Table 2 Process description of the model

Phase 1: Prepare

The preparation phase involves preparation and planning for the educational encounter and includes external and internal environmental elements. The external environment represents the SANC, NEI as a higher education institution, and the clinical practice that prescribes the legal, ethical, and professional frameworks that influence and guide nurse educators’ teaching–learning practices at accredited NEIs. The internal environment exemplifies the nurse educator and nursing students as multi-dimensional (physiological, psychological, and spiritual) human beings with unique experiences interacting with each other and their environment to create reality and together discover presence in the moment and reflect on it. Phase 1: internal environment includes the teaching–learning environment, meaningful relationships, attributes of the nurse educator and nursing students

The nurse educator creates the mediated teaching–learning environment by ensuring an atmosphere that supports purposeful inquiry and meaningful collaboration and encourages interactive participation where nursing students can feel safe, trusted, supported, respected and free to participate. This environment consists of the nurse educator creating conducive physical settings and authentic surroundings by utilising adequate resources and implementing sufficient time management as follows. 1) Conducive physical settings: Ensure adequate lighting, sufficient ventilation, appropriate layout, and classroom seating arrangements. Within the clinical practice, the nurse educator establishes a conducive environment through adequate orientation and effective accompaniment of nursing students. 2) Authentic surroundings: Connect with nursing students through active participation, interaction, engagement, and meaningful feedback and provide opportunities for self-reflection and self-assessment. 3) Adequate resources: Include relevant study material (study guides, textbooks, handouts, etc.); correct equipment (Proxima, whiteboard, flip charts, manikins, etc.); adequate support (faculty, colleagues, peers, and students); effective use of technology including technological strategies; and design appropriate reflective exercises. 4) Sufficient time management: Allocate sufficient time for specific educational tasks and activities

The nurse educator establishes meaningful relationships that are open and promote mutual trust, honesty, and dignity by connecting with and attuning to nursing students. The nurse educator utilises reflection to examine and transform nursing students by creating a shift in their frame of reference through discovering new meanings and perspectives. The nurse educator aims for a positive change in nursing students’ thoughts, feelings, beliefs, and behaviour, and encourages nursing students to engage in studying to acquire specific knowledge, skills and understanding needed for nursing practice. In this process, nurse educators inspire nursing students to engage and interpret direct and active learning experiences by utilising critical reflection

Within this model, the nurse educator and nursing students enter the educational encounter, each with their specific attributes. The nurse educator needs to be enthusiastic, communicative, compassionate, sincere, and trustworthy in providing stability for nursing students during teaching and learning. The nurse educator must portray certain attributes by being a role model, exhibiting professional, personal, and moral maturity, demonstrating relational skills, being open, and empowering nursing students as follows

1. Role model: The modelling of presence by the nurse educator (role model) to nursing students will help them to internalise the behaviour to implement during patient care. This is done by sharing experiences and intimately connecting in the moment when it is safe to share ideas. This enables nursing students to learn what is important to the other and to respond with compassion, doing what can be done or being who the other needs one to be. Further behaviours include portraying a professional appearance by adhering to the professional dress code of the institution and profession, and the correct use of non-verbal body language

2. Maturity: a) Professional maturity. The nurse educator remains knowledgeable, skilled, and experienced in both theory and practice to guide nursing students through processes of knowledge construction, reflection, and discussion in preparing them for professional practice. b) Personal maturity: The nurse educator demonstrates self-awareness and self-knowing by being open-minded. c) Moral maturity: The nurse educator bases their teaching practices on understanding the importance of values and attitudes in nursing care. This is achieved through adherence to the moral principles of commitment to help by being available to nursing students and showing respect for individual differences. Moral responsibility refers to the nurse educator’s willingness to engage with nursing students to strive for excellence in nursing practice

