A Cross-sectional Study on Associated Factors to Nursing Students' Satisfaction with the Clinical Learning Environment

Nguyen Viet Phuong1, Nguyen Van Tuan1*, Nguyen Thi Thuy Trang1, Le Kim Tha1, Le Thi Cam Tu2, Wantonoro3

1Department of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, 179 Nguyen Van Cu street, An Khanh Ward, Ninh Kieu, District, Can Tho City 900000, Vietnam

2Department of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy,179 Nguyen Van Cu Street, An Khanh Ward, Ninh Kieu, Can Tho City 900000, Vietnam

3Department of Nursing, Faculty of Health Sciences, Universitas ‘Aisyiyah Yogyakarta, Gamping Sleman 55292, Yogyakarta, Indonesia

*Corresponding Author's Email: nvtuan@ctump.edu.vn

ABSTRACT

Background: A good clinical learning environment helps students practise closely to the theoretical framework, hone skills, and improve nursing practice capacity. Factors associated with learners' satisfaction with the clinical learning environment support nursing schools as a basis for enhancing and promoting teaching quality. Objectives: This study aimed to identify the level of satisfaction with the clinical learning environment in nursing students and to explore the related factors. Methods: A cross-sectional descriptive study was conducted on 131 third and fourth-year nursing students using the Vietnamese version of the Clinical Learning Environment, Supervision, and Nurse Teacher scale (CLES+T). The Mann-Whitney U, Kruskal-Wallis test, and Multiple Regression analysis were used to analyse the data using SPSS version 22.0. Results: The nursing students' level of satisfaction with the clinical learning environment had an average score ranging from 3.84±0.61 to 4.23±0.69, and the total CLES+T was 4.07±0.56. Religion, working part-time during the learning process, clinical practice hospital, and the setup of night shift rooms in the clinical ward were associated with nursing students’ satisfaction with the clinical learning environment. Conclusion: Nursing students were satisfied with the clinical practice environment at a relatively high level. Providing part-time employment opportunities within the healthcare model and continuously improving the facilities at clinical wards will support student learning activities.

Keywords: CLES+T; Clinical Learning Environment; Nursing Students; Satisfaction

INTRODUCTION

Clinical learning was essential for nursing and medical students, bridging theory from lectures to practical application in hospitals-a key element in showcasing nurses' abilities and assessing healthcare quality (Ahmed et al., 2023; Masilaca, Kumar & Balekiwai, 2018; Kalyani et al., 2019). The clinical learning environment (CLE) fostered relationships and communication, enabling students to practice patient care strategies and develop interpersonal skills (Attia & Ibrahim, 2023; Zhang et al., 2022). It also provided practical experience across nursing roles, shaping professional culture and social norms (Baraz et al., 2015; Manoochehri et al., 2015; Rodríguez-Monforte et al., 2023; Woo & Li, 2020). Through clinical practicum, students

became skilled practitioners, capable of delivering high-quality care and improving public health, highlighting the indispensable role of clinical experience in nursing education (Baraz et al., 2015; Miller, 2024).

The CLE for nursing students should offer diverse contexts influenced by social, cultural, and psychological factors, shaping the learning experience and behaviours within the clinical practice (Baghdadi, Alotaibi & Abdelaliem, 2023; Lengetti et al., 2021; Masilaca, Kumar & Balekiwai, 2018; Saarikoski, 2002). This sociocultural setting allowed varied opportunities for engagement and was supported by mentoring to enhance readiness for professional practice (Baraz et al., 2015; Campbell et al., 1994; Chan & Ip, 2007; Newton et al., 2010). Positive interpersonal interactions further enriched students' experiences in this complex learning environment (Antonsen et al., 2023).

The Health Belief Model (HBM) posited that health behaviour is shaped by personal beliefs about a health issue, influencing decisions to engage in certain behaviours (Etheridge et al., 2023; Rosenstock, Strecher & Becker, 1988). This study applied HBM to examine nursing students' satisfaction with the CLE. Believing they were supported and able to overcome barriers increased satisfaction, a crucial factor in readiness for nursing and retention in the workplace post-graduation, affecting recruitment (Lamont, Brunero & Woods, 2015; Rodríguez‐García et al., 2021). Nurse shortages and early departures add pressure to healthcare systems (Miller, 2024). In competitive education, satisfaction is vital for institutional success and student achievement, with higher service quality setting institutions apart (Wong & Chapman, 2023).

