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

ObjectivesThe 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 sourcesMedline, CINAHL and Cochrane databasesReview methodsDatabases 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.ResultsAn 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.ConclusionsInstruments 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.     

Clinical learning environment,supervision and nurse teacher (CLES+T) scale: Translation and validation of the Arabic version

AimThis study aimed to translate the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale into Arabic and to evaluate its psychometric properties in the context of Morocco.BackgroundThe CLES + T scale is internationally valid and reliable instrument used to evaluate the quality of the clinical learning environment for students in the health professions.DesignTranscultural validation studyMethodsThe present study was carried out between March and May 2019 at two public nursing education institutions in Morocco. The sample included 1550 undergraduate students enrolled in the first, second and third year of nursing, midwifery and health-techniques degree program and who have just completed a course of clinical practicum in hospital ward or primary healthcare settings. The CLES + T scale was translated into Arabic and back-translated. Internal consistency reliability and construct validity using exploratory and confirmatory factor analysis were conducted.ResultsThe CLES+T scale showed alpha coefficients ranging from 0.71 to 0.92 and the five factors identified explained 55% of the variance, with “Role of nurse teacher” and “Supervisory relationship” as the two main factors explaining 41% of the variance. Confirmatory factor analysis approved the factor structure of the Arabic version of the instrument.ConclusionThe Arabic version of CLES+T displayed suitable psychometric properties for using it in evaluating the quality of clinical learning environment of nursing students in Morocco and likely in other Arabic speaking countries.     

Quality Assessment of Neonatal Pain Scales Translated and Validated to Brazilian Portuguese: A Systematic Review of Psychometric Properties

ObjectivesThe objective of this systematic review was to identify and describe the psychometric properties of neonatal pain scales that were translated into Brazilian Portuguese and to verify the methodological quality of these translation, transcultural adaptations and validation.DesignThe present study is a systematic review. A systematic search in the literature included studies of development, validation, and transcultural adaptation of neonatal pain scales to Brazilian Portuguese. The instruments must have been developed for health care professionals to evaluate neonatal pain and stress in full-term and preterm newborns.Data SourcesThe search strategy was conducted in PubMed, Web of Science, Scopus, and Scielo databases following The PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).Review /Analysis MethodsA total of 1,479 publications were identified and 5 fulfilled the inclusion criteria, with 4 instruments evaluated. For the methodological quality analysis of the measurement properties of the instruments the Consensus-based Standards for Health Measurement Instruments (COSMIN) Risk of Bias checklist was used. The psychometric properties verified were internal consistency, content validity, reliability, and construct validity.ResultsThree instruments reviewed were inadequate and one was doubtful.ConclusionsThe neonatal pain scales wich were cross culturally adapted to Brazilian Portuguese were shown to be of low methodological quality based on COSMIM checklist. Caution should be considered for clinical decisions about pain management judgment coming from these instruments.     

Health care students experience of using digital technology in patient care: A scoping review of the literature

ObjectivesTo explore how undergraduate health care students use digital technology to deliver patient care during their clinical placements.DesignA scoping review of primary research was conducted using the extended PRISMA guidelines.Data sourcesA subject specialist librarian assisted in searching for the academic literature in four electronic databases: CINAHL, PubMed, Scopus and ERIC.Review methodsFour reviewers, working in pairs, independently reviewed a total of 332 potentially relevant articles according to set inclusion and exclusion criteria. Then, all included papers underwent an independent quality review by two reviewers.ResultsSeven studies involving medical or nursing/midwifery students were included in the review. Three studies evaluated the use of mobile learning devices in patient care with four studies evaluating the use of digital systems in practice. Due to the heterogeneity of studies, which used differing digital systems and instruments, the researchers decided the most suitable method of analysis was a narrative review. The results are explained using four key themes: student learning needs when using technology in practice; access to technology in placements; perceptions of using technology in placements; and impact of technology on patient care.ConclusionThe use of digital systems in clinical settings creates challenges and benefits to student learning in delivering patient care. When students are prepared and facilitated to use digital systems, a sense of confidence and belonging to the team is fostered. Lack of availability and access to these systems, however, may impede students’ ability to be involved in all aspects of patient care. Limitations of the current review included the relatively low quality of the educational research being conducted in this field of research. Further quality research is needed to explore how students in the health care professions are supported in digital environments and how higher education institutions are adapting their curricula to meet the digital learning needs of health care students.     

