The Clinical Learning Environment, Supervision and the Nurse Teacher Evaluation Scale: Turkish Version.

AIM: The aim of this study is to adapt the Clinical Learning Environment, Supervision and Nurse Teacher Evaluation Scale to the Turkish language and culture. METHODS: This psychometric test was conducted in a nursing school in Ankara, Turkey, from April to June 2014. Convenience sampling was used. The sample of this study was 190 third- and fourth-year nursing students. The items of the scale were evaluated by Pearson correlation coefficient for correlation-based item analysis. Cronbach's alpha, test and retest analysis were used to measure reliability. Exploratory factor analysis and correlation analysis were performed to determine validity. Principal component analysis was used to analyze factor. RESULTS: The subscales' Cronbach's alpha values were varied between .760 and .933. A positive relationship was found between tests and retests points of the subscales (P < .05). Five factors were identified in the exploratory factor analysis. There was a meaningful correlation between subscale points of the Clinical Learning Environment, Supervision and Nurse Teacher Evaluation Scale and the Clinical Learning Environment Scale (P < .05). CONCLUSION: The Turkish version of the Clinical Learning Environment, Supervision and Nurse Teacher Evaluation Scale was validated and a reliable measurement tool. It can be used to evaluate clinical nursing education in Turkey.

Effectiveness of mobile cooperation intervention on students' clinical learning outcomes: A randomized controlled trial.

AIMS: The aim of this study was to evaluate the effectiveness of the mobile cooperation intervention in improving the competence and self-efficacy of students and the quality of the clinical learning environment. BACKGROUND: For students, the clinical practicum is challenging as such and moreover the student - teacher cooperation, which supports the clinical learning of the students, has become complicated. Mobile applications have potential but their role in facilitating this cooperation remains unknown. DESIGN: A parallel-group randomized controlled trial. METHODS: Data were collected between January-March 2015 in Finland. The nursing students were randomly allocated to an intervention group (N = 52) or control group (N = 50). The intervention group used a mobile application to cooperate with the teacher during the clinical practicum. The control group engaged in standard cooperation. The primary outcome was competence. The secondary outcomes comprised self-efficacy and the quality of the clinical learning environment. Nurse Competence Scale, Self-efficacy in Clinical Performance instrument and the Clinical Learning Environment, Supervision and Nurse Teacher scale were used for student self-assessments. For the main analysis, hierarchical linear mixed models were used with the intention-to-treat principle. RESULTS: Competence and self-efficacy showed no significant between-group differences in mean improvements, but significant improvements in both groups were detected over the 5 weeks. Satisfaction with the clinical learning environment showed no significant between-group differences, however, the role of the nurse teacher subscale, especially regarding cooperation, showed significant group differences. CONCLUSION: The mobile cooperation intervention was not significantly effective in improving individual outcomes, but did seem to improve significantly some aspects of the contextual outcomes. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02635295.

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

AIM: The purpose of this study was to develop and test the psychometric properties of the new Cultural and Linguistic Diversity scale, which is designed to be used with the newly validated Clinical Learning Environment, Supervision and Nurse Teacher scale for assessing international nursing students' clinical learning environments. BACKGROUND: In various developed countries, clinical placements are known to present challenges in the professional development of international nursing students. DESIGN: A cross-sectional survey. METHODS: Data were collected from eight Finnish universities of applied sciences offering nursing degree courses taught in English during 2015-2016. All the relevant students (N = 664) were invited and 50% chose to participate. Of the total data submitted by the participants, 28% were used for scale validation. The construct validity of the two scales was tested by exploratory factor analysis, while their validity with respect to convergence and discriminability was assessed using Spearman's correlation. RESULTS: Construct validation of the Clinical Learning Environment, Supervision and Nurse Teacher scale yielded an eight-factor model with 34 items, while validation of the Cultural and Linguistic Diversity scale yielded a five-factor model with 21 items. CONCLUSION: A new scale was developed to improve evidence-based mentorship of international nursing students in clinical learning environments. The instrument will be useful to educators seeking to identify factors that affect the learning of international students.

