Abstract

Clinical placement is a vital part of nursing students’ education. The clinical learning environments consider the first place of professional practice for nurses and student opinion contribute to its improvement. The aim of the current study was to assess nursing student's level of satisfaction with their clinical learning environment. A descriptive, cross sectional research design was used. A convenient sample of 400 nursing students enrolled from Faculty of Nursing. This study was conducted at the Faculty of Nursing, Menoufia University. Clinical Learning Environment Inventory (CLEI) used to measure nursing student's satisfaction with their clinical learning environments. The mean score of the total CLEI scale was 118.90 (54.86) which indicate a medium level of satisfaction. The satisfaction subscale perceived by the nursing students as the most important domain 23.68(9.98) of clinical learning environment. While, the least important domain perceived by nursing students was individualization subscale 14.42 (7.87). Nursing students have a medium level of satisfaction with their clinical learning environments. Assessment of nursing student's level of satisfaction plays an important role in the education process, thus it is necessary to assess the learning environment from different perceptions. Collaboration between the nursing educational institutions and health care agencies is essential to ensure the availability of effective clinical learning environment, which meet the needs of undergraduate nursing students.

1. Introduction

The clinical learning environment is important in facilitating students to achieve their learning outcomes. Learning transferring in the clinical context needs an encouraging clinical learning environment ¹. It has been suggested that student learning outcomes from clinical practice can be improved by adjusting the clinical environment to assemble their expressed needs. It is important to understand students’ satisfaction with their clinical learning environment in order to maximize their learning experience ².

The atmosphere of the clinical learning environment includes the clinical setting, the staff and the patients. ³. Students on clinical setting are exposed to unexpected learning experiences and activities where they engage directly with patients and other health care professionals. When the students enter the unfamiliar area of the clinical setting, the atmosphere of this particular setting can have enduring influences on their learning experience ⁴.

The clinical learning environment can have a great influence in the development of the attitude, knowledge, skills, and problem solving ability of students who engage into this situation ^{5, 6}. Clinical learning environment plays a crucial role, especially during the clinical training of student nurses, as they face the reality of their function ⁷.

Clinical experience and satisfaction are factors that affect nursing student attribution. Assessing student's satisfaction with their clinical experience is essential for nursing faculty to enhance educational performance ⁸.

It is important that, clinical learning environments to meet the student's satisfaction and expectations especially with the presence of critical shortage of fieldwork placement experiences ⁹. As the time allocation for the clinical component of nurse education is limited so the clinical time needs to be used efficiently. The outcomes of clinical field placement may be improved through matching the student's satisfactions and their clinical learning environment ¹⁰. Despite the studies of the characteristic of a good learning environment has been in progress since the late 1970s ^{11, 12}, healthcare organizations and nursing educators are still challenged with the question of what comprise a good learning environment for students and new graduates. Thus, this study aimed to examine nursing student's satisfaction with their clinical learning environments.

Clinical Learning Environment: is theoretically defined as "a complex network of forces that are effective on clinical learning outcomes and includes everything that surrounds the nursing students, including the clinical setting, the staff and the patients" ⁶. In the present study, student's satisfaction of the clinical learning environment is defined as the obtained individual score on the Clinical Learning Environment Inventory ¹³.

The aim of the current study was to assess nursing student's level of satisfaction with their clinical learning environments.

To what extent nursing students are satisfied with their clinical learning environment?

2. Methods

A descriptive, cross sectional research design was used.

The current study was conducted at the Faculty of Nursing, Menoufia University, Shebin EL-Kome, Menoufia Governrat, Egypt.

A convenient sample of 400 nursing students enrolled from Faculty of Nursing, Menoufia University. Students who finished at least two clinical rotations in hospital were recruiting. Students were excluded if did not exposed to clinical training.

(1) Socio- demographic data such as age, gender as well as the experience of clinical setting.

