A Descriptive Study to Assess the Perception of Clinical Learning Enviroment among the students in selected Nursing Colleges of Metroplitan City
Aparna B. Sankhe
Principal, College of Nursing, J J H, Mumbai.
*Corresponding Author E-mail: endlasrini@gmail.com
ABSTRACT:
Introduction: The clinical learning environment (CLE) is an interactive network of forces within the clinical setting, i.e., staff, the patient, the preceptor, and the nurse educator, that influence the clinical learning outcomes and have impact on student behaviours. Hence, clinical experiences are important for student learning and professional development. Nursing as a profession has evolved in response to society's needs for well-prepared, caring practitioners during clients’ episodes of illness and promote health among all age groups. Clinical education is an essential part of nursing education. It provides students with the opportunity to put the knowledge, skills and concepts they acquire from classes into practice Experience gained in clinical learning environments makes a major contribution to students' professional development by enabling them to think in new ways. The aim of the study is to assess the perception of clinical learning environment among the students in selected nursing colleges. Method: Quantitative, descriptive cross-sectional design was used to evaluate the nursing students' perceptions at college of nursing, sir J J Hospital, Mumbai by using structured questionnaires. Probability simple random lottery method used to select 200 nursing students. Descriptive analysis done with frequency and percentages and fisher exact test used to find out association between between the perception of clinical learning environment among the students with their selected demographic variables. Result: In this study, 88(44%) nursing students were in 21-22 year of age group and majority 106(53%) of the participants were female. 31%Nursing student were studying in third year while 69(34.5%) had clinical experiences 536 to 1702 hours. Perception of clinical environment among nursing students was good 109(54.5%) where 86(43%) having excellent. Discussion: The study showed association between selected demographic year of nursing degree, type of supervision with the perception of clinical learning environment among the students. The nursing students were oriented to unit settings/ wards by clinical instructor/teacher, they felt that they receive individualized supervision and continuous feedback, round clock supervision frequent visit and suggestions of improvement from clinical instructors.
KEYWORDS: Nursing students, Perception, Clinical learning environment.
INTRODUCTION:
Clinical learning is main part of nursing education. Student’s exposure Students exposure to Nursing as a profession has evolved in response to society's needs for well-prepared, caring practitioners during clients’ episodes of illness and promote health among all age groups. Originally taught at the bedside by skilled practitioners, the majority of nurses in Hong Kong received their training from hospital schools of nursing. As the government of the Special Administrative Region of Hong Kong has suspended all hospital schools of nursing in Hong Kong since 2013, nursing education within the region has been completely transferred to tertiary institutions.1 However, nursing students continue to acquire the majority of their clinical experience in hospitals and health care institutions. Most importantly, the role of the student nurse has been reinstated from worker to learner.
Clinical practice, which takes place in the clinical environment, is a vital component in the nursing curriculum and has been acknowledged as central to nursing education. The clinical environment encompasses all that surrounds the student nurse, including the clinical setting, the staff, the patient, the nurse mentor, and the nurse educator. In contrast to traditional classroom settings, clinical practice takes place in a complex social context. A few of these differences are: one has little control of environmental conditions; students must combine the use of cognitive, psychomotor, and affective skills to respond to individual client needs; client safety must be maintained while he or she is cared for by a novice practitioner; and nurse educators must monitor client needs as well as student needs.2
Clinical education has a vital role in nursing curriculum. Clinical education environment can be enhanced by feedbacks provided by students. Clinical education is an essential part of nursing education. It provides students with the opportunity to put the knowledge, skills and concepts they acquire from classes into practice. Experience gained in clinical learning environments makes a major contribution to students' professional development by enabling them to think in new ways.3
A favourable clinical learning environment is critical for favourable learning experiences, and studies on the experiences of students in clinical learning environments have listed the specific factors affecting learning as being instructors However, it is difficult to control clinical environments since they do always involve all these different factors. Consequently, student nurses should be supported in clinical environments, and the role of nurse teachers and nurse mentors is important in providing this support. The most critical individuals for student learning in clinical environment are instructors. Studies have revealed that the relationships between instructors and students have an effect on students' learning experiences.
