a spatial environment that has the social character of conventional space.
For this study, lived space was the human face-to-face classroom where students
connect, share, feel, learn, talk, and understand, with each other, and with a teacher. Alice
gave voice to the classroom spatiality when she said that "I have to have that humanistic
communication with people;" and "it matters and makes a big difference when the
teacher is /here because she wants you to understand, not give you information." Molly,
too, echoed her impression ofa "good classroom:" "Yes, you get that 'goi ng in the right
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direction' feeling. If you get the right kind of encouragement and the right kind of
·nudges,' it's good."
Participants spoke of humanism and humanistic traits several times during their
interviews to characterize face-to-face learning. They valued humanistic connections in
classroom conversations.
The overall pattern was "the learning space" and the theme was "the real thing."
van Manen ( 1990) spoke of lived space as a category for inquiring into the ways we
experience the affairs of our day-to-day existence. Experiencing the classroom from the
participants' points of view was a "coming together" and a "being together" where
feelings and insights meshed to create an atmosphere of " live" closeness. As Ella said.
"the conversation just seems to ' come out."'
Lived body (corporeality) is van Manen' s ( 1990) second lifeworld existential. We
are always bodily in the world. "When we meet another person in his or her landscape or
world we meet that person first of all through his or her body" (van Manen, p. 103). The
human senses personify lived body and were the most-talked-about attributes of face-to
face learning during each interview. In this study, lived body was a primary
characteristic of face-to-face learning and was how we reveal ourselves to others
through our bodies. Sight was the most frequently discussed human sensor, followed by
hearing; "being there" was included as a subtheme. Judy stated that "In face-to-face, you
can see their emotions, see whether they' re hiding something, lying to you; if a situation
really tore them up, maybe even for years, they're willing to share with you and you can
learn from it. When you' re talking with others, there is no filter." "I want to be there to
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hear the teacher to really understand it," was Nancy's view. Ella spoke on talking:
"'Conversation is perceived just as it is-tone of voice and body language." Participants
talked of the ability to know someone personally through their eyes and body gestures.
Body language was an important aspect of knowing others. The meanings of face-to-face
learning, they said, comes from body language, facial expressions, and caring teachers;
you can see emotions and know whether someone is hiding something.
The overall pattern of lived body was "in-person presence" and the theme was
"learning through the senses." Subthemes were being there, seeing, and hearing.
In lived body, we reveal ourselves to others as we learn. Bodily presence of the
teacher was significant to Nancy as she said, " It helps just knowing that she's there; she's
physically present; it ' s comforting." Molly gave an apt postscript to the importance of
seeing: "You can learn about it, learn the rules, but until you see it in action, it doesn ' t
translate. Seeing is like ' Yah, that ' s how it's done."' Attitude was also spoken by several
participants as critical to the environment of learning for each individual student; "you
want someone in-person to back you up and help you. If you' re scared, you don't learn."
Lived time (lemporality) is van Manen ' s (1990) third lifeworld existential. "The
temporal dimension of past, present, and future constitute the horizon ofa person ' s
temporal landscape. Lived time is our temporal way of being in the world" (p. I 04).
Lived time was subjective time for participants. They talked of time that affected
their learning. For example, when students experienced the extended time it took to get
immediate help from the teacher (primarily in online learning), it seemed like an eternity
and therefore was a hindrance to their learning and their progress. When immediate
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responses took place, they processed this as essential to their thinking and internalization
of information. Each participant defined time as related to their ability to fully
understand concepts and meanings of what they were truly learning. "Time," whether
measured in hours, minutes, or days, was unique to each learner. However, the
immediacy of receiving feedback or confirmation of what they were learning, was a
coveted parameter of students' learning in a face-to-face classroom. " It 's the real time
that constitutes face-to-face learning," said Molly. Alice explained this dilemma of time
as, ··You' re in the zone and all ofa sudden, barn, you've hit a roadblock and can' t go any
further. It 's all fresh in your mind; you want an answer right now and can ' t continue that
one step and go to something else. When the instructor is right there, you can ask the
question and deal with it immediately; it's immediate gratification." "When you're
having face-to-face communication, clarification happens right then," according to Ella.
In this study, the overall pattern of lived time was "immediacy" and the theme was
"timely feedback."
lived other (relationality) is the fourth lifeworld existential. This existential is
"the lived relation we maintain with others in the interpersonal space that we share
with them" (van Manen, I 990, p. I 04). As we meet others, we can develop a
conversational relation by which we can transcend ourselves. To me, this existential
represents the soc ial , interactional nature of face-to-face learning. Alice helped to
explain: "The interactions, the dynamics that go on between teacher and student, are very
important." Relationality is humanistic communication with people; learners receive
reassurance from others-teachers and fellow students. Judy like interaction: " If the
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whole room is sharing their opinions, I like that. Doing things together makes a huge
difference. ·• When human interaction takes place in an educational sdting, it's important.
Sara further explained that "I can internalize what I'm trying to understand when there ' s
human interaction." Reassurance from others was very helpful in learning; one example
given was group projects. Human interaction took on a special role in learning when
Molly stated a perfunctory, yet crystal-clear reason: " We're pack animals and we like
being around each other!"
The overall pattern of lived other, human relations, was "learning dynamics" and
the theme was "lived relation to the other." As Nancy stated: "It ' s just knowing the
teacher is right there to answer questions and to explain in more depth." One of the
participants summarized lived other by saying that the benefit of face-to-face classes is
the human interaction. Appendix F, Lifeworlds, contains an extensive list of participants '
words and phrases, categorized into the four lifeworlds and is a summary of the
participants' lived experiences.
Summary
One of the participants in this study provided a novel , yet intriguing historical
aspect to face-to-face learning that was not directly applicable to the existentials, but
provided valuable and clairvoyant insight into learning. It served as an apt summation to
this chapter.
Sara laced her interview with these insights: " Face-to-face learning is the human
experience- it ' s just so ... there are so many human emotions. At least 70% to 90% of
human communication is nonverbal. We lose that when we don ' t have face-to-face
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interactions. As humans we 're desixned to interact with each other. From the time we
were created, we have learned by watching children see their parents do something-they
see their siblings, their peers in school- acting in a certain way. socializing in certain
ways. And then. interpreting it is how to do it. We learn things as children and that's how
we continue to learn; stories help us learn. I feel like that's very important, especially in
nursing. Nursing has such a human holistic care focus and we continue to care for other
people. When you really learn something, it 'just clicks.' Face-to-face learning is being
around people- that's how we're designed; it ' s an inborn instinct. I think we'll always
have face-to-face and a classroom. It ' s not that we've always done it this way, but it still
is how we learn best. It's worked from the beginning of time. We've survived this long,
doing face-to-face."
rt1is participant, in her own authentic way, captured the essence of face-to-face
learning but also assisted in providing a prelude for the summary of this chapter. The
interviews, as a whole, were rich sources of the above descriptive lived experiences in
face-to-face learning. van Manen's (1990) six research activities served as guides for
interviewing and understanding of how participants extracted particular experiences for
discussion. Participants shared vivid stories and examples that magnified the meanings
brought forth during the interviews as recorded. Examples included the "immediate
gratification" that came from face-to-face experiences, and a comment on "filtering' ' that
lent a clear picture of how biases or misconceptions can occur, especially without face-to
face interaction. The interviews were analyzed, interpreted, and translated into patterns
and themes, according to van Manen's (1990) scheme of lifeworlds.
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Methodological rigor was incorporated into the research process through
validation. carefol listening, and precise recording. Truthti.ilness and authenticity served
lo guide questions and interpretation of words and phrases from the participants.
Consistency along with appropriate pattern and theme development were foremost in my
mind in assuring accuracy and wise interpretation. A highlight throughout this research
process was the wealth and depth of face-to-face descriptors ·'brought to speech" by the
participants. They were true learners who spoke easily and interpreted readily.
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CHAPTER V
SUMMARY OF THE STUDY
Review of the Problem
Historically, nursing education has been associated with face-to-face teaching/
learning methods. We are, however, now in an age of transformation in nursing
education. At the crux of this transformation are critical nursing and faculty shortages and
the concurrent rapid adoption of Web-based technologies by many educational
institutions that include nursing programs. Online programs are omnipresent and have
provided opportunities for students who might not otherwise have been able to advance
their education. However, face-to-face learning methodologies continue to survive, and
even thrive, in spite of the burgeoning ofonline nursing education programs (Halter,
Kleiner, & Hess, 2006).
