Development and testing of the CALDs and CLES+T scales for international nursing students’ clinical learning environments

International nursing students and clinical learning environments: A convergent mixed-methods study

AIM

To acquire a comprehensive understanding of the international nursing students' clinical learning environments, comparing and contrasting qualitative and quantitative insights.

BACKGROUND

The influx of international nursing students has increased in Italy and across Europe. These students, diverse in culture and language, encounter significant challenges to their education in clinical learning environments.

DESIGN

convergent mixed-methods research.

METHODS

Qualitative and quantitative data were collected concurrently and independently, with equal emphasis, following a QUAL-QUANT structure. Qualitative analysis used descriptive content analysis, while quantitative data were based on descriptive and correlation analyses on surveys using the CALD scale.

RESULTS

Overall 96 international nursing students participated in 24 focus groups. The CALD scale mean scores ranged from 2.7 to 4.5. The qualitative analysis presented two overarching themes: factors that promote a successful clinical learning environment and factors that inhibit a successful clinical learning environment in international students. The integration of qualitative and quantitative data generated four concordant and one discordant meta-inferences about the learning environment.

CONCLUSIONS

Culturally sensitive clinical learning environments are imperative for the holistic development of international nursing students. Nurse educators must cultivate transcultural competencies and pedagogical skills to enhance the competencies and skills of this student population effectively.

A scoping review of the questionnaires used for the assessment of the perception of undergraduate students of the learning environment in healthcare professions education programs

The learning environment (LE) includes social interactions, organizational culture, structures, and physical and virtual spaces that influence the learning experiences of students. Despite numerous studies exploring the perception of healthcare professional students (HCPS) of their LE, the validity evidence of the utilized questionnaires remains unclear. This scoping review aimed to identify questionnaires used to examine the perception of undergraduate HCPS of their LE and to assess their validity evidence. Five key concepts were used: (1) higher education; (2) questionnaire; (3) LE; (4) perception; and (5) health professions (HP). PubMed, ERIC, ProQuest, and Cochrane databases were searched for studies developing or adapting questionnaires to examine LE. This review employed the APERA standards of validity evidence and Beckman et al. (J Gen Intern Med 20:1159-1164, 2005) interpretation of these standards according to 5 categories: content, internal structure, response process, relation to other variables, and consequences. Out of 41 questionnaires included in this review, the analysis revealed a predominant emphasis on content and internal structure categories. However, less than 10% of the included questionnaires provided information in relation to other variables, consequences, and response process categories. Most of the identified questionnaires received extensive coverage in the fields of medicine and nursing, followed by dentistry. This review identified diverse questionnaires utilized for examining the perception of students of their LE across different HPs. Given the limited validity evidence for existing questionnaires, future research should prioritize the development and validation of psychometric measures. This will ultimately ensure sound and evidence-based quality improvement measures of the LE in HP education programs.

Mentoring Support Quality in Group and Individual Mentoring Approaches during Nursing Clinical Training: A Quasi-Experimental Study

Clinical training is an essential element in nursing education, the outcomes of which are directly related to the quality of mentoring support. This quasi-experimental study aimed to examine whether the group or individual form of the mentoring approach used and the order of application of the mentoring approach contribute to the quality of mentoring support provided to students. The study comprised two measurement points with 130 nursing students, divided into two groups with different orders of application of the mentoring approach. The validated Mentoring Support Quality Evaluation Questionnaire (MSEQ) was used. Students in both groups rated the quality of mentoring support as higher following an individual mentoring approach. A significant interaction was found between the mentoring approach used and the order in which the mentoring approaches were applied (p = 0.002). The individual mentoring approach contributed significantly to a higher quality of mentoring support after the second round of clinical training (p = 0.021), while after the first round, the difference between the group and individual approaches was not as clear. The results suggest that not only the form of the mentoring approach but also the sequence of changes in the mentoring approach should be planned when implementing clinical training.

Nurse educators' views of integrating culturally and linguistically diverse future registered nurses into healthcare settings: A qualitative descriptive study

AIM

To describe nurse educators' views of how culturally and linguistically diverse future registered nurses are integrated into healthcare settings.

DESIGN

A qualitative descriptive design was adopted.

PARTICIPANTS

A total of 20 nurse educators were recruited from three higher education institutions in Finland.

METHODS

Participants were recruited in the spring of 2021 through snowball sampling. Individual semi-structured interviews were held and recorded. The collected data were analysed using inductive content analysis.