Effectiveness of a mobile cooperation intervention during the clinical practicum of nursing students: a parallel group randomized controlled trial protocol.

AIM: The aim of this study was to describe a study protocol for a study evaluating the effectiveness of a mobile cooperation intervention to improve students' competence level, self-efficacy in clinical performance and satisfaction with the clinical learning environment. BACKGROUND: Nursing student-nurse teacher cooperation during the clinical practicum has a vital role in promoting the learning of students. Despite an increasing interest in using mobile technologies to improve the clinical practicum of students, there is limited robust evidence regarding their effectiveness. DESIGN: A multicentre, parallel group, randomized, controlled, pragmatic, superiority trial. METHODS: Second-year pre-registration nursing students who are beginning a clinical practicum will be recruited from one university of applied sciences. Eligible students will be randomly allocated to either a control group (engaging in standard cooperation) or an intervention group (engaging in mobile cooperation) for the 5-week the clinical practicum. The complex mobile cooperation intervention comprises of a mobile application-assisted, nursing student-nurse teacher cooperation and a training in the functions of the mobile application. The primary outcome is competence. The secondary outcomes include self-efficacy in clinical performance and satisfaction with the clinical learning environment. Moreover, a process evaluation will be undertaken. The ethical approval for this study was obtained in December 2014 and the study received funding in 2015. DISCUSSION: The results of this study will provide robust evidence on mobile cooperation during the clinical practicum, a research topic that has not been consistently studied to date.

Work-engaged nurses for a better clinical learning environment: a ward-level analysis.

AIM: To correlate workgroup engagement in nursing teams and the clinical learning experience of nursing students. BACKGROUND: Work engagement plays a pivotal role in explaining motivational dynamics. Nursing education is workplace-based and, through their clinical placements, nursing students develop both their clinical competences and their professional identity. However, there is currently a lack of evidence on the role of work engagement related to students' learning experiences. METHODS: A total of 519 nurses and 519 nursing students were enrolled in hospital settings. The Utrecht Work Engagement Scale (UWES) was used to assess work engagement, and the Clinical Learning Environment and Supervision plus nurse Teacher (CLES+T) scale was used to assess students' learning experience. A multilevel linear regression analysis was performed. RESULTS: Group-level work engagement of nurses correlated with students' clinical learning experience (ß = 0.11, P < 0.001). Specifically, the 'absorption' and 'dedication' factors mostly contributed to enhancing clinical learning (respectively, ß = 0.37, P < 0.001 and ß = 0.20, P < 0.001). CONCLUSIONS: Nursing teams' work engagement is an important motivational factor to enhance effective nursing education. IMPLICATION FOR NURSING MANAGEMENT: Nursing education institutions and health-care settings need to conjointly work to build effective organisational climates. The results highlighted the importance of considering the group-level analysis to understand the most effective strategies of intervention for both organisations and nursing education.

Exploratory factor analysis of the Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T).

BACKGROUND AND PURPOSE: The Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) scale measures student nurses' perceptions of clinical learning environments. This study evaluates the construct validity and internal reliability of the CLES+T in hospital settings in New Zealand. Comparisons are made between New Zealand and Finnish data. METHODS: The CLES+T scale was completed by 416 Bachelor of Nursing students following hospital clinical placements between October 2008 and December 2009. Construct validity and internal reliability were assessed using exploratory factor analysis and Cronbach's alpha. RESULTS: Exploratory factor analysis supports 4 factors. Cronbach's alpha ranged from .82 to .93. All items except 1 loaded on the same factors found in unpublished Finnish data. The first factor combined 2 previous components from the published Finnish component analysis and was renamed: connecting with, and learning in, communities of clinical practice. The remaining 3 factors (Nurse teacher, Supervisory relationship, and Leadership style of the manager) corresponded to previous components and their conceptualizations. CONCLUSION: The CLES+T has good internal reliability and a consistent factor structure across samples. The consistency across international samples supports faculties and hospitals using the CLES+T to benchmark the quality of clinical learning environments provided to students.

