Creating a caring learning environment in nursing education

Document Type : Letter to Editor


Department of Operating Room and Anesthesiology, Nursing and Midwifery Care Research Center ,School of Nursing and Midwifery ,Mashhad University of Medical Sciences, Mashhad, Iran


Since 1987, the National Nursing Association (NNA) has called for the need to reform in nursing education. The currency of behavioral models ,the rule of prescriptive laws and one-way teacher-student relationships, consequently, the creation of an educational environment free of caring and human principles, has recalled the need to revise in nursing education. Many efforts have been made to change the nursing education paradigm and introduce the concept of caring in nursing curriculum. The concept of caring in nursing education is a teaching and learning approach that is defined based on sustainable teacher-student interaction and based on human values.
One of the prerequisites for integrating the concept of caring in nursing education is providing a caring environment in nursing schools. The caring learning environment has been introduced as a climate to increase the student's perception and ability to learn and apply the concept of caring, which is based on sharing experiences, respect and support. The caring environment is introduced as a supportive environment and free expression of ideas without judgment and with respect for the human dignity of students, faculty and staff.
The structural features of nursing schools (standards, leadership, curriculum) along with the affective characteristics, such as: the ability and understand caring, as well as caring behaviors, create a caring environment. In this atmosphere, everyone feels valued and respected. The outcome of caring learning environment are: retaining faculty and students in the profession, Improving the civic environment, decreasing faculty- practice gap and preparing nursing students who provide patient-centered care.


Since 1987, there has been a need for change in nursing education programs and now the advancement of the nursing education system and the proportion of curriculum components with the concepts of the field, needs of the society and students, and views of experts are the main concern of nursing schools all over the world. The high volume of curriculum content, predominance of biomedical approaches in nursing education programs, prevalence of behavioral education system, dominance of prescriptive rules, and one-way relationship of professor and student in the clinic, and consequently, creation of an educational environment free of human caring, have all highlighted the need to revise of nursing education (1).

In the last two decades, numerous efforts have been made to transform, revise, and improve nursing education and there have been extensive changes, especially in the field of curricula (2). For example, nursing researchers have emphasized the development of concept-based curricula and the need to change the nursing education paradigm so that the concept of caring has been integrated into the nursing domain. They believe that part of the nursing paradigms should be allocated to caring (3,4).

The concept of caring in nursing education has been defined and analyzed in several studies. Caring in nursing education is defined as a teaching and learning strategy that is based on sustained teacher-student interaction and human values. The creation of a supportive environment by the faculty, knowing of the student, reflection on the situation and needs, development of ethical values ​​and compassion, strengthening the critical thinking, development of research-based approaches, and stimulation of the spirit of effort are among the features of the concept of caring in nursing education. In short, the concept of caring in education is highly close to the concept of clinical care and it is assumed that care in the teacher-student relationship is similar to the meaning of patient care. According to such a view, the concept of caring in education is derived from and influenced by the beliefs and values ​​of the profession (5,6).

Caring learning environment

One of the requirements for integrating the concept of caring and the influence of the spirit of caring in nursing education is to provide a caring environment in educational environments and nursing schools. Redmond and Sorrell have defined the caring environment as all the formal and informal learning experiences between teacher and student in the classroom and clinic. Benkert also pointed out in his study that such features as participation, commitment, mutual respect, and creativity would lead to a caring environment. In a study conducted by Simon and Kavana, the teacher's support for the student has been introduced as one of the most important components of the caring environment in the faculty (7).

The caring learning environment has been introduced as an atmosphere to increase the student's understanding and ability to learn and use the concept of caring, which is based on general concepts, such as student-centeredness, respect, and support. It can be said that by providing the caring environment, the necessary conditions for the full realization and implementation of the curriculum goals will be created. The caring environment is introduced as a supportive environment where the ideas and opinions are expressed freely without judgment and with respect for the human dignity of students, faculty, and staff. However, it should be added that the caring environment is not a separate part from the nursing curriculum, rather, it is a supportive environment that overshadows the entire curriculum and affects all teaching and learning interactions (7).

Hayne has also presented a caring model for nursing education that is comprehensive and dynamic, consists of three principles of communication, influence, and synergy, and synergy at both micro (individual) and macro (organizational) levels, and combines three concepts of organizational climate, leadership, and caring theories. This evolutionary pattern in nursing schools creates a space full of care in the educational environment of the school, which is necessary to prepare nursing students to enter the community and caring for the patient. This caring environment is associated with the formation of trust and the ability of faculty to caring for each other and students. This model is presented to provide a caring atmosphere in which everyone feels valued and respected and can affect various outcomes.