3. Relational skills: The nurse educator demonstrates expertise and craftsmanship in facilitating presence by being accessible and flexible. The nurse educator acknowledges her vulnerability in having to manage large classes as well as the vulnerability of nursing students being young adults and coping with student and personal lives. The nurse educator connects with nursing students in an intimate way by being who they need her to be in the moment and being present in a holistic way. By being sensitive to and aware of nursing students’ needs, the nurse educator shows practical wisdom in adapting to the class and reaching the outcomes according to nursing students’ learning needs. The nurse educator is fully present by being alert, attentive, aware, and receptive to nursing students’ needs while engaging in active listening and demonstrating consideration towards their feelings. Further, the nurse educator is authentic and shows fidelity by keeping to deadlines and expecting nursing students to reach the expected outcomes

4. Openness. The nurse educator is human, honest, and open to nursing students by showing interest in their lives and experiences. The nurse educator facilitates presence through an openness to learn, change and acknowledge the perspectives of others

5. Empowerment The nursing educator supports and guides nursing students, making them feel valued, involving them in decision-making, actively listening to them, and reducing anxiety through continuous encouragement and motivation

Nursing students as adult learners enter the teaching–learning process with their self-concept, past experiences, readiness to learn and orientation to learning. The nurse educator acknowledges the attributes of the adult learner by regarding nursing students as adult learners who are self-directed with a life-long orientation to learning, are motivated to learn, and experience needs and interests that learning will satisfy. The nurse educator can accommodate the adult learner as follows. Self-directed: Utilise the study guide, use the interactive method (discussions), and provide clearly defined goals and criteria for evaluation, continuous feedback, and development of critical reflection. Readiness to learn: Point out the relevance and value of the application of the study content, use relevant and applicable examples from real-life situations, guide students from the known to the unknown, and encourage an attitude of questioning. Experiences: Utilise the experience of students, develop thinking, problem-solving and evaluation skills, develop the ability to correlate theory and practice, develop critical-evaluating thinking and critical self-reflection, and provide feedback regarding achieving the purposes of learning, motivating them to study further. Learning orientation: Establish a physical and psychological climate conducive to learning. Involve adult students in decisions about their learning, and plan methods and content with them. Involve the students in diagnosing their own learning needs or the gap between what they know and what they feel they need to know. Motivate students to identify learning resources and to find strategies for using these resources to achieve the learning outcomes. Support students in carrying out their learning plans, and involve them in evaluating their own learning

Phase 2: Process

The process phase involves the implementation of the educational encounter. The nurse educator and nursing students engage in an authentic reflective encounter to develop an interpersonal connection where presence can be facilitated using guided reflection to reach transformative learning. This teaching–learning process comprises three steps

Step 1: Planning for the educational encounter: Presence is facilitated by demonstrating care and consideration in developing the content (plan and structure the lesson plan including an introduction, the presentation and a structured conclusion); selecting appropriate learning activities such as activities for reading (assignments for nursing students to become engaged), writing (journals, both handwritten and electronic, to stimulate reflection), doing (engage nursing students in doing activities, e.g., portfolios) and telling (telling of an experience to engage nursing students in reflection); selecting suitable teaching strategies such as reflective diaries, reflective journals, mindfulness minute, video discussions, authentic scenarios, role-play, critical incidents, simulations, case studies, narratives, rubrics and portfolios; selecting correct assessment techniques by deciding on the type of assessment, e.g., formative or summative; being accessible during assessment time; providing constructive and timely feedback after each assessment; and engaging in regular follow-up for clarifying any concerns

