Assessment on the Level of Perception of Clinical Learning Environment among Undergraduate Nursing Students under Institute of Medicine, Tribhuwan University, Nepal

Nursing & Healthcare International Journal
ISSN: 2575-9981
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Assessment on the Level of Perception of Clinical Learning Environment among Undergraduate
Nursing Students under Institute of Medicine, Tribhuwan University, Nepal
Nurs Health Care Int J
Abstract
The study investigated undergraduate nursing students’ perceptions of the clinical learning environment (CLE) in Nepal.
A sample of 117 undergraduate students from two nursing campuses under the Tribhuwan University was participated. A
semi-structured self-administered questionnaire was used to assess various dimensions of the CLE, including pedagogical
environment, personalization, student involvement, innovation, individualization, task orientation, and supervision. The
findings revealed that approximately one-third of the students had a high perception level of the CLE. Student involvement
received the highest mean score, while individualization and innovation scored lower. Results of the study suggest areas for
improvement in the clinical education of nursing students in Nepal.
Keyword: Clinical Learning Environment; Perception; Tribhuwan University; Undergraduate Nursing Students
Assessment on the Level of Perception of Clinical Learning
Environment among Undergraduate Nursing Students under
Institute of Medicine, Tribhuwan University, Nepal
Prajapati U*, Koirala M and Shrestha S
Department of Nursing, Tribhuwan University, Nepal
*Correspondingauthor:UrmilaPrajapati,MaharajgunjNursingCampus,InstituteofMedicine,
Tribhuwan University, Nepal, Tel: +9779841405821; Email: prajapati.urmila2020@gmail.com
Research Article
Volume 8 Issue 4
Received Date: May 17, 2024
Published Date: August 21, 2024
DOI: 10.23880/nhij-16000322
Abbreviations
CLE:ClinicalLearningEnvironment;BSN:BachelorofScience
in Nursing; CLEI: Clinical Learning Environment Inventory.
Introduction
Nursing education encompasses both theoretical
and clinical components, with clinical learning playing a
predominant role [1]. The quality of the clinical learning
environment significantly influences learning outcomes and
the acquisition of skills and nursing students’ perception of
thisenvironmentiscrucialforpatientcare[2].Understanding
students’ perspectives on the clinical environment, which can
evoke anxiety due to the balancing act between learning and
professional demands, is essential [1,3]. Student satisfaction,
reflecting the fulfilment of educational expectations, serves
as a key measure [4]. Discrepancies in studies regarding
students’ perceptions underscore the necessity for this
review to explore various contexts.
Clinical education is fundamental for the development of
nurses’ practical skills. Creating an engaging clinical setting
supports learning, with faculty involvement enhancing
the environment [5]. Understanding multiple perspectives
of the clinical learning environment, including physical
surroundings, relationships, and teaching components, is
crucial [6,7]. Positive student-faculty relationships influence
on learning outcomes [8,9]. Clinical faculty must consider
various factors affecting student relationships to guide
them effectively [10]. Assessing students’ experiences and
providing tailored learning opportunities are vital tasks for
nurse educators [6,11]. Faculty should focus on leadership,
teaching, and creating authentic and motivational

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Prajapati U, et al. Assessment on the Level of Perception of Clinical Learning Environment among
Undergraduate Nursing Students under Institute of Medicine, Tribhuwan University, Nepal. Nurs
Health Care Int J 2024, 8(4): 000322.
Copyright© Prajapati U, et al.
environments [12]. Effective communication and addressing
psychological needs are crucial for student learning [7,13].
Clinical faculty serves as intermediaries between the clinical
environment and student learning, necessitating strategies
to foster a positive environment [14].
The field of nursing education is witnessing rapid
expansion in Nepal, evident in the increasing number of
colleges and the availability of study levels ranging from PCL
to PhD programs. Formal nursing education commenced
in 1956 AD [15]. The Basic B.Sc. Nursing program, a four-
year course, targets students who have completed their +2
education in the science stream with a major in biology.
Notably, in 1996, Nepal introduced its first Four-year Generic
Bachelor Nursing Programme (B.Sc. Nursing), initially
enrolling 20 students at BPKIHS Dharan. Subsequently, in
2005 AD, this program was extended to Tribhuvan University
[16].
