Instruments evaluating the quality of the clinical learning environment in nursing education: A systematic review of psychometric properties

BackgroundThe clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date.ObjectivesThe aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available.DesignA systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines).Data sourcesThe Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016.Review methodsThe included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used.ResultsThe search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated.ConclusionsClinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement.     

Exploring the observer role and clinical reasoning in simulation: A scoping review

AimThis scoping review aimed to explore nursing students experience as simulation observers and their level of engagement in learning through use of clinical decision-making models and learning scaffolds.BackgroundA gap continues to exist between the published empirical literature, the role and experiences of the simulation observer and teaching scaffolds that enhance learning outcomes, despite the increased understanding of simulation and its role in preparing nursing students for practice. Further, little is known about the nursing student’s experience of clinical reasoning whilst observing simulation and the impact of scaffolding observations using clinical decision-making models.DesignThis scoping review was conducted using the methodological framework of Arksey and O'Malley (2005) and the PRISMA checklist for systematic reviews (Page et al., 2020).MethodsA comprehensive search of the literature published in Medline and CINAHL databases between 1999 and 2020 was undertaken in May 2019. The studies selected for this review (n = 18) were analyzed thematically. The validated Mixed-Methods Appraisal Tool assessed quality of the quantitative, qualitative and mixed methods studies.ResultsThe role of the observer in simulation was explored and included observation to transform practice in self and observation to transform practice in others, namely peers in the nurse role in simulation. Application of the MMAT indicated that of the 18 studies included only 6 (33.3%) had a clear research question. Research aims or objectives were found in another six studies (33.3%). In this review 13 studies (72%) included answers to the research question or aim, three (17%) did not and in two (11%) it was impossible to tell.ConclusionsResults of this review indicate the paucity of research relating to nursing student’s experience of clinical reasoning while observing simulation. Further, it highlights the value of nurse educators optimizing the observer role and maximizing learning by scaffolding observer activities within the simulation experience.     

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.     

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.     

Belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment: A scoping review

AimThe aim of this scoping review was to map the literature investigating belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment.BackgroundThe concept of belongingness, which encompasses feelings of acceptance, connection and value alignment, has been tied to positive outcomes in undergraduate/pre-licensure nursing students including increased learning, participation, confidence and professional socialization. It is critical for educators and clinical staff to foster a sense of belongingness for nursing students to promote positive and effective clinical learning experiences.DesignThe scoping review strategy established by the Joanna Briggs Institute was followed. The databases searched were CINAHL Complete (EBSCO), Education Source, Medline Complete (EBSCO), APA PsycINFO (EBSCO) and Epistemonikos.MethodsFollowing a search of the five databases, studies were screened by title and abstract by two independent reviewers for inclusion. Data including population, concept, context, methods and key findings relevant to the review question were extracted and synthesized using an instrument developed by the reviewers.ResultsA total of 47 articles with varying methodologies were critically appraised. Three overarching focus areas emerged: outcomes resulting from feelings of belongingness versus alienation, factors that contribute to a sense of belongingness in the clinical learning environment and interventions to promote a sense of belongingness while students are immersed in the clinical learning environment.ConclusionsBelongingness in the clinical learning environment is an important concept that lends itself to positive learning experiences and increased satisfaction of undergraduate/pre-licensure nursing students. Environmental, relational and experiential factors can be maximized and specific interventions employed to promote belongingness. This review identifies a lack of evidence on measured interventional effectiveness at the student, school and clinical unit level. Future research to address these gaps is recommended.Tweetable abstractScoping review suggests environmental, relational and experiential factors promote positive outcomes in belongingness of nursing students.     

Nursing students' assessment of the learning environment in different clinical settings

IntroductionNursing students perform their clinical practice in different types of clinical settings. The clinical learning environment is important for students to be able to achieve desired learning outcomes. Knowledge is lacking about the learning environment in different clinical settings.AimThe aim was to compare the learning environment in different clinical settings from the perspective of the nursing students.DesignA cross-sectional study with comparative design was conducted.MethodData was collected from 185 nursing students at three universities by means of a questionnaire involving the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) evaluation scale. An open-ended question was added in order to ascertain reasons for dissatisfaction with the clinical placement.ResultsThe nursing students' satisfaction with the placement did not differ between clinical settings. However, those with clinical placement in hospital departments agreed more strongly that sufficient meaningful learning situations occurred and that learning situations were multi-dimensional. Some students reported that the character of the clinical setting made it difficult to achieve the learning objectives.ConclusionIn the planning of the clinical placement, attention must be paid to whether the setting offers the student a meaningful learning situation where the appropriate learning outcome may be achieved.     

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.     