Improving clinical experiences for nursing students in nursing homes: An integrative literature review

Well-organized clinical placements in older adult care settings will prepare nursing students to provide care for this growing population and may influence career choices. The purpose of this integrative review is to identify strategies that can be used to provide student nurses with effective clinical education experiences in residential aged care facilities offering skilled nursing (RACF-SNs). Twenty-three studies evaluating teaching and learning models and experiences were reviewed. Four themes were identified related to effective strategies for providing gerontological clinical education to students in residential aged care environments, principally nursing homes. These were: developing a partnership, comprehensive orientation, effective supervision for students, and supporting staff. Eight different models were described for enhancing clinical learning experiences in these environments. These models reflect the themes highlighted in the review. Relevance of the findings to a conceptual framework for evaluating gerontological clinical placements, the Senses Framework, is considered. Strong partnerships between schools of nursing and residential aged care environments can provide well-organized clinical education to undergraduate nursing students. To be sustainable, these partnerships must be developed in ways that do not require significant additional resources. A guideline for this process based on findings of the review has been developed.     

Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review

AimThe aim is to explore literature on the influence of the clinical learning environment on caring behaviors of undergraduate nursing students.BackgroundCaring is a fundamental aspect of nursing practice. However, factors of and in clinical learning environment that help shape the caring behaviors of nursing students as part of their education journey remain understudied.DesignA modified version of Cooper’s five-stage integrative review method was used.MethodsFour databases (Cumulative Index of Nursing and Allied Health, PubMed, Scopus and Embase) were searched for research studies published from 2011 to 2021 in peer reviewed journals, written in English and addressing caring behaviors among nursing students in the clinical learning environment. A combination of keywords with Boolean operators was used including: “nursing students OR nursing undergraduates OR student nurses” and “clinical learning environment” AND “caring behaviors”. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsEmpirical evidence was drawn from 11 studies including seven qualitative designs, three quantitative designs and one mixed method design. The results of this review suggest that factors in the clinical learning environment influence nursing students’ ability to develop caring behaviors. Specifically, the five themes of: [1] role modeling of clinical faculty and professional nurses, [2] creating a conducive clinical learning environment, [3] effective communication skills, [4] positive effect of simulation and [5] alternative clinical placements may facilitate the development of caring behaviors among nursing students.ConclusionThe findings highlight the factors in the clinical learning environment that influence nursing students’ caring behaviors. Improving students’ clinical learning experiences and implementing more effective role modeling and teaching strategies may advance their caring abilities. The information generated from this review provides evidence on how to enhance the clinical learning environment to develop students’ caring behaviors, subsequently leading to more optimal patient outcomes.     

Psychometric evaluation of undergraduate student nurses' learning perceived needs in disaster nursing: Two cross-sectional studies

BackgroundDisaster nursing education is a necessity for nurses and students to improve their disaster relief competencies. Determining undergraduate student nurses' learning perceived needs for disaster nursing can help improve curricula construction. In China there is currently no valid instrument available for the evaluation of influencing factors. A disaster nursing course content system was developed using the Delphi method in 2011. However, this system was unformed and lacked psychometric evaluation.ObjectivesTo adapt the disaster nursing course content system into an instrument, to evaluate its psychometric properties, and to investigate undergraduate student nurses' learning perceived needs for disaster nursing.Design, settings and participantsTwo cross-sectional studies were conducted in public higher education institutions in China. In the first study, a total of 1714 undergraduate student nurses were recruited in May to October 2016; in the second study, 68 were recruited in May 2019.MethodsThe instrument was adapted through literature review, face validity and pilot testing in preliminary studies. The construct validity and reliability of the instrument were tested using exploratory factor analysis, parallel analysis, confirmatory factor analysis, internal consistency reliability and test-retest reliability.ResultsThe exploratory factor analysis and parallel analysis extracted a three-factor solution comprising 19 items that accounted for 71.69% of the total variance, including discipline introduction, skills and knowledge in disaster relief, and disaster management. The fit indices indicated a good fit. The internal consistency and test-retest reliability was good, as indicated by a Cronbach's alpha of 0.89 and an intraclass correlation coefficient of 0.87.ConclusionThe Learning Needs for Disaster Nursing questionnaire exhibited good psychometric properties, thereby proving itself a valuable instrument for evaluating learning perceived needs in undergraduate student nurses.     