Though many studies has been carried out in other
countries, very few researches are found in researcher
knowledge, that have been conducted in Nepal to assess the
perception regarding CLE among nursing student [17]. Thus
researcher has interested to study on perception regarding
CLE among undergraduate nursing student. This research
seeks to assess the conduct of clinical faculty as perceived
by nursing students in the clinical setting, with a specific
emphasis on improving positive coaching approaches. The
study addresses questions regarding the influence of clinical
faculty on the learning of nursing students and the methods
employed by clinical faculty to foster student-centered
learning within the clinical environment.
Materials and Methodology
Setting of the Study
This study was conducted at Maharajgunj Nursing
Campus and Pokhara Nursing Campus, both under the
Institute of Medicine, Tribhuwan University, which is a
leading institution in Nepal [18]. The B.Sc. nursing program
was initiated at Maharajgunj Nursing Campus in 2005 and
at Pokhara Nursing Campus in 2016. Maharajgunj Nursing
Campus, established in 1956 AD, is a pioneering nursing
institution in Nepal [19]. It offers various academic programs
including Post Basic Bachelor of Nursing, Generic Bachelor
of Science in Nursing, Master of Nursing, and PHD Nursing
Program. Pokhara Nursing Campus, established in 1985
in Pokhara, Ramghat 12, was founded to provide nursing
education. It operates as a constituent college of Tribhuwan
University and offers a range of nursing academic programs
including PCL in nursing, BNS, B.Sc. nursing, and Master in
nursing, facilitated by experienced and qualified faculty
members [20]. The selected study area is as shown in Figure
1.
Figure 1: Study Area.

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Health Care Int J 2024, 8(4): 000322.
Study Population Sampling Procedure
The study included all second years nursing students
enrolled in the B.Sc. Nursing program at Maharajgunj Nursing
Campus and Pokhara Nursing Campus under the Institute of
Medicine, Tribhuwan University, who had completed more
than 90% of practical work, were willing to participate,
and were available during the data collection period. No
additional exclusion criteria were applied. Stratified random
sampling with proportionate allocation was employed to
select samples from Maharajgunj Nursing Campus and
Pokhara Nursing Campus. The sample was chosen using a
lottery method and the sampling sizes are as shown in Figure
2.
Maharajgunj Nursing Campus Pokhara Nursing Campus
1st
year 2nd
year 3rd
year 1st
year 2nd
year 3rd
year
20 20 20
40 40 36
29 29 26 15 15 15
Campus
Students Class
No. of Students
Sample No.
Figure 2: Diagrammatic flow of sampling technique.
The sample size was determined using a formula
based on the percentage of students perceiving the Clinical
Learning Environment (CLE) as “very good” in a similar
study conducted in Vellore, India [21]. The total population
was 176, and after considering a confidence level of 95% and
an allowable error of 5%, the sample size was calculated to
be 117. Adding a 10% non-response rate, the total sample
size became 128.
Research Tool
A semi-structured self-administered questionnaire
is a research tool used to collect data from participants
in a study. In a semi-structured questionnaire, there is a
predetermined set of questions or topics to guide the inquiry,
butrespondentshavesomeflexibilityinhowtheyanswerand
can provide additional information beyond the predefined
options and self-administered means that participants
complete the questionnaire on their own, without direct
involvement from the researcher. Thus, a semi-structured
self-administered questionnaire provides a framework for
data collection while allowing respondents some freedom
in their responses, making it a versatile tool for gathering
information in research studies.
In this study, the data was collected using a semi-
structured self-administered questionnaire comprising two
parts: i) socio-demographic information and ii) perceptions
of the clinical learning environment. The questionnaire was
validated through extensive literature review and pretesting,
ensuring reliability [22-25]. The initial segment involved
inquiries regarding the socio-demographic characteristics
of the participants, which were devised by the researcher.
The subsequent section evaluated perceptions of the
clinical learning environment using a 5-point Likert scale,
ranging from “strongly disagree” to “strongly agree,” across
42 statements, yielding a total score of 210. The items in
this section were adapted from [26,27]. Clinical Learning
Environment Inventory (CLEI), covering seven dimensions:
pedagogical environment, personalization, innovation,
student involvement, individualization, task orientation, and
supervision.
Validity and Reliability
Validity and reliability assessments were conducted
to ensure the quality of the tool. Content validity for parts
I and II was established through a non-statistical approach,
including extensive literature review, consultation with

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Health Care Int J 2024, 8(4): 000322.
a research advisor, subject matter experts, and research
professionals.