Literature Review

Saarikoski (2002) suggested that nursing students' satisfaction with the CLE is influenced by factors like the pedagogical atmosphere, leadership style of the ward manager, nursing practices, supervisory relationships, and the nurse teacher's role. Studies in various countries reported differing satisfaction scores: Ghana (3.07 ± 0.84 to 3.63 ± 0.85) (Ziba et al., 2021),Saudi Arabia(3.76 ± 0.64) (Aljohni et al., 2023), Vietnam (3.5 ± 1 to 4.3 ± 0.6) (Papastavrou et al., 2016), and Norway (4.08 ± 0.72 to 4.34 ± 0.87) (Rosenberg et al., 2019). In Palestine, supervisory relationships and the nurse teacher’s role scored highest (3.85 ± 0.82), while leadership style was lowest (3.8 ± 0.84) (Hammad et al., 2024). In Morocco, the pedagogical atmosphere was highest, while the nurse teacher’s role scored the lowest (Guejdad et al., 2024).

Effective clinical learning for nursing students faces challenges such as student-related issues, nursing staff shortages, limited teaching time from hospital nurses, inexperienced faculty, and the crucial role of the clinical learning environment in nursing education (Miller, 2024; Nool, 2024; Ramoeletsi & Tlou, 2024).

A study in Pakistan found that nursing students faced challenges in applying theory to practice, which caused confusion and helplessness (Nasiri & Adib-Hajbaghery, 2022). Similarly, a qualitative study in Iran revealed inefficiencies in the CLE, such as inadequate instruction, poor planning, and unsuitable environments (Kalyani et al., 2019). Since nursing care directly impacted patient health (Khiem et al., 2024), the CLE helped students bridge the gap between theory and practice, enabling them to overcome obstacles and confusion through experience (Flott & Linden, 2016; Lillekroken et al., 2024). It also strengthened their understanding of the nursing profession (Woo & Li, 2020). The culture of a new clinical setting left a lasting impact on student learning (Inocian et al., 2022; Rodríguez-Monforte et al., 2023).

Student readiness for learning in a clinical environment was a key factor influencing the quality of clinical training (Joolaee et al., 2015). The CLE elements played a crucial role in developing clinical competence and guiding students' goal orientation during their education (Adam et al., 2021; Mikkonen et al., 2020; Pitkänen et al., 2018). To prepare nursing students for their future roles, clinical learning must be well-structured (Kaphagawani & Useh, 2013; Lillekroken et al., 2024; Tang & Chan, 2019). Improving clinical teaching quality and patient care directly enhanced the CLE, leading to greater student satisfaction and retention (Mihanović et al., 2016; Wong & Chapman, 2023). Gathering student feedback was essential for developing effective improvement plans and refining teaching strategies (Cohen, 1980).

Can Tho University of Medicine and Pharmacy, a large institution in southern Vietnam, and quality control is a constant problem. However, no survey on nursing students' satisfaction with the CLE has been conducted. Therefore, the researchers undertook this study to assess student satisfaction with the CLE and explore related factors.

METHODOLOGY

Design: A cross-sectional descriptive-analytical investigation was conducted

Research Questions

1. What is the current status of nursing students’ satisfaction with the clinical learning environment?

2. What are the associated factors with nursing students’ satisfaction with the clinical learning environment?

Sample

Data were collected from third- and fourth-year nursing students at Can Tho University of Medicine and Pharmacy between January and April 2023. A sample of 131 students was selected using purposive sampling.

Inclusion Criteria: Third- and fourth-year students who completed at least one clinical practice module and consented to participate.

Exclusion Criteria: Students missing over 20% of clinical practice hours or absent during the survey period.

Data Collection and Instrument

Students were interviewed using pre-made questions to assess general traits (age, gender, religion, clinical practice hospital, ward, and on-call room setup). The CLES+T scale (Saarikoski et al., 2008) was used to measure satisfaction with the physical learning environment, comprising 37 questions across five areas: pedagogical atmosphere (12 items), leadership style (4 items), nursing care (4 items), supervisory relationship (8 items), and nurse teacher role (9 items). Responses were rated on a 5-point Likert scale, with higher scores indicating greater satisfaction. The scale's reliability was confirmed with a Cronbach's Alpha of 0.83, and a Vietnamese version was used (Papastavrou et al., 2016).

Statistical Analysis

Data were analysed using SPSS Version 22.0. Frequency (n) and percentage (%) described qualitative variables, while weighted mean and SD were used for quantitative variables. Mann-Whitney U and Kruskal-Wallis tests assessed relationships between student demographics and CLE+T. Multiple regression analysis identified CLE+T predictors, with categorical variables coded as dummy variables. Statistical significance was set at p<0.05 (Landau, Everitt & Everitt, 2004).

Ethical Consideration

The research obtained ethical clearance from the Ethical Council for Biomedical Research at Can Tho University of Medicine and Pharmacy, Vietnam, with reference number, 22.033.GV/PCT-HDDD on 30th November 2022.

RESULTS

Sample Characteristics

A total of 131 nursing students participated in the survey, 78.6% of whom were female. Third- year students made up 51.9%, and 22.9% reported having religious beliefs. Additionally, 19.1% worked part-time during their studies. The largest group, 29%, interned at paediatric hospitals, while another 29% were assigned to the paediatric department. Notably, 9.2% did not have night duty rooms set up during their internship (Table 1).

