Combining qualitative and quantitative methods in assessing hospital learning environments

Clinical education is a vital component in the curricula of pre-registration nursing courses and provides student nurses with the opportunity to combine cognitive, psychomotor, and affective skills. Clinical practice enables the student to develop competencies in the application of knowledge, skills, and attitudes to clinical field situations. It is, therefore, vital that the valuable clinical time be utilised effectively and productively. Nursing students' perception of the hospital learning environment were assessed by combining quantitative and qualitative approaches. The Clinical Learning Environment Inventory, based on the theoretical framework of learning environment studies, was developed and validated. The quantitative and qualitative findings reinforced each other. It was found that there were significant differences in students' perceptions of the actual clinical learning environment and their preferred learning environment. Generally, students preferred a more positive and favourable clinical environment than they perceived as being actually present.     

The relationship between student learning outcomes from their clinical placement and their perceptions of the social climate of the clinical learning environment

RATIONALE: Clinical learning is an integral part of nursing education; yet, clinical education has been problematic. Various studies have suggested that not all practice settings are able to provide nursing students with a positive learning environment. In order to maximize nursing students' clinical learning outcomes, there is a need to examine the clinical learning environment. AIM: To investigate the relationship between student learning outcomes from their clinical placement and their perceptions of the social climate of the clinical learning environment. METHOD: The Clinical Learning Environment Inventory was used to collect data in the survey study. Returning of the completed questionnaires implied consent to participate. The final sample group consisted of 108 second-year nursing students undertaking clinical placement in 14 metropolitan hospitals in South Australia. RESULTS: Findings from the study suggested that students' perceptions of the outcomes of their clinical placement are strongly associated with allfive scales of the CLEI namely; Individualisation, Innovation, Involvement, Personalisation and Task Orientation. It is interesting to note that students who perceived the outcomes of their clinical placement as greatly positive, have placed high expectations on the scale, Task Orientation. The study also found that there were significant differences between students' perceptions of the actual clinical learning environment with their preferred clinical learning environment. IMPLICATIONS: The value of this study lies in the resulting implication for nursing education and future research. A better understanding of what constitutes quality clinical education from the students' perspective would be valuable in providing better educational experiences.     

Validation of the Clinical Learning Environment Inventory

One hundred eight preregistration nursing students took part in this survey study, which assessed their perceptions of the clinical learning environment. Statistical data based on the sample confirmed the reliability and validity of the Clinical Learning Environment Inventory (CLEI), which was developed using the concept of classroom learning environment studies. The study also found that there were significant differences between students' actual and preferred perceptions of the clinical learning environments. In terms of the CLEI scales, students preferred a more positive and favorable clinical environment than they perceived as being actually present. The achievement of certain outcomes of clinical field placements might be enhanced by attempting to change the actual clinical environment in ways that make it more congruent with that preferred by the students.     

Associations between student learning outcomes from their clinical placement and their perceptions of the social climate of the clinical learning environment

The aim of this study was to investigate the associations between student learning outcomes from their clinical placement and their perceptions of the social climate of the clinical learning environment. The Clinical Learning Environment Inventory (CLEI) was used to collect data. The final sample group consisted of 108 second-year nursing students undertaking clinical placement in 14 metropolitan hospitals in South Australia.Findings from the study suggested that students' perceptions of the outcomes of their clinical placement are strongly associated with all five scales of the CLEI namely; Individualisation, Innovation, Involvement, Personalisation and Task Orientation. It is interesting to note that student who perceived the outcomes of their clinical placement as greatly positive, have placed high expectations on the scale, Task Orientation. The study also found that there were significant differences between students' perceptions of the actual clinical learning environment with their preferred clinical learning environment.The value of this study lies in the resulting implication for nursing education and future research. A better understanding of what constitutes quality clinical education from the students' perspective would be valuable in providing better educational experiences.     

The use of learning contracts in mental health nursing clinical placement: an action research

This paper examines the implementation of learning contracts with a cohort of undergraduate nursing students in Hong Kong during a mental health nursing clinical placement. An action learning approach was used by the researchers. Data collection methods included questionnaires and semi-structured interviews. Results showed that students' autonomy and motivation in clinical learning increased through the use of learning contracts. There was more sharing between students and teachers and the quality of teaching and learning was improved. The report concludes that contract learning should be integrated into the curriculum of nurse education as a learning strategy for nursing students.     