RESULTS

The performed content analysis identified a total of 534 meaning units from the data, which were categorized into 343 open codes and 29 sub-categories. Furthermore, nine categories were identified and categorized into three main categories. The first main category was pre-graduation and represented a time point during which educators experienced early integration, nurse educator support and cooperation with stakeholders. The second main category was integration strategies into healthcare settings, which included workplace strategies, language competence and individual competencies and attributes. The third main category was the post-graduation experience, during which educators reported organizational readiness, migration and efficacy of the integrational model.

CONCLUSIONS

The results revealed a need for increased resources linked to how nurse educators support the integration of culturally and linguistically diverse future registered nurses. Moreover, a nurse educator's presence during the last clinical placement, early transition and integration was found to exert a significant effect on the smooth integration of culturally and linguistically diverse future nurses.

IMPACT

This study establishes the need to enhance stakeholder cooperation between universities and other organizations towards supporting the integration process. Maximizing nurse educators' support during the final clinical practice, early transition and post-graduation allows for successful integration and intention to stay.

REPORTING METHOD

This study was reported according to the Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC PARTICIPATION

Participating educators shared their experiences of culturally and linguistically diverse future nurses' integration.

Appraisal and Evaluation of the Learning Environment Instruments of the Student Nurse: A Systematic Review Using COSMIN Methodology

BACKGROUND

Nursing education consists of theory and practice, and student nurses' perception of the learning environment, both educational and clinical, is one of the elements that determines the success or failure of their university study path. This study aimed to identify the currently available tools for measuring the clinical and educational learning environments of student nurses and to evaluate their measurement properties in order to provide solid evidence for researchers, educators, and clinical tutors to use in the selection of tools.

METHODS

We conducted a systematic review to evaluate the psychometric properties of self-reported learning environment tools in accordance with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Guidelines of 2018. The research was conducted on the following databases: PubMed, CINAHL, APA PsycInfo, and ERIC.

RESULTS

In the literature, 14 instruments were found that evaluate both the traditional and simulated clinical learning environments and the educational learning environments of student nurses. These tools can be ideally divided into first-generation tools developed from different learning theories and second-generation tools developed by mixing, reviewing, and integrating different already-validated tools.

CONCLUSION

Not all the relevant psychometric properties of the instruments were evaluated, and the methodological approaches used were often doubtful or inadequate, thus threatening the instruments' external validity. Further research is needed to complete the validation processes undertaken for both new and already developed instruments, using higher-quality methods and evaluating all psychometric properties.

A phenomenographic study exploring the conceptions of stakeholders on their teaching and learning roles in nursing education

BACKGROUND

Nursing education involves a number of stakeholders in the teaching and learning process, and these are student nurses, lecturers, clinical instructors and nurses. The role that each of these parties play in the teaching and learning process is dependent on each other and is key to the development of competence among student nurses. However, there is scanty literature on the discourse of how these stakeholders conceptualise their roles to maximise student learning. The objective of this study was to explore the conceptions of stakeholders on their teaching and learning roles in nursing education.

METHODS

Thirty-eight semi-structured interviews and three focus group discussions were conducted with nursing students, lecturers, clinical educators at a Namibian nursing college and nurses at teaching hospitals. Phenomenographic data analysis approach was applied.

RESULTS

Four conceptions were constructed that described the level of involvement of the different parties in teaching and learning. These were initiating, supporting, becoming part of and owning the teaching and learning role. Three dimensions of variation marked the differences among the conceptions: responsibility and accountability, priorities and level of collaboration.

CONCLUSIONS

The parties involved in the teaching and learning in nursing education have qualitatively different understating of their roles and those of others. There is a pattern transcending from being at the periphery of teaching and learning to taking ownership of teaching and learning. And a movement from limited responsibility and collaboration to that of being responsible, accountable and high level of collaboration in the teaching and learning of nursing students. The conceptions in this study add more ways of enhancing collaboration between theoretical and clinical sites in nursing education, by ensuring that those involved are aware of their role and that of others and work collaboratively at the micro-level.

Factors that influence international nursing students' experiences and perceptions of their learning environments: a scoping review protocol

OBJECTIVE

The objective of this review is to explore the research on factors that influence international undergraduate nursing students' experiences and perceptions of their learning environment.