The nursing and educational literature reflected contradictory views and outcomes
of face-to-face and online education, particularly as related to the enhancement of student
learning. The American Association of Colleges of Nursing (AACN, 1999), however.
posed questions regarding the traditional relationship of technology to the humanistic
practice-oriented care that is the hallmark of nursing. The AACN asked, for example. if
students learned to relate well in a multi-disciplinary environment when their dominant
educational experiences have been technology-based, essentially isolated from classmates
and teachers, except for telecommunications. It is likely that some content,
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such as development of behavioral skills, will continue to occur in traditional ways but
with increased flexibility to better match learner needs (AACN). Hall (2009), however.
noted that as more nurse educators turned to online teaching, students continued to value
traditional face-to-face approaches. Two legitimate questions were asked by Neuman
(2006): "What is the future of human touch and face-to-face contact in the impersonal
technological world? What impact will technology have on the historically valued,
interpersonal relationships in nursing?" (p. 15). Therefore, face-to-face learning was the
justified focus of this study. The identified problem was a lack of scholarly understanding
of what this phenomenon contributed to learning and knowledge.
As online learning grew, the dynamics of face-to-face learning remained an
unsolved dilemma in nursing education. There was a need to explore the value of face-to
face learning which was found to constitute a gap in the literature. Online learning,
however, was discussed in this study, as appropriate and necessary context only. to the
overall vision of learning experiences. A requirement of participants in this study was
that they had experienced both modes of learning.
The philosophical framework of this investigation was based on interpretive
phenomenology and Gadamerian hermeneutics, capturing the essence of language and
text, both inherent in face-to-face learning. The primary research question was: What are
the lived experiences and meanings of face-to-face learning among RN nursing students?
The essence of face-to-face learning was a secondary research question of the study.
This chapter begins with a discussion of the study framework and meanings of the
study, including commentaries of the two research questions and their answers. This is
I 12
followed by brief descriptions of the participants and the interviews. Patterns, themes.
and meanings were summarized in relationship to van Manen's (1990) lifeworlds, and
supported by pieces of the literature. Constructivism undergirds many educational
theories and was discussed in the literature and in this study as a foundation of learning.
Two additional topics that were relevant to learning and to this study were
discussed in varying degrees by all research participants. First was the importance of the
teacher, and second, participants ' views on choices in learning modalities (e.g., online
versus face-to-face learning). Even though these two topics were peripheral to the
research goal, they did lend valuable context to student learning experiences. The
importance of the teacher was integrated into the discussion of lived space, the human
face-to-face classroom. The discussion of choices in learning modalities was included in
the discussion of lived time, time that affects learning. Following this are the conclusions;
assumptions, with commentary; significance; recommendations for nursing education,
practice, and research; and a summary.
Discussion of Findings
Framework and Meanings
A hermeneutic phenomenological approach to this investigation was appropriate.
Knowing Gadamer's ( 1960/2004) attention to language helped me to focus continuously
on spoken and illustrative words that gave "color" and enhanced understanding of face
to-face learning. The phenomenon was face-to-face learning and the hermeneutic
analysis, then, focused on the experiences of the participants in this modality of learning.
The process of extracting meanings came after intense and multiple readings of the
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transcripts, then framing these readings around van Manen' s ( 1990) six analytic
activities. The six activities assisted in focusing on the "whole" of each participant' s
transcript. interpreting exact words and phrases used by the participants, and going back
to each recorded interview to validate the interpretations. Along the way, there were
multiple "looks back" to the descriptions of"phenomenological" and "hermeneutic."
Reflection back to the original tenets of phenomenological research became very
important in order to again "see the whole" of this study. van Manen 's (1990) lifeworlds
seemed to just mesh closely with the collected data. so the process of extracting meanings
(e.g., the learning space, in-person presence, immediacy, and learning dynamics, along
with themes and subthemes) became quite obvious and was joyful for me, the researcher.
Patterns (broad structures or categories), themes and subthemes (subheadings)
were meaning/id to me as general headings of the lifeworlds; these were the "big
pictures" of what the participants spoke of and how I interpreted their responses in the
interviews. I identified the following patterns and themes: Lived Space, the human face
to-face classroom and the importance of the teacher; Pa/tern, the learning space; Theme,
the real thing. Lived body, we reveal ourselves to others through our bodies; Paltern, in
person presence; Theme , learning through the senses. Lived Time, time that affects
learning, and choices in learning modes; Pa/tern, immediacy; Theme, timely feedback.
Lived other. the "other" relationality; Pallern, learning dynamics. Theme, lived relation
to the other (See Table I in Chapter 4). Raw words, phrases, and sentences, then voiced
by the participants, were meanings of the participants' face-to-face learning experiences.
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The extensive list of participants' theme and subtheme lived experiences (Liteworlds) is
round in Appendix F.
Aflirmation for choosing a qualitative, phenomenological framework, but
especially van Manen' s ( 1990) liteworlds as frames , came as I processed and classified
the participants' experiences. Their experiences just seemed to naturally fit into one of
the patterns and themes of the four lifeworlds. It was this process that sealed the
importance of meanings in this study for me and the participants. A discussion of
concentration on the nature of lived experiences and the experiences as lived by the
participants, the reflection on essential themes and the discovery, insight and the writing
and rewriting were all done to accurately transform texts into words and language that
were meaningful in clustering similar themes and subthemes together. Meanings are
further illuminated in the two research questions of this study.
Research question one. These data (i.e., student meanings) represented the core
significance of this study in that the meanings answered a core of the first research
question, which was: What are the lived experiences and meanings of face-to-face
learning among nursing students?
"Lived experiences," stated Kleiman (2004), are experiences that reveal
immediate, pre-reflective consciousness one has regarding events in which one has
participated" (p. 10), portrayed by the participant responses reported in Chapter 4 and
below. van Manen ( 1990) believed that lived experiences were at the crux of
phenomenological research. The rich, well-spoken lived experiences that came from the
participants were at the crux of meanings in this qualitative phenomenological research.
I 15
Examples of these lived experiences with meanings included "teeling and
sharing," '·humanistic connections" (lived space); "understanding better," "'getting it' in
lirst person," "seeing faces that enrich learning" and "knowing" (lived body); "immediate
gratification," "waiting hinders understanding," and "being right there" (lived time); and
"knowing by human connections," "experiences of others bring insight," and " learning
from others" (lived other).
Research queslion two. The second research question was: What is the essence of
face-to-face learning? Essence was described as the fundamental, real, or ultimate nature
of a thing, applied to how humans learn and how the express how they learned.
Phenomenological research is the study of essences, according to van Manen ( 1990).
Physicality or corporeality, presence as "being right there," and proximity as closeness,
were words of essence. Urry (2002) brought forth "co-presence" which described face-to
face learning. In the literature, physicality was described as paramount in face-to-face
learning, calling forth intimacy, identity, immediacy, trust, and a community of
knowledge (Hodge, Bosse, Faulconer, & Fewell, 2006; Kaiser, 2004; Streibel, 1998).
"Being present' in the sense of"being there" with others is how I, the researcher,
processed this essence of learning. "Being present" appeared frequently in participant
comments and appeared to capture the one overall significant essence of face-to-face
learning.
Parlicipanls and fnlerviews
The study participants were articulate, forthright, and intelligent. Throughout the
interviews, I was provided with valuable insights into how these nursing students
I 16
processed and described their lived experiences of learning. A portion of their
descriptions compared the two modes of learning (face-to-face and online) which
enhanced the understanding for both them and me. I used the Interviewing Guide
occasionally, then primarily to follow through on their words and descriptions. The focus
for the interviews, however, was their experiences in face-to-face learning.
I'allerns and Themes
The participants' experiences, the main source of meanings, were organized by
patterns, themes, and subthemes. van Manen's (1990) four lifeworlds-lived space, lived
body, lived time, and lived other- became the overall framework used for explicating
meanings from participants lived experiences, their actual spoken words. Validation from
the literature of this was also added to the discussions of the four categories below.
Lived .1pace. For this study, the primary pallern of lived space was the " learning
space" and the theme was "the real thing." Spatiality was processed by the participants as
a place, the human face-to-face classroom, a home, where they could be, connect, feel,
talk, and understand in a safe environment. Phrases used were "humanistic connections,"
"no filtering of what we say," "feeling and sharing," "not being on my own," and
'"bringing insights." Clearly, these students relished this haven and expressed their
feelings of being "right there" and, most importantly, truly learning in this atmosphere.
The importance of the teacher was laced throughout as "teacher right there," "teacher and
students with each other," and "when the teacher cares, I care." Their language was
exquisite and mirrored van Manen's (1990) description of this lifeworld as " ... the world
or landscape in which human beings move and find themselves at home" (p. I 02).
l 17
The literature validated some of these participants ' comments. In a classroom
setting, wrote Ryan, Carlton, and Ali ( 1999), content was covered better than in online
learning, interactions and participation were increased, and faculty preparation and
expertise gained in importance, validating some of the above participant-voiced
experiences. Chen and Jones (2007) believed that the traditional classroom environment
would continue to offer benefits that arguably could not fully be obtained in any other
manner. The classroom setting, they said, continued to add value regarding instructional
clarity. These thoughts were verified by the participants in this study as they told of their
learning space: "no filtering of what we say" (in a face-to-face classroom); "getting to
know you and others," " live learning," "brings insights," and "the real thing in learning.''
