Validity and reliability of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T), Turkish version1

Using a Behavioral Health Integration Model in a Family Nurse Practitioner Residency

BACKGROUND

Primary care serves as an entry point for many patients to access health care services, especially those who reside in medically underserved areas. Because an initiative exists for family nurse practitioners (FNPs) to fill primary care gaps in medically underserved areas, they must be included in educational strategies to provide quality behavioral health care within their scope of practice.

METHOD

An academic-practice partnership was used to provide FNP residents the opportunity to learn to work within their scope of practice in a behavioral health integration model.

RESULTS

The residents noted satisfaction with the learning environment, supervisory relationship, and role of the faculty.

CONCLUSION

Innovative continuing education activities are needed to prepare novice FNPs to safely practice and enter into a health care workforce pipeline focused on reducing disparities in medically underserved areas. [J Contin Educ Nurs. 2024;55(4):203-208.].

Development and validation of satisfaction with clinical practice questionnaire for mentors and students

OBJECTIVES

To develop and validate a questionnaire on satisfaction with clinical practice for mentors (QSCP-M) and a questionnaire on satisfaction with clinical practice for students (QSCP-S).

METHODS

Two versions of the questionnaires were constructed: a version for mentors and a version for students. Both surveys were conducted at two time points. The first survey was completed by 252 students and 86 mentors, and the second by 291 students and 94 mentors.

RESULTS

Several exploratory factor analyses were performed on the results obtained, and two factors were identified for the QSCP-M and one factor for the QSCP-S. The coefficients of internal reliability for both questionnaires indicated stable and reliable measuring instruments.

CONCLUSIONS

Clinical practice satisfaction questionnaires for mentors and students showed good metric characteristics. The validation shows that both questionnaires are appropriate for examining general and specific satisfaction with clinical practice.

Instruments evaluating the quality of the clinical learning environment in nursing education: An updated systematic review

OBJECTIVES

The clinical learning environment offers meaningful learning opportunities for nursing students to apply theoretical knowledge to practice on actual or simulated patients. A previous systematic review assessed the quality of several instruments that evaluated the quality of clinical learning environments. This updated systematic review aimed to identify: any additional instruments that have been researched in the last 5 years, ii) the psychometric properties of available instruments and iii) the estimated comparable psychometric properties of the available instruments.

DATA SOURCES

Medline, CINAHL and Cochrane databases REVIEW METHODS: Databases were searched from January 2016 to January 2023. Studies were included if they: a) validated instruments evaluating the experience and quality of clinical learning environments; b) assessed the pre-licensure nursing student experience; c) were published in English; and d) were published after April 2016. Two independent reviewers conducted title and abstract screening, full text screening, data extraction and methodological quality assessment. Any disagreements were resolved by consensus. A summary of the findings was tabulated using the same format as the initial review.

RESULTS

An additional 18 studies were found, which used seven different clinical learning environment evaluation instruments. Internal consistency and structural validity were the most frequently reported psychometric properties. In almost all studies, methodology for these properties were of sufficient quality according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) tool evaluation. Other properties were inconsistently reported, with differing qualities in the methodology. Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) remains the most translated and validated instrument across several countries.

CONCLUSIONS

Instruments developed and validated using a systematic, transparent and high-quality methodology assist in accurately assessing the skills, attitudes and decision-making abilities of the preregistration level nursing student. These tools can be used in clinical placement accreditation and quality improvement of nursing education. The methodology for evaluation of the psychometric properties of instruments should be clearly described.

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.

Factors Associated with Nursing Student Satisfaction with Their Clinical Learning Environment at Wolkite University in Southwest Ethiopia

Background. The clinical learning environment has been defined as “an interactive network of strengths within the clinical environment that influence the clinical learning outcomes of students. Understanding students’ level of satisfaction with their clinical learning environment is crucial to ensuring the required teaching and learning process. Therefore, this study was designed to assess the level of satisfaction with the CLE among nursing students at the Wolkite University of Ethiopia. Methods. A cross-sectional study was conducted at Wolkite University. This study was carried out in March 2022 on 208 student nurses selected by purposive and convenient sampling techniques. This study used the English version of the Clinical Learning Environment and Supervision + Nurse Teacher (CLES + T) evaluation scale. The collected data were cleaned, coded, and entered into Epi data 3.1, and then, statistical analyses were performed using SPSS version 26. Bivariate and multivariable logistic regression models were used to identify factors associated with the satisfaction level of nursing students towards CLE. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and $p$ values < 0.05 were considered to indicate statistical significance. Results. More than half of the study participants were females, and nearly half (50.5%) of the participants were in year three of the nursing program. The study found that 39.9% (95%CI: 32.2%, 46.6%) of students were satisfied with their CLE. Factors that had a significant association with the satisfaction level of nursing students towards CLE were gender (female students) (AOR = 16.053 (6.397, 40.286)), year of study (4th year) (AOR = 6.296 (2.679, 14.796)), and the type of the hospital in which their last clinical placement was held (at a primary hospital) (AOR = 2.961 (1.122, 7.815)). Conclusion. Effective nursing education programs need to be developed to increase satisfaction with clinical practice and to promote positive emotional regulation in nursing students. Nurse practitioners and managers should be aware of their important role in the professional development of students and their satisfaction with clinical placements.