Table 1: Characteristics of Nursing Students

Satisfaction with the Clinical Learning Environment in Nursing Students

Table 2 describes nursing students’ satisfaction with the CLE across the 5 dimensions of the CLES+T scale ranges from 3.84 to 4.23. The overall average satisfaction score of students regarding the CLE was 4.07.

Table 2: Mean Score on the CLES+T and Dimensions

Associated Factors to Nursing Students’ Satisfaction with the Clinical Learning Environment

The Mann-Whitney U test showed that religious students (e.g., Buddhism, Christianity, Hoa Hao) had lower satisfaction with the CLE than non-religious peers (U=1134, p=0.037). Part-time workers also reported lower satisfaction (U=949, p=0.028). The Kruskal-Wallis test revealed significant differences in satisfaction based on hospital and ward (Χ2=16.5, p<0.001 and Χ2=16.9, p<0.001, respectively). Additionally, the availability of night shift rooms significantly affected satisfaction (Χ2=16.9, p<0.001). These findings, as summarised in Table 3, highlight the association between student demographic profiles and the mean score of the dimensions of CLES+T.

Table 3: Association between Student Demographic Profiles and Mean Score of the Dimensions of CLES+T

Multiple regression analysis revealed key factors influencing nursing students' satisfaction with the CLE. Religious students (e.g., Buddhism, Christianity, Hoa Hao) reported lower satisfaction than non-religious peers (β=-0.276; 95% CI: -0.49, -0.06; p=0.011). Part-time workers also had lower satisfaction (β=-0.27; 95% CI: -0.5, -0.04; p=0.041). Students with access to night shift rooms, either shared with on-call nurses or designated classrooms, showed higher satisfaction (β=0.367; 95% CI: 0.021, 0.713; p=0.038 and β=0.444; 95% CI: 0.056, 0.833; p=0.025). Furthermore, students at Can Tho Central General and Children’s hospitals were less satisfied compared to those at specialised hospitals (β=-0.372; 95% CI: -0.74, -0.002; p=0.049 and β=-0.435; 95% CI: -0.822, -0.048; p=0.028).These factors explained 19.8% of the model's variance. Table 4 presents the detailed results of the multiple regression analysis.

Table 4: Factors Related to Nursing Students' Satisfaction with the Clinical Practice Environment

DISCUSSION

Nursing students reported high satisfaction with the CLE (4.07/5, SD=0.56), with the supervisory relationship receiving the highest score and the pedagogical atmosphere the lowest. This satisfaction reflects improvements in training quality through sessions aligned with the Ministry of Health Vietnam's standards, including contributions from experienced faculty and hospital head nurses. Compared to other studies, this result was higher than those by Papastavrou (2016) in Vietnam(3.5±1 to 4.3±0.6) and Ziba et al. (2021) in Ghana (3.07±0.84 to 3.63±0.85), as well as Aljohni et al. (2023) in Saudi Arabia (3.76±0.64). However, it was lower than Rosenberg et al. (2019) in Norway (4.08±0.72 to 4.34±0.87). Research in Palestine identified "supervisory relationship" and "nurse teacher's role" as highest-rated factors, while Morocco ranked "pedagogical atmosphere" highest (Guejdad et al., 2024; Hammad et al., 2024). These differences may reflect variations in practice settings, educational cultures, and developmental stages, underscoring the need for improvements in the CLE atmosphere.

In Vietnam, the collectivist culture, which emphasises hierarchical relationships and respect for authority, likely influences nursing students' satisfaction with the CLE. This may explain the high satisfaction with the supervisory relationship, as students value guidance from experienced instructors. However, this structure may limit autonomy and critical thinking, contributing to lower satisfaction with the pedagogical atmosphere. In contrast, in European countries, where education systems promote independence and critical thinking, satisfaction with the CLE is higher, as seen in Norway (D’Souza et al., 2015). Understanding these cultural differences is crucial for developing educational approaches that balance autonomy and satisfaction in Vietnam. Institutions should continue improving the pedagogical atmosphere while enhancing supervisory relationships and infrastructure. Educators should also foster student autonomy and critical thinking while respecting cultural norms.

Nursing students’ clinical learning experiences are shaped by multiple factors (Baghdadi, Alotaibi & Abdelaliem, 2023; Inocian et al., 2022; Jamshidi et al., 2016; Lengetti et al., 2021), which highlight significant gaps between their views of the current and desired CLE (Inocian et al., 2022). Students prefer environments characterised by personalisation, engagement, satisfaction, task focus, teaching innovation, and individualised attention (Inocian et al., 2022). The results of the multiple regression analysis indicated that four factors-religion, part-time work during studies, clinical practice hospital, and the setup of night shift rooms-were significantly related to nursing students’ satisfaction with the CLE.