Humanistic relationships develop in the classroom. Kleiman (2007) discussed
relationships or connections between student-teacher, evolving as coming to know and
understand the nature of nursing with its value and meanings. Perhaps this could explain
what a participant meant when she spoke ofa "humanistic connection." Kleiman believed
that technological advancement could play a major role in dehumanizing nursing care and
therefore she emphasized the importance of nursing education with human-centered
aspects, the "primordial nature of nursing" (p. 213).
The teacher. The importance of the teacher was voiced by all participants. "The
teacher is really, really important; it's good to have an instructor for safety; we learn from
questions asked." "In face-to-face learning you' re getting it first person, from the teacher.
rather than a secondary source like just reading a textbook." Teachers gave
encouragement and feedback. One participant described the good teacher as someone
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who --comes across as caring." Another said, "A good teacher explains and personally
takes time to address a student's concerns; hearing her talk brings reassurance." Thus,
participants linked a caring classroom atmosphere, basically initiated by the teacher, as a
--must" for effective learning.
The importance of caring in the classroom was validated in the literature.
Olshansky (2007) noted that caring in the classroom relies on knowledge and we can ' t
simply count on the fact that caring is innate in nurses, or in students. Teaching and
learning about caring needs to be incorporated into the curriculum. Kleiman (2007) spoke
of humanistic teaching in the classroom, the purpose of which was to introduce students
to concepts and experiences that will help them gain insight into patients' human
responses to nursing care and to healthcare issues. Her Humanistic Teaching Model
integrates humanism with an existential understanding of the patient's and nurses lived
experiences, with a phenomenological interpretation.
The interesting relationship of caring in the classroom to caring for patients was
voiced by Rossetti and Fox (2009). They stated that how students ultimately care for
patients has a lot to do with their capacity for trust, respect, and caring, important factors
in the nurse-patient relationship. This climate of trust, respect, and caring is also
significant in the relationship between students and professors and may promote the
professors' ability to be present with students. Comments about effective teachers was
made by Finke (2005), who said that nurse educators, in a caring curriculum, must have
respect for learners and incorporate attributes that facilitate learning (e.g., caring,
confidence, patience, integrity, and flexibility) .
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Vandeveer and Norton (2005) also emphasized a caring curriculum and stated that
"content and student learning experiences must be based on the science of human caring
and grounded in and derived from the actual experience as it should be" (p. 273). The
educational experience requires caring faculty-student relationships. Learning occurs
when an individual's behavior or knowledge changes, they stated, engendered by a true
caring posture.
For the participants, having a teacher instantly available and present promoted
learning: "It's easier to learn 'in person;' the teacher is right there to explain things we
may not clearly understand." Teacher presence was relished because it helped to know
that "she' s there to explain more." A good teacher was an "advocate of the student." said
one participant. Presence was described by Rossetti and Fox (2009) as a factor for
successful teachers. as "a deeper level of awareness that allows thoughts, feelings, and
actions to be known, developed, and harmonized within" (p. 13). The primary role of
teachers is their interaction with students, in a climate of trust, said the authors.
Of importance to the participants was the ability of the teacher to assist in
Lmderstanding: "I expect a teacher to do his/her part in helping me learn." A good teacher
asked questions and verified understanding, especially of new material or topics: '·It was
important to the teacher that we understood a process or a concept that was new to us. A
good teacher doesn't just rush through 'stuff; ' she asked questions and made sure that we
knew." On material learned, another participant stated that "If you respect the teacher, the
information seems valuable. A good teacher puts material in different terminology that
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makes you understand, rather than just reading it and wondering what it meant."
Respected teachers were experts and mentors to their students.
The participants lauded teachers who helped them learn but also stated that peers
possessed major human factors in their learning: ' 'Peers can be good teachers, too; we
teach each other." One participant said that "face-to-face interaction teaches you how to
relate to people: "If you ' ve not learned to interact face-to-face, you're missing out on a
huge keystone of interaction." Another coveted factor in successful teaching was
enlhusiasm, defined as an affective quality of teaching which engenders passion,
enjoyment, and a true love of teaching (Rossetti & Fox, 2009). In their interpretive study
of factors related to superb teaching, as told to them by recognized university professors,
the complete list of related themes were: Presence, Promotion of Leaming, Teachers as
Learners, and Enthusiasm. The authors suggested that nursing faculty might increase
their confidence and effectiveness in teaching by '"learning" from faculty members who
were recognized as exceptionally successful in teaching.
Teachers can also affect choices of learning methodologies. Sometimes, the
participants in this study had choices among course teachers or between modes of
learning (face-to-face or online). The decision-making of these participants was
interesting. When they anticipated that a course would be difficult or they had a weakness
in the topic that they perceived, or when they had a lot of questions, or they wanted the
teacher in front to immediately explain, they chose the face-to-face class: ·'When I
wanted assurance that I would understand as I went along," the choice was face-to-face.
··J would gel ii better face-to-face." One comment was: " In face-to-face , clarification
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happens right then and not later; in online learning, this could extend over four to five
Jays." There was no doubt in their minds that teachers, good or not so good, could sway
the students to one mode of learning over another.
AccorJing to the participants, teachers could also be problematic and could leaJ
to impeding the learning process. Comments consisted ofoccasionally fearing teachers:
"When a teacher puts fear in you, you get scared and then can't learn at all." A teacher' s
attitude, perceived by the learner as positive or not, and approachable or not, was stated
to he an important factor in being able to readily learn: "If you get the wrong kind of
' nudges,' it works against you."
The supreme importance of the teacher-student relationship, whether in face-to
face. or online, learning, was articulated by the participants as a major factor in their
learning. Therefore, faculty must be facilitators of learning and students must be active
learners (Vandeveer & Norton, 2005).
Lived body. For this study, the primary pattern of lived body was "in-person
presence" and the Iheme was " learning through the senses." The participants viewed this
corporeality as learning through the senses and revealing to others through their bodies.
Being there , with in-person presence was highly significant to these students; their words
relevant to learning were "a presence in the zone," and "getting it first person rather than
a secondary source like reading a book." Seeing was translated as '·the way the eyes
look," "seeing one another is teaching one another," "seeing interaction between student
and teacher promotes learning," and "seeing a face enriches learning." Hearing was also
highlighted as "hearing tone of voice important," "hearing touches your heart," and "my
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ear listens for emotions." These nonverbal communications were emphasized as
important to learning and also included "physical impressions," "can know someone
personally by eyes and gestures," and "your ears touch your heart and eyes are connected
to your ears."
The literature mirrored the importance of these nonverbal communications in
face-to-face learning. For example, Buckley (2003) spoke of positive attributes of
nonverbal cues that conveyed overt, as well as unspoken, meanings, which can contribute
to the learning process. Another theme was presence, spoken by participants as " in-
person presence," and "a presence in the zone." The presence of a teacher is central in
nursing education and was defined as a "deeper level of awareness that allows thoughts,
feelings, and actions to be known, developed, and harmonized" (Rossetti & Fox, 2009, p.
13). The importance of getting to know students, building relationships with them, and
treating them as individuals were attributes of presence. And, in a treatise of students '
lived experiences of learning, educators Stodel, Thompson, and MacDonald (2006)
analyzed what learners perceived was missing from their online learning experiences.
They identified body language and visible expressions, energy and emotion, physical
presence, a sense of personal caring, and dynamics of discussions.
Streibel ( 1998) stated that we are all embodied in physical, not virtual, bodies and
are situated in physical, not virtual locations. All important aspects of working and
learning, he said, happen in the here and now of our physical bodies, mimicking the
above statements regarding lived body. Even a best-selling author, Malcolm Gladwell
(2005), spoke of the importance of nonverbal cues in effective communications. The face
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is an enormously rich source of information about emotion; our face is a signal of what 's
going on in our mind, he said; you listen with your eyes. Words are textualized with
facial expressions and nonverbal cues, an apt observational meaning.
lived lime. For this study, the primary pattern of lived time was "immediacy"
and the theme was "timely feedback." The participants highly valued time as it aftected
their learning. Immediacy and immediate gratification, coupled with timely feedback,
were for them, hallmarks of face-to-face learning that they truly treasured. They coveted
immediate feedback. "This 'delay thing' (in online learning) is a problem" said one.
Voiced attributes of face-to-face learning were "answering questions in real time,"
"waiting hinders understanding," "time affects remembering," and " immediate help
equals better understanding." Delayed responses (in online learning), that are way, way
atier the fact, hinder my learning," "don't have to wait to get that e-mail (in face-to-face
learning)," and "when fresh in my mind, learning is immediate" were their ways of
demonstrating how important feedback is when it is immediate and not delayed. Delayed
time meant that the material had to be learned over again atier a lapse, therefore, context
and facts had to be re-learned or may even have been forgotten. This was the meaning of
participants who said that understanding, the ultimate goal of learning, is hindered or
possibly obliterated by time. Mancuso-Murphy (2007), quoting Billings, Connors, and
Skiba (2001) and Seiler and Billings (2004), stated that meaningful and timely feedback
were essentials to learning. Even though her study described online learning, the same
applies to face-to-face learning, according to the participants in this study.