The effectiveness of shared clinical teaching in nursing

AimClinical learning is a critical component of a nursing curriculum. Student satisfaction in clinical environment is crucial to foster a positive learning experience. Faculty shortages have made clinical teaching more challenging; as such, alternate models of clinical teaching must be explored by nursing programs. The purpose of this study was to measure the perception of student satisfaction in regard to the effectiveness of shared clinical teaching in nursing.MethodsUtilizing Chan's Clinical Learning Environment Inventory (CLEI), this quantitative comparative study examined nursing students' preferred and actual clinical learning environment. The CLEI contains 42 questions in six subscales: Individualization, Innovation, Involvement, Personalization, Task Orientation, and Satisfaction in both the actual and preferred clinical learning environment. The sample consisted of 202 nursing students in two groups: the first group had 91 students who experienced shared clinical teaching with two faculty, whereas the second group had 111 students who experienced the traditional, single faculty model. The results were analyzed using independent sample T-tests.ResultsThe preferred learning environment was rated highest in all six subscales. Scores of the Satisfaction subscale and the Innovation subscale for Actual Learning Environment, and the score of the Innovation subscale for Preferred Learning Environment of students experiencing shared clinical teaching with two faculty were higher than the scores of students experiencing traditional, single faculty model, with statistically significance (P＜0.05).ConclusionThe results indicated students preferred the shared clinical teaching model with two faculty over the single faculty model. Nursing programs can utilize this model and apply these results to develop and maintain quality clinical teaching.     

Implementing contract learning in a clinical context: report on a study

This paper reports on a study of the implementation and evaluation of learning contracts in a clinical context for a group of students who were in their third year of study in a pre-registration bachelor of nursing degree programme in Hong Kong. A learning contract was implemented as a learning tool in the students' clinical placement in mental health nursing. An action research approach was used in this study. Data were collected from questionnaires and interviews with students and clinical instructors. Results showed that students and clinical instructors generally agreed that there was an increase in students' autonomy and motivation in learning with the use of a learning contract. It also increased the sharing between students and clinical instructors. The findings of the questionnaire and interviews supported each other. However, the lack of experience in using contract learning and the limited time in the clinical areas created difficulties for both students and clinical instructors. Despite the limitations, contract learning is considered beneficial to students' learning and has the potential to be used in clinical learning.     

Professional nursing values among baccalaureate nursing students in Hong Kong

The development of a nursing code of professional conduct is to guide nurses to make appropriate clinical decision, in particular when facing ethical dilemma. It is of paramount importance that nurse educators understand baccalaureate nursing students' perceptions of the importance of the code of professional conduct and the level of difficulties in implementing this code while preparing them for future practicing nurses. The Code of Professional Conduct in Hong Kong has been developed to guide nursing practice for over two decades. Nevertheless, no study has examined Hong Kong baccalaureate nursing students' perception about this professional code. The aim of this paper was to examine the perceptions of 263 baccalaureate nursing students about this professional code using a cross sectional survey design. The results indicated that most items in the professional code were rated as important and "provide safe and competent care" was rated as the most important one. A few areas that the students perceived as difficult to implement were discussed and future research was recommended. The significant differences identified among students from different years of study also highlighted areas for consideration in planning educational program to further equip students with the ability to deal with challenges in professional practice.     

护理伦理学与问题为导向学习

21世纪的高等教育改革,着重培养学生的批判性思维能力和国际视野。日新月异的医疗及生物科技,为人类健康带来无限希望的同时,也引发了对于生命伦理的争议。专业医护人员要面对应否使用和如何使用生物科技来提供医疗服务的伦理决策。在科技发达国家,如美国、日本等国把培养伦理思辨能力作为医护课程必修的一门学科。本文论述如何在护理本科伦理的教学中应用问题为导向学习(Problembasedlearning,PBL)。分别介绍了PBL的特点,护理伦理学的PBL课程设计,以及如何通过PBL活动开拓学生的国际视野及培养他们的伦理判断能力。     

粤港澳大湾区护理本科临床实践教学现状及启示

目的 比较粤港澳大湾区护理本科实践教学的优势与不足,为湾区内护理本科实践教学改革提供参考。方法 采用网络资料调查法、文献分析法与访谈法对粤港澳大湾区10所全日制护理本科院校实践教学体系进行横向比较。结果 广东高校与香港高校分别参照国标、香港护士管理局规定设立培养目标,澳门无统一标准;港澳高校较注重临床实践教学,实践课程设置体现了循序渐进的教学理念;澳门临床师资准入标准明确,具有相对完善的临床教学架构;港澳实习基地注重与社会的联系,重视学生国际视野的培养,广东高校临床资源丰富,实习护生承载量大;港澳高校实践方法与评价方式的运用始终服务于人才培养目标的实现。结论 港澳高校实践教学设置值得广东高校商榷与借鉴,三地应加强合作与交流,促进三地高等护理教育深度融合与发展。     

