journal entry

218 J U l Y / A U G U S T 2 0 1 4 V O l U M E 3 5 N U M B E R 4 219

best practices for Creating social presence and Caring behaviors online Kathleen Plante and Marilyn E. Asselin

doi: 10.5480/13-1094.1

The Institute of Medicine (2011) recom-

mends that nursing programs examine and

update their curricula so that faculty are

better equipped to adjust to changes in sci-

ence and technology, patient care needs, and

student preferences. In response to this call,

innovative and creative nursing programs

that incorporate technologic advances — in

both synchronous and asynchronous formats

— are emerging to address the unique learn-

ing styles of a diverse student population,

including the millennial learner. Courses

offering traditional, didactic, face-to-face

learning are being augmented or simulta-

neously offered with online pedagogies that

feature voice-over lectures and Internet dis-

cussions. Although some students and fac-

ulty find traditional classes appealing, online

or distance learning attracts students who

might not otherwise have the opportunity to

attend nursing classes due to work and family

demands (Mayne & Wu, 2011).

Students often state that their reason for

choosing nursing as a career is based on a

desire “to care” for people (Roach, 2008,

p. 16). Caring has been a dominant theme

in shaping nursing programs and a compo-

nent of nursing student skills assessment.

According to Watson (1988), caring is “the

moral ideal of nursing,” defined as a “value

and an attitude that has to become a will, an

intention, or a commitment, that manifests

itself in concrete acts” (p. 32). Caring is the

“heart of nursing,” an ontology that is the

ethical and philosophical foundation of the

art of nursing, and it involves a deep com-

mitment to the patients, families, and com-

munities that nurses encounter. Students

learn caring behaviors through faculty mod-

eling and values in the traditional classroom

setting (Watson); however, these behav-

iors are difficult to portray in the online

environment (Gallagher-Lepak, Reilly, &

Killion, 2009).

If caring is viewed as the essence of

nursing, can caring and social presence

be demonstrated in a virtual environment

where visual and verbal cues and behaviors

are absent? One challenge that faces fac-

ulty who teach online classes is to create a

sense of social presence where students feel

connected and part of the learning environ-

ment. Mayne and Wu (2011) define social

presence as the “degree to which partici-

pants in computer-mediated communication

feel affectively connected to one another”

(p. 111). Students often describe feeling iso-

lated and disconnected when participating

in online learning. Fostering social presence

is a challenge for faculty because the feel-

ing of presence is an emotion that conveys

a connection of being wanted by others and

being cared for. In the context of an online

community, social presence has common

characteristics with models of caring (Shen,

Yu, & Khalifa, 2010).

AIm to identify best practices and evidence-based strategies for creating an online learning environment that encompasses caring behaviors and promotes social presence.

bACkGround Faculty who teach online classes are challenged to create a sense of social presence and caring behaviors in a virtual world in which students feel connected and part of the learning environment.

method To extrapolate evidence to support best practices, a review of literature was conducted focused on social presence and caring online.

resuLts faculty messages that are respectful, positive, encouraging, timely, and frequent foster social presence and caring behaviors while also allowing for caring interactions, mutual respect, and finding meaning in relationships.

ConCLusIon A variety of measures to emulate caring online intertwine with social presence to promote a sense of caring and belonging. More research is needed to support the evidence for these strategies.

Abstract

nursing education Perspectives

220 J U l Y / A U G U S T 2 0 1 4 V O l U M E 3 5 N U M B E R 4 221

Nursing Education Perspectives

An additional challenge in the online

environment involves identifying ways to

display the caring behaviors typically dis-

played in the traditional classroom setting,

(Gallagher-Lepak et al., 2009) through

behaviors, interactions, and role-modeling by

faculty. In an online class, these behaviors are

difficult to portray.

Numerous examples of nursing courses

exist that address best practices on how to

promote social presence to a diverse student

body; however, there is a dearth of literature

that addresses how caring and social pres-

ence can be conveyed in an online classroom.