Positive relationships between instructors and students improve development of problem-solving skills, satisfaction with the clinical environment, clinical performance, increase motivation for learning and decrease anxiety. In addition to this relationship, other studies indicate that student learning is affected by instructors' skills in providing feedback, and by the kind of support and guidance students receive from instructors. Consequently, instructors have an important role to play in creating the appropriate clinical environments for students. Improvements in the clinical environment are, without doubt, only possible through an evaluation of the feedback provided by students about their experiences in the clinical learning environment. Previous studies have not dealt with all the factors in clinical learning environments as a whole.4,5,6,7
Nursing education consists of theory and practice. Clinical learning forms half of the educational experience of students in nursing education. The theoretical part, conducted in classrooms and labs through lectures, case studies, and directive discussions, provide students with opportunities to develop their knowledge, skills, attitudes, and values taught. As complementary, clinical practice assists students in developing clinical knowledge and skills, integrating theory into practice,4,5 get opportunity to gain an insight into the real nurse’s roles and meanwhile expanding their expectations of their future careers.
The clinical learning environment (CLE) is theinteractive network of forces within the clinical setting that influence the students’ clinical learning outcomes, and it also has an impact on students’ internship preparation and satisfaction with the nursing profession. In this new context, students learn how to apply practical skills, also interact with patients and other skills that acquired in the theoretical courses, in addition, considering nurses’ obligation to continue their professional development, their experience regarding CLE and mentoring models have an impact on their decisions and motivation as regards further workplace7. Unlike theory course where student’s learning activities are structured, students in clinical settings are often exposed to unplanned events, such as dealing with challenging patient.
The clinical learning environment is a complex social entity that influences student learning outcomes in the clinical setting. Exploration of this environment gives insight into the educational functioning of the clinical areas and allows nurse teachers to enhance students’ opportunities for learning. Since Cyprus is undergoing major reforms in nursing education, building on the experience and knowledge gained, this study aims to explore the present clinical situation and how this would impact on nursing education moves university. The reformation of the traditional nursing education system and the integration with higher education is suggested to have many advantages as well as complexities like the scepticism whether theory would diminish clinical skills and practice.8
REVIEW OF LITERATURE:
The research scholar has learnt many things from the past literature reviews and started his research study on past background. He summarized the past researches and integrated those research findings which can facilitate him for the present research. Research scholar felt the need to divide the reviewed literature to be divided into various peculiar sections which can best possible lgive the idea about the work of past and present researches. This will allow future researchers to co- relate their research projects and have the future guidelines to put forward their literature review. The clinical environment is a key component in nursing education, aiding students in engaging in authentic practice and enhancing the effectiveness of clinical teaching. Clinical experiences, recognized internationally as an essential component of nursing education, significantly shape both the teaching process and the learning outcomes of students, as evidenced by numerous studies.9,10
Clinical settings offer freedom to withdraw from the study anytime has assured. Students the opportunity to not only develop practical skills but also gain an understanding of the fundamental principles governing healthcare system processes.11,12 In these settings, nursing students typically work alongside a multidisciplinary healthcare team, which underscores the need for strong communication skills essential for professional nursing practice. These environments are conducive to fostering therapeutic communication, thereby nurturing positive and trusting relationships during the training period. Effective communication facilitates essential interactions among students, clinical instructors, nurses, and other healthcare team members, enabling them to work collaboratively toward mutual goals and ensure optimal outcomes.13,14