Clinical learning environment and supervision plus nurse teacher (CLES+T) scale: testing the psychometric characteristics of the Italian version.

BACKGROUND: A clinical learning environment is an "interactive network of forces within the clinical setting that influence the students' learning outcomes". International research indicates the Clinical Learning Environment and Supervision plus Nurse Teacher scale (CLES+T) as the gold standard to assess a good clinical learning environment. AIM: This study aims to evaluate the psychometric proprieties of CLES+T Italian version. METHODS: 875 students attending the Bachelor in Nursing in 3 Universities in Italy participated in the study. Cronbach's alpha, item to total correlations, skewness and kurtosis were calculated; factor analysis was performed using Principal Axis Factoring and an oblique rotation method. RESULTS: Results showed a Cronbach's alpha of 0.95 of the scale and ranging from 0.80 to 0.96 among factors; all items verified item to total correlation and answers' variability criteria. Factor analysis showed a 7-factors model as explaining more than 67% of the variance, the higher variance was explained by the "pedagogical atmosphere" factor (37.61%). The nurse teacher factor in the Italian model is split into 3 sub-factors: theory-practice integration, cooperation with ward staff and relationship with mentor and student. CONCLUSION: These results enable an international debate concerning the theoretical structure of CLES+T and provide a reliable and valid tool for the comparison of supervisory models in guiding nursing students' clinical learning.

Clinical learning environment, supervision and nurse teacher evaluation scale: psychometric evaluation of the Swedish version.

AIM: This article is a report of the development and psychometric testing of the Swedish version of the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale. BACKGROUND: To achieve quality assurance, collaboration between the healthcare and nursing systems is a pre-requisite. Therefore, it is important to develop a tool that can measure the quality of clinical education. The Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale is a previously validated instrument, currently used in several universities across Europe. The instrument has been suggested for use as part of quality assessment and evaluation of nursing education. METHODS: The scale was translated into Swedish from the English version. Data were collected between March 2008 and May 2009 among nursing students from three university colleges, with 324 students completing the questionnaire. Exploratory factor analysis was performed on the 34-item scale to determine construct validity and Cronbach's alpha was used to measure the internal consistency. RESULTS: The five sub-dimensions identified in the original scale were replicated in the exploratory factor analysis. The five factors had explanation percentages of 60.2%, which is deemed sufficient. Cronbach's alpha coefficient for the total scale was 0.95, and varied between 0.96 and 0.75 within the five sub-dimensions. CONCLUSION: The Swedish version of Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale has satisfactory psychometric properties and could be a useful quality instrument in nursing education. However, further investigation is required to develop and evaluate the questionnaire.

A process evaluation of a mobile cooperation intervention: A mixed methods study.

BACKGROUND: A mobile cooperation intervention was developed to facilitate the cooperation of nursing students with nurse teacher and to improve the students' clinical learning outcomes. The intervention consisted of training in a mobile application's functionality and its use during clinical practicum cooperation procedures. OBJECTIVES: To describe the development of a mobile application for student-teacher cooperation and to examine the acceptability of the mobile cooperation intervention for advancing intervention development. DESIGN: A user-centred design and a mobile application development lifecycle model were applied to develop a mobile application. A process evaluation that used mixed methods design was conducted within the intervention group after a randomized controlled trial of a complex mobile cooperation intervention. SETTING: The clinical practicum wards of seven hospitals in a hospital district in Finland. PARTICIPANTS: Second-year pre-registration nursing students (N = 52) from one nursing school. METHODS: Process evaluation questionnaires were completed upon completion of the five week intervention and essays were written by the students eleven weeks after the intervention ended. RESULTS: A system usability scale (SUS) assessed the overall usability of the mobile application as rather good (a mean SUS score of 69.86 out of 100). Positive feedback about the mobile application's usability and utility was reported and recommendations for further development were highlighted. The intervention demonstrated high acceptability. In general, the students actively used the mobile application for intervention procedures at home and in the clinical practicum ward. CONCLUSIONS: The findings support the high acceptability of mobile cooperation intervention and its potential while also providing evidence for the development team's future development of the mobile application. Additionally, this study provides an example of mobile application development and process evaluation in nursing education research.