The consequences of use of this model include the job satisfaction of faculty members, retention of professors and students in the profession, creation of a healthy civic work environment, and nurture of nursing students, which develop the ability to provide communication-based and patient-centered care (8). Evidence also shows that the implementation of this participatory approach in clinical nursing education has a positive effect on working relationships among faculty members, nursing students, and clinical leaders, removes the gap between faculty and clinic, and promotes patient care (9,10).

According to the proposed care model, nursing schools have structural and emotional features. Structural features include standards, leadership, and curriculum. Emotional features in nursing schools include the ability to caring, understanding the caring for all individuals, and caring behaviors in the educational environment. The interactions and dynamics of these variables in nursing education create a space full of caring. This model shows the contribution of nursing education in the continuity of caring as the main value and the preparation of nursing graduates to provide patient-centered care.

In short, the provision of a caring environment is known as a prerequisite for the occurrence of caring behavior. The dimensions of such an environment are as follows:

Developing trust in the educational environment (between professor and student, colleagues, and officials with professors and staff)

Professors' ethical obligations towards educational interactions

Giving the student the opportunity to freely express their thoughts without worry and anxiety

Establishing interactions based on respect for the human dignity of individuals

Supporting sincerely

Being available

Being receptive to all comments and opinions

Paying attention to the unique needs of staff and students

Providing grounds for scientific, research, and cultural development and promotion of professors

Providing welfare needs for professors

Developing physical and educational conditions of the faculty and clinical environment

Based on the defined dimensions of the caring learning environment in nursing education, it can be said that it would be possible to provide a caring environment in all classrooms, physical space of nursing schools, and clinical education environments. Generally, wherever there are teacher-student interactions and the goal is learning, it is necessary to think about creating a caring learning environment (5,6).

Faculties' role in the development of the caring environment

Faculty has a valuable and effective role as models of caring in the education and growth of students. The faculties' scholarly and conscious presence in interaction with students and their knowledge, skills, and caring experiences and application of them in creating and developing objective and real learning opportunities and situations for students are the prerequisites of the caring learning environment. Accepting the student without restrictions, providing a safe environment without worry and anxiety for the student to express individual feelings and opinions, and listening to their words without judgment are examples of the professor's smart measures in creating a supportive environment.

The provision of an environment to share experiences and ideas, flexibility, and encouragement are other behaviors expected from professors in creating a caring environment. To create a caring interaction, it is necessary for professors to act creatively beyond the usual methods, and with a conscious, trustworthy, presence, and avoidance of misconceptions such as avoiding and distancing from students, and through the justification of maintaining their position and power, they may pave the way for the true guidance of students (5,6).

Ethical considerations 

Ethical issues including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc. have been completely observed by the authors.

  • Forbes MO, Hickey MT. Curriculum reform in baccalaureate nursing education: Review of the literature. Int J Nurs Educ Scholarsh. 2009;6(1).
  • Nikfarid L, Rasouli M. Caring curriculum: a new paradigm in nursing education. Iran Journal of Nursing. 2011;24(7):61-71. Persian
  • Redmond GM, Sorrell JM. Creating a caring learning environment. In Nursing Forum 1996 Oct Vol. 31. Oxford, UK: Blackwell Publishing Ltd
  • Letcher DC, Massey AM, Nelson MJ, Elverson CA. Creating a Culture of Caring: A Shared Academic-Practice Clinical Curriculum. Nurse educ. 2020 ;45(5):269-72.
  • Salehian M, Heydari A, Moonaghi HK, Aghebati N. Developing the concept of caring in nursing education. Electron physician. 2017;9(5):4425.Persian
  • Salehian M, Heydari A, Aghebati N, Moonaghi HK. Faculty-student caring interaction in nursing education: An integrative review. Journal of caring sciences. 2017;6(3):257. Persian
  • Redmond G, Sorrell J. Creating a caring learning environment. Nurs Forum. 1996;31(4):21-7.
  • Hayne AN, Schlosser SP, McDaniel GS. A caring model for nursing education. Int J Nurs Educ Scholarsh. 2020 Jan 1;17(1).
  • Gierach M, Knuppe M, Winterboer V, Randall R. Creating a culture of caring: A collaborative academic‐practice approach to clinical education. In Nursing forum 2019; 54(3 ): 386-91.
  • Barton AJ. Improving environments for learning: Implications for nursing faculty. Journal of Nursing Education 2018: 515-16.