Clinical instructors are pivotal in fostering the development of students’ professional skills, emphasizing practical skill-building rather than solely theoretical knowledge acquisition The Clinical Teaching Effectiveness Instrument has been established as an effective measure for assessing the performance of clinical educators. This tool is also instrumental in helping healthcare educators effectively assign teaching roles, foster competency development, and deliver impactful feedback for enhancement Glatz et al. (2017)15 and Nursing students, particularly at the onset of their clinical training in hospitals, often experience significant stress. Thus, understanding their perceptions of the effectiveness of the clinical teaching environment is vital to positively influencing their knowledge acquisition, safe training practices, and professional growth. When designing an optimal clinical teaching environment, it is essential to consider various factors, including curriculum objectives, the learning environment, clinical instructor experience, and the individual characteristics of students. Nursing educators need to recognize the importance of exploring these elements through students’ perceptions, which can significantly impact their achievement and performance levels. Conducting these investigations is essential for equipping nursing students with the skills and knowledge needed to seamlessly integrate into healthcare systems at an early stage in their careers. This study also enables educational systems to highlight the effectiveness of clinical teaching environments and conduct further research aimed.16,17,18
Clinical nursing education provides baccalaureate nursing students an opportunity to combine cognitive, psychomotor, and affective skills in the Middle East. The aim of the paper is to assess the satisfaction with and effectiveness of the clinical learning environment among nursing students in Oman. A cross-sectional descriptive design was used. A convenience sample consisting of 310 undergraduate nursing students was selected in a public school of nursing in Oman Ethical approval was obtained from the Research and Ethics Committee, College of Nursing in 2011. A standardized, structured, validated and reliable Clinical Learning Environment Supervision Teacher Evaluation instrument was used. Informed consent was obtained from all the students. Data was analysed with ANOVA and structural equation modelling. Satisfaction with the clinical learning environment (CLE) sub-dimensions was highly significant and had a positive relationship with the total clinical learning environment. In the path model 35% of its total variance of satisfaction with CLE is accounted by leadership style, clinical nurse commitment (variance = 28%), and patient relationships (R (2) = 27%). Higher age, GPA and completion of a number of clinical courses were significant in the satisfaction with the CLE among these students. Nurse educators can improvise clinical learning placements focusing on leadership style, premises of learning and nursing care, nurse teacher, and supervision while integrating student, teacher and environmental factors. Hence the clinical learning environment is integral to students' learning and valuable in providing educational experiences. The CLE model provides information to nurse educators regarding best clinical practices for improving the CLE for BSN students. Baccalaureate nursing; Clinical learning environment; Clinical placement; Nursing education; Structural equation modelling; Student satisfaction; Supervision; Teaching.19,20,21,22 A total of 46 otolaryngology residents across 14 residency training programs (22% resident response rate) completed our survey. Residents who scored above the 80th percentile perceived greater.23,24 support (median = 3.84) than residents who scored below the 40th percentile (median = 3.31), U = 48.00, P = 0.047, η2 =0.14. Residents interested in fellowship reported less burnout (median= 2.44) compared to those who did not plan to pursue fellowship (median = 3.56), U = 105.00, P = 0.010, η2 = 0.05. Residents pursuing fellowship also reported less work-life strain (median = 2.56) than those forgoing fellowship (median = 2.89), U = 126.00, P = 0.044, η2 = 0.10. Residents with children reported greater work-life strain (median = 3.11) compared to those without (median = 2.56), U = 60.50, P = 0.008, η2 = 0.15. For otolaryngology residents in this survey sample, the perception of organizational support and well-being may influence resident performance and ultimate career goals (fellowship applications). Program directors and coordinators can use this information to strengthen the perceptions of organizational support as well as improve the clinical learning environment to optimize training conditions for their residents. Residency program directors can also use the identified study measures to assess resident perceptions of the clinical learning environment and well-being for annual evaluation and improvement purposes. Clinical learning environment; otolaryngology residency training; well-being.24,25,26
Clinical education has a vital role in nursing curriculum. Clinical education environment can be enhanced by feedbacks provided by students. The purpose of this research was to search factors that affect the clinical learning environment. A qualitative approach was used. 36 nursing students were recruited from school of nursing in Turkey. It was found that students are negatively affected by communication errors and feedbacks given in the presence of patients by instructors. The constant presence of instructors may be the source of stress for some students. Besides peer support and favorable communication with peers have a positive impact on student learning. Communication with hospital staff and instructors are important. The study revealed that student learning is affected by the level of confidence and support displayed by patients. In order to ensure the most favorable learning environment for students, it is essential that cooperation should be increased between school staff and clinical staff, instructor skills should be developed, and students should be supported in the clinical environment.27,28,29
OBJECTIVES:
· To find out the perception of clinical learning environment among the students
· To find out association between the perception of clinical learning environment among the students with their selected demographic variables.