Patients’ involvement in nursing students’ clinical education: A scoping review

BackgroundActual contacts with patients are crucial in developing the skills that students need when working with patients. Patients are accustomed to the presence of students. The concept of learning from patients has emerged recently, shifting the focus from learning from professionals as role models to the relationship between the student and patient.AimWith focus on patients’ perspective in clinical practice placements, this scoping review aims to review and summarize the existing empirical literature regarding patients’ involvement in nursing students’ clinical education.Design and methodA broad search without time limitations was performed in the databases CINAHL, Medline, PsycINFO and ERIC. A manual search was also performed. Only empirical studies describing aspects of patient involvement in nursing education from the patient’s perspective were taken into account. Thirty-two studies published from 1985 to June 2016 met the selection criteria and were analysed using inductive content analysis.ResultsThe perspective of real patients focused on their role in students’ learning and assessment processes. In general, patients appreciated the opportunity to contribute to a student’s learning process and thus enhance the quality of patient care. However, the patients’ approaches varied from active to passive participants, comprising active participants contributing to students’ learning, followers of care and advice, and learning platforms with whom students practiced their skills. Some patients perceived themselves as active participants who facilitated students’ learning by sharing knowledge and experience about their own care and wellbeing as well as assessed students’ performance by providing encouraging feedback.ConclusionThe state and degrees of patient involvement in nursing students’ clinical education were made explicit by the literature reviewed. However, the number of studies examining the involvement of real patients in students’ education in clinical settings is very limited. To understand this untapped resource better and to promote its full realization, recommendations for nursing education and future research are made.     

Nursing students’ perceived stress and clinical learning experience

BackgroundStressors among nursing students arise from both academic activities and clinical placement. Understanding how nursing students perceive academic and clinical stressors and the clinical learning environment could help develop useful approaches to reducing levels of stress and contribute to the maintenance of a good learning environment. There is a paucity of studies that investigated associations between the clinical learning environment and the stress of nursing students.ObjectivesTo investigate the relationship between the perception of the clinical learning environment and stress in nursing students; to compare the perception of the clinical learning environment and stress in terms of the year and terms of the organization of supervision.DesignCross-sectional correlation studySettingsUniversityParticipantsThe sample consisted of 155 nursing students in the bachelor's degree program. During the four academic years, students of individual years of the bachelor's study program were included in the study after completing all clinical placements in a given academic year.MethodsThe following instruments were used for the data collection: Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, Perceived Stress Scale; Physio-Psycho-Social Response Scale and Coping Behaviour Inventory. Correlation analysis and multiple linear regression analysis using stepwise methods were used to determine the relationships between the variables.ResultsThe clinical learning environment is a strong predictor of students' perceptions of stress related to teachers and nursing staff. Types and degrees of stressful events during clinical practice varied between years of study. The experience with supervision was related to the overall perception of the clinical learning environment, but not to the students' physio-psychosocial status, types of stressful events during clinical practice and coping behaviors. Also, the differences in the students' physio-psychosocial status were not significant in terms of individual years of study and method of supervision.ConclusionsThere is a significant relationship between the clinical learning environment and the perception of academic stress. The attitude of the teacher and the medical staff can thus be important in influencing the level of stress in nursing students.     