Development of an innovative tool to assess hospital learning environments

Nursing as a profession has evolved in response to societal needs for well-prepared practitioners who provide quality care to the needed in episodes of illness, and promote health among all age groups. Clinical practice enables the student to develop competencies in the application of knowledge, skills, and attitudes to clinical field situations. The clinical learning environment is a multidimensional entity with a complex social context. Previous research on clinical learning environment was examined, yet minimal studies have been conducted on hospital learning environments from the psychosocial educational perspective. With the mission to maximize nursing students' clinical learning experiences, the author developed and validated the Clinical Learning Environment Inventory (CLEI) based on the theoretical framework in psychosocial education. It is envisaged that this tool will assist the nurse professional to facilitate nursing students to achieve a productive clinical practice. This paper highlights the need and details the conceptual framework in the development of the CLEI. Although it is not presented as a research based paper, some statistical data are included to verify the reliability and validity of the newly-developed instrument.     

Development of the Clinical Learning Environment Inventory: using the theoretical framework of learning environment studies to assess nursing students' perceptions of the hospital as a learning environment

Clinical learning is an integral part of nursing education; yet, clinical education has been problematic. Why are some clinical experiences better than others? Various studies have indicated that not all practice settings are able to provide student nurses with a positive learning environment. The clinical learning environment is a multidimensional entity with a complex social context. Classroom learning environment research based on psychosocial educational conceptual frameworks has been well established in the past 30 years, with evidential benefits. Previous research on clinical learning environment was examined. However, minimal studies have been conducted on hospital learning environments from the psychosocial educational perspective. To maximize nursing students' clinical learning experiences, the author developed the Clinical Learning Environment Inventory based on the theoretical framework in psychosocial education.     

Nursing students' perceptions of learning in practice environments: a review

Effective clinical learning requires integration of nursing students into ward activities, staff engagement to address individual student learning needs, and innovative teaching approaches. Assessing characteristics of practice environments can provide useful insights for development. This study identified predominant features of clinical learning environments from nursing students' perspectives across studies using the same measure in different countries over the last decade. Six studies, from three different countries, using the Clinical Leaning Environment Inventory (CLEI) were reviewed. Studies explored consistent trends about learning environment. Students rated sense of task accomplishment high. Affiliation also rated highly though was influenced by models of care. Feedback measuring whether students' individual needs and views were accommodated consistently rated lower. Across different countries students report similar perceptions about learning environments. Clinical learning environments are most effective in promoting safe practice and are inclusive of student learners, but not readily open to innovation and challenges to routine practices.     

护理大专生临床实习环境与专业自我概念的相关性研究

目的了解护理大专生临床实习环境与专业自我概念现状,探讨二者之间的相关性。方法采用一般资料调查表、护理临床实习环境评价量表、护理专业自我概念量表对214名护理大专生进行问卷调查。结果护理大专生临床实习环境总分(118.08±17.27)分,处于较满意水平;护理专业自我概念总均分为(13.23±1.61)分,处于较积极水平;护理大专生临床实习环境与专业自我概念呈正相关(P0.01或P0.05)。结论临床实习环境对于专业自我概念具有正向预测作用,改善护理大专生客观临床实习环境,有助于提高其专业自我概念。     

Evaluation of an innovative nursing exchange programme: health counselling skills and cultural awareness