Materials and method and study design:
H0: There will be no significant association between learning perception of clinical environment among nursing students with their selected demographic variables.
H1: There will be significant association between learning perception of clinical learning environment among nursing students with their selected demographic variables.
· The perception may differ from Student to student.
· Some students may perceive it negatively or positively.
· Clinical learning environment may be effective subjected to If it is based on principles of organization of learning environment.
1) Duration of research block is limited to one month only.
2) Sample size for research is limited to 200 only.
3) Study is related to nursing students only.
1) Research proposal have approved by the ethical committee at college level.
2) The permission is obtained from the respective authority before data collection.
3) Informed written consent from the students have taken.
Study setting:
College of Nursing, Sir J.J. Group of Hospitals
DURATION OF STUDY - 1 YEAR
SAMPLE SIZE- 200
SAMPLING TECHNIQUES:
· Simple Random Probability Technique
· Lottery Method
Dependent variable—Perception of clinical learning environment
Age, sex, education, qualification, working experience, previously attended sessions.
RELIABILITY:
Test – Re-test Method:
Pilot study were conducted on 10% of sample
1) Study Population: All nursing students studying in nursing colleges.
2) Target population: Nursing students who fulfil the inclusion criteria.
3) Accessible population: Nursing students available at the time of data collection.
INCLUSION CRITERIA:
Nursing students who,
· Attends clinical Rotation
· Willing to participate in this study.
· Available at the time of data collection
Nursing students who were present in the pilot study.
DATA COLLECTION TECHNIQUES:
The phenomenon in which researchers are interested must ultimately be captured and translated into data that can be analyzed without quality data collection method. The accuracy and robustness of the conclusion are subjected to challenge; hence a researcher must often choose from an array of alternative data collection method and approaches.
Section1: Description of samples (nursing students) based on their personal characteristics in terms of frequency and percentage.
Section 2: Analysis of data related to the perception of clinical learning environment among nursing students.
Section 3: Analysis of data related to the association of perception of clinical learning environment among the nursing students with their selected demographic variables.
RESULT:
In this study, 47% were males and 53% of them were females.26% of them were first year students, 25.5% of them were second year students, 31% of them were third year students and 17.5% of them were fourth year students. 8% of them had round a clock supervision, 51% of them had daily supervision, 34% of them had alternate day supervision and 7% of them had weekly supervision. 14.5% of them had equipment available, 42% of them did not have equipment available, 24% of them had equipment frequently available and 19.5% of them had equipment available according to situation.
27% of them had seminar halls available adjacent to ward. 0.5% of the nursing students had poor perception, 2% of them were neutral, 54.5% of them had good perception and 43% of them had excellent perception of clinical learning environment. 62.5% of the nursing students had good perception regarding time, 30.5% of them were neutral, 7% of them had poor perception regarding time of clinical learning environment. 93.5% of the nursing students had good perception regarding activities and 6.5% of them were neutral regarding activities of clinical learning environment.
65% of the nursing students had good perception regarding interest, 32.5% of them were neutral, 2.5% of them had poor perception regarding interest of clinical learning environment.75% of the nursing students had good perception regarding learning, 22.5% of them were neutral, 2.5% of them had poor perception regarding learning of clinical learning environment.