Students practicing a religion (e.g., Buddhism, Christianity, Hoa Hao) had lower average satisfaction scores compared to non-religious students (β=-0.276; 95% CI: -0.49, -0.06; p=0.011). This could be due to religious students seeking fulfillment beyond their current state or focusing more on emotional well-being from their spiritual practices (Davis et al., 2023). Religion, although beneficial to patient care (Whitley, 2012), has not yet been formally integrated into Vietnam’s healthcare education system. Given that religious activities can also influence happiness indices (Mitchell, 2019), educational institutions might consider addressing the specific emotional and spiritual needs of religious students to enhance their satisfaction with the CLE.

Students who worked part-time reported lower satisfaction with the CLE compared to those who did not(β=-0.27; 95% CI: -0.5, -0.04; p=0.041). While part-time work offers financial support and experience, it also causes stress and fatigue, particularly in nursing (Kishwer et al., 2023; Tessema, Ready & Astani, 2014; Wang et al., 2010). In Vietnam, where academic and family pressures are high, balancing work and study is especially challenging. Part-time work can negatively affect academic performance and satisfaction, particularly in demanding fields like nursing (Alanazi et al., 2023; Attia & Ibrahim, 2023; Lillekroken et al., 2024). Educators should develop support systems and offer flexible job opportunities within healthcare to help students manage work-study demands.

The choice of clinical practice hospital significantly affected student satisfaction (Rodríguez- Monforte et al., 2023). Students at Can Tho Central General Hospital and Can Tho Children's Hospital have reported lower satisfaction than those at specialised hospitals (β=-0.372; 95% CI: - 0.74, -0.002, p=0.049 and β=-0.435, 95% CI: -0.822, -0.048; p=0.028, respectively). Le's research also showed higher satisfaction at specialised hospitals (Papastavrou, 2016). This may be due to specialised hospitals having shorter practice periods, smaller groups, and fewer patients, while general hospitals with higher patient loads offer less personalised instruction, leading to lower satisfaction (Pham et al., 2023). Truong (2015) found longer practice periods correlated with lower satisfaction, but shorter periods reduced learning quality (Truong, 2015). Miller (2024) noted that mentoring adds extra burdens to nurses, impacting student learning. Clinical placements are essential for enhancing competencies and integrating theory with practice (Masilaca, Kumar & Balekiwai, 2018). Therefore, selecting appropriate clinical hospitals and optimising placement durations are vital for maintaining student satisfaction.

The study found that night shift room availability in clinical wards significantly influenced student satisfaction. Students with access to designated rooms for on-call duties reported higher satisfaction (β=0.367; 95% CI: 0.021, 0.713; p=0.038 and β=0.444; 95% CI: 0.056, 0.833; p=0.025). On-call duty, a critical learning opportunity, allowed students to engage more deeply in patient care and nursing practice (Manoochehri et al., 2015; Woo & Li, 2020). It provided valuable experience and supported future careers (Amukugo et al., 2017; Goren et al., 2015; Kaphagawani & Useh, 2013; Palese et al., 2017). However, the absence of on-call rooms, needed for storing tools, changing attire, and resting, could lead to increased stress and fatigue, negatively impacting satisfaction. Some studies noted that students often felt bored during night shifts and performed non-nursing tasks (Dobrowolska et al., 2020). Adequate facilities, including night shift rooms, are essential to support students, as they provide spaces for rest and storage, helping reduce stress and fatigue. Universities should ensure clinical hospitals are properly equipped for student placements.

Limitation

The study has some limitations that the cross-sectional design prevented the identification of causal relationships, highlighting the need for future longitudinal or qualitative studies, such as interviews or focus groups, to gain deeper insights. Additionally, focusing on a single university limits the generalisability of the findings. Comparative studies across multiple universities could offer broader and more generalisable recommendations for improving clinical education in Vietnam.

CONCLUSION

Nursing students reported high satisfaction with the CLE, influenced by factors such as religion, part-time work, clinical practice hospitals, and night shift room setups. Educational institutions should improve student satisfaction by enhancing the pedagogical atmosphere, addressing religious needs, and offering flexible support and part-time job opportunities. Additionally, selecting suitable clinical hospitals, optimising placement durations, and ensuring facilities like night shift rooms are crucial. Future research should expand to include qualitative studies to explore causal relationships between these factors and the CLE. This study enhanced understanding of factors influencing nursing students' satisfaction with the CLE in Vietnam, where research is limited. It offers valuable insights for developing strategies to improve clinical training.

Conflict of Interest

The authors declare that they have no competing interests.