The nurse teacher in clinical practice: developing the new sub-dimension to the Clinical Learning Environment and Supervision (CLES) Scale.

BACKGROUND: Building on previous work undertaken in developing the clinical learning environment and supervision (CLES) scale this report outlines the development of a new sub-dimension to the CLES scale. OBJECTIVES: The aim was to develop an additional sub-scale to the CLES scale for measuring the quality of nurse teacher's co-operation with the crucial actors in the clinical practice of student nurses. DESIGN, SETTING AND METHODS: The original CLES scale and the subsequent CLES+T scale have been validated in two different empirical studies (N=416 and 549). Construct validity of the instrument was assessed with explorative factor analysis (EFA) and principal components analysis (PCA). RESULTS: The structure of the CLES+T scales factor model followed theoretical presumptions and the factors' eigenvalues and explanation percentages (64%) were sufficient. CONCLUSIONS: A validated evaluation tool-the CLES+T scale-can be used as a part of the total quality assessment of nurse education perceived by student nurses in Finland.

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

OBJECTIVE: A methodological type of study was conducted for the purpose of investigating the validity and reliability of the Turkish version of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale of the clinical learning environment of students, clinical nurses, and educators. METHODS: Sample was comprised of 602 Turkish nursing students with clinical practice experience at the hospital. The CLES+T, developed by Saarikoski, was used for data collection. Language equivalency, internal consistency, item-total correlation, and structure validity were conducted within the scope of the validity and reliability study on the CLES +T scale. RESULTS: It was determined that item-total correlations of four items were lower than 0.30, and those items were removed from the scale as a result of item analysis. The Cronbach's alpha value of the scale was 0.93-0.99; item total point correlations of the scale varied between 0.45 and 0.66; six factors were identified in the CLES+T factor analysis study, with a total variance explained by these six factors of 64%. CONCLUSION: According to the findings of the research, the CLES+T Turkish version was found to be a valid and reliable scale, which can be used to evaluate satisfaction of nursing students with their clinical education in Turkey.

Healthcare students' evaluation of the clinical learning environment and supervision - a cross-sectional study.

BACKGROUND: The purpose of clinical placements and supervision is to promote the development of healthcare students´ professional skills. High-quality clinical learning environments and supervision were shown to have significant influence on healthcare students´ professional development. OBJECTIVES: This study aimed to describe healthcare students` evaluation of the clinical learning environment and supervision, and to identify the factors that affect these. DESIGN: The study was performed as a cross-sectional study. METHODS: The data (n = 1973) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale during the academic year 2015-2016 from all healthcare students (N = 2500) who completed their clinical placement at a certain university hospital in Finland. The data were analysed using descriptive statistics and binary logistic regression analysis. RESULTS: More than half of the healthcare students had a named supervisor and supervision was completed as planned. The students evaluated the clinical learning environment and supervision as 'good'. The students´ readiness to recommend the unit to other students and the frequency of separate private unscheduled sessions with the supervisor were the main factors that affect healthcare students` evaluation of the clinical learning environment and supervision. Individualized and goal-oriented supervision in which the student had a named supervisor and where supervision was completed as planned in a positive environment that supported learning had a significant impact on student's learning. CONCLUSIONS: The clinical learning environment and supervision support the development of future healthcare professionals' clinical competence. The supervisory relationship was shown to have a significant effect on the outcomes of students' experiences. We recommend the planning of educational programmes for supervisors of healthcare students for the enhancement of supervisors' pedagogical competencies in supervising students in the clinical practice.