(2) Clinical Learning Environment Inventory (CLEI) ¹³. It is a self-report instrument consisting of 42 positively and negatively worded items. The scale was developed to examine nursing students’ satisfaction of their clinical learning environment in six psychosocial aspects ¹³. The items were classified into six subscales: personalization subscale (7 items); student involvement subscale (7 items); task orientation subscale (6 items); innovation subscale (7 items); satisfaction subscale (7 items) and individualization subscale (4 items). Responses to each item are marked on a Five- point Likert- type scale with the response options (5- strongly agree, 4- agree, 3- uncertain, 4- disagree and 5- strongly disagree). To calculate mean scores, the scores on negative items were reversed. The total score ranged from 38 to 190. Higher scores on each subscale indicate high satisfaction level. Reliability of the total CLEI is reported in study of one hundred eight preregistration nursing students ¹⁴ in which the Cronbach’s alpha was 0.95 for the total scale. In the present study, the reliability of the scale was tested and a Cronbach's alpha of 0.97 for the total scale was reported.

An offical permission was obtained from the Faculty of Nursing Dean. Also, an approval from the Reasearch Committee at the Faculty of Nursing was obtained. An oral consent was obtained from the students to participate in the study. The participants were given a brief explanation of the study purpose. The students were informed that their participation is voluntary and they have the right to refuse to participate in the study and assured that their responses will be confidential and will be used only for a research purpose.

A pilot study was conducted on 10% (40 students) of the study sample to test the practicality and applicability of the questionnaire and to estimate the time needed to fill in the questionnaire. Students who participated in the pilot study were excluded from the final analysis of the sample.

3. Results

Characteristics of the sample: The mean age of the participanting students was 19.92 ±0.92.The participants age range from 18 years to 21 years old. The majourity of the participants 69.8% were female and 30.2% were male. Regarding the area of clinical experience , 33.8% had experience in general medical area, 33.2% had expirience in general surgery area and 33% had experience in intensive care unites. See Table 1.

Table 2 illustrates the nursing student’s satisfaction level with their clinical learning environment and the mean and stander deviation of clinical learning environment inventory subscales. The mean score of the total scale was 118.90 (SD= 54.86) which indicate high satisfaction level. The participating nursing students rated the satisfaction subscale as the most important domain with a mean score of 23.68(SD=9.98) while they rated the Individualization subscale as the least important domain with a mean scores of 14.42 (SD= 7.87).

Table 3 represents ranking of the highest five items of the clinical learning environment as perceived by the participating nursing students. The clinical teacher helps the students who is having trouble with work 4.57 (SD = 1.04); the clinical teacher goes out of his/her way to help students 4.56 (SD = 1.01); the clinical teacher consider students feelings 4.36 (SD = 1.33), students look forward to coming to clinical placement 4.29 (SD = 1.55) and work load allocation in this ward is carefully planned 4.21 (SD = 1.38).

Table 4 represents the ranking of the lowest five items of clinical learning environment as perceived by the participating nursing students. The clinical placement is boring 2.01 (SD = 1.32); the clinical teacher talks rather than listens to the students 2.02 (SD = 1.36); the clinical placement is a waste of time 2.04 (SD = 1.63); the clinical teacher is not interested in students’ problems 2.06 (SD = 1.43) and the clinical teacher is unfriendly and inconsiderate towards students 2.10 (SD = 1.47).

4. Discussion

The clinical learning environment considers the initial area of professional practice for nurses and student opinion contributes to its improvement ⁸. The clinical education is beneficial in preparing today novice nursing students to become tomorrow health care providers.

The findings of the current study revealed that the participating nursing students are satisfied with their clinical learning environment. Similar findings have been reported by O'Mara, et al., ¹⁵, who assessed the nursing student’s experiences and satisfaction toward their clinical learning environment and found good satisfaction level. Also, The findings of the present study are similar to what was reported by Sundler, et al., ^{16, 17} whom examined nursing students’ satisfaction with their clinical learning environment and found that, the total mean score of CLEI was more than medium which indicate good satisfaction.

