Teachers’ Practices for Written Feedback in Nursing


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Factors Influencing Teachers’ practices to provide written feedback to nursing students


The process of evaluation is significant to acquire information to judge students’ learning, to define proficiency in practice and to derive a judgment about students. Evaluation fulfills two major roles: it is formative and summative (Oermann & Gaberson, 2013, p. 9). With formative evaluation, teacher evaluates students’ learning and performance, and provides them definite feedback about the knowledge and expertise which still needs to be modified and enhanced. It is usually considered as diagnostic and many researchers (Bienstock et al., 2007; Corcoran, Halverson, & Schindler, 2014) found it helpful in students’ learning and improvement in their career. On the other hand, summative evaluation is end-of-instruction evaluation designed to determine what the student has learnt. It was usually occurred at the end of the learning process. There are a number of strategies which has used to evaluate students’ learning and skills. The most common tool used to enhance students’ learning is feedback system. Feedback is “an interface between teachers’ pedagogical goals; students’ learning needs; and institutional and governmental education policies, which structure and regulate practices and procedures” (Bailey & Garner, 2010). Numerous ways are used to give feedback for example; written, verbal, peer, audio, online, student to faculty, faculty to student, structured feedback, unstructured feedback, face to face feedback, and so on. In fact, feedback is given to students from faculty for their improvements and making them aware about their progress and informing them about their strength and areas for improvements. In my teaching and academic career, I have observed that, there is a great diversity in teachers’ practices of providing feedback to their students. Some teachers follow the strict principles of feedback while others do not. I want to explore “what are the factors which influence on teachers’ practices to provide feedback to their students” and “what are the perceptions of students about their feedback which they receive from their faculty or teachers”.

Purpose/Aim of the paper

This paper aims to;

Analyze existing literature on teachers’ practices for written feedback as well as challenges for teachers to provide written feedback to their students.
Appraise students’ perceptions/expectations from written feedback on their assignments.
Identify the gaps between what is known and what is not known through literature.

Significance of the topic

It is well recognized that feedback is an essential constituent of academic discipline which offers consideration and improvement in learning as well as in teaching in any discipline (Corcoran, Halverson, & Schindler., 2014; Giles, Gilbert, & McNeill, 2014; Horeman et al., 2013; Matzie et al., 2009; Rogers et al., 2012). Eminence feedback plays an important role in learning and teaching part whether it is provided or received. There are a few studies conducted on feedback in nursing academia to explore different aspects of feedback in order to improve learning and teaching in nursing education.

Literature search strategy

In order to explore the studies conducted on “teachers’ practices about feedback on written assignments”, an ample search was conducted through a number of Databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google scholar, and Science direct. Different key terms were used to search the existing data on the selected topic. The terms used in searching databases were “written assignment”, teacher’s practices” teacher’s feedback”. “Written feedback” was the inclusion criteria in searching literature but the studies conducted other than “nursing discipline” were also included. Most of the studies conducted in developed countries e.g. Canada, USA, U.K, England, Norway, and Australia. There are some studies conducted in Asian countries, China, Hong Kong, Taiwan, and in Pakistan but unpublished. The detailed flow diagram for search strategy is following;

(Flow diagram for literature selection)

In addition, substantial assistance was also taken from librarian in order to access some online articles, which were quite relevant to the topic. Furthermore, reference lists in all including studies were explored and secondary sources which were quite relevant to the chosen topic were searched manually for reading and including literature as a primary source. Moreover, two unpublished theses of Iqbal (2013) “Teachers’ accounts of their perceptions and practices of providing written feedback to nursing students on their assignments” and Khowaja’s (2011) “students’ perceptions and their responses to written feedback in nursing degree program in Karachi” have been issued from library in order to review and include necessary and important information in this paper. I have also attended seminar which was conducted by one of senior student on a relatively similar topic (feedback to improve learning) to get additional information in order to augment my paper.

Literature review

Literature review has organized according to four different themes.

Importance/Usefulness of written feedback
Characteristics of effective feedback
Challenges for teachers and students in feedback
Discrepancy in teachers and students’ perception about feedback

1. Importance/Usefulness of written feedback

Feedback is given to students from faculty for their improvements and making them aware about their progress and informing them about their strength and areas for improvement (Bourgualt, Mundy & Joshua, 2013; Corcoran et al., 2014; Giles, Gilbert, & McNeill, 2014; Horeman et al., 2013; Khowaja, 2011; Rogers et al., 2012). On the contrary, MacLellan (2001) argued that the most common purpose of the students and the staff for feedback is to grade or rank the achievement. Braend et al. (2010) directed a study on Fifth year medical students at the University of Oslo and recommended that most of the students considered triangulation feedback from teachers and patients valuable but time-consuming. Rogers, et al. (2012) had conducted an interventional study to focus student-centred approach for improving feedback in medical education in the clinical settings. The satisfaction rate was significantly higher in the group receiving feedback with instructions rather than the group receiving compliments without any instructions (p. 23).

No doubt, feedback plays an important role in students’ learning and improvements, but it is also a fact, that feedback in the form of evaluation is also used for the purpose of ranking the students’ achievements. Although one author argued with other researchers’ findings but according to second author feedback was considered useful in another context (to grade achievement). Furthermore, some of the studies had conducted in comparison of different feedback channels to the students. Besides that, instructions for the students are very useful in clinical settings.

