In search of the ideal clinical learning environment

Yasuko Hosoda |

Author developed tool that measures five of its dimensions.

Yasuko Hosoda

After 23 years of nursing education experience and research, author concludes that learning in a community of practice is most effective.

For six years, I provided nursing care at Tokai University Hospital in Isehara, Kanagawa Prefecture, Japan. As a clinical preceptor at the hospital, I guided nursing students and newly licensed nurses through the process of learning nursing practice. As a result, I came to have great interest in nursing education.

Since then, I have accumulated about 23 years of nursing education experience as a faculty member at three universities in Japan—Tokai University Junior College of Nursing and Technology, Saitama Prefecture University, and Osaka Prefecture University. I continue to be interested in research about clinical learning environments that support development of competency in nursing students and nurses who have recently graduated.

Reflection brings insight
After transitioning to nursing education, I reflected deeply as a new faculty member on my prelicensure education and the guidance I had later provided nursing students as a clinical preceptor in a hospital. Novice nurses lacked well-developed clinical nursing competency and, thus, were often unprepared to deal with real-life situations associated with complex healthcare circumstances. I also recognized that, as the result of personal experience and interaction with others, my own perspectives had changed. In thinking about the competency that nursing students need to develop to practice effectively, I realized that the clinical learning environment (CLE) is very important.

Several years later, when I began my doctoral program at Osaka University, I had the opportunity to conduct research on what is needed to provide nursing students with an effective clinical learning environment. The design of the CLE is a key factor in determining how well nursing students learn in clinical practicum. To design an optimal CLE, instruments that measure various aspects of the learning process are necessary. Thus, for my dissertation research, I developed a Clinical Learning Environment Diagnostic Inventory (CLEDI) for baccalaureate nursing students. This instrument measures the affective, perceptual, symbolic, behavioral, and reflective dimensions of the clinical learning environment, and I found the scale to be a reliable and valid instrument. It has been adopted for research and education in several countries.

Using the CLEDI
Later, as a visiting scholar for six months at Oregon Health & Science University in the United States, I compared the CLEs of a U.S. university and a university in Japan, assessing their relative effectiveness in developing the clinical competence of nursing students. The survey, a self-administered questionnaire, included the CLEDI. The results revealed both similarities and differences, and it is hoped that the study’s findings will contribute to effective clinical learning in both countries.

For the qualitative, descriptive portion of the study, semistructured interviews were conducted with nursing students as well as faculty members in charge of clinical practicums in both the United States and Japan. The interviews covered clinical learning environments, perceptions of their effect—both desirable and undesirable—on student learning, and related clinical competencies. The findings revealed some of the situated cognition of the U.S. and Japanese students and faculty members regarding the clinical learning environment and the clinical competence it cultivates. In contrasting desirable and undesirable CLEs, similarities and differences were demonstrated, with the results influenced, perhaps, by variations between the clinical instructional systems of the two countries. Building international partnerships will facilitate the design of optimal clinical learning environments that enhance patient care and develop the student competencies needed to practice effectively in environments that are increasingly global.

OCNE Clinical Education Model
For field study, I explored the instructional design of nursing education, focusing specifically on the Clinical Education Model of the Oregon Consortium for Nursing Education (OCNE). Observations were conducted in a clinical setting, at a simulation center, and so on. Information collection methods included taking notes and photographs, conducting face-to-face interviews with key participants, and gathering related documentation.

The core competencies of the OCNE curriculum, which address the need for nurses to be skilled in clinical judgment and critical thinking, are shared among the consortium’s members. In the OCNE Clinical Education Model, simulations and clinical practicums provide an important opportunity for students to address a variety of clinical problems and develop interprofessional healthcare relationships. An innovative, statewide education model, the OCNE curriculum continues to be developed with significant collaborative effort.

I would like to utilize this experience to educate baccalaureate nursing students and graduate students at my university and others—as well as to engage in collaborative studies with researchers from Japan and the United States. Presently, I am working as a professor at Osaka Prefecture University, where, in addition to teaching nursing ethics and nursing management in the master’s program, I am conducting research on nursing methods and nursing education within the school’s doctoral program.

My research in nursing education includes identifying—in collaboration with graduate students—factors involved in the growth and development of nursing students, nurses, and instructors. In the baccalaureate program, I oversee subjects such as fundamental nursing, nursing process, nursing education, and clinical study, and I organize the university’s nursing practicum program. As a member of a committee established by the Osaka Nursing Association, I also teach nursing school educators about nursing education assessment.

Metacognition
In other research, conducted in collaboration with graduate students and faculty members, I’ve used my Clinical Learning Environment Diagnostic Inventory, together with a questionnaire, to determine if the CLE contributes to student metacognition. We found that, in addition to facilitating metacognitive knowledge, the CLE supports metacognitive activities. We assume, therefore, that enhancing the clinical learning environment will lead to increased student metacognition.

We’ve also examined, from the perspective of educational supervisors in hospitals, how to improve mentor-coordinated clinical learning for nursing students and nurses who have recently graduated. Based a self-administered survey, we found that “learn from experts” is the preferred learning method for clinical mentors, a conclusion to consider when designing the clinical learning environment.

I began my research by asking, “What is the ideal CLE?” I have found that learning within a community of practice is most effective. As a result, finding ways to enhance that support has become the central focus of my research. At present, I am engaged in developing and designing CLE support programs and expect to continue finding important clues that, if acted upon, will enhance the clinical learning environment. RNL

Yasuko Hosoda, PhD, RN, is a professor at Osaka Prefecture University School of Nursing, College of Health and Human Sciences, in Habikino City, Osaka, Japan.

Editor’s note: Yasuko Hosoda will present a session titled “The Effects of Competency on the Nursing Careers of Novice Nurses,” on Saturday, 21 April at Nursing Education Research Conference 2018 in Washington, D.C.

Check out these additional articles by presenters at Nursing Education Research Conference 2018.

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