INTRODUCTION

International nursing students bring valuable cultural and economic opportunities to universities and health care. It is important that their clinical learning experiences are positive. Factors that influence nursing students' experiences may include cultural and communication differences, diversity related to health care systems, learning and teaching strategies, and programs to improve communication. International nursing students' experiences and perceptions are reported in terms of expressed confidence, perceived competence, and levels of satisfaction. A scoping review is required to identify what is known and to identify the knowledge gaps in this area.

INCLUSION CRITERIA

International nursing students are those who are enrolled in an undergraduate nursing program in a higher-education institution in a country other than their own. International students studying vocational nursing and exchange students will be excluded. The learning environment is considered to be one in which any person who may influence patient care learns. Primary research, both qualitative and quantitative methods, published since 1995 in any language that the research team can translate will be included.

METHODS

This review follows the JBI methodology for scoping reviews. Data extraction will include the factors influencing students' experiences and the concepts that were explored. Data analysis will include frequencies of concepts and associations between them. Results will be presented in tabular form and mind maps.

SCOPING REVIEW REGISTRATION NUMBER

Open Science Framework (osf.io/r4v6q).

The ward manager role in the context of nursing and midwifery students' clinical learning: Testing a model

AIM

To test a model of clinical learning that focuses on the role of the ward manager.

BACKGROUND

The ward manager's role in supporting clinical learning indirectly focuses on the ward climate connected to students' clinical placements. In this way, the ward manager influences both nursing care and the pedagogical atmosphere in the ward.

DESIGN

Cross-sectional, secondary analysis.

METHODS

The sample included nursing and midwifery students (N = 5,776, n = 1,900) who had completed their clinical placement. Data were collected with the Clinical Learning Environment, Supervision and Nurse Teacher scale. Structural equation modelling was adopted to test the hypotheses.

RESULTS

Estimates of the model parameters demonstrated that a ward manager's leadership style influences both the premises of nursing at the ward (0.84, p < .001) and the pedagogical atmosphere (0.93, p < .001), although the pedagogical atmosphere affects the mentoring relationship (0.87-0.86, p < .001).

CONCLUSIONS

Ward managers exert a significant influence on the clinical learning environment via their support for an effective pedagogical atmosphere and, consequently, effective mentoring.

IMPLICATIONS FOR NURSING MANAGEMENT

Leadership style guides both the premises of nursing at the ward and pedagogical atmosphere. These findings recommend that ward managers should be involved in promoting a supportive learning climate, which supports the mentor-student relationship and, eventually, leads to effective clinical learning.

Nursing students' evaluation of clinical practice placements using the Clinical Learning Environment, Supervision and Nurse Teacher scale - A systematic review

OBJECTIVES

To review undergraduate nursing students' perceptions of the quality of their clinical placement experiences by means of surveys conducted using the Clinical Learning Environment Supervision and Nurse Teacher questionnaire.

DESIGN

Systematic review of English language studies published between 2014 and 2020, in any clinical setting, utilising data collected in the decade 2010 to 2020.

DATA SOURCES

Structured searches were conducted in CinahlPlus, Ovid Medline, Scopus, PubMed and Google Scholar.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses framed the review.

RESULTS

A total of 111 records were screened, after which 21 studies met criteria for inclusion. Studies were centred on students in Sweden and in 15 other countries. Students' ratings of 'Experience' were positive across five scale subdimensions with means 3.0-3.95 of a possible 5 (overall mean 75.4%). 'Satisfaction' across seven studies was rated highly (mean 4.16 of 5) 83.2% agreement. The highest rated subdimension was Supervisory relationship, with the Role of the Nurse Teacher rated lower and inconsistently. The underlying elements are discussed.

CONCLUSION

Although students' Experience and Satisfaction were rated highly averaging over 75%, there is still room for improvement. Further research is needed to examine how students perceive various components of 'satisfaction' within clinical learning environments because this can be seen as the primary measure of program quality. Research using experimental and observational study designs is needed to compare ways of preparing clinical teachers and reporting measurable learning outcomes for models of supervision that are applicable in varied clinical learning environments.

Clinical supervisors' perspectives of factors influencing clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement: A qualitative study

BACKGROUND

Undergraduate nursing students from culturally and linguistically diverse backgrounds experience unique challenges with their learning needs during clinical placements. There is limited research on clinical supervisors' perspectives of the factors impacting clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement.

