A Cross-sectional Study on Associated Factors to Nursing Students' Satisfaction with the Clinical Learning Environment
DOI:
https://doi.org/10.31674/mjn.2025.v16i03.014Abstract
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, SatisfactionDownloads
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=646e6e773770af7b0c3857d69b090da8a0d32648. 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
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The Malaysian Journal of Nursing (MJN)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