Reliability was ensured by pretesting the tool among
10% of the total sample size (117 students), resulting in a
sample of 12 participants from the Manmohan Memorial
Institute of Health Sciences, Kathmandu, Nepal. This pretest
aimed to evaluate the practicality and applicability of the
questionnaire and estimate the time required for completion.
Necessary modifications were made based on the pretest
results, guided by the supervisor. For the reliability analysis
of part II, Cronbach’s alpha coefficient was computed for the
total scale, yielding a value of 0.716 (ranging from 0.501 to
0.76 among dimensions).
Data Collection Procedure
Permission was obtained from the research committee
of Maharajgunj Nursing Campus, and ethical approval was
obtained from the Institutional Review Board of the Institute
of Medicine, Tribhuwan University. Formal permission
was also obtained from Maharajgunj Nursing Campus and
Pokhara Nursing Campus. Informed consent was obtained
from participants, confidentiality and anonymity were
ensured, and data was collected by the researcher over a
period of four weeks.
Data Analysis
Data was edited, coded, and entered into SPSS VERSION
20. The assessment of missing data was conducted using
Little’s Missing Completely at Random test, as suggested
by Li C [28]. The results of the test indicated that the
missing data occurred randomly and were not statistically
significant. Descriptive statistics were used to summarize
the data, including percentages, means, and standard
deviations. Inferential statistics, such as the chi-square
test and Pearson’s correlation, were employed to analyze
associations and relationships.
Results of Study
Demographic Characteristics
In terms of socio-demographic information, Table 1
reveals that the majority of respondents, comprising 71.3%,
are over 20 years old, with a mean age of 19.88 and a standard
deviation of ±1.12. The religious beliefs of the respondents
indicate that 93% identify with Hinduism, while only 1.6%
identify with Christianity. Ethnically, approximately two-
thirds(69%)identifyasBrahmin/Chhetri,whereasonly1.6%
identify as Madhesi. Furthermore, 89.9% of respondents
come from nuclear families, while the remaining 10.1%
belong to joint families. Regarding living arrangements,
approximately three-fourths (77.5%) of respondents reside
in hostels, with the remaining 22.5% living at home.
Characteristics Number Percent
Age in completed yrs.
≤ 20 92 71.3
>20 37 28.7
Religious
Hinduism 120 93
Buddhism 7 5.4
Christianity 2 1.6
Ethnicity
Brahmin/ Chhetri 89 69
Janajati 33 25.6
Dalit 5 3.9
Madhesi 2 1.6
Academic Year
B.Sc. 1st year 44 34.1
B.Sc. 2nd year 44 34.1
B.Sc. 3rd year 41 31.8
Type of Family
Nuclear 116 89.9
Joint 13 10.1
Residence
Hostel 100 77.5
Home 29 22.5
Exposure in Clinical Practice this Year
Fundamental 44 34.1
Midwifery & Pediatric 44 34.1
Adult, Geriatric & Psychiatric 41 31.8
Duration of Exposure Completed in Weeks
16 44 34.1
21 41 31.8
29 29 22.5
30 15 11.6
Table 1: Socio-Demographic Characteristics of the
Respondents.
In terms of clinical practice exposure, 34.1% of
respondents practiced fundamental nursing, 34.1%
practiced midwifery and pediatrics, and 31.8% practiced
adult, geriatric, and psychiatric care during the current year.

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Students’ Perceptions of the University
Supervision and Guidance Environment
Regarding supervision and guidance, Table 2 indicates
that the majority of respondents (58.1%) were consistently
supervised and guided by clinical nurses. Additionally, 23.3%
received supervision from clinical teachers, while 18.6%
received guidance from both clinical teachers and clinical
nurses.
Variables
Always Often Sometime
NO % NO % NO %
Clinical Nurse 75 58.1 24 18.6 30 23.3
Clinical teacher 30 23.3 68 52.7 31 24
Both Clinical Nurse & Teacher 24 18.6 38 29.5 67 51.9
Table 2: Supervision and Guidance in Clinical Learning Environment.
Student’PerceptiononPedagogicalAtmosphere
Regarding students’ perception of the pedagogical
atmosphere, Table 3 illustrates that half of the respondents
(51.2%) agreed that the staff were easily approachable in
the ward. Nearly half (47.3%) of the respondents agreed
that they felt comfortable going to the ward at the start of
their shift. Similarly, a majority (56.6%) of respondents
agreed that there was a positive atmosphere for meaningful
learning situations on the ward. However, one-third (33.3%)
of respondents disagreed that the staff were generally
interested in student supervision. Additionally, 41.1% of
respondents disagreed that the staff learned to know the
students by their personal names. On the other hand, more
than half (55.8%) of respondents agreed that the learning
situation was multidimensional in terms of content.