ACKNOWLEDGEMENT

The authors are thankful to Can Tho University of Medicine and Pharmacy, Vietnam, the expert panel, research assistants, hospitals, and nursing students for their valuable participation. The study participants are sincerely appreciated, and these findings are dedicated to enhancing nursing students' satisfaction with the CLE in the future.

REFERENCES

Adam, A. B., Druye, A. A., Kumi-Kyereme, A., Osman, W., & Alhassan, A. (2021). Nursing and midwifery students’ satisfaction with their clinical rotation experience: the role of the clinical learning environment. Nursing Research and Practice, 2021 (1), 1-9. https://doi.org/10.1155/2021/7258485

Ahmed, F. A., Alrashidi, N., Mohamed, R. A., Asiri, A., Al Ali, A., Aly, K. H., Nouh, W. G., N. A., Marzouk, S. A., Omar, A. M., Marzouk, M. M., Alkalash, S. H., Moursy, S. M., Fadila, D. E., Eldin, S. S., & Almowafy, A. A. (2023). Satisfaction and anxiety level during clinical training among nursing students. BMC Nursing, 22(1), 187. https://doi.org/10.1186/s12912- 023-01352-3

Alanazi, M. R., Aldhafeeri, N. A., Salem, S. S., Jabari, T. M., & Al Mengah, R. khalid. (2023). Clinical environmental stressors and coping behaviors among undergraduate nursing students in Saudi Arabia: A cross-sectional study. International Journal of Nursing Sciences, 10(1), 97–103. https://doi.org/10.1016/j.ijnss.2022.12.007

Aljohni, K. A., Almarwani, A. M., Tubaishat, A., Awadh, A. A., & Aljohani, M. S. (2023). Nurse interns’ experiences with the clinical learning environment and supervision. Teaching and Learning in Nursing, 18(4), e123–e128. https://doi.org/10.1016/j.teln.2023.04.011

Amukugo, H. J., Kapofi, G. K., & Nuuyoma, V. (2017). Learning opportunities and challenges of nursing students during night duty at an Intermediate Hospital in Windhoek, Namibia. Journal of Nursing Research and Practice. 1(1), 13-16. Retrieved from: https://www.pulsus.com/scholarly-articles/learning-opportunities-and-challenges-of-nursing-students-during-night-duty-at-an-intermediate-hospital-in-windhoek-nami.pdf. Accessed on 15th September, 2023.

Antonsen, T., Stenberg, C., Hansen, K. H., André, B., & Bogsti, W. B. (2023). Nursing students' experience of an alternative model for supervision during practical studies in the municipal health service: A qualitative study. Heliyon, 9(11). https://doi.org/10.1016/j.heliyon.2023.e21719

Attia, Y. K., & Ibrahim, R. H. (2023). Difficulties experienced in clinical learning settings for nurses in Iraq: Perspectives of nursing administrators and nursing instructors. Informatics in Medicine Unlocked, 38. https://doi.org/10.1016/j.imu.2023.101229

Baghdadi, N. A., Alotaibi, T., & Abdelaliem, S. M. F. (2023). Assessing the quality of nursing clinical placement: A quantitative cross-sectional study. Nursing Open, 10 (9), 6143–6149. https://doi.org/10.1002/nop2.1836

Baraz, S., Memarian, R., & Vanaki, Z. (2015). Learning challenges of nursing students in clinical environments: A qualitative study in Iran. Journal of Education and Health Promotion, 4(1), 52. https://doi.org/10.4103/2277-9531.162345

Campbell, I. E., Larrivee, L., Field, P. A., Day, R. A., & Reutter, L. (1994). Learning to nurse in the clinical setting. Journal of Advanced Nursing, 20(6), 1125–1131. https://doi.org/10.1046/j.1365-2648.1994.20061125.x

Chan, D. S. K., & Ip, W. Y. (2007). Perception of hospital learning environment: A survey of Hong Kong nursing students. Nurse Education Today, 27(7), 677–684. https://doi.org/10.1016/j.nedt.2006.09.015

Cohen, P. A. (1980). Effectiveness of student-rating feedback for improving college instruction: A meta-analysis of findings. Research in Higher Education, 13(4), 321–341. https://doi.org/10.1007/BF00976252

D’Souza, M. S., Karkada, S. N., Parahoo, K., & Venkatesaperumal, R. (2015). Perception of and satisfaction with the clinical learning environment among nursing students. Nurse Education Today, 35(6), 833–840. https://doi.org/10.1016/j.nedt.2015.02.005

Davis, E. B., Worthington, E. L., & Schnitker, S. A. (Eds.). (2023). Handbook of Positive Psychology, Religion, and Spirituality. Springer International Publishing. https://doi.org/10.1007/978-3-031-10274-5