Nursing students' perceptions on clinical learning environment and mental health: a multicenter study

OBJECTIVE

this study aimed at evaluating the perceptions of Nursing students from public universities in three European Union countries on mental health and clinical learning environments, a topic that has been rarely investigated in the literature.

METHOD

data collection took place using a demographic data form, the Clinical Learning Environment, Supervision and Nurse Teacher Scale, and the Mental Health Continuum Short Form. A total of 571 participants from Turkey, Lithuania and Portugal were included in the study.

RESULTS

there was a significant difference among the three groups regarding clinical learning environment and mental health status (p<.001). Supervision was the most valued element. The Portuguese students presented the highest mean in the Mental Health Continuum Short Form and Clinical Learning Environment, Supervision and Nurse Teacher Scale scores (p<.001). Age, gender and mental health were effective in the Clinical Learning Environment, Supervision and Nurse Teacher Scale scores.

CONCLUSION

the results indicated that the Mental Health Continuum Short Form and Clinical Learning Environment, Supervision and Nurse Teacher Scale scores obtained by the Portuguese Nursing students were higher. It was also revealed that the students' perceptions on the clinical learning environment were affected by age and gender, and that their perceptions on mental health were influenced by the Clinical Learning Environment, Supervision and Nurse Teacher scale scores.

The clinical learning environment, supervision and future intention to work as a nurse in nursing students: a cross-sectional and descriptive study

BACKGROUND

Clinical practice is a core component of nurse education. It is believed that nursing students' clinical placement experiences can affect their learning outcomes, satisfaction, as well as influence their choice of future career. To examine nursing students' perception of clinical learning environment and mentoring in hospital where they perform their clinical placement and the connection of these factor with intention to work as a nurse once graduated.

METHODS

Nursing students enrolled in clinical practice at least 6 months in hospitals in China were surveyed between January-March 2021. Percentages, frequencies, mean, standard deviation, t-test, ANOVA, and regression analysis were used to analyse the data.

RESULTS

Of the five scales in the CLES+T, 'Leadership style of the ward manager' scored the highest mean while 'Pedagogical atmosphere at the ward' scored the lowest. Nursing students with lower educational level, those supervised by fixed preceptor, and those intent to be a nurse in the future were significantly more satisfied with the CLES+T. Most of the nursing students are intent to work as a nurse in the future. CLES+T total scores and sub-dimensions (Premises of nursing on the ward) have significantly effectiveness on the intention to be a nurse in the future.

CONCLUSIONS

Given the significant correlation of between learning environments and nursing students intention to be a nurse in the future, ward managers need to build a good clinical teaching atmosphere and promote opportunities for theoretical and practical connections among students through effective feedback mechanisms, which can enable students to experience a better clinical learning environment and meaningful experiences to build their professional roles and competencies, thus helping to enhance students' willingness to pursue nursing careers in the future.

Percepciones de estudiantes de enfermería sobre el Ambiente de Aprendizaje Clínico y la salud mental: estudio multicéntrico

Resumen Objetivo: este estudio tuvo como objetivo evaluar las percepciones de estudiantes de enfermería de universidades públicas de tres países de la Unión Europea sobre la salud mental y los Ambientes de Aprendizaje Clínico, tema poco estudiado en la literatura. Método: la recolección de datos se realizó mediante un formulario de datos demográficos, la Escala de Evaluación de Ambiente de Aprendizaje Clínico, Supervisión y Profesor de Enfermería y el Mental Health Continuum Short Form. Se incluyeron en el estudio un total de 571 participantes de Turquía, Lituania y Portugal. Resultados: hubo una diferencia significativa entre los tres grupos con respecto al Ambiente de Aprendizaje Clínico y al estado de salud mental (p < 0,001). La supervisión fue el elemento más valorado. Los estudiantes portugueses obtuvieron los puntajes promedio más altos en el Mental Health Continuum Short Form y Ambiente de Aprendizaje Clínico, Supervisión y Profesor de Enfermería (p<0,001). La edad, el sexo y la salud mental influyeron en los puntajes de Ambiente de Aprendizaje Clínico, Supervisión y Profesor de Enfermería. Conclusión: los resultados indicaron que los estudiantes de Enfermería portugueses obtuvieron los puntajes más altos en el Mental Health Continuum Short Form y Ambiente de Aprendizaje Clínico, Supervisión y Profesor de Enfermería. También se reveló que las percepciones de los estudiantes sobre el Ambiente de Aprendizaje Clínico se vieron afectadas por la edad y el género, y que sus percepciones sobre la salud mental fueron influenciadas por los puntajes de la escala de evaluación de Ambiente de Aprendizaje Clínico, Supervisión y Profesor de Enfermería.