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Leasure. Davis, and Thievon (2000) also found that one of the positive eftects of
face-to-face learning included immediate leedback and clarification of the materials that
led to more meaningful learning activities because there was more direction and
4uestions could be answered face-to-face immediately. Students in their nursing research
rnurse said they had more interaction with both faculty members and peers. engendered
more sdt~confidence, leading to more meaning in their learning activities. Stodel et al.
(2006) further delineated what learners perceived was missing from their online learning
experiences. They identified spontaneity and improvisation which included the " tangent
factor," or those teaching moments that are not in the syllabus; the learning that comes
with discussion-shared experiences, energy and emotion, dynamics of discussions and
real time. The literature gave credence to the participants' experiences and verified
concepts of lived time.
Lived time was also important to participants in the sense of life styles and
juggling time for work as RNs, home responsibilities, plus their academic studies. For
some participants, these responsibilities also determined whether they chose face-to-face
or online class work (when there were choices). Life styles were changed as they
struggled to "do all. " Participants spoke of these dilemmas. One participant described her
situation in detail: " If I were not a working mom and lived closer to campus, I'd prefer to
do my classes in person just because I like to know my teachers and the students l"m
corresponding with. But with my life, I do like online, even though I understand things
better in person." Another participant commented that "online learning scheduling allows
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working adults to go to school. I could not have taken the class ifit were face-to-face.
But we'll always need face-to-face."
Choices can produce dilemmas of time. The participants in this study had life
styles that included work (some full-time), child care and home responsibilities, as well
as full student loads. One participant commented that her household was "scheduled to a
'T."' All of the participants were multi-taskers. Convenience, flexibility , expediency, and
accessibility were factors that clearly influenced the choices of classes taken by the
participants in this study. The literature validates the above factors that can influence the
methodology of learning chosen (or taken without choice) by students. Leasure et al.
(2000) reported on both face-to-face and online courses. Their Web-based group liked the
flexibility, cost, and convenience of the course. Convenience was also a positive
comment in an online course even though the students felt disconnected and isolated
(Ryan et al., 1999). Mancuso-Murphy (2007), in relation to distance education, also cited
convenience, accessibility, and flexibility as positive aspects of this learning modality;
however, technology can be a major issue. Salyers (2005) reported student satisfaction, in
a Web-enhanced section, was related to greater scheduling flexibility and less travel.
lived other. For this study, the primary pal/em of lived other was " learning
dynamics," and the theme was "lived relation to the other." The "other" relationality
(lived other) was discussed by the participants as human interactions that affect the
dynamics of learning; they learned from one another. "Knowing by human connection"
and "learning together" illuminated the importance to them of needing others. Social
aspects were also described by the participants as: "Sharing promotes learning," "power
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in numbers," "easier if you know your classmates personally," and "camaraderie
important." van Manen's ( 1990) writings about relationality mirror the meanings of the
above participant phrases: "In a larger existential sense human beings have searched in
this experience of the other, the communal, the social for a sense of purpose in life" (p.
105). Meeting the "other," he said, allows us to develop a conversational relation that
allows us lo transcend our selves. I believe this is what one participant meant when she
spoke of the power in numbers in concert with '·learning a lot in group discussions" and
describing how the experiences of others brought insight to her learning. Therefore, we
learn as we become communal, transcending ourselves to include others in our circle of
discussions. Thus, " interaction" is akin to communal learning.
The importance of interactive teaching was verified and discussed by Ridley
(2007) and was also included in participants' comments on group discussions and
insights gained through communal learning; they spoke of coveted interaction in the
classroom. Ridley confirmed that traditional lecture is the most widely used nursing
educational method but that methods such as interactive teaching are becoming more
popular. In a concept analysis study, interactive teaching strategies were discussed and
included students taking an active role in their learning; educators facilitating rather than
controlling learning; and teachers providing an accepting, flexible, and supportive
environment. Attributes of interactive teaching included students talking more than the
educator; and being accountable for their own learning, with a focus on construction and
reflecting and communicating meanings of their experiences. Students must engage in
authentic communications with each other and with the teacher. Empowering students to
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become independent learners and exposing them to new ideas but also valuing past
experiences. were important goals for interactive learning.
The positive effects ofmeaningfol interactions in face-to-face learning presented
by Leasure et al. (2000) included decreased opportunity to procrastinate, immediate
feedback, and more meaningful learning activities; these were similar to the thoughts of
the participants in this study. The students in this study valued opportunities for face-to
face interaction with both faculty and peers; they felt more confident in the in-class
coursework. One student said that she did better when having interaction from the
instructor and getting feedback. Work in the classroom was deemed very important for
learning. Ryan et al. (1999) spoke of the importance of interaction immediacy;
facilitation of face-to-face interactions, along with outcomes of increased connectedness
and speaking abilities were important among students. Bonding with others, dynamics of
discussions, and shared experiences were "other" related experiences that students found
missing in online learning, and relished in face-to-face learning (Stodel et al., 2006). One
of the contributions of Vygotsky, a cognitive theorist, was his emphases on the social
dimensions of "other" relationality learning whereby learners construct their meanings
within social environments (Vygotsky's Theory of Social Cognitive Development, n.d.;
Mcinerney, 2005), as in a face-to-face classroom.
Constructivism
Even though constructivism was not a major theme in this study, it did give
context to the whole of learning and therefore, undergirds the study of learning. 1 saw
constructivism as an adjunct in understanding how students learn.
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Construction of meanings is inherent in the process of face-to-face learning and
therefore discussed here. Constructivism was the epistemological approach to my
research whereas phenomenology, hermeneutics, and van Manen 's (1990) human science
were the ontological approaches.
The metaphor of construction was used because it defines a foundation for
learning in nursirtg that portrays an epistemological view of building new knowledge on
existing knowledge (Magnussen, 2008; Peters, 2000). Vygotsky's (n.d.) major theme was
the relationship of thought to the supremacy of language (Vygotsky 's Theory of Social
Cognitive Development), which was an additional factor in this study. The notion of the
supremacy of language, the words used, was in concert with the philosophical thoughts of
Gadamer ( 1960/2004), for whom understanding was inherently connected with language.
This relationship of thought and words to language is inherent in face-to-face learning.
Examples of these words came from the participants' constructed meanings of their
learning experiences: "the real thing," "humanistic connection," "hearing touches your
heart," "immediate gratification helps to better understand," and "in the zone of
learning."
A constructivist theme of meaning was found in the literature on learning. Utts,
Sommer, Acredolo, Maher, and Mathews (2003) spoke of principles of student learning.
Students learn by constructing knowledge and by active involvement in learning
activities. Students learn to do well only when they practice doing. The authors stated that
the traditional classroom setting continued to add value to education in terms of
instructional clarity. Learning occurs as an experience incorporated in the learners'
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existing knowledge base. The purpose of instruction and learning is to support this
construction rather than just communicate information (Broussard, McEwen, & Wills,
2007 ; Vandeveer & Norton. 2005; Weller, 2004).
It has been projected that students' minds are not blank slates waiting to be
written on. Their minds contain existing knowledge (foundation), based on prior
experiences, which new knowledge (brick) is based on ( constructed) and therefore
modifies preexisting knowledge to accommodate new experiences. Adroit teaching can
change the landscape of students' minds. This is how learning takes place (Peters, 2000;
Ridley, 2007).
Constructivist epistemology, the construction of knowledge through experience.
was transformed into words of participants in this study. One participant spoke of passing
along stories of history: '"We talk with each other about these stories from our
experiences; stories help us learn; that's how humans are. Being around other
people . .. that's how we' re designed. Face-to-face in the classroom is not how we ' ve
always done it, but it's how we learn best. It's worked from the beginning of time." She
constructed her background of learning through history and interpreted this experience
into meaningful insights into how she was learning nursing. A number of the participants
in this study used their views of learning nursing to construct meanings of humanism,
human interactions, human holistic caring foci , and also caring in nursing. One
participant constructed her thoughts on face-to-face learning by saying that "People
require that humanistic connection."
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When viewed through the lens of constrnctivism, learning seemed to me, to add
another dimension to the processing of information that, for most learners, was "really
making it part of their being." Constructivism is an epistemological view of building new
knowledge on existing knowledge, through experiences. Legg, Adelman, Mueller, and
Levitt (2009) stated that "Regardless of the reason, the paucity ofliterature on
constructivism in nursing education is compelling and should not be ignored" (p. 66).
And, Olson (2000), in a study of curriculum as narrative, said it best: "When curriculum
is understood as narratively constrncted and reconstructed through experience, the stories
lived and told by students and teachers of what is important, relevant, meaningful, or
problematic for them are valued" (p. 170).
Con cl us ions
Even though face-to-face learning was the prime subject of this research, it cannot
be discussed in isolation. Online and blended learning are also present in today's
educational milieu and were used as context and as comparisons to face-to-face learning.
Two claims are discussed here.