The highest mean score for the pedagogical atmosphere
was (3.62 ± 0.82) for “there was a positive atmosphere for
meaningful learning situations on the ward,” while the
lowest was (1.05 ± 1.05) for “the learning situation was
multidimensional in terms of content.”
Statements
Responses
SD D U A SA
Mean ± SD
NO (%) NO (%) NO (%) NO (%) NO (%)
The staff were easy to approach in the
ward
2 21 29 66 11
3.49±0.92
-1.6 -16.3 -22.5 -51.2 -8.5
I felt comfortable going to the ward at
the start of my shift
7 34 22 61 5
3.18±1.05
-5.4 -26.4 -17.1 -47.3 -3.9
There was a positive atmosphere for
meaningful learning situation on the
ward
3 8 35 73 10
3.62±0.82
-2.3 -6.2 -27.1 -56.6 -7.8
The staffs were generally interested in
student supervision
5 43 42 37 2
2.91±0.92
-3.9 -33.3 -32.6 -28.7 -1.6
The staff learned to know the student
by their personal names
2 53 28 23 3
2.48±1.05
-17.1 -41.1 -21.7 -17.8 -2.3
The learning situation
multidimensional in term of content
(medical equipment, case availability,
supportive staff)
7 12 27 72 11
1.05±1.05
-5.4 -3.3 -20.9 -55.8 -8.5
n=117
Table 3: Respondents’ Perception on Pedagogical Atmosphere.

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Students’ Perception on Personalization
In response to students’ perception of personalization,
Table 4 indicates that nearly half (42.6%) of the respondents
agreed that clinical teachers consider students’ feelings.
Regarding individual communication with students, a
majority (59.7%) of respondents agreed that clinical
teachers talk individually with students whenever needed.
Moreover, more than half (59.7%) of the respondents agreed
that clinical teachers help students who have problems or
difficulties with clinical work, followed by (52.7%) who
agreed that clinical teachers are friendly and understanding
towards students. Similarly, (42.6%) of respondents agreed
that clinical teachers regularly visit the ward to talk to
students. Additionally, more than one-third (39.6%) of
respondents agreed that clinical teachers are interested in
students’ personal and academic problems and try to solve
them.
The highest mean score was 3.6 ± 0.85 for “the clinical
teacher helps students who have problems or difficulties
with clinical work,” while the lowest was 3.13 ± 1.00 for
“the clinical teacher is interested in students’ personal and
academic problems and tries to solve them.”
Statements
Responses
SD D U A SA
Mean ± SD
No (%) No (%) No (%) No (%) No (%)
The clinical teacher consider students’
feeling
10 30 33 55 1
3.05±1.00
-7.8 -23.3 -25.6 -42.6 -0.8
The clinical teacher talk individually with
students whenever needed
3 11 27 77 11
3.63±0.84
-2.3 -8.5 -20.9 -59.7 -8.5
The clinical teacher helps the student
who have problem or difficulty with the
clinical work
3 11 27 77 11
3.64±0.85
-2.3 -8.5 -20.9 -59.7 -8.5
The clinical teacher is friendly and
understanding towards students
4 15 40 68 2
3.38±0.84
-3.1 -11.6 -31 -52.7 -1.6
The clinical teacher regularly goes
around to the ward to talk to the
students
5 27 35 55 7
3.25±0.98
-3.9 -20.9 -27.1 -42.6 -5.4
The clinical teacher is interested in
students’ personal & academic problems
and try to solve them
6 33 34 51 5
33.13±1.00
-4.7 -25.6 -26.4 -39.6 -3.9
n=117
Table 4: Respondents’ Perception on Personalization.
Students’ Perception on Student Involvement
As shown in Table 5 reveals that nearly half (47.3%) of
the respondents agreed that clinical teachers always talk
more rather than listen to the students. Additionally, close to
one-third (28.7%) of the respondents agreed that students
put effort into the activities they do in the ward. However,
a majority of respondents (70.5%) agreed that students pay
attention to what others are saying and doing in the ward.
