A comparison of the most used instruments to assess the quality of clinical learning environments of nursing students

Abstract

A clinical learning environment (CLE) promotes the development of professional competences, of critical and diagnostic reasoning in future nurses, thus the continuous assessment of its quality is pivotal. To describe and compare the most used instruments to measure the nursing students' perception of the quality of CLEs. Six validated questionnaires were identified and compared: CLE (Clinical Learning Environment), CLEDI (Clinical Learning Environment Diagnostic Inventory), SECEE (Student Evaluation of Clinical Education Environment), CLEI (Clinical Learning Environment Inventory), CLES (Clinical Learning Environment and Supervision), CLES+T (Clinical Learning Environment and Supervision plus Teacher nurse). The following elements were described: conceptual framework, psychometric properties, dimensions explored, the more relevant constructs able to guarantee a high quality CLE: relations between students and ward staff; level of involvement of nurse coordinators; inclusion of the student in the ward team, ward climate, involvement of clinical teacher and feedback to the students. The only instrument that explores all the relevant constructs is the CLES+T. The involvement of clinical nurse teacher and nurse coordinator are the less explored dimensions. The questionnaires CLEI, CLES and CLES+T, validated in Italian and used in several learning environments share the following weaknesses: do not assess the feedback offered to the students, the students' satisfaction for the tutoring strategies and the role of different professionals in the students' learning. The analysis of strengths and weaknesses is the basis to start from to devise and validate a new questionnaire.