OBJECTIVES

This study sought to identify clinical supervisors' perspectives of the factors impacting on the clinical learning experience of nursing students from culturally and linguistically diverse backgrounds and strategies to overcome challenges.

DESIGN

A qualitative research design using semi-structured interviews.

METHODS

Nine nurses who had experience supervising culturally and linguistically diverse nursing students were interviewed as part of data collection. Thematic analysis was used for data interpretation.

RESULTS

Identified factors include: Poor proficiency in English language, unfamiliarity with Australian slang and medical terminologies, cultural expectations interfering with professional responsibilities, incongruity with teaching delivery and learning style, short duration of placement, inconsistency with preceptor allocation and inadequate preceptor training.

CONCLUSION

Recommendations to facilitate the learning of nursing students from culturally and linguistically diverse (CALD) backgrounds on clinical placement include flexibility with assessments, modifying teaching styles according to learning needs, providing appropriate orientation, creating a welcoming environment, providing consistency with allocation of preceptors, and providing appropriate training for preceptors. Inconsistency in preceptor allocation was reported to have a negative influence on CALD student learning. A collaborative approach between Universities and the health care settings is essential in assisting clinical supervisors to address the unique learning needs of nursing students from culturally and linguistically diverse backgrounds while on clinical placement.

Nursing students' evaluation of clinical learning environment and supervision in a Norwegian hospital placement - A questionnaire survey using CLES+T scale

AIM

The clinical learning environment and supervisor-student relationship play vital roles in the learning outcomes of nursing students. The aim of this study is to evaluate nursing students' experiences with the clinical learning environment and supervision in a hospital placement organised with a dual preceptor team - preceptors holding dual positions both in the clinic and the nursing faculty in addition to the standard one-to-one supervision by a clinical preceptor.

DESIGN

The study is a paper-based survey based on a validated questionnaire developed and tested in hospital settings in various European countries, including Norway.

METHOD

The Norwegian version of the CLES+T Evaluation Scale, was distributed to all second-year students in three different years (2015-2017) at a nursing faculty.

RESULTS

A total of 61% students (n = 261) returned the questionnaire. Overall, the students considered that their hospital placement provided a good clinical learning environment. The results suggest that the dual preceptor team on top of one-to-one supervision did not interfere negatively with the clinical learning environment Nevertheless, the dual preceptor model did not compensate for a poor relationship with the clinical preceptor. Thus, the association between a reported 'strained relationship' with the clinical preceptor and low scores on the CLES+T, reported on by other studies, remained in our data.

CONCLUSIONS

To better grasp the complexity in this area, various methods are needed, such as in-depth interviews with students, nurse teachers and clinical preceptors. Further studies need to elaborate on students' experiences of clinical learning environment according to how supervision is organised.

Exploratory Factor Analysis for a Nursing Workaround Instrument in Korean and Interpretations of Statistical Decision Points

The use of workarounds by nurses is prevalent in clinical settings. Understanding how work processes are adjusted as a result of implementing an electronic medical record is important because of its impact on patient care. The purpose of this study was to conduct an exploratory factor analysis of a 20-item nursing workaround instrument translated into Korean. The responses from 104 nurses were analyzed. Examinations of sample size, factorability of a correlation matrix, the Kaiser-Meyer-Olkin value, the P value of Bartlett test of sphericity, anti-image correlation coefficients, and communality were acceptable to proceed with exploratory factor analysis. The original dimensionality of four groups was retained. However, the number of items loaded onto each group was reduced from five to three. These four factors explained 66% of the total variance between the items. Cronbach's α for the internal consistency reliability of the instrument was .70. The 12-item nursing workaround instrument was specific to an electronic medical record, which was the strongest point of the instrument. Further confirmatory factor analysis of this instrument is needed. This translated instrument is expected to contribute to the proliferation of studies examining nurses' workarounds related to the use of electronic medical records in Korean clinical settings, thereby improving clinical information systems for clinical practice.

The implementation of a dedicated education unit in a public health setting

INTRODUCTION

The dedicated education unit (DEU) is an innovative clinical model that prepares preceptors for success in clinical settings with nursing students. Though the DEU is mostly used in acute-care settings, this project explores the implementation of a DEU in a public health setting.

OBJECTIVES

Better preparation of public health nurses and social workers as clinical preceptors for nursing students with the implementation of a DEU in a public health setting.

DESIGN

IRB approved, pre/post survey with participant comments.