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.

Clinical education and training of student nurses in four moderately new European Union countries: Assessment of students' satisfaction with the learning environment.

Nurses underwent different models of education during various historical periods. The recent decade in Europe has been marked with educational transitions for the nursing profession related to Bologna Declaration and enlargement of the European Union. This paper aims to explore the situation of clinical placements for student nurses and assess students' satisfaction with the learning environment in four relatively new member states of European Union: the Czech Republic, Hungary, Lithuania and Romania. The data for cross-sectional quantitative study were collected during the exploratory phase of EmpNURS Project via a web based questionnaire which utilized a part of Clinical Learning Environment scale (CLES + T). The students evaluated their clinical learning environment mainly positively. The students' utter satisfaction with their clinical placements reached a high level and strongly correlated with the supervisory model. Although the commonest model for supervision was traditional group supervision, the most satisfied students had the experience of individualised supervision. The study gives a picture of the satisfaction of students with the learning environment and, moreover, with clinical placement education of student nurses in four EU countries. The results highlight the individualized supervision model as a crucial factor of students' total satisfaction during their clinical training periods.

Validation of the clinical learning environment and supervision scale.

The aim of the study was to validate a new research instrument to evaluate the quality of the clinical learning environment and the supervision given to nursing students by qualified staff nurses. This paper describes the validation process of the research instrument. Dunn's and Burnett's (1995) CLE scale was chosen for the concurrent research instrument to test validity. The theoretical framework of this study draws on empirical research into clinical learning environments and supervision undertaken during the 1980's and 1990's. The sample consisted of nursing students who had undertaken a clinical placement in a hospital setting. The data (n=416) were collected from four Nursing Colleges in Finland. Students evaluated their clinical placements as being 'good' in both instruments. The supervisory relationship was the most important factor in students' supervisory system but this requires a positive atmosphere and a 'good' leadership in order to be effective. The congruence between the instruments in use was high so that it is impossible to note the possible impact of cultural differences in this instrument validation process.

Factors associated with student learning processes in primary health care units: a questionnaire study.

BACKGROUND: Clinical placement plays a key role in education intended to develop nursing and caregiving skills. Studies of nursing students' clinical learning experiences show that these dimensions affect learning processes: (i) supervisory relationship, (ii) pedagogical atmosphere, (iii) management leadership style, (iv) premises of nursing care on the ward, and (v) nursing teachers' roles. Few empirical studies address the probability of an association between these dimensions and factors such as student (a) motivation, (b) satisfaction with clinical placement, and (c) experiences with professional role models. OBJECTIVE: The study aimed to investigate factors associated with the five dimensions in clinical learning environments within primary health care units. DESIGN AND METHODS: The Swedish version of Clinical Learning Environment, Supervision and Teacher, a validated evaluation scale, was administered to 356 graduating nursing students after four or five weeks clinical placement in primary health care units. Response rate was 84%. Multivariate analysis of variance is determined if the five dimensions are associated with factors a, b, and c above. RESULTS: The analysis revealed a statistically significant association with the five dimensions and two factors: students' motivation and experiences with professional role models. The satisfaction factor had a statistically significant association (effect size was high) with all dimensions; this clearly indicates that students experienced satisfaction. CONCLUSIONS: These questionnaire results show that a good clinical learning experience constitutes a complex whole (totality) that involves several interacting factors. Supervisory relationship and pedagogical atmosphere particularly influenced students' satisfaction and motivation. These results provide valuable decision-support material for clinical education planning, implementation, and management.

Use of mobile devices in nursing student-nurse teacher cooperation during the clinical practicum: an integrative review.