Nursing students’ perceptions on clinical learning environment and mental health: a multicenter study

Objective:

this study aimed at evaluating the perceptions of Nursing students from public universities in three European Union countries on mental health and clinical learning environments, a topic that has been rarely investigated in the literature.

Method:

data collection took place using a demographic data form, the Clinical Learning Environment, Supervision and Nurse Teacher Scale, and the Mental Health Continuum Short Form. A total of 571 participants from Turkey, Lithuania and Portugal were included in the study.

Results:

there was a significant difference among the three groups regarding clinical learning environment and mental health status (p<.001). Supervision was the most valued element. The Portuguese students presented the highest mean in the Mental Health Continuum Short Form and Clinical Learning Environment, Supervision and Nurse Teacher Scale scores (p<.001). Age, gender and mental health were effective in the Clinical Learning Environment, Supervision and Nurse Teacher Scale scores.

Conclusion:

the results indicated that the Mental Health Continuum Short Form and Clinical Learning Environment, Supervision and Nurse Teacher Scale scores obtained by the Portuguese Nursing students were higher. It was also revealed that the students’ perceptions on the clinical learning environment were affected by age and gender, and that their perceptions on mental health were influenced by the Clinical Learning Environment, Supervision and Nurse Teacher scale scores.

Clinical learning environment, supervision and nurse teacher scale (CLES+T): Psychometric evaluation of the Chinese version

BACKGROUND

Clinical learning environment plays a vital role in nursing clinical education. The Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts.

OBJECTIVES

To validate the Chinese version of the CLES+T scale that is in line with the Chinese culture and educational context.

DESIGN

A cross-sectional survey.

SETTING

Data were collected from nursing students in six provinces in different parts of China between September and October 2018.

PARTICIPANTS

Six hundred and ninety-four nursing students participated in this study.

METHODS

Purposeful sampling was used, and students completed online survey to explore the structure of the CLES+T scale. Internal consistency reliability was tested on the total scale and its sub-dimensions using Cronbach's alpha.

RESULTS

An exploratory factorial analysis identified a three-component solution, with 11 items, and explained 60.01% of the variance. Confirmatory factor analysis supported the factor structure. Cronbach's alpha coefficient for the scale was 0.82, and those of the three subscales were 0.79, 0.71, and 0.70.

CONCLUSIONS

The unique, stable and relatively concise Chinese version of CLES+T scale instrument could be a useful instrument for using as an assessment scale in Chinese-speaking countries.

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.

The relationship between clinical placement duration and students' satisfaction with the quality of supervision and learning environment: A mediation analysis

Multiple factors that influence the learning experience of nursing students while they are in clinical training have been identified, such as the clinical learning environment, the supervision provided by supervisors, and the level of cooperation with the nurse teacher. The objective was to examine whether the relationship between the clinical placement duration and overall satisfaction with clinical training is mediated by the supervisory relationship and learning environment. A secondary analysis was conducted using the data from a cross-sectional study conducted in 17 higher educational institutions in nine European countries with the Clinical Learning Environment, Supervision and Nurse Teacher scale (n = 1903 pre-registration nursing students). Satisfaction with the supervisor and a good learning environment mediated the relationship between clinical placement duration and overall satisfaction as perceived by the students. Nursing students with longer clinical placement durations were more satisfied with clinical training as a result of both their satisfaction with their supervisor and their perceptions of good learning environment. The optimal duration a nursing student should remain in the different practice settings is approximately 7 weeks.

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.

Elaboração e validação de uma tecnologia educacional acerca da violência contra a mulher

RESUMO Objetivo elaborar e validar uma tecnologia educacional acerca da violência contra a mulher. Método estudo metodológico de validação de conteúdo e aparência. Para a validação, participaram deste estudo 11 especialistas de conteúdo e técnicos, 7 especialistas de design e 79 mulheres. Foram utilizados três instrumentos para a coleta de dados, um para cada grupo de participantes, e os dados foram analisados quanto ao nível de concordância e Índice de Validade de Conteúdo. Resultados a média de concordância dos especialistas de conteúdo e técnicos foi de 87%, o Índice de Validade de Conteúdo global por parte dos especialistas de design foi de 0,92 e o nível de concordância das respostas positivas pelo público-alvo foi de 96,2%. Conclusão e implicações para a prática o Alertômetro mostrou-se uma tecnologia educacional válida para ser utilizada, pois promove conhecimento acerca das diversas manifestações da violência contra a mulher.