DISCUSSION:
On of the study, 303 students enrolled on the bachelor of nursing programme, there were 43(14%) male and 260 (86%) females among the group with an age range of 18–23 years. Two hundred and eighty one completed actual forms (response rate 92.7%) and 243 preferred forms (response rate 80.2%) were returned. The Cronbach alpha coefficients for each scale questionnaires obtained from the study ranged from 0.50 to 0.80 for the actual form and 0.51 to 0.76 for the preferred form.
RECOMMENDATION:
Other longitudinal study with large population with comparison of first year Bsc nursing and forth year Bsc nursing. Year wise Comparative study also useful to find out expected outcome.
LIMITATIONS:
Perhaps the greatest limitation of this study is that the subjects were nursing students from just one university nursing school in Hong Kong, and thus the findings may not be representative of nursing students in general with respect to their clinical placement. A second limitation is that the findings are limited to the students’ perspective.
CONCLUSION:
The findings of this project help to describe Hong Kong nursing students’ perception of the social climate of the clinical learning environment. It was found that there were significant differences between students’ perceptions of the actual clinical learning environment and the ideal clinical learning environment they desired. Clinical education is a vital component the nursing curriculum yet clinical practice takes place in a complex social context. A supportive clinical learning environment.
FINANCIAL SUPPORT:
Author has been wholly responsible for financial related matter.
CONFLICT OF INTEREST:
The author declares no conflict of interest.
REFERENCES:
1. Jahanpour F, Azodi P, Azodi F, Khansir AA. Barriers to practical learning in the field: a qualitative study of Iranian nursing students’ experiences. Nurs Midwifery Stud. 2016; 5(2):4–6.
2. Mabuda BT, Potgieter E, Alberts UU. Student nurses’ experiences during clinical practice in the Limpopo Province. Curationis. 2008; 31(1): 19–27.
3. Arkan B, Ordin Y, Yılmaz D. Undergraduate nursing students’ experience related to their clinical learning environment and factors affecting their clinical learning process. Nurse Educ Pract. 2018; 29: 127–32. doi:10.1016/j.nepr.2017.12.005.
4. Öhman E, Alinaghizadeh H, Kaila P, Hult H, Nilsson GH, Salminen H. Adaptation and validation of the instrument clinical learning environment and supervision for medical students in primary health care. BMC Med Educ. 2016; 16(1): 308.
5. Jackson D, Mannix J. Clinical nurses as teachers: insights from students of nursing in their first semester of study. J Clin Nurs. 2001; 10(2): 270–7. doi:10.1046/j.1365-2702.2001.00471.x.
6. Dunn SV, Burnett P. The development of a clinical learning environment scale. J Adv Nurs. 1995; 22(6): 1166–73. doi:10.1111/j.1365-2648.1995.tb03119.x.
7. Flott EA, Linden L. The clinical learning environment in nursing education: a concept analysis. J Adv Nurs. 2016; 72(3): 501–13. doi:10.1111/jan.12861.
8. Gardner A, Gardner G, Coyer F, Gosby H. Educating for health service reform: clinical learning, governance and capability—a case study protocol. BMC Nurs. 2016; 15: 32. doi:10.1186/s12912-016-0152-8.
9. Levett-Jones T, Lathlean J, Higgins I, McMillan M. Staff–student relationships and their impact on nursing students' belongingness and learning. J Adv Nurs. 2009; 65(2): 316–24. doi:10.1111/j.1365-2648.2008.04865.
10. Mikkonen K, Tomietto M, Cicolini G, Kaucic BM, Filej B, Riklikiene O, et al. Development and testing of an evidence-based model of mentoring nursing students in clinical practice. Nurse Educ Today. 2020; 85:104272. doi:10.1016
11. Kurt E, Eskimez Z. Examining self-regulated learning of nursing students in clinical practice: a descriptive and cross-sectional study. Nurse Educ Today. 2022; 109: 105242. doi:10.1016/j.nedt.2021.105242.
