Clinical Learning Environment and Supervision. Development and Validation of the CLES Evaluation Scale

The purpose of the study is: (1) to describe how nursing students' experienced their clinical learning environment and the supervision given by staff nurses working in hospital settings; and (2) to develop and test an evaluation scale of Clinical Learning Environment and Supervision (CLES). The study has been carried out in different phases. The pilot study (n=163) explored the association between the characteristics of a ward and its evaluation as a learning environment by students. The second version of research instrument (which was developed by the results of this pilot study) were tested by an expert panel (n=9 nurse teachers) and test-retest group formed by student nurses (n=38). After this evaluative phase, the CLES was formed as the basic research instrument for this study and it was tested with the Finnish main sample (n=416). In this phase, a concurrent validity instrument (Dunn & Burnett 1995) was used to confirm the validation process of CLES. The international comparative study was made by comparing the Finnish main sample with a British sample (n=142). The international comparative study was necessary for two reasons. In the instrument developing process, there is a need to test the new instrument in some other nursing culture. Other reason for comparative international study is the reflecting the impact of open employment markets in the European Union (EU) on the need to evaluate and to integrate EU health care educational systems. The results showed that the individualised supervision system is the most used supervision model and the supervisory relationship with personal mentor is the most meaningful single element of supervision evaluated by nursing students. The ward atmosphere and the management style of ward manager are the most important environmental factors of the clinical ward. The study integrates two theoretical elements - learning environment and supervision - in developing a preliminary theoretical model. The comparative international study showed that, Finnish students were more satisfied and evaluated their clinical placements and supervision with higher scores than students in the United Kingdom (UK). The difference between groups was statistical highly significant (p= 0.000). In the UK, clinical placements were longer but students met their nurse teachers less frequently than students in Finland. Arrangements for supervision were similar. This research process has produced the evaluation scale (CLES), which can be used in research and quality assessments of clinical learning environment and supervision in Finland and in the UK. CLES consists of 27 items and it is sub-divided into five sub-dimensions. Cronbach's alpha coefficient varied from high 0.94 to marginal 0.73. CLES is a compact evaluation scale and user-friendliness makes it suitable for continuing evaluation.Siirretty Doriast

Development and psychometric testing of the clinical learning environment, supervision and nurse teacher evaluation scale (CLES+T): The Spanish version

Background: The Clinical Learning Environment, Supervision and Nurse Teacher scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts. Objectives: This paper reports the development and psychometric testing of the Spanish version of the Clinical Learning Environment, Supervision and Nurse Teacher scale. Design: Cross-sectional validation study of the scale. Setting: 10 public and private hospitals in the Alicante area, and the Faculty of Health Sciences (University of Alicante, Spain). Participants: 370 student nurses on clinical placement (January 2011–March 2012). Methods: The Clinical Learning Environment, Supervision and Nurse Teacher scale was translated using the modified direct translation method. Statistical analyses were performed using PASW Statistics 18 and AMOS 18.0.0 software. A multivariate analysis was conducted in order to assess construct validity. Cronbach’s alpha coefficient was used to evaluate instrument reliability. Results: An exploratory factorial analysis identified the five dimensions from the original version, and explained 66.4% of the variance. Confirmatory factor analysis supported the factor structure of the Spanish version of the instrument. Cronbach’s alpha coefficient for the scale was .95, ranging from .80 to .97 for the subscales. Conclusion: This version of the Clinical Learning Environment, Supervision and Nurse Teacher scale instrument showed acceptable psychometric properties for use as an assessment scale in Spanish-speaking countries

Congruence between graduating nursing students' self-assessments and mentors' assessments of students' nurse competence

Self-assessment is widely used to assess competence in health care, although there is evidence of the weaknesses of self-assessment in the literature. In general, the process of self-assessment has been found to stimulate students' deep-level learning and problem-solving skills. Nursing students need to develop their self-assessment skills in order to identify their learning and ensure up-to-date outcomes and safe practice. This study aims to assess the congruence between graduating nursing students' self-assessment and their mentors' assessments concerning nurse competence with particular focus on nursing skills. The data were collected in November December 2011 in the last week of final clinical placement of nurse education. Completed questionnaires were received from 60 students and 50 mentors. From these, 42 student mentor pairs were matched for the sample of this study. Descriptive and inferential statistics were used in the data analysis. Comparisons between the assessments showed that students assessed their nurse competence as higher than their mentors (VAS 64.5 +/- 12.2 vs. 56.7 +/- 19.0). In nursing skills, the assessments were closer to each other (VAS 75.4 +/- 12.8 vs. 72.2 +/- 16.7); however, students' assessments still remained higher than those of mentors'. No congruent assessments were found between students and mentors. Compared to mentors' assessments, students overestimated their nurse competence. However, the results may be due to different understanding of nurse competence, and more research is needed on students' self-assessment by comparing students' assessments with those of peers, mentors and/or educators or knowledge tests. Nursing students should practise self-assessment during their nurse education. Mentors would also benefit practising in assessing students' nurse competence. (C) 2015 Australian College of Nursing Ltd. Published by Elsevier Ltd.Peer reviewe