Claim #I. Based on the literature and the participants ' responses in this study,
face-to-face learning continues to hold a strong presence in nursing education. The
American Association of Colleges of Nursing (AACN, 1999) spoke of the humanistic
practice-oriented care that is the hallmark of nursing. Hall (2009) noted, however, that as
more nurse educators turn to online teaching, students continue to value traditional face
to-face approaches. Nursing is a humanistic profession and humanism is a hallmark of
both teaching-learning in nursing and caring for patients (Kleiman, 2007).
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The literature often compared face-to-face learning with online methodologies;
however, many of the comparative studies often lacked methodological rigor. In spite of
this, advantages of face-to-face learning that were gleaned from the literature included:
greater interaction with faculty and peers; connecting with others; immediate feedback
and clarification; content covered better; increased sell:confidence; more meaningful
learning activities; and greater course structure (Bala-Jones & Avery, 2004; Buckley,
2003, Leasure et al., 2000). Participants spoke of how non-verbal cues and unspoken
meanings contributed to the learning process. Identification of puzzling and problematic
areas of learning was more often found in face-to-face learning classrooms (Cragg,
Dunning, & Ellis. 2008). Other participant comments described better communication
about course assignments and greater interaction with faculty and peers in face-to-face
classrooms versus online teaming. Physical proximity and presence were identified as
having high value in face-to-face learning and in the nursing profession. Easter (2000)
and Urry (2002) spoke of presence in the sense of"being there," as in a nurse-patient
relationship but also in learning and communicating with others. It is the human
connections that are critical in higher education and in nursing education. The
participants in this study upheld and reinforced Claim #1 by their numerous, insightful,
and erudite descriptions of their lived experiences and meanings of face-to-face learning.
Claim #2. The theoretical framework of this study seemed to be ideal for an
investigation of face-to-face learning, based on interpretive phenomenology and
Gadamerian ( 1960/2004) hermeneutics. Capturing essences of language and text were
significant experiences and meanings voiced by the participants. The language used by
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the participants appeared to judiciously illuminate lived experiences. The Interviewing
Ciuide was a structural plan that incorporated van Manen's (2000) suggestions for
questioning and responding, on my part, as the researcher. van Manen's (2000) lifeworlds
enabled participants' comments to have meanings that were apropos to lived space, lived
body, lived time, and lived other. I found that the lifeworlds could be utilized so as to
include a majority of the spoken words and meanings. For me, this framework was key to
my ability in interpreting and concluding the results of the study. Constructivism brought
an additional piece to my understanding that learning is multi-faceted and requires more
than one " look" at raw data. Face-to-face learning is both epistemological as well as
ontological. There are, though, many intervening variables oflearning that we have not
yet unearthed. The mystery of learning, with all of its colors and complexities, has yet to
be perfectly described.
Assumptions
The assumptions of this study are listed along with commentaries:
Face-lo:face learning is imporlant and valuable. This mode of learning was of
supreme importance to the participants. The importance was documented in student
meanings of face-to-face learning and through multiple references throughout this study.
The dynamics offace-to:face are no/ fully understood. These reported dynamics,
along with the theoretical framework, will hopefully contribute additional concepts of
how students prefer to learn. I plan to publish the findings. Compared to educational
studies. nursing continues to publish comparative studies that do not necessarily
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contribute additional new information or meanings. Educational research seems to be a
step ahead of where nursing research is at this point in time.
The present wired world, with its online learning, presents a challenge to.further
st11dy.fi1ce-to:face learning. Yes, this is true . Online methodologies of teaching/learning
are entering the realm of simulation that does seem to enhance learning. But this can only
go so far. It appears, to the participants, not to be the "real thing." Blended learning,
however, is very popular and shows signs of accurately integrating online and face-to
face modalities.
Face-to-face interactions with patients are valuable components of nursing
responsibilities and are a hallmark of the nursing profession. This was said earlier by the
AACN ( 1999). We, as nurses, however, must continue to examine the humanistic
components of patient care, which goes a step beyond this study. Participants in this
study, however, did point out humanistic and human interaction characteristics of face-to
face learning that could mirror the characteristics of patient care.
Nurse-patient relationships are closely related to the face-to:face learning that
most students experience in becoming a nurse. A number of the participants mentioned
and acknowledged the relationship. Benner (l 994) argued that as we learn more about
face-to-face learning, we may enhance caring communications and respect the primacy of
caring. Because this was not a primary purpose of this study, it should be a topic for
future research.
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Nursing students will want to talk and reflect on their fc1ce-to:fc1ce learning
experiences. Yes, all eight participants talked eagerly and gave illustrative answers and
many examples, and were enthusiastic in talking about their learning experiences.
This study will contribute to learning pedagogy. Leaming pedagogy is an all
encompassing theme. However, this study should encourage other nurse researchers to
continue pursuing the "what" and "how" of face-to-face and online learning. In addition,
these studies should be designed to use desired learning outcomes as dependent variables
versus the over-abundance of the present nursing studies that utilize test scores and
satisfaction indices, for example, as dependent variables. Also, the mode of blended
learning is increasing rapidly. Perhaps this signifies the importance of retaining both
face-to-face and online methodologies in learning, as a valuable adjunct to the "whole" of
learning pedagogies.
Significance
The significance of this study to nursing education and practice is that it began to
identify what is most valuable and meaningful in the students' lived experiences in face
to-face learning. Hopefully, this study will augment the existing knowledge ofteaching
leaming strategies. Furthermore, this study could identify additional interpretations of
face-to-face interactions that were so significant to the study participants and enhance
curricula and methodological alterations. Similar experiential studies of online and
blended learning, as well as face-to-face studies, should be undertaken to advance the
science of nursing education. The significance of this study, too, with its in-depth
analyses of feeling, "being," and experiencing, may lead us, as teachers, to sensitize
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students to "be.'' to feel, and to connect interpersonally with others, and perhaps, with
patients, just as they felt and connected with their learning and professional development.
Another significance of this study for nursing education and practice is that it is,
to my knowledge, the.firs/ study of lived experiences of face-to-face learning that was
developed around qualitative, hermeneutic, phenomenological, Gadamerian
interpretation, framed around van Manen' s ( 1990) lived experience methodology and
interviewing concepts. Even though there is literature (stated previously) that
incorporates parts of this framework, none was found that mirrored this study.
From their comments, I believe that participants benejilted from the thinking,
interaction, and rich verbalizing that evolved in the interviews. New insights into learning
may have been realized. Participants need to know how significant their input into
research was and how important it was that they contributed to understandings of how
face-to-face learning takes place; I told them so.
Significance also has sociopolilical benefits. This research may add to the extant
body of nursing knowledge regarding how we learn, knowledge that may also be
applicable to how we care for patients. Medical practitioners may also be influenced by
best practices of teaching-learning with students and interactions with patients. Nursing
care may be enhanced for patients and families in the community by teaching improved
methods of interacting, communicating, and learning, in neighborhood and community
conferences and small group work. The results of this study could also be used to educate
policy makers and legislators of the need for adequate funding that highlights teaching
and learning in nursing and healthcare.
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Recommendations
In this study, the elements of face-to-face learning in nursing student participants
were valued and recognized by them as contributing to understanding of the learning
process. The participants were cognizant of how they learned, and spoke boldly and
artistically about it. They believed that face-to-face learning was "alive and well" and
was a mainstay of their education. "Face-to-face learning will not go away," one said.
They relished "being there," experiencing the "real thing," and were independent and
assertive thinkers who spoke thoughtfully and realistically about how they lean and what
they learned.
Nursing Education and Research
This study may assist nurse educators in planning meaningful, interactive, and
multi-sensory learning experiences. Needed are studies that identify and evaluate the
"learning space," the environment in which students process information and learn. The
environment of the classroom played a major role in how participants processed
information and, more important, in whether or not they truly learned. Teachers must
"feel and share" and reveal themselves as caring and knowledgeable. The translation of
van Manen's ( 1990) lifeworlds (lived space, lived body, lived time, and lived other) as
told by the participants, portrayed meanings that educators could use to evaluate "the
classroom." These multitasking participants wanted education that was patterned to their
mode of learning and strictly to their available time. They wanted meaningful classes
where teachers were well-prepared, interacted appropriately, and respected their
intelligence and needs. They expected teachers to go the extra mile when they
137
experienced problems and also expected their classmates to be as prepared for
meaningful conversations as they were. The importance of teachers in learning was
universally spoken ofby all participants. They verbalized the need for face-to-face
learning, especially when studying nursing and being in clinical situations. Some of the
participants also liked online learning when it fit their busy work/home/study that gave
them flexibility , convenience, and accessibility to courses. I recommend that additional
research be done to identify and evaluate this learning space and specify this very
important role of the teacher in enhancement of student learning.
Research studies must be done to further validate the concept of physical presence
in face-to-face learning. Physicality and being present were paramount in face-to-face
learning, calling forth intimacy, identity, immediacy, trust, and a community of
knowledge (Hodge et al., 2006; Kaiser, 2004; and Streibel, 1998).
