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Background:Metacognitive knowledge and activities are valued in clinical learning. The clinical learning environment helps determine the quality of the clinical experience of the nursing student. It is necessary to investigate how educational activity can promote students’ metacognition in the clinical learning environment.
Methods: Participants were 145 university instructors (67.1% response rate) and 110 vocational school instructors (56.4% response rate) from nursing programs in Japan. The Clinical Learning Environment Diagnostic Inventory—which measures the affective, perceptual, symbolic, behavioral, and reflective aspects of the clinical learning environment—and a questionnaire regarding support that facilitates students’ metacognition—consisting of items to measure metacognitive knowledge and metacognitive activities—were administered. The data were analyzed using IBM SPSS Statistics to compare the clinical learning environment and the support to facilitate students’ metacognition between two groups (university instructors and vocational school instructors). Simultaneous analysis of multiple groups was conducted between the two groups using AMOS. The study was approved by the Ethical Review Board of School of Nursing, Osaka Prefecture University, Japan.
Outcomes: The results indicated that university instructors were significantly higher than the vocational school instructors in all subscales for the Clinical Learning Environment Diagnostic Inventory. The university instructors had higher values of support that facilitates students’ metacognitive knowledge for students’ problem solving compared to the vocational school instructors. In structural equation models with latent variables, “support that facilitates students’ metacognitive knowledge” was influenced by the “clinical learning environment” as perceived by the instructors, and “support that facilitates students’ metacognitive activities” was affected by “support that facilitates students’ metacognitive knowledge.” Multiple-group structural equation modeling between the two groups was tested with equality constraints placed on each path coefficient. The fit indices for the hypothetical model were goodness-of-fit index = .904, adjusted goodness-of-fit index = .867, and root mean square error of approximation = .037. The standardized parameter estimates of path coefficients indicating degrees of influence of the “clinical learning environment” on “support that facilitates students’ metacognitive knowledge” were .42 for the university instructors and .56 for the vocational school instructors. The critical ratio for the difference between these parameters for the two groups was not significantly different. The path coefficients (standardized parameter estimates) of “support that facilitates students’ metacognitive knowledge” on “support that facilitates students’ metacognitive activities” were .88 for the university instructors and .96 for the vocational school instructors. The critical ratio for the difference between these parameters of the two groups was significantly different (P < 0.05).
Implications:Results revealed that the “clinical learning environment” affected the instructors’ “support that facilitates students’ metacognitive knowledge, ”which in turn affected the “support that facilitates students’ metacognitive activities.” These effects were seen in both university instructors and vocational school instructors. In particular, the vocational school instructors seemed to have a more consistent effect on the clinical learning environment regarding their support to facilitate students’ metacognition. It is assumed that enhancing the clinical learning environment will lead to the instructors’ support facilitating students’ metacognition.