Effectiveness of mobile cooperation intervention on students' clinical learning outcomes: A randomized controlled trial

AimsThe aim of this study was to evaluate the effectiveness of the mobile cooperation intervention in improving the competence and self‐efficacy of students and the quality of the clinical learning environment.BackgroundFor students, the clinical practicum is challenging as such and moreover the student — teacher cooperation, which supports the clinical learning of the students, has become complicated. Mobile applications have potential but their role in facilitating this cooperation remains unknown.DesignA parallel‐group randomized controlled trial.MethodsData were collected between January–March 2015 in Finland. The nursing students were randomly allocated to an intervention group (N = 52) or control group (N = 50). The intervention group used a mobile application to cooperate with the teacher during the clinical practicum. The control group engaged in standard cooperation. The primary outcome was competence. The secondary outcomes comprised self‐efficacy and the quality of the clinical learning environment. Nurse Competence Scale, Self‐efficacy in Clinical Performance instrument and the Clinical Learning Environment, Supervision and Nurse Teacher scale were used for student self‐assessments. For the main analysis, hierarchical linear mixed models were used with the intention‐to‐treat principle.ResultsCompetence and self‐efficacy showed no significant between‐group differences in mean improvements, but significant improvements in both groups were detected over the 5 weeks. Satisfaction with the clinical learning environment showed no significant between‐group differences, however, the role of the nurse teacher subscale, especially regarding cooperation, showed significant group differences.ConclusionThe mobile cooperation intervention was not significantly effective in improving individual outcomes, but did seem to improve significantly some aspects of the contextual outcomes.</div

Effectiveness of a mobile cooperation intervention during the clinical practicum of nursing students: a parallel group randomized controlled trial protocol

AimThe aim of this study was to describe a study protocol for a study evaluating the effectiveness of a mobile cooperation intervention to improve students’ competence level, self-efficacy in clinical performance and satisfaction with the clinical learning environment.BackgroundNursing student–nurse teacher cooperation during the clinical practicum has a vital role in promoting the learning of students. Despite an increasing interest in using mobile technologies to improve the clinical practicum of students, there is limited robust evidence regarding their effectiveness.DesignA multicentre, parallel group, randomized, controlled, pragmatic, superiority trial.MethodsSecond-year pre-registration nursing students who are beginning a clinical practicum will be recruited from one university of applied sciences. Eligible students will be randomly allocated to either a control group (engaging in standard cooperation) or an intervention group (engaging in mobile cooperation) for the 5-week the clinical practicum. The complex mobile cooperation intervention comprises of a mobile application-assisted, nursing student–nurse teacher cooperation and a training in the functions of the mobile application. The primary outcome is competence. The secondary outcomes include self-efficacy in clinical performance and satisfaction with the clinical learning environment. Moreover, a process evaluation will be undertaken. The ethical approval for this study was obtained in December 2014 and the study received funding in 2015.DiscussionThe results of this study will provide robust evidence on mobile cooperation during the clinical practicum, a research topic that has not been consistently studied to date.</p

Chemical and physical characterization of oil shale combustion emissions in Estonia

In this study, oil shale combustion emission measurements were conducted in a 60 kW(th) Circulating Fluidized Bed combustion test facility located in a laboratory-type environment. A comprehensive set of instruments including a nitrate-ion-based Chemical Ionization Atmospheric Pressure interface Time-of-Flight Mass Spectrometer, a Soot-Particle Aerosol Mass Spectrometer, and a Potential Aerosol Mass (PAM) chamber was utilized to investigate the chemical composition and concentrations of primary and secondary emissions in oil shale combustion. In addition, the size distribution of particles (2.5-414 nm) as well as concentration and composition of gaseous precursors were characterized. Altogether 12 different experiments were conducted. Primary emissions were studied in seven experiments and aged emissions using PAM chamber in five experiments. Combustion temperatures and solid fuel circulation rates varied between different experiments, and it was found that the burning conditions had a large impact on gaseous and particulate emissions. The majority of the combustion particles were below 10 nm in size during good burning whereas in poor burning conditions the emitted particles were larger and size distributions with 2-3 particle modes were detected. The main submicron particle chemical component was particulate organic matter (POM), followed by sulfate, chloride, nitrate, and ammonium. The secondary particulate matter formed in the PAM chamber was mostly POM and the concentration of POM was many orders of magnitude higher in aged aerosol compared to primary emissions. A significant amount of aromatic volatile organic compounds (VOCs) was measured as well. VOCs have the potential to go through gas-to-particle conversion during the oxidation process, explaining the observed high concentrations of aged POM. During good combustion, when VOC emissions were lower, over 80% of SO2 was oxidized either to gaseous H2SO4 (37%) or particulate sulfate (46%) in the PAM chamber, which mimic the atmospheric processes taken place in the ambient air after few days of emission.Peer reviewe