Recommendations for further research include replication of this study with a
larger cohort of students than in this study and in another institution of higher learning,
but with the same study parameters. "How teachers and students make sense of
phenomena in light of their experience reveals practical knowledge embedded in
experience. Research that covers teaching and learning experiences contributes to the
development of a phenomenologic pedagogy" (Young, 2008, p. 96).
Research that compares face-to-face and online, and face-to-face and blended
learning is a critical need in nursing education. Nurse educators must identify appropriate
variables that truly measure learning vis-a-vis dependent variables such as satisfaction
indices, test scores, and course grades. Vignettes that exemplify superior classroom
138
learning, as evaluated by students, would be a welcome addition to the nursing education
and research literature.
Blended learning in nursing education must continue to be studied. ls blended
learning superior to face-to-face and to online learning? Will blended learning continue to
increase or is it a temporary " fix" to education?
In addition, I recommend that the humanism, human responses, and human care
that were voiced by the participants be studied in depth; this could lend valuable insights
to the terms that were and are often used in concert with education, but not understood in
depth (e.g., human care, humanism in nursing, human interaction in learning).
Participants spoke of humanism but neither they nor I fully understood what this meant,
especially in relation to learning. I previously wrote: "It seems obligatory that we pay
marked attention to the human component of learning that may also become the primary
mode of caring for patients." ls classroom humanism with peers or teachers the same, or
different, than humanism in the care of patients? A recommendation is that this question
becomes the focal point of further study.
One of the dilemmas identified in this study was the choices that multitasking
students may have in face-to-face and online courses, and modes of delivery. In ending
that discussion, I posed a question that should be studied: Is true learning jeopardized
when choices must, out of necessity, be made that primarily accommodate the
overarching responsibilities of home and work that are outside of academia? The findings
in this study highlighted the dilemma of ample time for the participants ' work, home, and
139
their studies. The exact nature of this dilemma. plus how students successfully use their
time to accommodate their multifaceted lives, begs for additional study.
Nursing Practice
The links between nursing education and practice are many, if not only
marginally understood. Further exploration of nurses ' and students ' humanistic
behaviors, present or not, in care of patients, is recommended. If caring and humanism
can be taught in the classroom, do they transfer over to the care of patients? However,
can nursing students be taught how to truly care?
Summary
Pwpose
The purpose of this phenomenological hermeneutic study was to illuminate the
meanings and essence of face-to-face learning experiences in nursing students, van
Manen's (1990) method of interviewing and Gadamer's (1960/2004) emphasis on
language and text were used to record and understand students' responses. van Manen's
four lifeworld existentials (lived space, lived body, lived time, and lived other) were the
foundation for the analyses. Methodological rigor underpinned the study.
Methodology
An integration of Gadamerian hermeneutics, stories, and van Manen 's ( 1990)
analytic interviewing points comprised the research approach. Face-to-face interviews
were conducted individually with eight Texas Woman's University (TWU) students who
volunteered for the study. TWU' s Institutional Review Board approved the study
proposal (Appendix B). Privacy and confidentiality were assured. Tape-recorded
140
interviews. transcribed word-for-word by me. were the major data used for the analysis.
Transcribed interviews were read numerous times. each time uncovering additional
relevant data. Patterns and themes were then extracted from the recorded interviews
(Appendix F).
Findings
Words and meanings of students ' experiences became rich sources of patterns and
themes. After carefully analyzing and categorizing the data, I translated van Manen' s
( 1990) lived space as the learning space (the real thing), lived body as in-person presence
(learning through the senses), lived time immediacy (timely feedback), and lived other as
learning dynamics (lived relation to the other).
The findings were a rich source for understanding how participants processed
their learning experiences. The first research question yielded multiple responses of
experiences and meanings that represent the fabric and importance of face-to-face
learning. The second research question, on essence, helped to further understand how
learning takes place. " Being present" was the primary essence of face-to-face learning.
These findings, not seen elsewhere in the literature, are significant to nursing
research in understanding how face-to-face learning was regarded by a cohort of nursing
students. This study should alert nursing educators that face-to-face learning remains a
firmly-voiced mainstay in student learning. Raising the consciousness of the importance
of face-to-face learning for nurse educators, nurse practitioners, schools of nursing, and
healthcare executives, was a goal of this study. Studies that illuminate and more fully
understand face-to-face learning are sorely needed.
141
End Notes
Presented here are three vignettes of face-to-face activities, non-nursing
experiences that demonstrated the enduring value of face-to-face encounters. All three
lend credence to the notion that, as long as we are human beings, we will continue to
value face-to-face interactions and learning moments.
At a pivotal stage in its history, the American College of Surgeons, 75,000 strong,
asked if there was any enduring value to periodic meetings where surgeons gathered in
person to learn and socialize. They asked, " Why should we attend such meetings? ls there
any value in meetings?" After much consternation, the College members realized that
there was a great value in meetings. Many of the nuances and details of papers come out
only in discussion; discussions did not stop at the podium; a convivial gathering provided
the milieu for exchange of ideas. The role of friendship and face-to-face contact cannot
be emphasized enough, they said. Body language in a face-to-face situation is certainly
more telling than a phone call. Meeting colleagues in person gave them a sixth sense of
whom they could trust. There was an intangible reward of associating with like
professionals; a good group helped them to grow and develop. They agreed that there was
real value to meetings, a "continuously refreshing thing" (Baker, 2001).
Dr. Jose Bowen is the Dean of the Meadows School of the Arts at Southern
Methodist University in Dallas, Texas. After hearing about his "Teaching Naked'
concept (Bowen, 2006), I knew that I wanted to meet him, which I did. We spoke of his
beliefs about learning and my thoughts on face-to-face learning. While it sounded to be
an anti-technology approach, Teaching Naked really wasn ' t. Technology would not be
142
hanished, but we need to rethink how we use technology, both inside as well as outside of
the classroom. Lectures should be taken out of the classroom and put into podcasts.
Classrooms should be stripped of computers, he said, but then moving to more classroom
discussion and interaction among professors and classmates. Real-world experiences
should be discussed in the classroom and PowerPoint slides should be banned. Class time
should be used creatively to spark questions and discussions. If we believe that the value
ofa college experience consists largely of the human interaction between professors and
students, Dr. Bowen claimed, then we should maximize that experience. He advocated
naked, non-technological face-to-face classroom interaction with students that includes
time for discussion and robust exchange of ideas. Coming to class must add value;
reducing the technology and increasing the human interaction was the best way to create
something interactive that can't be duplicated online. Class time was too valuable to
allow students to sleep, he said.
Physical proximity was highlighted in an ingenious paper by Urry (2002) who
was intrigued by business travel and its significant relationship to physical proximity.
Why do business people travel? And why is there more and more physical, corporeal
travel? It's because corporeal co-presence and interaction are fundamental to social
intercourse that leads to the all-important trust. People felt that they "knew" someone
from having communicated with them face-to-face; to "be there" for oneself was critical.
Face-to-face mobility maintained social capital, important in business. The attributes and
nature of co-presence were closely akin to descriptive attributes of face-to-face learning
(e.g., physical presence and place, interaction, and social presence).
143
These three vignettes had one thing in common; they all demonstrated the human
and enduring value of face-to-face interactions in professional meetings, education, and
business. Face-to-face interactions and experiences are inherent in learning and in living.
I feel privileged to have studied face-to-face learning in nursing students, obtained raw
and poignant data from unfettered and unflappable participants, and learned more than
anyone else. It was truly an opportunity that will forever imprint on my mind the value of
face-to-face learning in nursing education.
144
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160
APPENDIX A
Recruitment Flyers #1 and #2
161
Attention Nursing Students!!
I am a PhD nursing student who is preparing an exciting research study on
face-to-face learning among nursing students
You are invited to participate!
Participants must be currently enrolled as an undergraduate or graduate nursing student at TWU/Denton Campus, must have experienced both face-to-face ( classroom) and online (Webbased) classes, be 18 years of age or older, be English-speaking, and be available for individual interviews (no more than 2 hours total). Participation is voluntary.
Interviews will be audiotaped for data analysis. All information will be kept stri~tly confidential.
A $15 gift card to Target will be given to participants after interviewing.
If interested in participating, please send an e-mail to Barbara Gruendemann at bgruen @msn.com
162
Attention RN-BS/MS Nursing
Students!! H ·I:x c Ls: ri V/(Wt-1.1'evf 1,<l 01Ypcwtuv\,Ltt1 to be IA
·p n vt uf 11i !"Cseci n.:.h .stu.o: L--1 ovl, Le/A rv\.,LV\.-D.\ ! ' ' (..J -:_;
( Note i:hange in n~in'lbursement}
I am a PhD nursing student who is preparing an exciting research study on
face-to-face learning among nursing students
You are invited to participate!