A model (CMBP) for collaboration between university college and nursing practice to promote research utilization in students' clinical placements: A pilot study

BackgroundA collaborative project was initiated in Norway between a university college and a hospital in order to improve RNs' and nursing students' research utilization in clinical placements. This paper describes the model (CMBP) that was developed, its first application, and evaluation.AimThe evaluation aimed at describing nurses' and students' experiences of the CMBP related to collaboration, facilitation, learning, and impact on nursing care.MethodsThirty-eight students from the second and third year of nursing education, and four nurses answered questionnaires with closed and open ended questions. In addition two of the nurses wrote diaries. Data were subjected to qualitative and quantitative analysis.FindingsAlmost all participants reported that collaboration between nursing college and nursing practice had been beneficial. Most students and all nurses reported about valuable learning, increased understanding of research utilization, and improved quality of nursing care. Both students and RNs recommended the CMBP to be used in all clinical placements to support academic learning and increase research utilization in clinical practice.ConclusionDespite study limitations the findings indicate that the CMBP has a potential to be a useful model for teaching RNs' and students EBP. However, further refinement of the model is needed, followed by a more comprehensive implementation and evaluation.     

The nursing critical thinking in clinical practice questionnaire for nursing students: A psychometric evaluation study

AimTo adapt and validate the N-CT-4 Practice for use with Spanish nursing students.BackgroundPromoting critical thinking is one of the primary objectives of nursing education programs all over the world. Using reliable and valid instruments to measure critical thinking is essential. The Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice) is used internationally to assess critical thinking in nursing practice. However, little is known about the possible applications of this instrument in the context of nursing education.MethodsTwo-phase study: Phase I, adaptation of the N-CT-4 Practice for use with nursing students and verification of its content validity; phase 2, cross-sectional study to validate its psychometric properties in a sample of 331 nursing students from three university nursing schools. A subsample of 34 students completed the questionnaire on two occasions, with a time interval of two weeks. The construct validity and reliability of the instrument were tested using confirmatory factor analysis, convergent validity, internal consistency reliability and test-retest reliability. The STROBE guidelines and the COSMIN checklist were followed.ResultsAll items obtained optimal content validity values. The model fit indices obtained from the confirmatory factor analysis supported the hypothesis of the four-dimensional structure on which the original questionnaire was based. Cronbach's alpha of 0.96 indicated high reliability. The correlations between the total score and the scores for the dimensions were statistically significant, positive and high, with values above r = 0.78 (p < 0.05). Lin's concordance correlation coefficient was 0.6 (p < 0.001).ConclusionsThe adapted version of the N-CT-4 Practice is suitable for measuring critical thinking skills in the educational context of the degree course in nursing in Spain. Its psychometric validation yielded satisfactory results.     

Nursing students' lived experience of a clinical placement in prison healthcare: A systematic review

AimA systematic review of the literature to explore nursing students’ lived experience of a clinical placement in a healthcare setting in a prison, to identify how and if their needs were met to enable an optimal learning environmentBackgroundThere is an increasing demand for clinical placements to support undergraduate/prelicense nurse education, especially within primary and community healthcare settings. A clinical placement in a prison has the potential to provide multiple learning opportunities for nursing students due to the unique requirements of prisoners. However, there remains a need to understand nursing students’ experiences of a clinical placement in a prison.MethodsThe updated PRISMA guidelines for reporting systematic reviews guided the development of this study. Inclusion and exclusion criteria informed the search strategy of recognised MeSH terms and Boolean operators, which were applied to search CINAHL complete, APA Psycinfo, MEDLINE, Google Scholar and Grey Open. Manual searching of the reference lists of all identified studies was completed. Standardised critical appraisal instruments were applied to each included study. Data extraction and analysis was completed by adhering to the thematic analysis process described by Thomas and Harden.ResultsThe electronic database and reference list search identified 81 studies published between January 2000 and December 2021 in the English language, which was reduced to the inclusion of five studies. Following screening, studies were completed in USA (n = 2), Australia (n = 1), Canada (n = 1) and UK (n = 1). A total of 228 nursing students had completed a clinical placement in prison. Four themes were identified: 1) pre-placement anxiety; 2) a sense of safety; 3) impact on negative stereotypes; and 4) an opportunity for learningConclusionThe voluntary and opt-in nature of clinical placements in prison may have created some bias in the results. However, standardised preparation and orientation of nursing students prior to commencing a clinical placement in prison is essential. Nursing students require structured support to understand their anxieties, the rules and regulations of security and how to interact with prisoners prior to entering a prison. Clinical placements within prison provide nursing students with an opportunity to challenge negative attitudes towards diverse and marginalised populations, develop clinical practice, knowledge and become socialised into the profession. However, the experience, knowledge and willingness of Registered Nurses to support nursing students is essential, to enable and empower their learning within this non-traditional clinical placement.Tweetable abstractOn completion of a placement in prison healthcare nursing students identified pre-placement anxiety, a sense of safety, impact on negative stereotypes and an opportunity for learning, however, the need for preparation, orientation and realistic understanding of safety remains.     

