Lack of presence in online courses can result in perceived isolation leading to student dissatisfaction with the learning experience. The purpose of this study was to measure nursing students' perceived extent of teaching, social and cognitive presence and course satisfaction in an online undergraduate nursing course, and whether relationships and associations existed between the three presences, course satisfaction, student demographic, academic, and technology variables, and selected instructional strategies. The Community of Inquiry theory was the framework used in this descriptive correlational study of RN-BSN students (n= 76). Variables were measured using the Community of Inquiry Survey and the Perceived Student Satisfaction Scale instruments, and a researcher developed survey. Findings indicated students' perceived teaching and cognitive presence were present to a greater extent than social presence. Significant positive correlations (p & lt; .01) were found between teaching and cognitive presence (r =.79), cognitive and social presence (r =.64), teaching and social presence (r =.52), satisfaction and the teaching (r =.77), social (r =.63), and cognitive (r =.52) presences. There were no significant findings associated with age, ethnicity, race, number of online courses taken, expected course grade or GPA and perceptions of the three presences and course satisfaction. There was a significant difference (p d".05) with gender and perceived social presence with male students reporting stronger levels. Students experiencing course technology difficulties reported significantly (p d".05) lower perceptions of teaching presence than those experiencing no difficulty. Significant differences (p d".05) were found between specific course instructional strategies and each presence and course satisfaction. The findings provide faculty with an understanding of online course management and teaching/learning strategies that may increase students' perceptions of presence in online courses and improve student satisfaction with online learning.

Faculty-student relationships include overlapping concepts of caring and presence, both of which can have an impact on learning outcomes, satisfaction, and retention. Students of varying generations may have different attitudes and expectations for their academic experience concerning technology and the faculty-student relationship. Based upon the Theory of Human Caring (Watson, 1979) and the Community of Inquiry Framework (Garrison, Anderson, & Archer, 1999), the purpose of this study was to explore how students of different generations perceived caring behaviors by faculty and presence in online RN-BSN pregrams. The study utilized the Organizational Climate for Caring Questionnaire (Hughes, 1993) to measure students' perceptions of faculty caring behaviors, the Community of Inquiry Survey Instrument (Arbaugh et al., 2008) to measure students' perceptions of presence, and a researcher-developed demographic questionnaire. Participants were recruited from online RN-BSN programs within the northeast region of the United States to complete an online survey. Results showed no difference between generational perceptions of caring; however, millennials reported statistically significant higher perceptions of social presence when compared with non-millennials. Although generation was not a predictor of caring, all Presence subscales were positively and significantly correlated with the total caring score. Also, the number of online courses a student has taken was negatively and significantly correlated with total caring scores. Teaching presence and the reported number of online courses were significant predictors of the students' perceptions of caring in online courses.

Caring is the essence of nursing and a core value of the profession of nursing (Beck, 1992; Bevis & Watson, 1989; National League for Nursing (NLN), 2011; Roach, 2008; Swanson, 1991; Touhy & Boykin, 2008; Watson, 1985b). There is theoretical agreement amongst researchers that caring can be learned through interactions with faculty in an environment characterized by supportive faculty-student relationships (Beck, 1992; Gaines & Baldwin, 1996). In the virtual world of online nursing education, caring behaviors displayed by faculty are difficult to convey over wires and screens where there is a lack of the spoken voice, gestures and human connection that is vital to nursing (Plante & Asselin, 2014). Text-based language often replaces the multidimensional physical characteristics of communication such as tone of voice, facial expressions and body language contributing to a potential disconnection between the faculty teacher, computer screen and student sitting in front of it. The challenge is to discover ways in which caring behaviors are demonstrated in online nursing education. A mixed method research design, grounded on Watson's theory of human caring (Watson, 1996), was used to discover which of the carative factors most highly or is least likely to demonstrate caring in an online nursing course. The quantitative aspect of the study identified caring behaviors perceived by online RN-BSN degree nursing students using a modified version of the Nursing Students' Perception of Instructor Caring instrument (Wade & Kasper (2006). Data analysis indicated Watson's first carative factor, formation of humanistic-altruistic system of values, was most important and perceived most highly when faculty displayed kindness, made themselves available to students, clearly communicated expectations, were attentive during communications, and made the student feel that they can be successful. In addition to the quantitative instrument, study participants described examples of behaviors that communicated caring in online nursing courses. The findings from this research provided contemporary data to identify which specific faculty behaviors support nursing students feeling cared for in an online nursing course. Implications for nursing education and further research are presented.

The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.