Participants must hold a current RN license, be currently enrolled as an RN-BS/MS nursing student at TWU/Denton or Dallas Campus, must have experienced both face-to-face ( classroom) and online (Web-based) classes, be 18 years of age or older, be Englishspeaking, and be available for individual interviews (no more than 2 hours total). Participation is voluntary.
Interviews will be audiotaped for data analysis. All information will be kept strictly confidential.
A $50 gift card to Target will be given to participants after interviewing.
If interested in participating, please send an e-mail to Barbara Gruendemann at [email protected]
163
APPENDIXB
University Approval Letters to Conduct Study
164
DENTON DAllAI HOUSTON
October 12, 2009
Ms. Barbara J. Gruendemann
86 I I Breakers Pt.
Dallas, TX 75243
Dear Ms. Gruendemann:
Institutional Review Board OHice of Research and Sponsored Programs P.O. Box 425619, Denton, TX 76204-5619 940-898-3378 Fox 940-898-3416 e-mail: [email protected]
Re: lived Experiences vf Face-to-Face learning in Nursing Students
The request for an extension of your !RB approval for the above referenced study has been reviewed by the TWU Institutional Review Board (!RB) and appears to meet our requirements for the protection of individuals' rights.
If applicable, agency approval letters must be submitted to the !RB upon receipt PRIOR to any data collection at that agency. A copy of all signed consent forms and an ·annual/final report must be filed with the Institutional Review Board at the completion of the study.
This extension is valid one year from October 14, 2009. According to regulations from the Department of Health and Human Services, another review by the !RB is required if your project changes in any way. If you have any questions, feel free to call the TWU Institutional Review Board.
Sincerely,
Dr. Kathy DeOmellas, Chair
Institutional Review Board - Denton
cc. Dr. Patricia Holden-Huchton, College of Nursing
Dr. Jane S. Grassley, College of Nursing
Graduate School
165
Date: June 30, 2009
To: Dr. David Nichols, Chair Institutional Review Board-Denton, TWU
From: Barbara J. Gruendemann, RN, MS, FAAN Doctoral Student, Nursing, TWU
Re: Exempt IRB Application Changes
R~::~:~:D RESEARCH & SPONSORED PROGRAMS
TEXAS WOMAN'S UNIVERSITY
I~ f~ ~00m
--~ \ DL l -Z.009
Q~~\ln Dr. Nichols, this Memo is in regard to changes on my Pilot Study Exempt IRB, approved October, 2008.
I will soon be collecting data for my dissertation and now wish to propose a few minor changes to the original !RB and still be in compliance for data collection this Fall. I have highlighted the proposed changes below. These changes have also been inserted into the attached documents.
The changes proposed to the original IRB are:
1. p. I I: Q# J, first sentence: change "a class project" to "my dissertation"
2. p. 11: Q#2, first para: "Recruitment will be by posted flyers on the TWU/Denton/Dallas campuses, and on Blackboard (for RN-BS/MS in nursing students). Delete "postings in the TWU print and online newspapers" and "and the online Doctoral Lounge."
3. p. 11 :Q#2, second para: "Outline of the recruitment process script: "Attention RNBS/MS Nursing Students!! Here is a wonderful opportunity to be a part of a research study in learning! I am a PhD nursing student who is preparing an exciting research study on face-to-face learning among nursing students-You are invited to participate! Participants must hold a current RN license, be currently enrolled as an RN-BS/MS nursing student at TWU/Denton or Dallas Campus, must have experienced both face-to-face (classroom) and online (Web-based) classes, be 18 years of age or older, be English-speaking, and be available for individual interviews (no more than 2 hours total). Participation is voluntary. Interviews will be audiotaped for data analysis. All information will be kept strictly confidential. A $15 gift card to Target will be given to participants after interviewing. If interested in participating, please send an e-mail to Barbara Gruendemann at [email protected]."
166
4. p. l 2:Q#2 (cont 'd). "Attachment I is sample flyer. " Note: Flyer has minor word changes. N cw flyer is attached.
5. p. 12, Q#4 (cont'd). "Attachment 2 is the Interviewing Guide." Guide has minor changes ( e.g., new second question: "Please describe one of your experiences of learning in a face-to-face environment? What was it like'!"). New Interviewing Guide is attached.
6. p. 13: Q#7e, Line #2: "Participant must be currently enrolled as a nursing student on the Denton/Dallas TWU campus." Delete last two sentences of this paragraph.
7. p. 14: Q#8b: " It is anticipated that individual student interviews will be conducted in a quiet room on the TWU Denton/Dallas campus or at another location acceptable to both the participant and the researcher.
8. Consent Form: "Explanation and Purpose of the Research," first two lines: Delete " .. a class project in one of Barbara Gruendemann's doctoral classes at Texas Woman's University," and insert: "Barbara J. Gruendemann's dissertation as part of her doctoral studies in nursing at Texas Woman's University," A clean copy with the change inserted is attached.
Thank you for your consideration of these changes. If you have questions, please contact me at 214.553.5538 or [email protected]. I look forward to hearing from you.
167
APPENDIXC
Informed Consents
168
TEXAS WOMAN'S UNIVERSITY CONSENT TO PARTICIPATE IN RESEARCH
Title: Lived Experiences of Face-to-face Learning in Nursing Students
[nvestigator: Advisor:
Barbara J. Gruendemann, Graduate Student .. Jane S. Grassley, PhD.
Explanation and Purpose of the Research
. .. [email protected] 940.898.2420
You are being asked to participate in a research study for Barbara J. Gruendemann's dissertation as part of her doctoral studies in nursing at Texas Woman's University. The purpose of this research is to examine descriptions of face-to-face learning as experienced by TWU nursing students.
Research Procedures For this study, the investigator will conduct face-to-face interviews that will focus on your experiences of face-to-face interaction in learning. Prior to giving your informed consent and participating in the study, you will have an opportunity to ask any questions. Questions regarding the study and your participation in it may be asked at any time throughout your participation. You will be audiotaped during the face-to-face interview. The purpose of the audiotaping is to provide a transcription of the information discussed in the interview and to assure accuracy of the reporting of that information. The audiotapes will be transcribed to typed copies, without any identifying information, and saved to my computer for analysis. Itis anticipated that this interview will be 1 to I ½ hours in length. The researcher may want to call you at a later date for clarification of comments you made during the interview. Your maximum total time commitment is anticipated to be 2 hours (i.e., the interview plus a potential follow-up phone call).
Potential Risks Potential risks related to your participation in the study are (l) fatigue or physical discomfort, (2) emotional discomfort during your interview, and (3) loss of confidentiality. To avoid fatigue and physical discomfort, you may take a break (or breaks) during the interview as needed. If you experience emotional discomfort regarding the interview questions, you may stop the interview at any time. You may resume the interview when you are ready, or choose to stop, or reschedule. The researcher can give you the phone number of the TWU Counseling Center as a resource (940.898.3801 ). Other counseling resources are on page 3. There is a potential risk of loss of confidentiality in all email, downloading and internet transactions.
Because Joss of confidentiality is a risk, confidentiality will be protected to the extent that is allowed by Jaw. The interview will take place in a private location agreed upon by you and the researcher. A code name, rather than your real name, will be on the audiotape and transcription, transcripts, or reports. Only the researcher, her advisor, and the transcriber
Approved by the Texas Woman's University lnslilutionai Review 803rd
,/1 ,,L ~
169
Participant's initials Page I of3
dL
will have access to the tapes. The tapes, hard copies of the transcripts, and computer diskettes containing the transcription text files will be stored in a locked file cabinet or password protected computer in the researcher's home office. All data will be erased, shredded, or deleted within two years of the completion of the study.
2
The researcher will try to prevent any problem that could happen because of this research study. You should let the researcher know at once if there is a problem and she will help you. However, TWU does not provide medical services or financial assistance for injuries that might occur because you are taking part in this research.
Participation and Benefits Participation in this study is voluntary and you may withdraw from the study at any time without penalty. While you may benefit educationally and personally from participation in this study, the one direct benefit to you is that, at the completion of the study, a summary of the results can be mailed to you provided that you so request. You will receive a$ 15 gift card for participating.
Questions Regarding the Study You will be given a copy of this signed and dated consent form to keep. If you have any questions about this research study, you should ask the researcher; her e-mail address is at the top of this form. If you have questions about your rights as a participant in this research or the way the study has been conducted, you may contact the Texas Woman's University Office of Research & Sponsored Programs at 940.898.3378 or via e-mail at [email protected].
Signature of Participant Date
**If you would like to receive a summary of the results of this study, please provide an address to which this summary should be sent:
Approved by the Texas Woman's University lnstitutiona! Review Board
Date /12.::.d_ · tYi
Page2of3
170
In addition to the TWU Counseling Center, Denton (940.898.3801), other resources are available:
TWU Parkland-Dallas Counseling Center (214.689.6655)
TWU Houston Counseling Center (713.794.2059).