Measurement properties of patient-reported hand function measures in rheumatoid arthritis: a systematic review protocol

Background: Patient-reported outcome measures (PROMs) are commonly used to evaluate hand function in people with rheumatoid arthritis (RA). A decision will always need to be made about which appropriate PROMs to use. The present review therefore aims to describe the available hand function PROMs for use in people with RA by appraising their methodological quality and psychometric properties using a contemporaneous method.

Methods/design: The proposed systematic review will include published studies written in English, which report evidence for psychometric properties and/or practical properties of hand function PROMs in RA. Four major databases (MEDLINE, Embase, PsycINFO, and CINAHL) will be searched from inception to May 2019. A three-staged search strategy will be applied: (1) electronic bibliographic databases for published studies, (2) ‘named measures’ searching approach, and (3) reference lists of studies with included PROMs. The proposed systematic review will be conducted in compliance with the consensus-based standards for the selection of health measurement instruments (COSMIN) guideline for systematic review of PROMs. Accordingly, the methodological quality of the included studies will be assessed against the updated COSMIN risk of bias checklist, and each study’s results will be assessed for their psychometric quality.

Conclusion: The proposed systematic review seeks to provide rigour, and transparent evaluation of PROMs used to evaluate hand function in the RA population. The findings will provide clarity for healthcare professionals and researchers on the appropriate PROMs for hand function assessment. It will also provide a summary of hand function PROM recommendations for RA.     

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.     

Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review

ObjectiveTo conduct a systematic review to appraise and review evidence on the impact of simulation-based education for undergraduate/pre-licensure nursing students, using existing reviews of literature.DesignAn umbrella review (review of reviews).Data SourcesCumulative Index of Nursing and Allied Health Literature (CINAHLPlus), PubMed, and Google Scholar.Study SelectionReviews of literature conducted between 2010 and 2015 regarding simulation-based education for pre-licensure nursing students.Data ExtractionThe Joanna Briggs Institute methodology for conduct of an umbrella review was used to inform the review process.Results of Data SynthesisTwenty-five systematic reviews of literature were included, of which 14 were recent (2013–2015). Most described the level of evidence of component studies as a mix of experimental and quasi-experimental designs. The reviews measured around 14 different main outcome variables, thus limiting the number of primary studies that each individual review could pool to appraise. Many reviews agreed on the key learning outcome of knowledge acquisition, although no overall quantitative effect was derived. Three of four high-quality reviews found that simulation supported psychomotor development; a fourth found too few high quality studies to make a statistical comparison. Simulation statistically improved self-efficacy in pretest-posttest studies, and in experimental designs self-efficacy was superior to that of other teaching methods; lower level research designs limiting further comparison. The reviews commonly reported strong student satisfaction with simulation education and some reported improved confidence and/or critical thinking.ConclusionThis umbrella review took a global view of 25 reviews of simulation research in nursing education, comprising over 700 primary studies. To discern overall outcomes across reviews, statistical comparison of quantitative results (effect size) must be the key comparator. Simulation-based education contributes to students' learning in a number of ways when integrated into pre-licensure nursing curricula. Overall, use of a constellation of instruments and a lack of high quality study designs mean that there are still some gaps in evidence of effects that need to be addressed.     

Electronic Patient-Reported Outcome Measures Evaluating Cancer Symptoms: A Systematic Review

ObjectivesThis systematic review aims to evaluate the psychometric properties and the methodologic quality of studies describing smartphone-, tablet- or computer-based questionnaires for Patient-Reported Outcome Measures (PROM) evaluating symptoms in oncology and hematology patients.Data SourcesA literature search was conducted in PubMed, Scopus, Cochrane, Cinahl, Cuiden, Lilacs, and PsycINFO. Criteria for inclusion were (i) primary studies evaluating scales for symptoms assessment, (ii) developed in adult population (>18 years) with an oncology or hematology malignancy diagnosis, (iii) validations tested via phone or computer, and (iv) describing at least one psychometric property. The exclusion criteria were (i) tools diagnosing any type of cancer and (ii) case series, surveys, and audits. The outcome variables were internal consistency, test-retest reliability, measurement error, content validity, structural validity, hypothesis testing, cross-cultural validity, and responsiveness. For the evaluation of the quality of methodology, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used.ConclusionThe present study gathered five tools in 12 articles to evaluate cancer symptoms through smartphone, tablet, or computer format. Although four were generic, one was specific for breast cancer. Although none of the tools had been fully validated, some of the items of the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) were successfully tested for content, reliability, construct validity, and responsiveness.Implications for Nursing PracticeOur results can guide professionals choosing symptoms assessment instruments when performing telepractice, and they raise awareness of using with precaution scales not intended for remote use.     

