ANALYZING THE DIFFERENCE BETWEEN STANDARD CLINICAL

PRACTICES IN HOSPITAL AND SCHOOL SETTINGS AMONG NURSING

STUDENTS OF WESTERN LEYTE COLLEGE: A COMPREHENSIVE STUDY.

Review of Related Literature

Nursing students’ satisfaction of the clinical learning environment:

a research study

Papastavrou, E., Dimitriadou, M., Tsangari, H., & Andreou, C. (2016).

The acquisition of quality clinical experience within a supportive and

pedagogically adjusted clinical learning environment is a significant concern

for educational institutions. The quality of clinical learning usually reflects

the quality of the curriculum structure. The assessment of the clinical

settings as learning environment is a significant concern within the

contemporary nursing education. The nursing students’ satisfaction is

considered as an important factor of such assessment, contributing to any

potential reforms in order to optimize the learning activities and

achievements within clinical settings. The aim of the study was to investigate

nursing students’ satisfaction of the clinical settings as learning

environments. Methods: A quantitative descriptive, correlational design was

used. A sample of 463 undergraduate nursing students from the three

universities in Cyprus were participated. Data were collected using the

Results: Nursing students were highly satisfied with the clinical learning

environment and their satisfaction has been positively related to all clinical

learning environment constructs namely the pedagogical atmosphere, the

Ward Manager’s leadership style, the premises of Nursing in the ward, the

supervisory relationship (mentor) and the role of the Nurse Teacher (p <

0.001). Students who had a named mentor reported more satisfied with the

supervisory relationship. The frequency of meetings among the students and

the mentors increased the students’ satisfaction with the clinical learning

environment. It was also revealed that 1st year students were found to be

more satisfied than the students in other years.

Perception of and satisfaction with the clinical learning environment

among nursing students

D’Souza MS, Karkada SN, Parahoo K, Venkatesaperumal R. (2015).

Clinical supervision, mentorship and preceptorship strategies have

improved student learning in nursing education. In clinical placements

nursing students depend upon a supportive atmosphere based on

psychological and pedagogical aspects for clinical learning like staff–student

relationships, peer support , meaningful learning situations, good

interpersonal relations, support and feedback. There is a reciprocal process

centered learning leading to ‘learning practice’. The premises of nursing on

the ward showed that best practices in nursing care were the essential

context for successful learning experiences and establishing relationships

between students and staff and between patients and staff. Nurse educators

need to orient students to the culture or atmosphere of the clinical

environment. Students reported belonging, teaching and learning, feedback,

confidence and competence as factors influencing the good CLE. Hence, the

quality of the CLE is an essential element for determining the quality of

students' clinical experience and is vital for the teaching process. Methods:

Ethical approval was obtained from the Research and Ethics Committee,

College of Nursing in 2011. A standardized, structured, validated and reliable

Clinical Learning Environment Supervision Teacher Evaluation instrument

was used. Informed consent was obtained from all the students. Data was

analyzed with ANOVA and structural equation modeling. Results: Satisfaction

with the clinical learning environment (CLE) sub-dimensions was highly

significant and had a positive relationship with the total clinical learning

environment. In the path model 35% of its total variance of satisfaction with

CLE is accounted by leadership style, clinical nurse commitment (variance =

28%), and patient relationships (R2 = 27%). Higher age, GPA and completion

of a number of clinical courses were significant in the satisfaction with the

CLE among these students.

Theoretical Framework
Patricia Benner's Novice to Expert Theory

Patricia Benner's Novice to Expert Theory is a foundational framework for

understanding how nursing students develop clinical competencies in both

hospital and school settings. According to Benner, nurses progress through

five stages of expertise: novice, advanced beginner, competent, proficient,

and expert. This theory is particularly relevant to the study as it allows for an

exploration of how students at different stages of expertise perform and

perceive clinical practices across these environments. In the hospital setting,

students are likely to encounter more complex and dynamic situations that

challenge their skills and push them to advance in their development,

potentially moving from novice to a more competent or proficient level. In

contrast, school settings offer a more structured and controlled environment,

which may limit the complexity of situations they face. By using Benner’s

theory, the research can identify how the level of clinical experience in

different settings influences the students’ growth and their ability to apply

learned concepts to real-world situations.