Accommodating and supporting students with disability in the context of nursing clinical placements: A collaborative action research

Aim/objectiveTo examine issues and challenges encountered by university and clinical milieus in addressing the needs of students with disability during their clinical placements; and to identify existing or potential accommodation and support measures to address the challenges encountered.BackgroundThe influx of students with learning disabilities, attention deficit disorder [with or without hyperactivity], mental health disorders or on the autism spectrum has caused an increase in the number of students with disabilities of more than 900% in universities in the past decade. This increase is causing added pressures to both the academic services providing student assistance and the personnel responsible for these students’ clinical placements. While several studies have focused on measures designed to accommodate students with disabilities during their theoretical courses, only a small number worldwide have focused on student accommodation and support in the context of clinical placements. In the current paper, strategies highlighted in these studies were grouped under three categories: prior, during and post clinical placements.DesignCollaborative action research conducted amidst three learning communities.MethodsThe larger study included learning communities from three disciplines: education, social work and nursing. Three tools helped guide the discussions: 1) brainstorming and classification tool; 2) contribution and feasibility tool; and 3) carrousel tool. The current study focusses solely on the findings from the five meetings of the nursing learning community (n = 14 participants).ResultsSix categories of challenges were documented: 1) Poor writing skills; 2) Difficulty adapting to clinical milieus; 3) Difficulty linking theory with practice and setting priorities; 4) Difficulty managing specific and situational needs; 5) Issues with interpersonal skills and overall attitude; and 6) Challenges pertaining to students’ professional responsibility to disclose their condition. Several accommodation and support measures were identified for each set of challenges and were also grouped under three categories: prior, during and post clinical placements.ConclusionsOur study revealed that the issues identified could in fact be faced by any students, albeit their impact and complexity increased considerably when dealing with students with disability. It brought to light that the implementation of some of the measures identified will require changes to the structure of nursing programs. It also highlighted the ever-growing complexity of the clinical instructor role and the fact that clinical instructors do not always feel adequately prepared to support students with disability.     

Improving the quality of nursing students' clinical placements in nursing homes: An evaluation study

The aim of this study was to explore students' experiences during their clinical placements in five nursing homes after implementing measures to improve the learning environment.It is vital to stimulate more future nurses to consider a career within geriatric wards and nursing homes. One way to achieve this, is to enhance nursing students' learning experiences during clinical placements in these settings.Measures to improve the learning environment were implemented as a result of a joint effort between a university college and five nursing homes. An explorative design was developed to collect empirical data concerning the students' experiences expressed through questionnaires and logs.The results generally conveyed more positive than negative experiences. Students expressed most satisfaction with peer collaboration, the placement's contribution to awareness of future nursing role and described the learning arena as exciting and interesting. They expressed less satisfaction with supervision from preceptor and how the practice site was prepared for and organized students' placements.Clinical placement arenas and educational institutions should collaborate closely to explore and develop models of supervision appropriate for the nursing home context, to build on existing potentials and resolve the issues that represent barriers for creating interesting and effective learning environments.     