Concerning whether clinical teachers encourage debriefing
sessions, (63.6%) of respondents agreed. Similarly, more
than one-third (39.5%) of respondents agreed that there are
opportunities for students to express their opinions in the
clinical ward. Furthermore, (41.1%) of respondents agreed
that students have enough opportunities to be involved in
the process of handing over to staff for the next shift.
The highest mean score was 4.1 ± 0.64 for “students pay
attention to what others are saying and doing in the ward,”
while the lowest mean score was 0.78 ± 0.93 for “there are
opportunities for students to express their opinions in the
clinical ward.”

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Statements
Responses
SD D U A SA
Mean ±SD
No (%) No (%) No (%) No (%) No (%)
The clinical teacher always talk more
rather than listens to the students*
3 29 25 61 11
2.6±1.00
-2.3 -22.5 -19.4 -47.3 -8.5
Students put effort into the activities
what they do in the ward.
0 2 10 80 37
4.18±0.64
-1.6 -7.8 -62 -28.7
Students pay attention to what others
are saying and doing in the ward
0 4 7 91 27
4.18±0.62
-3.1 -5.4 -70.5 -20.9
The clinical teacher encourage debrieﬁng
(reviews of the actions or activities taken
in the ward) sessions
2 8 26 82 11
3.72±0.78
-1.6 -6.3 -20.2 -63.6 -8.6
There are opportunities for students
to express their opinions in the clinical
ward
6 25 44 51 3
0.78±0.93
-4.7 -19.4 -34.1 -39.5 -2.3
Students have enough opportunity to
involve in the process of handing over to
staff in the ward for the next shift
9 27 22 53 18
3.35±1.17
-7 -20.9 -17.1 -41.1 -14
n=117
Table 5: Respondents’ Perception on Student Involvement.
Students Perception on Innovation
Table 6 illustrates that more than one-third (35.7%)
of the respondents agreed that new ideas are always tried
out for patient care in the ward. Concerning the utilization
of new and different ways of clinical teaching for students,
close to one-third (31.8%) of respondents agreed. Similarly,
nearly half (45.7%) of respondents agreed that clinical
teachers or supervisors devise innovative activities and
teaching approaches for students. Additionally, almost half
(46.3%) of respondents agreed that students seem to do
the same type of tasks in every shift. However, one-third
(34.1%) of respondents disagreed that clinical teachers or
supervisors often think of interesting activities for students.
Regarding whether the same ward staff member works with
students for most of their placement, one-third (34.9%) of
respondents disagreed.
The highest mean score was 3.58 ± 1.13 for “students
seem to do the same type of tasks in every shift,” while the
lowest mean score was 2.32 ± 1.09 for “students seem to do
the same type of tasks in every shift.”
Statements
Responses
SD D U A SA
Mean ± SD
No (%) No (%) No (%) No (%) No (%)
New ideas are always tried out for the
patient care in the ward
9 32 36 46 6
3.06±1.04
-7 -24.8 -27.9 -35.7 -4.7
New and different ways of clinical
teaching to the students are always used
in the ward
12 31 36 41 9
3.03±1.10
-9.3 -24 -27.9 -31.8 -7
The clinical teacher or supervisor thinks
up innovative activities and teaching
approaches for students.
8 18 41 59 3
3.24±0.94
-6.2 -14 -31.8 -45.7 -2.3
Students seem to do the same type of
tasks in every shift *
5 23 21 52 28
2.32±1.09
-3.9 -17.8 -16.3 -40.3 -21.7

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Health Care Int J 2024, 8(4): 000322.
The clinical teacher or supervisor often
thinks of interesting activities for the
students
19 44 39 24 3
2.6±1.03
-14.7 -34.1 -30.2 -18.6 -2.3
The same ward staff member works
with the students for most of this
placement
11 45 40 31 2
2.75±2.75
-8.5 -34.9 -31 -24 -1.6
n=117
Table 6: Respondents’ Perception on Innovation.
Students’ Perception on Individualization
Table 7 presents the perception on individualization,
indicating that nearly half (45.7%) of the respondents
agreed that all staff in the ward are expected to do the same
work in the same way. Conversely, around half (41.1%) of
respondents disagreed that students are generally allowed
to work at their own pace. Similarly, almost half (46.5%)
of the respondents disagreed that students are allowed
to negotiate their workload in the ward. Regarding the
perception that there is little opportunity for a student
to pursue their particular interest in this ward, one-third
(35.7%) of respondents agreed. Additionally, nearly half
(44.2%) of respondents agreed that teaching approaches
allow students to proceed at their own pace.
