Nursing Students' Perception of the Clinical Learning Environment in Macao

Background: Nursing is a practice based discipline. Clinical placements provide a social context for nursing students to engage in the profession and apply their knowledge to practice. However, the clinical learning environment is not primarily designed for education purposes. It is therefore essential to understand students’ expectation and their experience in the clinical learning environment.

Purpose: The aim of this study was to investigate students’ expectation and perception towards the clinical learning environment in Macao.

Methods: A survey using the Clinical Learning Environment Inventory (CLEI) was conducted in the academic year 2012-2013. The CLEI is a 42-item self-report inventory measuring students’ perception of the psycho-social aspect of the clinical learning environment. It consists of 6 subscales (individualization, innovation, involvement, personalization, task orientation and satisfaction), and the subscale satisfaction is used as an outcome measure. The inventory was translated to Chinese and administered to all second to fourth year students of a nursing college in Macao. Participants were invited to complete the preferred form of the CLEI before placement commencement and the actual form on the last day of placement. SPSS version 21 was employed to analyse the data.

Results: A total of 147 preferred forms and 150 actual forms were returned, with 88% and 90% response rate respectively. The mean scores of the subscales of the preferred form ranged from 19.71 to 23.44 and from 16.22 to 20.66 for the actual form.  Personalization was found to be the most important domain on both preferred and actual clinical learning environment. Paired sample t-test demonstrated that the subscale scores of the actual form were significantly different from the preferred form (p < 0.001). Effect sizes were large for individualization, innovation and personalization, and medium for student involvement and task. The result of multiple linear regression showed that student involvement, task orientation and individualization are the predictors of the model, and account for 54% of the variance of student satisfaction in the actual clinical learning environment. The Cronbach’s alpha of the subscales for the preferred and actual form ranged from 0.54 to 0.81 and 0.39 to 0.83 respectively.

Conclusion: The study shows that there are significant differences between students’ expectation and their perception towards the actual clinical learning environment. A thorough investigation on the influence of the clinical learning environment on student learning will be essential to maximize learning outcome on placements.