Lewin's Change Theory

Lewin’s Change Theory is a well-established framework that focuses on the

process of change and how individuals or groups adapt to new behaviors or

environments. It consists of three stages: Unfreezing, where individuals

things; Change (Transition), where new behaviors, skills, or practices are

adopted; and Refreezing, where these changes are solidified and become a

stable part of the individual's routine. In the context of this research, Lewin’s

Change Theory is highly relevant as it provides insight into how nursing

students adapt and evolve their clinical practices as they transition from the

structured school environment to the dynamic and demanding hospital

setting. The theory is reliable because it has been widely applied across

various fields, including education and healthcare, to explain how individuals

process and integrate changes. By using Lewin's theory, this research can

analyze how nursing students adjust their clinical practices through the

stages of learning and how their clinical behaviors are reshaped and

sustained in different environments, making it a crucial tool for

understanding the adaptation process in clinical education.

Research Participants

For this study, the target participants will be 60 second-year nursing

students from Western Leyte College who have undergone clinical training in

both hospital and school settings. The respondents will be randomly selected

using purposive sampling, a method where participants are selected based

on specific criteria relevant to the research. Targeting students with direct

clinical experience ensures that the data collected will reflect the
perspectives of those with practical, firsthand experience applicable to the

research topic.

Study Locale

The study will be conducted within the premises of Western Leyte College,

specifically in the Department of the College of Nursing and Allied Health

Sciences. The researcher will have at least (60) participants to be

interviewed.

Measurement Tool

This study will use the Clinical Practices Assessment Questionnaire (CPAQ) to assess

the clinical experiences, competencies, and challenges of nursing students in

hospital and school settings.

Clinical Practices Assessment Questionnaire (CPAQ)

Description of the Measurement Tool

The Clinical Practices Assessment Questionnaire (CPAQ) uses Likert Scale (1-5) for

self-assessment and include open-ended questions that gather insights of the

students, ensuring a comprehensive evaluation of their clinical learning

experiences.
Validity and Reliability

The CPAQ is designed to align with established nursing education literature and

theoretical frameworks, including Benner’s Novice to Expert Theory and Lewin’s

Change Theory. It is supported by elements from validated tools such as the Clinical

Learning Environment, Supervision, and Nurse Teacher (CLES+T) scale, CLES+T has

been widely used to assess students’ perceptions of their clinical learning

environments and the quality supervision and mentorship.

This tool will measure students’ experiences, competencies, and challenges

in both environments using a structured survey questionnaire consisting of

four sections:

Section 1: Demographic Profile

 Age

 Gender

 Section

 Clinical experience duration (in months)

 Previous exposure to healthcare settings before nursing school

(Yes/No)

Section 2: Clinical Practices in Hospital Settings

 Frequency of performing direct patient care (e.g., vital signs

monitoring, IV insertion)

 Exposure to emergency situations and critical decision-making

 Level of supervision required

5)

 Challenges encountered in hospital-based training

Section 3: Clinical Practices in School Settings

 Frequency of performing health education and community outreach

 Involvement in first aid and basic healthcare in school settings

 Level of supervision required

 Self-assessed competency level in school-based procedures (Likert

Scale: 1-5)

 Challenges encountered in school-based training

Section 4: Comparative Analysis and Student Perception

 Perceived differences in learning experiences between hospital and

school settings

 Preference for hospital-based vs. school-based clinical training (Likert

Scale: 1-5)

 Perceived impact of both settings on overall nursing competency

 Open-ended question: What improvements can be made in clinical

training?

Authors:

 Saarikoski & Leino-Kilpi (2002)

 Chan (2002)
Scoring and Interpretation:

 Likert Scale (1-5) will be used for self-assessment questions, where:

 1 = Strongly Disagree / Very Low Competency

 2 = Disagree / Low Competency

 3 = Neutral / Moderate Competency

 4 = Agree / High Competency

 5 = Strongly Agree / Very High Competency

 Open-ended responses will be analyzed using qualitative content

analysis to identify recurring themes and insights.