This article identifies best practices and evi-

dence-based strategies for creating an online

learning environment that encompasses car-

ing behaviors and promotes social presence.

method

A Cumulative Index to Nursing and Allied

Health Literature search was conducted

using a combination of key words, including

social presence, caring, online, and distance

learning, for articles published between

2006 and 2011. Articles that included the key

words in the title or abstract and research that

concerned all levels of online degree-focused

programs were considered for this review;

conference abstracts and other “gray litera-

ture” were excluded. The articles were read

to determine their relevance in answering the

question: What are the best practices and evi-

dence-based strategies to create social pres-

ence and caring in an online environment?

Commonalities were extracted and themes

were identified to develop best practices.

The combination of the key words “social

presence” and “online” yielded 22 results,

but only four articles specifically addressed

students and faculty in the online setting

and focused on nursing (Cobb, 2011; Jones,

Wilson, Carter, & Jester, 2009; Lahaie, 2007;

Mayne & Wu, 2011). Two articles were found

for other disciplines: clinical laboratory sci-

ence (Esani, 2010) and computer technology

and education (Rockinson-Szapkiw, Baker,

Neukrug, & Hanes, 2010). A search using

the key words “caring” and “online” gener-

ated 120 articles, but only four studies met

the inclusion criteria (Gabbert, 2008; Leners

& Sitzman, 2006; Sitzman, 2010; Sitzman &

Leners, 2006). “Caring” and “distance learn- ing” yielded six potential articles for review;

of these, only one article, which focused on

an international distance-learning course

for clinical research study coordinators and

clinical research managers, met the criteria

(Jones et al., 2009). In summary, 11 articles

were used for this review.

resuLts

Social Presence Creating a sense of social presence in

which students feel connected and part of

the learning environment is a challenge

faced by faculty when teaching online

classes. Communication is guided by basic

Netiquette, defined as the rules of online

conduct, and text-based language that

lacks voice and tone inflections (Lahaie,

2007). Students interact with names but

no faces and miss the visual cues that help

them derive meaning from discourse: facial

expressions, body language, and eye contact

(Esani, 2010; Mayne & Wu, 2011). In addi-

tion, students often must wait a significant

time for their email questions to be answered

(Esani; Gallagher-Lepak et al., 2009).

Online students have reported feeling

isolated (Lahaie, 2007; Mayne & Wu, 2011;

Rockinson-Szapkiw et al., 2010; Sitzman

& Leners, 2006), not feeling “real” (Cobb,

2011), fearing they may have posted some-

thing incorrect (Gallagher-Lepak et al.,

2009), and lacking a personal connection to

faculty and fellow students (Lahaie; Sitzman

& Leners). Social presence has been studied

in the business and management literature

(Shen et al., 2010) and in disciplines such as

computer technology (Rockinson-Szapkiw et

al.). Until recently, the nursing literature has

focused on strategies to create social pres-

ence (Lahaie) and perceived learning (Cobb)

in graduate nursing students (Mayne & Wu)

and for those transitioning to online teaching

(Esani, 2010).

The process of socialization and feeling

connected to the group is a positive contrib-

utor to acquiring a sense of social presence.

Commitment to the group, supporting oth-

ers, and developing a sense of belonging fos-

ter a sense of community that is reciprocal in

nature (Gallagher-Lepak et al., 2009). Best

practicies for creating a sense of community

include having students and faculty post pho-

tographs of themselves, writing biographies,

encouraging interactions through teamwork,

and posting communications and oppor-

tunities to share challenges (Esani, 2010;

Gallagher-Lepak et al.; Mayne & Wu, 2011).

Jones et al. (2009) fostered social presence in

an international online course via videotaped

introductions by the faculty in addition to stu-

dent presentations to introduce themselves.

Social presence was further heightened by

the use of emails and video calls (e.g., Skype

and FaceTime), online chats, and discussion board postings. Jones et al. found that despite

differences in language, time-zone changes,

and cultural barriers, students valued these

experiences and interactions with faculty and

fellow students.

Results from the literature suggest that

faculty who use greetings and praise, initi-

ate discussions, and encourage students to

express their points of view develop a sense of

community and trust in their students (Cobb,

2011; Lahaie, 2007). Personal connectedness

is enhanced by sharing stories and invitations

to encourage discussion by, for example, join-

ing a “virtual café.”