The highest mean score was 2.79 ± 1.13 for “all staff in
the ward are expected to do the same work in the same way,”
while the lowest mean score was 1.09 ± 0.95 for “teaching
approaches allow students to proceed at their own pace.”
Statements
Responses
SD D U A SA
Mean ± SD
No (%) No (%) No (%) No (%) No (%)
All staff in the ward are expected to do
the same work in the same way*
10 36 18 59 6
2.79±1.13
-7.8 (27. 9) -14 -45.7 -4.7
Students are generally allowed to
work at their own pace
16 53 21 35 4
2.67±1.10
-12.4 -41.1 -16.3 -27.1 -3.1
Students are allowed to negotiate
their work load in the ward
25 60 19 21 4
2.37±1.07
-19.4 -46.5 -14.7 -16.3 -3.1
There is little opportunity for a
student to pursue her particular
interest in this ward*
9 23 37 46 14
2.72±1.08
-7 -17.8 -28.7 -35.7 -10.9
Teaching approaches allow students
to proceed at their own pace
4 36 30 57 2
1.09±0.95
-3.1 -27.9 -23.3 -44.2 -1.6
n=117
Table 7: Respondents’ Perception on Individualization.
Students’ Perception on Task Orientation
Table 8 presents that more than half (54.3%) of the
respondents agreed that ward staff and students are often
punctual on duty in the ward. Similarly, over half (56.6%)
of the respondents agreed that ward assignments are
clear, allowing students to know what to do in the ward.
Regarding the organization of the clinical placement, 43.4%
of respondents agreed that getting a certain amount of
work done is important in this ward, while nearly two-
thirds (63.6%) agreed. Additionally, 43.4% of respondents
gave an uncertain response regarding whether the clinical
teacher often gets side tracked instead of sticking to the
point. Concerning workload allocation, nearly half (44.2%)
of the respondents agreed that it is carefully planned for
the students. Furthermore, half of the respondents (51.9%)
strongly agreed that there was clear communication and
information flow related to patients’ care in the ward.
Regarding the documentation of nursing care, more than half
(59.7%) of the respondents agreed.

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The highest mean score was observed for “ward
assignments are clear so that students know what to do in
the ward” (3.85 ± 0.86), along with the documentation of
nursing care (3.85 ± 2.74). Conversely, the lowest mean score
was recorded for “the clinical teacher often gets sidetracked
instead of sticking to the point” (2.68 ± 0.78).
Statements
Responses
SD D U A SA
Mean ± SD
No (%) No (%) No (%) No (%) No (%)
Ward staffs and students are often punctual on duty of
the ward
4 14 17 70 24
3.74±099
-3.1 -10.9 -13.2 -54.3 -18.6
Ward assignments are clear so that students know what
to do in the ward
1 11 19 73 25
3.85±0.86
-0.8 -8.5 -14.7 -56.6 -19.4
This is an organized clinical placement
8 18 33 56 14
3.39±1.06
-6.2 -14.2 -25.6 -43.4 -10.9
Getting a certain amount of work done is important in
this ward
0 11 25 82 11
3.72±0.74
-8.5 -19.4 -63.6 -8.5
The clinical teacher often gets sidetracked instead
of sticking to the point*
3 21 56 45 4
2.68±0.78
-2.3 -16.3 -43.4 -34.9 -3.1
Workload allocation in the ward is carefully planned for
the students.
10 33 25 57 4
3.09±1.06
-7.8 -25.6 -19.4 -44.2 -3.1
There was clear communication and information flow
related to patients’ care in the ward
2 25 27 67 8
3.42±0.92
-1.6 -19.4 -20.9 -51.9 -6.2
Documentation of nursing care (nursing plan, daily
recording of nursing procedure) was clear in the ward
2 19 18 77 13
3.85±2.74
-1.6 -14.7 -14 -59.7 -10
n=117
Table 8: Respondents’ Perception on Task Orientation.
Students’ Perception on Supervision
Table9illustratesthatmorethanonethird(40.3%)ofthe
respondents disagreed that they felt each student received
individual supervision. Conversely, over half (56.6%) of the
respondents agreed that students continuously received
feedback from the clinical supervisor. Regarding supervision
based on a relationship of equality and promoted by learning,
nearly half of the respondents (44.2%) agreed.