OBJECTIVES: To identify and appraise study findings on the use of mobile devices, in particular for what purposes and how, in nursing student-nurse teacher cooperation during the clinical practicum. DATA SOURCES: A systematic literature search was conducted using the PubMed/Medline, CINAHL, PsycINFO and ERIC for primary empirical studies published in English. REVIEW METHODS: An integrative literature review was undertaken. Quality appraisal of the included studies was conducted using design-specific standardized checklists. Studies were thematically analyzed. RESULTS: Based on the inclusion and exclusion criteria, eleven studies were included in the review. Weaknesses in designs, samples, questionnaires and results, compromised comparison and/or generalization of the findings of the studies. Three main themes were identified: (1) features of mobile devices (2) utility of mobile devices and (3) barriers to the use of mobile devices. Problems of connectivity were the main challenges reported in the use of mobile devices. Participants used mobile devices primarily as reference tools, but less frequently as tools for reflection, assessment or cooperation during the clinical practicum. Interest in mobile device use during the clinical practicum was reported, but training and ongoing support are needed. CONCLUSIONS: As only a small number of eligible primary empirical studies were found, it is not possible to draw firm conclusions on the results. In the future, rigorous primary empirical studies are needed to explore the potential of mobile devices in providing a supplementary pedagogical method in nursing student-nurse teacher cooperation during the clinical practicum. Robust study designs, including experimental ones, are clearly needed to assess the effectiveness of mobile devices in nursing student-nurse teacher cooperation during the clinical practicum.

Development and psychometric testing of the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale (CLES+T): the Spanish version.

BACKGROUND: The Clinical Learning Environment, Supervision and Nurse Teacher scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts. OBJECTIVES: This paper reports the development and psychometric testing of the Spanish version of the Clinical Learning Environment, Supervision and Nurse Teacher scale. DESIGN: Cross-sectional validation study of the scale. SETTING: 10 public and private hospitals in the Alicante area, and the Faculty of Health Sciences (University of Alicante, Spain). PARTICIPANTS: 370 student nurses on clinical placement (January 2011-March 2012). METHODS: The Clinical Learning Environment, Supervision and Nurse Teacher scale was translated using the modified direct translation method. Statistical analyses were performed using PASW Statistics 18 and AMOS 18.0.0 software. A multivariate analysis was conducted in order to assess construct validity. Cronbach's alpha coefficient was used to evaluate instrument reliability. RESULTS: An exploratory factorial analysis identified the five dimensions from the original version, and explained 66.4% of the variance. Confirmatory factor analysis supported the factor structure of the Spanish version of the instrument. Cronbach's alpha coefficient for the scale was .95, ranging from .80 to .97 for the subscales. CONCLUSION: This version of the Clinical Learning Environment, Supervision and Nurse Teacher scale instrument showed acceptable psychometric properties for use as an assessment scale in Spanish-speaking countries.

The clinical learning environment and supervision by staff nurses: developing the instrument.

The aims of this study were (1) to describe students' perceptions of the clinical learning environment and clinical supervision and (2) to develop an evaluation scale by using the empirical results of this study. The data were collected using the Clinical Learning Environment and Supervision instrument (CLES). The instrument was based on the literature review of earlier studies. The derived instrument was tested empirically in a study involving nurse students (N=416) from four nursing colleges in Finland. The results demonstrated that the method of supervision, the number of separate supervision sessions and the psychological content of supervisory contact within a positive ward atmosphere are the most important variables in the students' clinical learning. The results also suggest that ward managers can create the conditions of a positive ward culture and a positive attitude towards students and their learning needs. The construct validity of the instrument was analysed by using exploratory factor analysis. The analysis indicated that the most important factor in the students' clinical learning is the supervisory relationship. The two most important factors constituting a 'good' clinical learning environment are the management style of the ward manager and the premises of nursing on the ward. The results of the factor analysis support the theoretical construction of the clinical learning environment modelled by earlier empirical studies.