Gallagher-Lepak et al. (2009) found that

emotional connectedness was a crucial fac-

tor in setting the tone for feeling a sense of

community, decreasing isolation, and build-

ing confidence. Gunawardena and Zittle

(1997) developed the Social Presence Scale to

study the effectiveness of social presence in

predicting satisfaction in the online environ-

ment. Results of two studies using the scale

revealed that faculty techniques can have a

significant effect on the perception of social

presence by students and lead to feelings of

connectedness, trust, belonging, and comfort

(Cobb, 2011; Mayne & Wu, 2011).

Discovering the best practices and evi-

dence to create social presence in the virtual

environment can be challenged by a lack of

research on the concept. However, drawing on

220 J U l Y / A U G U S T 2 0 1 4 V O l U M E 3 5 N U M B E R 4 221

social Presence and caring

the state of the science to date, social presence

can be fostered by multiple, creative strategies.

For example, online communications that use

text-based techniques such as abbreviations

(e.g., LOL, meaning “laughing out loud”),

emoticons (e.g., smiley faces), and punctuation

(e.g., exclamation points) can substitute for

tone of voice and other social cues. Purnell

(2006), on the other hand, found these forms

of communication distracting, inappropriate

for use in reflection, and disruptive to the pro-

cess of deep thinking by students.

Simple, human phrases that convey car-

ing and foster social presence are welcom-

ing (e.g., hello, take care) and help connect

students with one another (Lahaie, 2007).

Rockinson-Szapkiw et al. (2010) found that

combining synchronous and asynchronous

communications fostered a significantly

higher degree of social presence compared

with the exclusive use of asynchronous com-

munication. Opportunites for video calls

allowed students to express themselves and

alleviated feelings of isolation. Jones et al.

(2009) described how international students

overcame language barriers through the use

of video chats. Faculty commented on the

eager and respectful communication by stu-

dents, and students remained in contact with

faculty long after the course ended.

Shen et al. (2010) noted that “being

with another” is associated with caring as

well as social presence. The expression of

caring behaviors is reciprocal. Being aware

of the “other,” fulfilling another’s needs,

and the feeling of intimacy with others

through self-disclosure lead to the reciprocal

exchange of information that translates to

social presence.

Caring Teaching a caring pedagogy has roots in fem-

inism, phenomenology, and moral and ethical

principles that are core principles of nursing

(Emerson, 2007; Billings & Halstead, 2009). When nursing students witness their leaders

embracing caring behaviors and supporting

them in their nursing practice, they, in turn,

feel cared for (Gallagher-Lepak et al., 2009),

but the human connection vital to nursing is

disembodied in the online environment.

Few studies focus on caring in online

learning. A qualitative study by Gallagher-

Lepak et al. (2009) described the concept of

community (connectedness and trust among

group members) as a basis for implement-

ing caring behaviors and fostering a sense

of community in a virtual environment. The

study found that written communications can

convey attitudes of politeness, trust, concern

for others, and respect. A similar study by

Sitzman and Leners (2006) articulated the

perceptions of baccalaureate nursing stu-

dents about what constitutes a caring online

environment and how caring is differently

communicated in an online classroom. Some

best practices to convey caring in the online

classroom follow.

Faculty who display caring behaviors

via online responses use expressions of

concern, politeness, respectful communica-

tion, and convey trust in their written word

(Gallagher-Lepak et al., 2009). Leners and

Sitzman (2006) found perceptions of caring

similar for master’s and doctoral nursing stu-

dents during an online class. Students noted

that timeliness (prompt responses), empathy

(demonstrating concern, seeing the other’s

perspective), tones of appreciation (affirma-

tion and encouragement), “being the best I

can be” (encouraging), and “finding a cord

of harmony” (being viewed as an individual)

were positive behaviors demonstrated by

faculty.

Sitzman (2010) used a mixed-method

research design to determine online generic

and RN to BSN nursing students’ percep-

tions of important behaviors demonstrated

by faculty to convey feelings of caring.

Themes identified included empathetic pres-

ence, clarity/expertise, timeliness, and fully

engaged/accessible. The most important fac-

ulty behavior identified by students was writ-

ing clear instructions that helped students be

successful.