The study findings revealed that the satisfaction subscale was found to be the most important domain and the individualization subscale was found to be the least important domain. The satisfaction subscale refers to the extent of enjoyment of clinical placement and the feeling of actually achieving advancements in their clinical practice. The individualization subscale refers to the extent to which students are allowed to make decisions and are treated differently according to ability or interest. Similar findings had been reported by Williams et al., ¹⁷ who explored how 60 paramedic students at an Australian university perceived their clinical learning environment to determine the students’ actual and preferred perception of their clinical learning environment and found that satisfaction subscale was found to be the most important domain while individualization subscale was found to be the least important domain. It was surprising that individualization subscale scored the lowest important domain in both studies, because in health care setting emphasis is on the physical ability of students to perform their roles in the clinical setting. ¹⁸. A possible explanation of these findings may be due to the large number of students comparing to the number of clinical educators in the hospital and this is a consequence of the shortage in the nursing educators.

Also, the findings of the current study are similar to what was reported by Sundler, et al., ¹⁶ who assesses student nurses' experiences of the clinical learning environment in 175 nursing students after finishing the clinical areas and found that the satisfaction subscale was the most important domain and the individualization subscale was the least important domain.

However, the study findings are different from what was reported by Dale,et al., ^{5, 19} whom assessed factors that facilitate good clinical learning experiences in nursing students and found that the task orientation subscale was the most important domain of the CLEI. A possible explanation of the study findings may be due to that the nursing students preferred their clinical activities to be clear and organized because detail instructions facilitate active involvement of students in the ward activities and have a direct impact on clients’ wellbeing.

The findings of the current study indicated that the participating nursing students rated the highest five items of the clinical learning environment inventory as the following: 1) the clinical teacher helps the students who are having trouble with work; 2) the clinical teacher goes out of his/her way to help students; 3) the clinical teacher consider students feelings; 4) students look forward to coming to the clinical placement and 5) Workload allocation in this ward is carefully planned. These findings are similar to what was reported by Serena and Anna ²⁰ who examined the Italian nursing students’ satisfaction of their clinical learning environment in 232 students from three different levels at the nursing program in Trento Hospital and found that the highest five items of the clinical learning environment inventory rated by the Italian nursing students were similar to what was reported by our nursing students.

Whereas, the findings of the current study indicated that the participating nursing students rated the lowest five items of the clinical learning environment inventory as the following: 1) the clinical placement is boring; 2) the clinical teacher talks rather than listens to the students; 3) the clinical placement is a waste of time; 4) the clinical teacher is not interested in students’ problems and 5) the clinical teacher is unfriendly and inconsiderate towards students. Similar findings have been reported by Watson, et al., ²¹ who conducted a clinical trial in China and Finland to investigate the nursing satisfaction impression in different clinical learning environments in 857 nursing students and found that the Chinas nursing students rated the same five items as the lowest items.

Limitations of the Study:

(1) The results of the study are limited in their generalization because of the convenience sample. The lack of random sampling may contribute to sample selection bias and limits the generalization of the findings.

(2) One of the limitations of the current study was that the participants were selected from one nursing school in Menoufia. Therefore, the sample is not representative of all nursing students in other universities. Accordingly, the findings of the current study should be taken cautiously.

5. Conclusions

Careful understanding of students’ satisfaction of their clinical learning environments are essential for securing the required teaching and learning process. The findings of the current study help to assess nursing student's satisfaction with their clinical learning environments.

6. Recommendations

(1) The findings of the current study revealed that the participating nursing students rated the individualization subscale as the lowest domain. This subscale extent t to which students are allowed to make decisions and are treated differently according to their ability and interest. Thus, encouraging nursing educators to adapt the student-centeredness strategy will be beneficial to enhance student’s learning experience in the clinical settings.

(2) Collaboration between the nursing institutions and health care agencies is essential to assemble nursing student's satisfaction with their clinical learning environments.

(3) Future research is needed to study the best practice approaches of the way in which nurse educators and students’ learning can facilitate effective clinical learning environments.

References