2. Characteristics of effective feedback

Quality feedback should be within time limit, explicit, productive and should be based upon non-judgmental attitude (Bienstock et al., 2007, p. 508). Newton, Wallace, and McKimm (2012) conducted interventional study changing from a free-text feedback form to a simple structured feedback proforma focusing the areas of improvement in students’ performance which has increased in both the quantity and quality of feedback. In addition, Maclellan (2001) also inquired about student’s understanding of feedback and concluded that learning occurs when students really perceive feedback as an enabling and helping tool for improvement rather than being judgemental about their achievements. Moreover, it was concluded that teachers should openly discuss with the students how they can integrate this feedback in their upcoming papers (Hyland, 2003, p. 228). In addition, There should be a balance between strength and areas for improvements while providing feedback to students to make it useful for them (Hyland, F., & Hyland, K., 2001). There is a great importance of technology in enhancing feedback for the students in their practical tasks as feedback is recorded for students so they can reflect upon themselves and can review their weakness and strengthening areas (Corrigan & Hardham, 2011). Bourgualt, Mundy and Joshua (2013) conducted a pilot study by using audio feedback on student nurses’ written assignments and concluded that instructors’ focus was on the provision of positive/constructive feedback as the instructors were high alert before giving feedback and they had also highlighted the important areas to share with the students for their improvement (p.44).

The excellence of feedback depends upon many components which should be kept in consideration to make it effective. Except these features, effective feedback depends upon the form in which it is used whether in a simple form or some kind of structured form. Different studies concluded different aspects of quality feedback but the focus of most of the studies was to keep balance between students’ strength and areas for improvements and feedback should be simple and easy for the students to interpret so that they could incorporate the feedback into their next assignments. Moreover, teachers should incorporate advanced technology to make feedback effective and keep in consideration of students’ belief or understanding about feedback while providing feed back to them.

3. Challenges for teachers and students

Language and vocabulary is a big challenge for the teachers in providing feedback to students and for the students in understanding and interpreting the meaning of feedback (Bailey & Garner, 2010; Weaver, 2006). Schartel (2012) determined that numerous medical educators have limited knowledge about theoretical models of feedback and also dearth of skills in providing feedback (p.77). Harvey, Radomski and O’Connor (2013) conducted a study on medical students for clinical supervision and concluded that only 16% written feedback statements focused on the forward learning objectives for the students.

From the above mentioned studies’ findings, it can be analyzed that the focus of the studies was on the language, knowledge and vocabulary of the teachers which they used in providing feedback to the students. In this context, students often valued feedback but tutors comments would be more useful for them. Furthermore, sometime tutors do not provide detailed feedback to the students because of some contributing factors, sometime, personal, or institutional. Teachers should get proper training for feedback and should be trained in giving feedback.

4. Discrepancy in teachers own practices and students’ perception about feedback

I have experienced in my academic career being a student and being a teacher that teachers have different perceptions and different opinions on the purpose for providing feedback to the students and teachers do not know how their students would take their feedback and how it would be helpful for them. There is also ample evidence from literature to support that there is a great controversy between teacher’s perception about providing feedback and student’s expectation and interpretations of those written comments (Carless, 2006; Garner & Bailey 2010; Goldstein, 2004; Jensen et al, (2012). Moreover, Weaver 2006) concluded that students need support from faculty to understand feedback what they mean to it. He also determined a number of themes about feedback which are solely awkward for the students like comments too broad or unclear, lack of direction, intensive negative comments Moreover, these findings also supported by Bailey and Garner (2010) by suggesting that teachers are not very sure about the purpose of providing feedback to their students. (p. 187). Another similar kind of study has been done in order to explore the gap between faculty and the residents for receiving and giving feedback. Jensen, et al. (2012) concluded that residents/students satisfaction for the feedback was significantly lower than the satisfaction level of the faculty for giving feedback (p.248). In addition, Parboteeah and Anwar (2009) suggested that teachers considered feedback more useful rather than students in many contexts. On the contrary, Montgomery and Baker (2007) conducted research by triangulation design between students and faculty and they recommended that there is a well synchronization between students’ perception about feedback and teacher’s self-assessment in giving feedback to their students (p. 82).

All the studies conducted on the above mentioned theme, concluded that there is a great diversity among teachers and students in the process of feedback, but there is only one study (Montgomery & Baker, 2007) revealed synchronization among students and faculty about feedback.

Gap in literature:

There is enough evidence from existing literature about students’ perceptions regarding feedback and teacher’s expectation from students. Literature also available on a discrepancy in teachers’ actual practices in providing feedback to students and what they believe to provide. There is a need to explore the factors influence teachers’ practices to provide feedback which they really want to provide and what is the extent of those factors in Pakistani Nursing context.

Restatement of problem and its significance/implication for nursing:

Despite of importance of feedback in educational system, only one study has conducted in Pakistani context on “teachers’ practices about feedback”, which is unpublished yet. But none of the study conducted on “what factors influence on teachers’ practices for written feedback” and “what is the extent of pre-determined factors affecting teachers’ practices in providing written feedback to students”. This study probably would add new knowledge to the existing phenomena of written feedback and new interventions could be designed based on the study findings to improve or enhance the teachers’ practices for providing written feedback to their students ultimately to boost learning and teaching practices in nursing education.


To conclude, Feedback is not only important from student’s perspective but it is also significant from faculty and educational objectives. There are many studies conducted on the given phenomena but all the studies conducted in developed countries and some of them in Asian countries. Almost all the studies are designed qualitatively, some mixed methods, but none of the study designed quantitative. There is a need to explore the extent of predetermined factors influencing teachers’ practices in providing feedback which they really want to give to their students, so that according to study findings, interventions could be designed to improve teachers’ practices in nursing education.