Dobrowolska, B., Zec, A., Tosoratti, J., Machul, M., Pokorná, A., Nascimento, C., Ferrão, S., Ziakova, K., Solgajova, A., Rybarova, L., Achil, I., & Palese, A. (2020). Night shifts as a learning experience among nursing students across Europe: Findings from a cross-sectional survey. Nurse Education Today, 90. https://doi.org/10.1016/j.nedt.2020.104441

Etheridge, J. C., Sinyard, R. D., & Brindle, M. E. (2023). Chapter 90–implementation research. Eltorai AEM, Bakal JA, Newell PC, Osband A J. Translational Surgery: Handbook for Designing and Conducting Clinical and Translational. Academic Press, Elsevier Inc. https://doi.org/10.1016/B978-0-323-90300-4.00043-4

Flott, E. A., & Linden, L. (2016). The clinical learning environment in nursing education: A concept analysis. Journal of Advanced Nursing, 72(3), 501–513. https://doi.org/10.1111/jan.12861

Goren, E. N., Leizman, D. S., La Rochelle, J., & Kogan, J. R. (2015). Overnight hospital experiences for medical students: results of the 2014 clerkship directors in internal medicine national survey. Journal of General Internal Medicine, 30(9), 1245–1250. https://doi.org/10.1007/s11606-015-3405-4

Guejdad, K., Ikrou, A., Strandell-Laine, C., Abouqal, R., & Belayachi, J. (2024). Healthcare students’ perceptions of the quality of the clinical learning environment in Morocco: a cross- sectional study. Nursing Research and Practice, 2024(1), 1-9.https://doi.org/10.1155/2024/7849334

Hammad, B. M., Eqtait, F. A., Salameh, B., Ayed, A., & Fashafsheh, I. H. (2024). Clinical learning environment: perceptions of Palestinian nursing students. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 61. https://doi.org/10.1177/00469580241273101

Inocian, E. P., Hill, M. B., Felicilda-Reynaldo, R. F. D., Kelly, S. H., Paragas, E. D., & Turk, M. T. (2022). Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review. Nurse Education in Practice, 63. https://doi.org/10.1016/j.nepr.2022.103391

Jamshidi, N., Molazem, Z., Sharif, F., Torabizadeh, C., & Najafi Kalyani, M. (2016). The challenges of nursing students in the clinical learning environment: a qualitative study. The Scientific World Journal, 2016(1), 1-9. https://doi.org/10.1155/2016/1846178

Joolaee, S., Jafarian Amiri, S. R., Farahani, M. A., & varaei, S. (2015). Iranian nursing students’ preparedness for clinical training: A qualitative study. Nurse Education Today, 35(10), e13–e17. https://doi.org/10.1016/j.nedt.2015.07.026

Kalyani, M. N., Jamshidi, N., Molazem, Z., Torabizadeh, C., & Sharif, F. (2019). How do nursing students experience the clinical learning environment and respond to their experiences? A qualitative study. BMJ Open, 9(7). https://doi.org/10.1136/bmjopen-2018-028052

Kaphagawani, N. C., & Useh, U. (2013). Analysis of nursing students learning experiences in clinical practice: literature review. Studies on Ethno-Medicine, 7(3), 181–185.https://doi.org/10.1080/09735070.2013.11886459

Khiem, T. B., Dan, T. C., Tho, P. K. A., & Trang, T. Q. (2024). Managing clinical practice activities of students at Can Tho University of Medicine and Pharmacy, Vietnam. European Journal of Alternative Education Studies, 9(2). http://dx.doi.org/10.46827/ejae.v9i2.5409

Kishwer, R., Akhtar, D. Z., Farooq, D. M., Faiza, M., Khan, D. M. S., & Naimat, R. (2023). Impact of part-time job on students’ academic achievement and satisfaction: A case of teacher education program at International Islamic University Islamabad. Bulletin of Business and Economics (BBE), 12(2), 157-163. https://doi.org/10.5281/zenodo.8342097

Lamont, S., Brunero, S., & Woods, K. P. (2015). Satisfaction with clinical placement – The perspective of nursing students from multiple universities. Collegian, 22(1), 125–133. https://doi.org/10.1016/j.colegn.2013.12.005

Landau, S., Everitt, B., & Everitt, B. S. (2004). A handbook of statistical analyses using SPSS. Chapman & Hall/CRC. https://doi.org/10.1201/9780203009765

Lengetti, E., Cantrell, M. A., DellaCroce, N., Diewald, L., Mensinger, J. L., & Shenkman, R. (2021). Learning environment and evidence among professionals and students’ satisfaction(LEAPS), experienced during the COVID-19 pandemic. Teaching and Learning in Nursing, 16(4), 342–346. https://doi.org/10.1016/j.teln.2021.07.004

Lillekroken, D., Kvalvaag, H. M., Lindeflaten, K., Flølo, T. N., Krogstad, K., & Hessevaagbakke, E. (2024). Educating the nurses of tomorrow: Exploring first-year nursing students’ reflections on a one-week senior peer-mentor supervised inspiration practice in nursing homes. BMC Nursing, 23(1), 132. https://doi.org/10.1186/s12912-024-01768-5

Manoochehri, H., Imani, E., Atashzadeh-Shoorideh, F., & Alavi-Majd, A. (2015). Competence of novice nurses: Role of clinical work during studying. Journal of Medicine and Life, 8(Spec Iss 4), 32–38. Retrieved from: https://www.rroij.com/open-access/clinical-learning- environment-and-clinical-learning-outcomes-as-perceived-by-final-year-baccalaureate- nursing-students-in-fiji-nat.pdf. Accessed on 19th September, 2023.