An integrative literature review of pre-registration nursing students’ attitudes and perceptions towards primary healthcare

BackgroundThere is a renewed focus on the role of primary healthcare within the health system due to an ageing population, increasing cost of acute healthcare services, and an emphasis on developing healthier communities. Associated with this focus is the need for an increase in primary healthcare workforce capacity. Despite this, primary healthcare is rarely prioritised within the pre-registration nursing curricula. By understanding the perspectives and experiences of student nurses regarding clinical placement in primary healthcare, educators and industry will be better informed to support the student nurse within this setting.AimThe aim of this integrative literature review was to identify the established knowledge regarding the attitudes, perceptions and experiences of student nurses attending clinical placement within primary healthcare.MethodsA search of electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Pubmed, Proquest, Informit, Scopus, Clinical Key and Google Scholar was undertaken. The review included papers over a 10 year period; January 2007 to December 2017. Quality evaluation was undertaken using a Mixed Methods Appraisal Tool and the selected papers were then analysed thematically.FindingsAnalysis identified two interrelated themes. The first theme primary healthcare clinical experience is comprised of three sub themes; learning on placement, context of care, and support on placement. This theme discusses students understanding of primary healthcare practice and learning. The second theme attitudes towards primary healthcare also comprises three sub themes including focus on acute care, usefulness of placement, and autonomy in practice. This theme highlights the varied perspectives and attitudes pre-registration student nurses hold towards nursing within primary healthcare and their clinical placement experience.ConclusionStudent nurses are reported to have both positive and negative attitudes towards primary healthcare nursing. Despite this, clinical placement within primary healthcare is generally well received by the student nurse. To support student nurses in their learning within primary healthcare, it is essential to offer both theoretical content and clinical experiences which address preconceptions and attitudes towards the setting.     

Impact of experiential dementia care learning on knowledge,skills and attitudes of nursing students: A systematic literature review

AimThe aim of this systematic review was to synthesize evidence on the effect of clinical experiential learning approaches on pre-licensure nursing students' competence in dementia care and to identify associated challenges.BackgroundAs the prevalence of dementia increases, nurse educators must proactively prepare pre-licensure nursing students to care for people living with dementia. The limited number of physical clinical learning settings, especially during the current COVID-19 pandemic, has caused many nursing programs to use alternative experiential learning approaches.DesignSystematic Literature ReviewMethodsIn accordance with PRISMA guidelines, we conducted a systematic search for the literature in Cumulative Index to Nursing and Allied Health Literature, MEDLINE and ProQuest for relevant peer-reviewed studies published between 2010 and 2021. Using the Boolean operator search approach, the keyword "dementia care" was combined with "AND/OR" and other search terms. In addition, a descendent and an ascendent search were conducted to find other relevant studies.ResultsA total of 17 retrieved articles met the inclusion criteria. Five themes emerged, with the main findings being that face-to-face (in person), virtual and simulated experiential learning approaches increased pre-licensure nursing students' dementia care knowledge. However, the face-to-face experiential learning approach that provides physical contact with people living with dementia and clinical staff had more impact on their skills and attitudes.ConclusionThe evidence in this review could inform curriculum development, teaching methods, experiential learning experiences and clinical placements of pre-licensure nursing students with regards to dementia care. More research is needed to explore further the impact of virtual and simulated experiential learning approaches on pre-licensure nursing students' dementia care skills.Tweetable abstractThis systematic literature review synthesizes evidence of clinical experiential learning on prelicensure nursing students' competence in dementia care per PRISMA guidelines. Five themes emerged #dementia #experientiallearning #prelicensurenursingstudents #clinicalsducation     

Perceived clinical constraints in the nurse student–instructor interactions: A qualitative study

Effective student–instructor interactions impact the quality of nursing clinical education. There are a myriad of different factors related to clinical settings that affect these interactions and they have received less attention in nursing studies. Identifying clinical constraints that impact the nursing student–instructor relationships will help nursing instructors to manage clinical learning situations in a more effective manner.ObjectiveThe goal of this study was to identify the primary factors that influence the student–instructor interactions within clinical settings.MethodsA purposeful sampling strategy was applied to recruit 18 nursing students and instructors to participate in qualitative, semi-structured interviews. In order to identify relevant themes of transcribed interviews, qualitative content analysis was utilized.ResultsData analysis resulted in the development of five main themes that represent essential interaction constraints in clinical contexts. These themes include: outsiders' eyes, dominance of act, close contact, clinical workplaces' disputes, and instability and uncertainty.ConclusionsThe results of this study can serve to improve the understanding and practice of international clinical nursing instructors within the clinical education context. The behaviors that emerged were based on clinical constrains and an awareness each can serve to enhance the instructor–student relationship.