In an environment that is mutually

respectful, where faculty take advantage of all

opportunities to demonstrate caring behav-

iors, nursing students become aware of them-

selves as caring individuals and learn how

their own spiritual and psychological beliefs

can be incorporated into caring toward others

(Emerson, 2007). Purnell (2006) developed a

model of nursing education grounded in car-

ing, based on the “nursing as caring” theory

of Boykin and Schoenhoffer (1993, 2001) for

online nursing education. With this model,

caring language is embedded in all texts,

modules, and student-faculty exchanges. It is

centered on respect and valuing the other’s

contributions in a safe learning environment.

Caring in the online environment is con-

veyed by written expression, and each unique

learning experience is enhanced through

dialogue, a variety of ways of knowing, and

professional examples and reflection. Leners

and Sitzman’s study of preceptions of caring

by graduate nursing students (2006) states

that efforts to create caring in an online

setting lead to higher retention rates and a

boost in student self-esteem and perceived

competence. Their exploration of how fac-

ulty convey caring uncovered eight themes,

with prompt feedback by faculty the first

response. The other themes overlap with

fostering social presence in an online class-

room and include timeliness and consistency,

the reciprocal process of support, trust, and

respect, developing a personal connection

and empathy, making expectations known,

making faculty available, and the impor-

tance of feedback. Knowing that they were

not alone was an important aspect of feeling

cared for by faculty.

Cobb (2011) found that it was important

for faculty to use introductions to encourage

discussion, to facilitate discussion, and to

encourage students to express their points

of view. Mayne and Wu (2011) pointed to the

importance of setting boundaries for confi-

dentiality and professionalism online and

creating a safe environment built on trust

while encouraging students to post biogra-

phies and pictures and ask questions. Billings

and Halstead (2009) write of the need for

faculty to be flexible and manage diversity,

ambiguity, and conflict.

dIsCussIon

No research was found on the combined

concepts of social presence and caring in

222 J U l Y / A U G U S T 2 0 1 4 V O l U M E 3 5 N U M B E R 4 223

Nursing Education Perspectives

the online setting, but similar and overlap-

ping themes for each construct were found

in the literature. Practices to promote car-

ing and social presence were found in both

qualitative and quantitative studies, and best

practices were identified from data analy-

sis, feedback from participants, satisfaction

scores, narratives that reinforced feelings of

being cared for or a sense of belonging, and

behaviors that promoted social presence and

caring. (See Table.)

Faculty who teach online classes are chal-

lenged to create caring social engagement

through interactions that promote a sense of

belonging and a sense of community. This

perspective actualizes the human potential

of interpersonal relationships, the trust of

self and others, and awareness of others’ feel-

ings. Sitzman and Leners (2006) report that

students in a traditional classroom recount

caring traits and behaviors of their teachers

as “honesty, respect, understanding, kind-

ness, compassion” and “positive reinforce-

ment” (p. 255), as well as praise, sensitivity

to needs, and positive role-modeling. Similar

themes are present in Sitzman’s (2010) qual-

itative study, which describes how faculty

manifest caring by sending messages that are

respectful, positive, encouraging, timely, and

frequent. Students see caring as reciprocal.

Caring messages begin with trust and respect

and the use of polite and encouraging lan-

guage. Prompt feedback promotes trust and

confidence (Gallagher-Lepak et al., 2009).

Mutual attributes of caring and social

presence are: honesty; being responsive,

respectful, and open; freedom from retribu-

tion; and the ability to freely express thoughts

and ideas (Billings & Halstead, 2009). Caring

behaviors and social presence as perceived

in the traditional classroom setting can be

successfully incorporated into the online

environment by intentional caring of the fac-

ulty. Faculty who make a conscious effort to

support others, build confidence, trust, and a

sense of belonging, and demonstrate respect

in online discussions will have positive out-

comes and increased retention (Sitzman &

Leners, 2006).