Masilaca, O., Kumar, A., & Balekiwai, S. (2018). Clinical Learning Environment and Clinical Learning Outcomes as Perceived by Final Year Baccalaureate Nursing Students in Fiji National University, the Republic of Fiji. Research & Reviews: Journal of Nursing and Health Sciences, 4(1), 23–31. Retrieved from:https://www.rroij.com/open-access/clinical-learning- environment-and-clinical-learning-outcomes-as-perceived-by-final-year-baccalaureate- nursing-students-in-fiji-nat.pdf. Accessed on 26th September, 2023.

Mihanović, Z., Batinić, A. B., & Pavičić, J. (2016). The link between students’ satisfaction with faculty, overall students’ satisfaction with student life and student performances. Review of Innovation and Competitiveness: A Journal of Economic and Social Research, 2 (1), 37–60. https://doi.org/10.32728/ric.2016.21/3

Mikkonen, K., Tomietto, M., Cicolini, G., Kaucic, B. M., Filej, B., Riklikiene, O., Juskauskiene, E., Vizcaya-Moreno, F., Pérez-Cañaveras, R. M., De Raeve, P., & Kääriäinen,

M. (2020). Development and testing of an evidence-based model of mentoring nursing students in clinical practice. Nurse Education Today, 85. https://doi.org/10.1016/j.nedt.2019.104272

Miller, J. (2024). Effective clinical learning for nursing students. American Nurse Journal, 19 (4), 32-37. https://doi.org/10.51256/anj042432

Mitchell, T. (2019, January 31). Religion’s Relationship to Happiness, Civic Engagement and Health Around the World. Pew Research Center. Retrieved from: https://www.pewresearch.org/religion/2019/01/31/religions-relationship-to-happiness-civic- engagement-and-health-around-the-world/. Accessed on 21st August, 2023.

Nasiri, M.-A., & Adib-Hajbaghery, M. (2022). Nursing students’ perceptions and experiences of learning and using nursing theories: A qualitative study. Nursing Forum, 57(6), 997–1006. https://doi.org/10.1111/nuf.12773

Newton, J. M., Jolly, B. C., Ockerby, C. M., & Cross, W. M. (2010). Clinical learning environment inventory: factor analysis. Journal of Advanced Nursing, 66(6), 1371-1381. https://doi.org/10.1111/j.1365-2648.2010.05303.x

Nool, I. (2024). Nursing students’ assessment to the clinical learning environment and mentoring in medical-surgical wards: quantitative research. Biomedical Journal of Scientific & Technical Research, 54(3), 45883–45889. https://doi.org/10.26717/BJSTR.2024.54.008550

Palese, A., Basso, F., Del Negro, E., Achil, I., Ferraresi, A., Morandini, M., Moreale, R., & Mansutti, I. (2017). When are night shifts effective for nursing student clinical learning? Findings from a mixed-method study design. Nurse Education Today, 52, 15–21. https://doi.org/10.1016/j.nedt.2017.02.005

Papastavrou, E., Dimitriadou, M., Tsangari, H., & Andreou, C. (2016). Nursing students' satisfaction of the clinical learning environment: a research study. BMC Nursing, 15, 44. https://doi.org/10.1186/s12912-016-0164-4

Pham, H. L., Phouratsamay, S. L., Di Mascolo, M., & Nguyen, B. Q. (2023, May). Reducing outpatient waiting time: A case study in Vietnamese private hospital. In 2023 International Conference on Control, Automation and Diagnosis (ICCAD) (pp. 1-6). IEEE. http://dx.doi.org/10.1109/ICCAD57653.2023.10152381

Pitkänen, S., Kääriäinen, M., Oikarainen, A., Tuomikoski, A.-M., Elo, S., Ruotsalainen, H., Saarikoski, M., Kärsämänoja, T., & Mikkonen, K. (2018). Healthcare students’ evaluation of the clinical learning environment and supervision – a cross-sectional study. Nurse Education Today, 62, 143–149. https://doi.org/10.1016/j.nedt.2018.01.005