Step 2: Presenting the educational encounter: In presenting the content, presence is facilitated by being and remaining present in the classroom, being attentive and aware of nursing students’ needs, and demonstrating consideration towards their feelings. The most suitable teaching–learning strategy to facilitate presence is guided reflection. Guided reflection involves the nurse educator leading, directing, and supervising nursing students’ learning during the acquisition of knowledge through study in the classroom or accompanying them during skills acquisition through experience in practice. When presenting the new material, the nurse educator needs to follow nine strategies. 1) Engage nursing students in self-reflection by determining prior knowledge: Provide opportunities for them to reflect on the previous teaching by sharing their ideas, feelings, and perspectives. 2) Connect with nursing students: Display a “way of being” by welcoming and greeting your nursing students in a caring, polite, and humorous manner. Classroom rules are set during their first encounter to ensure classroom discipline, especially in large class group settings. Know your nursing students by name to show a genuine interest in them. Clearly state the learning outcomes and the outlay of the session, in the beginning, to ensure that nursing students know exactly what is happening and expected from them. Do not call out students by their names but allow them to participate as they feel comfortable. This makes them feel like an important part of the large class group and free to participate without judgement. Involve them in sharing personal and professional experiences and interpreting real-life clinical experiences. 3) Develop new practice insights: Reflect on learning experiences to change nursing students’ behaviour as well as their way of thinking by making meaningful connections between their previous learning and new ideas and experiences. 4) Develop clinical competence: Use practical examples for integrating knowledge and skills, enabling nursing students to engage in theory–practice integration. 5) Develop critical thinking skills: Encourage nursing students to explore decisions, thoughts, and feelings by critically analysing, synthesising, and evaluating learning experiences. 6) Guide towards self-discovery: Ask questions and provide an opportunity for nursing students to answer out loud, and if correct, a mark will be allocated. If the answer is incorrect, the nurse educator demonstrates sensitivity by not telling them it is wrong, but instead guiding and directing them towards discovering the correct answer for themselves. 7) Challenge participation in self-inquiry and self-analysis: Guide nursing students in critically reflecting on their own positive and negative experiences while learning about nursing care through discussing their thoughts, feelings, and knowledge. Guide them in practising self-inquiry and self-awareness by utilising the reflective process. In the first phase, nursing students create awareness of uncomfortable feelings and thoughts. The second phase includes engagement in critical analysis of the situation. A new perspective on a new situation is developed in the third phase. 8) Provision of timely and constructive feedback: Encourage active listening and communication. Encourage nursing students to listen to what others are saying, help each other to make the experience more explicit, and share certain ways of expressing or understanding specific actions. Provide appropriate feedback after discussions and assessments. 9) Acknowledge nursing students’ contributions: To build their morale and to make them feel valued, praise them regularly on their achieved outcomes

Step 3: Evaluating the educational encounter: When evaluating the new material, the nurse educator must consider the following. 1) Acknowledge contributions: At the end of each lesson, the nurse educator summarises the day’s work and completes a five-minute quiz. After nursing students have completed the quiz, they exchange theirs with the colleague next to them. This exercise assists them to practice presence by valuing ideas and feedback from others. 2) Engagement in self- and peer-assessment: The nurse educator completes a self-assessment rubric on her teaching practices for improvements. Encourage nursing students to complete a lecturer evaluation to expose them to practices such as self-reflection, self-analysis and self-evaluation that lead to a better understanding, learning and improved practice. Transformative learning is achieved when nursing students demonstrate a positive change in their thoughts and behaviour, resulting in transforming the way they learn in the classroom and act in practice. When this happens, it will continue into the final phase of achieving the set targets

Phase 3: Product

The product phase involves the recipients who benefit from the outcomes of the practice model and can be grouped into three categories as outlined below

Category 1: NEIs: Produce present and reflective nurse practitioners that contribute to personal and professional development, enhanced personal and professional satisfaction through feelings of making a difference in the lives of others, improved physical and mental well-being and positive learning experiences

Category 2: Nursing profession: Increasing nurses’ awareness of presence can transform the way they think, care and act in practice. This can lead to professional practice development that contributes to the physical and mental well-being of the nurse and patient. It can also result in improved interpersonal communication and build meaningful relationships between nurses and patients. Further, it can lead to improved professionalism, enhanced clinical knowledge and strengthened critical reasoning of nurses as it allows them to engage in internal dialogue; this builds their ability to think through and reflect on nursing actions and hence to provide better nursing care

Category 3: Patients: Qualified nurse practitioners who enter the clinical practice as reflective nurse practitioners by being physically, psychologically, and emotionally present with the patient will be able to understand and support patients’ needs more effectively, leading to quality patient care. This contributes to increased patient satisfaction, positive patient outcomes, and improved patient care