Relational pedagogy in student nurses’ clinical teaching at a Primary Healthcare setting

In the daily rhythm of a primary healthcare clinic, the work is often defined by a relentless tide of patients. Nurses are the steady hands managing this flow, diagnosing illnesses, administering treatments, and offering comfort. Yet, within this high-pressure environment, another vital role unfolds: the teaching of student nurses. These students are not just observers; they are learners placed in real clinics to bridge the gap between classroom theory and the messy reality of patient care. For decades, the assumption has been that teaching is a one-way street, where an experienced nurse pours knowledge into a student. However, a growing body of thought suggests that learning is actually a two-way conversation, a dynamic exchange where both parties shape the outcome. This idea, known as relational pedagogy, posits that the quality of teaching depends less on a rigid checklist of instructions and more on the quality of the relationship between the teacher and the learner. It asks a simple but profound question: does the student's willingness to engage change how the teacher teaches?

A team of researchers from the University of Johannesburg set out to explore this question within the bustling, resource-constrained clinics of Gauteng, South Africa. They focused on ten professional nurses who work in three different primary healthcare facilities. These clinics serve a massive population, handling thousands of patients a month with limited staff and resources. The researchers wanted to understand how these nurses actually teach their students when the pressure is on and time is scarce. Instead of sending out surveys or observing from a distance, the team sat down with the nurses for deep, one-on-one conversations. They asked the nurses to describe their experiences, their challenges, and their perceptions of the teaching process. The interviews took place over several months, allowing the nurses to share their stories in their own words, which were then carefully analyzed to find common patterns and themes.

What emerged from these conversations was a picture of teaching that is far more fluid and reciprocal than the traditional model suggests. The nurses described a process where learning is co-constructed, meaning it is built together by both the teacher and the student. In many cases, the nurses found that they were learning just as much as the students. One nurse noted that students often arrived with fresh, updated guidelines and new theoretical knowledge that the experienced staff were not yet aware of. This created a dynamic where the student could teach the teacher, turning the relationship into a mutual exchange of expertise rather than a simple transfer of facts. The nurses realized that by engaging with these students, they were refreshing their own knowledge and staying current with evolving medical standards. This reciprocal nature meant that teaching was not just a duty to be performed, but a collaborative journey where both parties contributed to the outcome.

The study also revealed that a nurse's own past experiences as a student deeply influenced how they taught today. Many participants reflected on their own training years, recalling mentors who were either incredibly supportive or harshly critical. These memories acted as a compass. Nurses who had suffered under strict, unkind mentors often made a conscious decision to be different, choosing to offer the care and encouragement they once lacked. Conversely, those who had positive mentors tried to replicate that supportive style. This suggests that the way a nurse teaches is not just a professional skill but a personal response to their own history. The relationship between the two is shaped by the teacher's desire to either emulate a good role model or correct a bad one, making the teaching process deeply personal and relational.

However, the researchers found that this beautiful exchange of knowledge has a fragile foundation: the attitude of the student. The effectiveness of the teaching was heavily dependent on the student's agency, or their active willingness to participate. When a student showed up with curiosity, asked questions, and took the initiative to learn, the nurses were eager to invest time and energy. They described these moments as rewarding, where the teaching felt natural and productive. But when a student was disengaged, disrespectful, or simply absent, the dynamic shifted dramatically. The nurses described feeling frustrated and drained, often leading them to withdraw their teaching efforts entirely. In a busy clinic where time is a precious commodity, nurses cannot afford to chase students who are not interested. The study suggests that without the student's active engagement, the teaching relationship breaks down, regardless of how skilled the nurse is at explaining a procedure.

The researchers were careful to note that this picture of mutual learning exists within a very specific and challenging context. They acknowledged that the high patient volumes and severe staff shortages in these clinics often force teaching to take a backseat to urgent patient care. In such an environment, the ideal of a relaxed, collaborative learning space is often impossible to maintain. The study does not claim that this relational approach solves all the problems of clinical education or that it works everywhere. Instead, it suggests that within these difficult conditions, the relationship between the nurse and the student is the most critical variable. When the student steps up as an active partner, the nurse can find a way to teach effectively. When the student is passive, the system struggles to function.

Ultimately, the study paints a clear picture of clinical education as a social ecosystem. It is not a machine where inputs produce outputs, but a living interaction where the behavior of one person directly shapes the actions of the other. The findings challenge the old idea that the nurse is the sole authority and the student is a passive receiver. Instead, they show that teaching is a shared responsibility, where the student's attitude can either unlock a wealth of learning or shut the door entirely. For the nurses in these clinics, the path to better education lies not just in better schedules or more resources, but in fostering a culture where students are encouraged to be active, curious, and respectful partners in their own learning journey. This approach, while demanding, offers a practical way to strengthen education even when the world around them is chaotic.