Testing the validity and reliability of the Arabic version of the Disaster Response Self-Efficacy Scale among Saudi nursing students

AimThe study tested the validity and reliability of the “Disaster Response Self-Efficacy Scale” Arabic version (DRSES-A) among Saudi nursing students.BackgroundDisaster self-efficacy is one such factor of increasing interest. Little research has explored disaster response self-efficacy despite growing evidence on disaster response preparedness in Saudi Arabia. A systematic, standardized and valid instrument is needed to assess disaster self-efficacy in the Saudi context. The DRSES is one of the tools with excellent psychometric properties that can evaluate the nursing students’ perceived self-efficacy in disaster preparation, mitigation and response.DesignThis investigation is a quantitative methodological design testing the validity and reliability of the DRSES-A.MethodIn this study, 290 Saudi nursing students were surveyed from May to June 2021 in the three government universities in Saudi Arabia using the convenience sampling technique. The Disaster Response Self-Efficacy Scale underwent a linguistic adaptation following a forward-backward translation method. Construct validity was established using the principal component analysis to extract the components of DRSES-A.ResultThe overall mean of the DRSES-A was 3.41 (SD = 0.75). The overall Cronbach alpha was 0.939. The subscales "Onsite rescue" and "Psychological nursing" had a similar alpha of 0.911, while "Role quality and adaptation" had a computed alpha of 0.878. The expert rated all item content validity index as 1 with an average score content validity index of 1. The principal component analysis supported a three-factor DRSES-A.ConclusionThe DRSES-A is a valid and reliable scale that can measure Arabic-speaking baccalaureate nursing students' self-reported disaster response self-efficacy.     

Nursing degree students’ clinical placement experiences in Australia: A survey design

AimThis study aimed to evaluate Australian nursing students’ views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET).BackgroundClinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences.DesignA survey design was used with a contemporary survey tool– the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed.MethodsA total of 1263 nursing students completed the Placement Evaluation Tool (PET) − 19 items (rated 1–5), one global rating (rated 1–10) − following placement in three Australian States (July 2019−February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall.ResultsThe total PET mean score was 78.3% with 29.8% being ‘extremely satisfied’ (10 out of 10 – Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle.ConclusionsWhilst students’ clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.     

Measurement properties of self-report physical activity assessment tools for patients with stroke: a systematic review

BackgroundIndividuals with stroke demonstrate low levels of physical activity. Self-report measures of physical activity are frequently used and the choice of the best one to use for each purpose and context should take into account the measurement properties of these instruments.ObjectiveTo summarize the measurement properties and clinical utility of self-report measures of physical activity of post-stroke subjects and to evaluate both the methodological quality of the studies and the quality of the measurement properties.MethodsSearches were made in MEDLINE, EMBASE, PEDro, LILACS, and SCIELO. Two reviewers independently screened studies that investigated measurement properties or clinical utility of self-report measures of physical activity in post-stroke subjects. The studies’ methodological quality, quality of the measurement properties, and clinical utility were evaluated.ResultsFrom the 11,826 identified studies, 19 were included. Six self-report tools were evaluated: The Activity card sort, Coded activity diary, Frenchay activities index (FAI), Human activity profile (HAP), Multimedia activity recall for children and adults, and the Nottingham leisure questionnaire. The methodological quality of the studies ranged from “poor” to “good”. Most of the results regarding the quality of the measurement properties were doubtful. None of the self-report tools had their content validity investigated. The FAI and HAP showed the highest clinical utility scores.ConclusionsContent validity needs to be better investigated to determine if the instruments actually measure the physical activity domain. Further studies with good methodological quality are required to assist clinicians and researchers in selecting the best instrument to measure physical activity levels.     

Reliability and validity of the simulation learning effectiveness inventory

BackgroundInstruments developed to measure simulation learning outcomes need evidence of their reliability and validity for rigorous research. The purpose of this paper is to report psychometric properties of the English version of the Simulation Learning Effectiveness Inventory.MethodsPsychometric properties of the English version of the Simulation Learning Effectiveness Inventory, which included internal consistency reliability and construct validity with factor analysis, were examined in a sample of 132 undergraduate nursing students.ResultsCronbach's alpha coefficients were >0.70 for all subscales. There was evidence of convergent, discriminant, and known-group validity. The factor analysis resulted in some items being associated with different subscales than in the original Chinese version.ConclusionsThe English version of the Simulation Learning Effectiveness Inventory has evidence of reliability and validity. Additional psychometric studies may result in changes in some of the subscales.