12. Brown J, Nolan M, Davies S, Nolan J, Keady J. Transforming students' views of gerontological nursing: realising the potential of 'enriched' environments of learning and care: a multi-method longitudinal study. Int J Nurs Stud. 2008; 45(8): 1214–32. doi:10.1016/j.ijnurstu.2007.07.002.
13. Papastavrou E, Dimitriadou M, Tsangari H. Psychometric testing of the Greek version of the clinical learning environment-teacher (CLES+T). Glob J Health Sci. 2015; 8(5): 59–71. doi:10.5539/gjhs.v8n5p59.
14. Pitkänen S, Kääriäinen M, Oikarainen A, Tuomikoski AM, Elo S, Ruotsalainen H, et al. Healthcare students' evaluation of the clinical learning environment and supervision—a cross-sectional study. Nurse Educ Today. 2018; 62: 143–9. doi:10.1016/j.nedt.2017.12.020.
15. Glatz, Kaila P, Ahlner‑Elmqvist M, Leksell J, Isoaho H, Saarikoski M; students' evaluation of the clinical learning environment; Int J Nurs Stud. 2015; 45(8)
16. Soemantri D, Herrera C, Riquelme A. Measuring the educational environment in health professions studies: a systematic review. Med Teach. 2010; 32(12): 947–52. doi:10.3109/0142159X.2010.507709.
17. Saarikoski M, Isoaho H, Warne T, Leino‑Kilpi H. The nurse teacher in clinical practice: developing the new sub‑dimension to the Clinical Learning Environment and Supervision (CLES) scale. Int J Nurs Stud. 2008; 45(8): 1233–7. doi:10.1016/j.ijnurstu.2007.07.009
18. Johansson UB, Kaila P, Ahlner‑Elmqvist M, Leksell J, Isoaho H, Saarikoski M. Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale: psychometric evaluation of the Swedish version. J Adv Nurs. 2010; 66(9): 2085–93. doi:10.1111/j.1365-2648.2010.05370.
19. Chan DSK. Combining qualitative and quantitative methods in assessing hospital learning environments. Int J Nurs Stud. 2001; 38(5).
20. Chan DSK. Associations between student learning outcomes from their clinical placement and their perceptions of the social climate of the clinical learning environment. Int J Nurs Stud. 2002; 39(3)
21. Papp I, Markkanen M, von Bonsdorff M. Clinical environment as a learning environment: student nurses’ perceptions concerning clinical learning experiences. Nurse Educ Today. 2003; 23(4): 262–8. doi:10.1016/S0260-6917(02)00309-1
22. Thorell‑Ekstrand I, Nilsson M, Bendermacher R, Berglund J, Stahlberg I. Nursing students’ experience of care planning activities in clinical education. Nurse Educ Today. 1995; 15(3).
23. Ashworth P, et al. Some ambiguities of the student's role in undergraduate nurse training. J Adv Nurs. 1989; 14(7).
24. Benner PE. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Prentice Hall; 1984.
25. Campbell IE, et al. Learning to nurse in the clinical setting. J Adv Nurs. 1994; 20(2).
26. Chan S. Nursing education reform in Hong Kong—a look at the history. Int J Nurs Stud. 2002; 39(7).
27. Chan DSK. Validation of the Clinical Learning Environment Inventory. West J Nurs Res. 2003; 25(4).
28. Chan DS, et al. Perception of hospital learning environment: a survey of Hong Kong nursing students. Nurse Educ Today. 2007; 27(6).
29. Elcigil A, et al. Determining problems experienced by student nurses in their work with clinical educators in Turkey. Nurse Educ Today. 2007; 27(4).
30. Graneheim UH, et al. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ. Today. 2004; 24(2).
|
Received on 11.08.2025 Revised on 30.08.2025 Accepted on 15.09.2025 Published on 31.10.2025 Available online from November 10, 2025 Int. J. of Advances in Nursing Management. 2025;13(4):247-252. DOI: 10.52711/2454-2652.2025.00045 ©A and V Publications All right reserved
|
|
|
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License. |
|