Billings and Halstead (2009) stress the

need to use multiple strategies to create

social presence and demonstrate caring in

an online classroom. They emphasize the

need for active participation by students and

student-teacher interactions with the shar-

ing of stories, personal reflection, problem

solving, and understanding the significance

of these experiences. Faculty messages that

are respectful, positive, encouraging, timely,

and frequent add to feelings of social pres-

ence and the reciprocal feelings of caring

among students. Timely feedback, respond-

ing to students’ questions, and displays of

empathy or support by faculty help students

feel connected to the class, promote student

interactions, and integrate caring and social

presence into student course work. Emerson

(2007) states that caring, as a partnership

between the student and faculty, is a com-

mitment and foundation for good teaching

practices.

future reseArCh

It is important to continue to seek ways to

advance social presence and caring in the

online environment through research. For

example, what specific communication styles

do faculty use to enhance social presence and

caring? To what extent do caring behaviors

learned in the online environment transfer

to the patient care setting? And, importantly,

if caring is viewed as the essence of nursing

and uniquely expressed in nursing, then to

what extent can caring be expressed in an

Table: Best Practices to Create Social Presence and Caring in an Online Environment

Caring language in all text, modules, and student-faculty exchanges, for example, respecting and valuing each other’s contributions (Purnell, 2006)

Discussion board postings (Gallagher-Lepak et al., 2009; Jones et al., 2009)

Encouraging interactions through teamwork (Esani, 2010; Gallagher-Lepak et al., 2009; mayne & Wu, 2011)

Encourage responses/ask questions (Cobb, 2011; Gallagher-Lepak et al., 2009; Lahaie, 2007; Mayne & Wu, 2011)

Encourage students to express their point of view (Cobb, 2011; Lahaie, 2007)

Frequent contact (Leners & Sitzman, 2006; Sitzman, 2010; Sitzman & Leners, 2006)

Initiate discussion (Cobb, 2011; Lahaie, 2007)

introductions to enhance and open discussion (cobb, 2011)

Messages that are respectful, positive, and encouraging (Leners & Sitzman, 2006; Sitzman, 2010)

Open dialogue/opportunities to express oneself/share challenges (Mayne & Wu, 2011; Rockinson-Szapkiw et al., 2010)

Posting communications (Esani, 2010; Gallagher-Lepak et al., 2009; Mayne & Wu, 2011)

Prompt feedback (Gallagher-Lepak et al., 2009)

Providing opportunities to share challenges (Esani, 2010; Gallagher-Lepak et al., 2009)

safe environment (mayne & Wu, 2011)

Supporting others (Gallagher-Lepak et al., 2009)

Timeliness (prompt responses) (Leners & Sitzman, 2006; Sitzman, 2010; Sitzman & Leners, 2006)

Tones of appreciation (affirmation and encouragement) (Leners & Sitzman, 2006)

Using human phrases for greetings and praise (hello, take care) (Cobb, 2011; Lahaie, 2007)

222 J U l Y / A U G U S T 2 0 1 4 V O l U M E 3 5 N U M B E R 4 223

social Presence and caring

environment where presence and sense of

self are perceived through the written word?

And what are the consequences of uncaring

behaviors in the online setting? How can fac-

ulty discern and identify nonverbal, unspo-

ken cues by students that may lead to feelings

of not belonging or not caring?

The patient-nurse perception of caring

is an important consideration culturally.

Research is needed to help students under-

stand cultural means of caring to improve

interactations within the online community

and with patients. Caring requires judgment,

moral values, and ethical insight, underpin-

ning diverse approaches of the knowledge

required to implement caring in diverse pop-

ulations (Watson & Smith, 2002).

Cobb (2011) found a strong correlation

between social presence, satisfaction, and

instructor performance. Valid and reliable

instruments are needed to evaluate these

concepts to advance the state of the science.

Further exploration of the Social Presence

Scale (Gunawardena & Zittle, 1997) is needed

with regard to online communication, instruc-

tor performance, and satisfaction with the

course (Cobb, 2011). Evaluation of caring and

social presence should be built into the cur-

riculum program evaluation. Social presence

has been highly correlated with student sat-

isfaction and learning (Cobb). More clarity is

needed to understand how positive outcomes

can be further achieved in the online setting

through the intentional engagement of faculty.

About the Authors

Kathleen Plante, MSN, RN, an assistant pro-

fessor at Bristol Community College School

of Nursing, Fall River, Massachusetts, is a

doctoral student in nursing at the University

of Massachusetts, North Dartmouth.

Marilyn E. Asselin, PhD, RN, BC, is an assis-

tant professor, University of Massachusetts-

Dartmouth, Department of Adult/Child

Nursing. For more information, contact Ms.

Plante at [email protected].

key Words

Nursing Education – Social Presence –

Caring – Online and Distance Learning

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