Ramoeletsi, S., & Tlou, B. (2024). Challenges of clinical accompaniment amongst undergraduate nursing students: University of KwaZulu-Natal. Health SA Gesondheid, 29 (0). https://doi.org/10.4102/hsag.v29i0.2535

Rodríguez‐García, M. C., Márquez‐Hernández, V. V., Granados‐Gámez, G., Aguilera‐ Manrique, G., & Gutiérrez‐Puertas, L. (2021). Magnet hospital attributes in nursing work environment and its relationship to nursing students’ clinical learning environment and satisfaction. Journal of Advanced Nursing, 77 (2), 787–794. https://doi.org/10.1111/jan.14629

Rodríguez-Monforte, M., Berlanga-Fernández, S., Rifà-Ros, R., Martín-Arribas, A., Olivé- Adrados, C., Villafáfila-Ferrero, R., Pérez-Cañaveras, R. M., & Vizcaya-Moreno, M. F. (2023). Comparing preferred and actual clinical learning environments and perceptions of first-year nursing students in long-term care: a cross-sectional study. International Journal of Environmental Research and Public Health, 20(5). https://doi.org/10.3390/ijerph20054500

Rosenberg, A., Husebø, A. M. L., Laugaland, K. A., & Aase, I. (2019). Nursing students’ experiences of the clinical learning environment in Norwegian nursing homes: a cross-sectional study. Nursing, 9(2), 70-78. Retrieved from: https://www.osetrovatelstvo.eu/_files/2019/2/70- nursing-students-experiences-of-the-clinical-learning-environment-in-norwegian-nursing- homes-a-cross-sectional-study.pdf. Accessed on 19th December, 2023.

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the Health Belief Model. Health Education Quarterly, 15(2), 175–183. https://doi.org/10.1177/109019818801500203

Saarikoski, M. (2002). Clinical learning environment and supervision. Development and validation of the cles evaluation scale. Turun Yliopiston Julkaisuja Annales Universitatis Turkuensis. Retrieved from: https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=646e6e773770af7b0c3857 d69b090da8a0d32648. Accessed on 15th September, 2023.

Saarikoski, M., Isoaho, H., Warne, T., & Leino-Kilpi, H. (2008). The nurse teacher in clinical practice: Developing the new sub-dimension to the clinical learning environment and supervision (CLES) scale. International Journal of Nursing Studies, 45(8), 1233–1237. https://doi.org/10.1016/j.ijnurstu.2007.07.009

Tang, F. W. K., & Chan, A. W. K. (2019). Learning experience of nursing students in a clinical partnership model: An exploratory qualitative analysis. Nurse Education Today, 75, 6–12. https://doi.org/10.1016/j.nedt.2019.01.003

Tessema, M. T., Ready, K. J., & Astani, M. (2014). Does part-time job affect college students’ satisfaction and Academic Performance (GPA)? The Case of a Mid-Sized Public University. International Journal of Business Administration, 5 (2). https://doi.org/10.5430/ijba.v5n2p50

Truong, T. H. (2015). Vietnamese nursing students’ perceptions of their clinical learning environment: A cross-sectional survey. (Doctoral dissertation, Queensland University of Technology). Retrieved from: https://eprints.qut.edu.au/91390/. Accessed on 17th May, 2024.

Wang, H., Kong, M., Shan, W., & Vong, S. K. (2010). The effects of doing part-time jobs on college student academic performance and social life in a chinese society. Journal of Education and Work, 23(1), 79–94. https://doi.org/10.1080/13639080903418402

Whitley, R. (2012). Religious competence as cultural competence. Transcultural Psychiatry, 49(2), 245–260. https://doi.org/10.1177/1363461512439088

Wong, W. H., & Chapman, E. (2023). Student satisfaction and interaction in higher education. Higher Education, 85(5), 957–978. https://doi.org/10.1007/s10734-022-00874-0

Woo, M. W. J., & Li, W. (2020). Nursing students’ views and satisfaction of their clinical learning environment in Singapore. Nursing Open, 7(6), 1909–1919. https://doi.org/10.1002/nop2.581

World Medical Association. (2013). World medical association declaration of helsinki ethical principles for medical research involving human subjects. JAMA. Retrieved from: https://jamanetwork.com/journals/jama/fullarticle/1760318. Accessed on 15th September, 2023.

Zhang, J., Shields, L., Ma, B., Yin, Y., Wang, J., Zhang, R., & Hui, X. (2022). The clinical learning environment, supervision and future intention to work as a nurse in nursing students: A cross-sectional and descriptive study. BMC Medical Education, 22(1), 548. https://doi.org/10.1186/s12909-022-03609-y

Ziba, F. A., Yakong, V. N., & Ali, Z. (2021). Clinical learning environment of nursing and midwifery students in Ghana. BMC Nursing, 20, 1-7. https://doi.org/10.1186/s12912-020- 00533-8