University of North Texas Counseling Center, Health Sciences Center, Fort Worth (817.735.2000)
Approved by the Texas Woman's University Institutional Review Board
Date/0 -1</---t)'t
171
___ Participant's initials
Page 3 of3
TEXAS WOMAN'S UNIVERSITY CONSENT TO PARTICIPATE IN RESEARCH
Title: Lived Experiences of Face-to-face Leaming in Nursing Students
Investigator: Barbara J. Gruendemann, Graduate Student Advisor: Jane S. Grassley, PhD ............. . ...... . .
Explanation and Purpose of the Research
... [email protected] 940.898.2420
You are being asked to participate in a research study for Barbara J. Gruendemann' s dissertation as part of her doctoral studies in nursing at Texas Woman ' s University. The purpose of this research is to examine descriptions of face-to-face learning as experienced by TWU nursing students.
Research Procedures For this study, the investigator will conduct face-to-face interviews that will focus on your experiences of face-to-face interaction in learning. Prior to giving your informed consent and participating in the study, you will have an opportunity to ask any questions. Questions regarding the study and your participation in it may be asked at any time throughout your participation. You will be audiotaped during the face-to-face interview. The purpose of the audiotaping is to provide a transcription of the information discussed in the interview and to assure accuracy of the reporting of that information. The audiotapes will be transcribed to typed copies, without any identifying information, and saved to my computer for analysis. It is anticipated that this interview will be I to 1 ½ hours in length. The researcher may want to call you at a later date for clarification of comments you made during the interview. Your maximum total time commitment is anticipated to be 2 hours (i.e. , the interview plus a potential follow-up phone call).
Potential Risks Potential risks related to your participation in the study are (I) fatigue or physical discomfort, (2) emotional discomfort during your interview, and (3) loss of confidentiality. To avoid fatigue and physical discomfort, you may take a break (or breaks) during the interview as needed. If you experience emotional discomfort regarding the interview questions, you may stop the interview at any time. You may resume the interview when you are ready, or choose to stop, or reschedule. The researcher can give you the phone number of the TWU Counseling Center as a resource (940.898.3801). Other counseling resources are on page 3. There is a potential risk of loss of confidentiality in all email, downloading and internet transactions.
Because loss of confidentiality is a risk, confidentiality will be protected to the extent that is allowed by law. The interview will take place in a private location agreed upon by you and the researcher. A code name, rather than your real name, will be on the audiotape and transcription, transcripts, or reports. Only the researcher, her advisor, and the transcriber
Approv&d by the Texas 1/Vomen's .University lns ti!uhone.J Rev1e;w Board
l 72 Participant's initials Page I of 3
will have access to the tapes. The tapes, hard copies of the transcripts, and computer diskettes containing the transcription text files will be stored in a locked file cabinet or password protected computer in the researcher's home office. All data will be erased, shredded, or deleted within two years of the completion of the study.
2
The researcher will try to prevent any problem that could happen because of this research study. You should let the researcher know at once if there is a problem and she will help you. However, TWU does not provide medical services or financial assistance for injuries that might occur because you are taking part in this research.
Participation and Benefits Participation in this study is voluntary and you may withdraw from the study at any time without penalty. While you may benefit educationally and personally from participation in this study, the one direct benefit to you is that, at the completion of the study, a summary of the results can be mailed to you provided that you so request. You will receive a $50 gift card for participating.
Questions Regarding the Study You will be given a copy of this signed and dated consent form to keep. If you have any questions about this research study, you should ask the researcher; her e-mail address is at the top of this form. If you have questions about your rights as a participant in this research or the way the study has been conducted, you may contact the Texas Woman's University Office of Research & Sponsored Programs at 940.898.3378 or via e-mail at [email protected].
Signature of Participant Date
**If you would like to receive a summary of the results of this study, please provide an address to which this summary should be sent:
Approve.ci by il1e Texas Woman's Universi: institutionai Rev1e•..-,; Boer'
173
Page 2 of3
In addition to the TWU Counseling Center, Denton (940.898.380 I), other resources are available:
TWU Parkland-Dallas Counseling Center (214.689.6655)
TWU Houston Counseling Center (713.794.2059).
University of North Texas Counseling Center, Health Sciences Center, Fort Worth (817.735.2000)
p ApprovE:d by the
L.,,1
- Texas Woman's University Institutional Review Board
Date: ✓/J-1~ " 0 '/
~v,·~11d ;z.-:'i°"~Lq
___ Participant's initials
Page 3 of3
174
APPENDIXD
University Approval Letter - Pilot Study
175
DENTON DALLAS HOUSTON
October 14, 2008
Ms. Barbara J. Gruendemann
8611 Breakers Pt.
Dallas, TX 75243
Dear Ms. Gruendemann:
Institutional Review Board Office of Research and Sponsored Programs PO. Box 425619, Denton, TX 76204-5619 940-B98-3378 fox 940·898-3416 e·moi l: IRB@twu edu
Re: lived Experiences of Face-to-Face Learning in Nursing Students
The above referenced study has been reviewed by the TWU Institutional Review Board (IRB) and appears to meet our requirements for the protection of individuals' rights.
If applicable, agency approval letters must be submitted to the IRB upon receipt PRIOR to any data collection at that agency. A copy of the approved consent form with the !RB approval stamp and a copy of the annual/final report are enclosed. Please use the consent form with the most recent approval date stamp when obtaining consent from your participants. The signed consent forms and final report must be filed with the Institutional Review Board at the completion of the study.
This approval is valid one year from October 14, 2008. According to regulations from the Department of Health and Human Services, another review by the IRB is required if your project changes in any way, and the !RB must be notified immediately regarding any adverse events. If you have any questions, feel free to call the TWU Institutional Review Board.
enc.
Dr. David Nichols, Chair
Institutional Review Board - Denton
cc. Dr. Patricia Holden-Huchton, College of Nursing
Dr. Jane S. Grassley, College of Nursing
Graduate School
176
APPENDIXE
Interviewing Guide
177
Interviewing Guide:
After explaining the overall goal of the study, the researcher will begin by asking openended questions, such as:
• What is the first thing that comes to mind when I say "face-to-face learning?"
• Please describe one of your experiences of learning in a face-to-face environment? What was it like?
• How is this different from online learning?
• How do you know when you have learned, in a face-to-face setting?
• What did that do for you? How did it make you feel?
• What is the importance for you to have fellow students and teachers physically around when you are learning?
• What do you think is the best way to learn how to be a nurse?
• What learnings were most important to you as you were learning to become a nurse?
• What helped you learn caring as part of being a nurse?
178
APPENDIXF
Lifeworlds
179
Lived Space
The human face-to-face classroom
Pattern The learning space
Theme The real thing
Subthemes Feeling and sharing Getting to know you and others No filtering of what we say Feeling of needing others Teacher right there Teacher and students with each other Humanistic connections Not being on my own By innuendo and talking with each other, things can be taken care of
easier When the teacher cares, I care Teacher explaining applications Get to know persons right then and there Need to feel we ' re not alone "Live" learning Brings insights Learning together Feedback from others Human contact huge The real thing
180
Lived Body
We reveal ourselves to others through our bodies
Pattern In-person presence
Theme Leaming through the senses
Subthemes Being there: In-person learning; knowing; a presence in the "zone;"
humanistic connection; "being;" physical impressions; getting confidence; understanding better; "getting it" in first person rather than a secondary source, like reading a book; being there in person
Seeing: The way the eyes look; seeing tears; seeing, hearing, speaking all go together; better if you can look at it; your ears touch your heart
and your eyes are connected to your ears; important to see a face; seeing one another-teaching one another; seeing a face enriches learning; impressions come from seeing; can see personality traits, values and trust in a teacher; have to see it; you can' t "see it" in a textbook; can know someone personally by eyes and body gestures; seeing interaction between student and teacher promotes learning; important for me to put a name with a face; tell me, show me, and I'll learn
Hearing: Hearing tone of voice important; listening; hearing touches your heart; talking with one another important; my ear listens for emotions
181
Lived Time
Time that affects learning
Pattern Immediacy
Theme Timely feedback
Sub themes Immediate gratification It 's real time Answering questions Getting to know persons right there and then " In the zone" of learning "Delay thing" a problem Waiting hinders understanding Time affects remembering When fresh in mind, learning is immediate Hearing and seeing in real time Not "too little, too late" Being right there Don't have to wait to get that e-mail Waiting for an answer online delays your progress Immediate help=better understanding Want teacher in front ofme to do immediate explanations Delay responses-way, way after the fact-hinder learning
182
Lived Other
The "other" relationality
Pattern Leaming dynamics
Theme Lived relation to the other
Subthemes Human interactions Feeling of needing others Knowing by human connection Leaming together Talking with each other Leaming a lot in group discussions Getting feedback when I don 't understand promotes learning Social aspects important Getting feedback guides you in the right direction "feeling" Power in numbers Getting encouragement Experiences ofothers bring insight Whole room sharing their opinions Leaming from each other Sharing promotes learning Human contact is huge Knowing by meeting Camaraderie important Easier if you know your classmates personally Can hear what other people say and see the responses of the teachers Learn from questions of others Clarification happens right then
183