MEASUREMENTS

Clinical Nurse Teacher Survey was assessed pre/post intervention with registered nurses and social work staff (n = 13). Paired t-tests analysis was used to determine significance. The Clinical Learning Environment and Nurse Teacher (CLES+T) scale completed postimplementation by nursing students (n = 8) after the clinical rotation.

RESULTS

Clinical Nurse Teacher Survey mean scores preintervention was 4.56 and increased postintervention to 4.89, though not statistically significant (p-value .11). CLES+T showing 100% fully agree or agree that the Public Health DEU is an effective learning environment.

CONCLUSIONS

The DEU model in a public health setting is an opportunity to improve lived clinical experiences of preceptors and nursing students, which may increase nursing students' positive perceptions of, and increase interest in serving as a public health nurse after graduation.

The clinical learning environment, supervision and nurse teacher scale (CLES+T): psychometric properties measured in the context of postgraduate nursing education

Background

The Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T) instrument is internationally used for the evaluation of clinical learning environment in undergraduate nursing education. However, no evidence is available on the possible applications of this instrument in the context of postgraduate nursing education.

Purpose

To examine the basic psychometric properties of CLES+T in the context of clinical postgraduate nursing education in Poland.

Methods

Study among a sample of 417 nurses participating in the clinical postgraduate training in Poland.

Results

Cronbach's alpha for the total scale was 0.97. A five-factor structure was confirmed in accordance with the assumptions adopted by the authors of the original version of the scale. Cronbach's alpha coefficient for the Polish version of the CLES+T subscales ranged from 0.83 (Nursing care on the ward) to 0.95 (The content of supervisory relationship). The mean results for individual subscales ranged from 4.52 ± 0.63 for nursing care on the ward to 4.73 ± 0.45 for role of the nurse teacher.

Conclusions

Having shown satisfactory psychometric properties, CLES+T can be considered a useful instrument to assess those elements of clinical learning environment which are important for the assurance of education quality at the postgraduate level.

Developing mentorship in clinical practice: Psychometrics properties of the Mentors' Competence Instrument

Clinical placements are an important part of nursing education to developing nursing students' competencies. In enhancing clinical learning, to focus on mentors' competences is pivotal as they are the main role models and experts in guiding. This study is validated the Italian version of the Mentors' Competence Instrument. A sampling frame of 648 mentors was involved. The final sample included 291 mentors (response rate 45%). Confirmatory Factor Analysis was performed. Fit indices were also calculated to evaluate validity. The scale demonstrated optimal fit indexes and its validity was confirmed by psychometrical testing. In detail, Root Mean Square Error of Approximation is 0.058, Standardized Root Mean Residual is 0.046, Comparative Fit Index is 0.893 and Tucker-Lewis Index 0.886. Cronbach's alpha ranges from 0.77 to 0.95 among factors. This is the first validation of the scale performed in a different country from the original study. The performed psychometric testing showed that the scale is valid and reliable, as well as consistent with the theoretical structure reported for a different national context. This scale can be beneficial for comparing mentors' competencies across different clinical learning environments and could be used to build a broader model of mentors' competencies.

Clinical learning environment and supervision of international nursing students: A cross-sectional study

BACKGROUND

Previously, it has been shown that the clinical learning environment causes challenges for international nursing students, but there is a lack of empirical evidence relating to the background factors explaining and influencing the outcomes.

OBJECTIVE

To describe international and national students' perceptions of their clinical learning environment and supervision, and explain the related background factors.

DESIGN

An explorative cross-sectional design was used in a study conducted in eight universities of applied sciences in Finland during September 2015-May 2016.

METHODS

All nursing students studying English language degree programs were invited to answer a self-administered questionnaire based on both the clinical learning environment, supervision and nurse teacher scale and Cultural and Linguistic Diversity scale with additional background questions. Participants (n=329) included international (n=231) and Finnish (n=98) nursing students. Binary logistic regression was used to identify background factors relating to the clinical learning environment and supervision.

RESULTS

International students at a beginner level in Finnish perceived the pedagogical atmosphere as worse than native speakers. In comparison to native speakers, these international students generally needed greater support from the nurse teacher at their university. Students at an intermediate level in Finnish reported two times fewer negative encounters in cultural diversity at their clinical placement than the beginners.

CONCLUSION

To facilitate a successful learning experience, international nursing students require a sufficient level of competence in the native language when conducting clinical placements. Educational interventions in language education are required to test causal effects on students' success in the clinical learning environment.