BACKGROUND: In 2006, a two-week summer exchange programme was conducted for nursing students from 15 institutes and/or universities, including places in Taiwan, Macau, Chinese mainland and Hong Kong. AIM: This paper evaluates a summer exchange programme focusing on nursing students' professional and personal development within the context of learning health counselling skills and studying cultural aspects of the host Region. METHOD: The programme was evaluated using a mixed method of both quantitative and qualitative research design. Three dimensions include students' exchange perspective, professional development and personal development were evaluated at the end of the two-week programme. Data for this evaluation were derived from the results of questionnaires completed by the 64 nursing students enrolled in this programme, and from the analysis of five focus group interviews. FINDINGS: Overall, students (98%) reported that they were very positive about their experiences during the programme, and felt they had gained a greater awareness of effective health counselling skills, of the latest developments in advanced nursing technology within the host School, and of cultural diversity in relation to their personal and professional development. Comparison of sub-total mean scores and standard deviations (mean+/-SD) of the three dimensions among students from Taiwan, Chinese mainland and Hong Kong/Macau, revealing significant differences in the exchange perspective (Taiwan: 18.6+/-1.4; Chinese mainland: 18.8+/-1.4; and Hong Kong/Macau: 16.5+/-1.1) professional development (Taiwan: 18.4+/-1.6; Chinese mainland: 18.2+/-1.5; and Hong Kong/Macau: 16.2+/-2.0) and personal development dimensions (Taiwan: 18.9+/-1.0; Chinese mainland: 18.6+/-1.4; and Hong Kong/Macau: 17.3+/-1.1) among these three places (p<0.001). For paired comparison (post-hoc test), the findings also show that the sub-total mean scores of the students from Taiwan and Chinese mainland were significantly higher than those of students from Hong Kong and Macau in the exchange perspective (Taiwan versus Hong Kong/Macau, p<0.001; Chinese mainland versus Hong Kong/Macau, p<0.001), professional development (Taiwan versus Hong Kong/Macau, p=0.001; Chinese mainland versus Hong Kong/Macau, p<0.001), and personal development (Taiwan versus Hong Kong/Macau, p<0.001; Chinese mainland versus Hong Kong/Macau, p=0.002). CONCLUSION: Although the findings cannot be generalized, the programme evaluation highlights the positive impact on one's exchange perspective and professional and personal development of a culturally integrated exchange programme for nursing students, with emphasis on skill practices and cultural diversity.     

Nursing students' anxiety and clinical performance

This study examined how mood states affect nursing students' performance on a treatment procedure consisting of a novel combination of familiar clinical steps. Thirty third-year and fourth-year nursing students were first taught the procedure and then given both an anxious-mood and a calm-mood induction in a randomly assigned counterbalanced order. Anxiety was induced by showing a video of interviews with frontline nurses and doctors during the severe acute respiratory syndrome epidemic in Hong Kong, China; calmness was induced by a video of a nursing student's pleasant orientation to a clinical placement site. Nursing students were significantly less proficient in performing the newly acquired procedure after an anxious-mood induction (focused on occupational risks) than after a calm-mood induction. Therefore, managing clinical training site anxiety among nursing students may help to optimize learning and clinical performance.     

Development and testing of a Clinical Learning Environment Diagnostic Inventory for baccalaureate nursing students

Aim. This paper reports the development and testing of the psychometric properties of the Clinical Learning Environment Diagnostic Inventory for baccalaureate nursing students. Background. The quality of the clinical learning environment is an essential factor in determining the quality of nursing students' clinical experience. It is also well-recognized that the clinical setting can be a source of stress and anxiety for students. To design an optimal clinical learning environment for students, instruments based on the cognitive and socio-emotional aspects of the learning process are necessary. Method. The hypothetical construct of the clinical learning environment was derived from a comprehensive review of the literature, including experiential learning theory and the epistemology of practice. Developing the instrument involved the collection of items through semi-structured interviews, assessing content validity and determining the scaling. After a pilot study, the instrument was tested with 312 undergraduate students and 157 preceptors between September and December 2004. The factor structure was determined by exploratory factor analysis. Results. Exploratory factor analysis produced a five-factor solution that was similar to the hypothetical model. Cronbach's alpha internal consistency reliability coefficients ranged from 0.65 to 0.77 across the five factors. Three-week test-retest reliability coefficients ranged from 0.59 to 0.74. Criterion-related validity and construct validity were estimated by the correlation between the Clinical Learning Environment Diagnostic Inventory and appropriate other instruments and a set of comparison data obtained from the students and preceptors. Conclusion. The findings yielded acceptable estimates of reliability and validity of the Clinical Learning Environment Diagnostic Inventory. Therefore, this instrument is considered useful for assessing learning environments in clinical settings.     

Clinical education: a challenging component of undergraduate nursing education

Clinical education is an essential part of every undergraduate nursing curriculum. The main benefits are that it allows students to put theory into practice and experience the realities of the practice-based nursing profession. Limitations include the unstable nature of the clinical area as a learning environment and the challenges this produces with students' assessments. This article reviews the literature and concludes there is room for significant improvement in the area of clinical education and numerous strategies can be implemented to do so.