Concerning mutual interaction and respect in the
supervisory relationship, nearly two-thirds (48.8%) of the
respondents agreed. Similarly, almost two-thirds (61.2%)
of the respondents agreed that the supervisory relationship
was characterized by a sense of trust.
The highest mean score of 3.74 ± 0.92 was obtained for
“students continuously received feedback from the clinical
supervisor.”
Statements
Responses
SD D U A SA
Mean± SD
No (%) No (%) No (%) No (%) No (%)
I felt each student received individual
supervision
16 52 24 30 7
2.69±1.12
-12.4 -40.3 -18.6 -23.3 -5.4
Students continuously received
feedback from the clinical supervisor.
2 15 18 73 21
3.74±0.92
-1.6 -11.6 -14 -56.6 -16.3

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Health Care Int J 2024, 8(4): 000322.
The supervision was based on
a relationship of a equality and
promoted by learning
2 26 40 57 4
3.27±0.87
-1.6 -20.2 -31 -44.2 -3.1
There was a mutual interaction
and respect in the supervisory
relationship
2 12 49 63 3
3.41±0.76
-1.6 -9.3 -38 -48.8 -2.3
The supervisory relationship was
characterized by a sense of trust
1 14 29 79 6
3.58±0.78
-0.8 -10.9 -22.5 -61.2 -4.7
Table 9: Respondents’ Perception on Supervision.
Students’ Perception on Different Dimensions
of CLE
Table 10 displays the scores for different dimensions
of the clinical learning environment as perceived by the
respondents. The highest score was obtained for student
involvement (3.51 ± 0.40), followed by task orientation
(3.44 ± 0.50). Conversely, the lowest score was obtained for
individualization (2.73 ± 0.54).
Different Dimension Minimum Maximum Mean SD
Student Involvement 2.17 4.33 3.54 0.4
Task orientation 2 4.38 3.44 0.5
personalization 1 5 3.36 0.64
Supervision 1.6 5 3.33 0.56
Pedagogical Atmosphere 1.67 4.67 3.19 0.59
Innovation 1 4.33 2.83 0.63
Individualization 1.4 4 2.73 0.54
Table 10: Obtained Mean Score in Different Dimension of Clinical Learning Environment
Students’ Perception on Distribution of the CLE
Table 11 illustrates the distribution of respondents’
perceptions of the clinical learning environment. More than
one third (34.9%) of respondents had a high perception,
while 42 (32.6%) had a moderate perception, and another 42
(32.6%) had a high level of perception regarding the clinical
learning environment. The mean score of respondents’
perception was 3.29.
Level of Perception Number Percent
High ( > 66.6 percentile) 45 34.9
Moderate ( 33.3-66.6 percentile) 42 32.6
Low (< 33.3 percentile) 42 32.6
Table 11: Overall Level of Students’ Perception on Clinical
Learning Environment.
Discussion
This study examined nursing students’ perceptions of
the clinical learning environment across various dimensions.
The findings reveal insights into the levels of perception and
highlight specific areas of strengths and weaknesses.
In terms of overall perception levels, approximately one
third of respondents had high, moderate, and low levels of
perception regarding the clinical learning environment, with
an average mean score of 3.29. Comparisons with studies
conducted in Vellore, India [21], and elsewhere indicate
variations in perception levels among nursing students.
Across different dimensions of the clinical learning
environment, notable findings emerged. Regarding the
pedagogical environment referring Table 3, respondents
generally perceived a positive atmosphere for meaningful
learning situations, although challenges were identified in
terms of multidimensional content learning. Similar studies
in other regions have reported varying perceptions of the
pedagogical environment, suggesting contextual differences.
Personalization, as another dimension in Table 4,
revealed mixed perceptions. While students acknowledged
assistance from clinical teachers with clinical work, there
were lower levels of agreement regarding teachers’ interest
in students’ personal and academic problems. Studies from

11
Health Care Int J 2024, 8(4): 000322.
Greece, Iran, and Myanmar offer comparisons, indicating
the importance of personalized support in enhancing the
learning experience [29,30].
Student involvement received the highest mean
score among the dimensions assessed, indicating active
participation and attentiveness in ward activities. However,
opportunities for students to express their opinions were
perceived to be limited, suggesting areas for improvement in
fostering student engagement.
Innovation, individualization, and task orientation
dimensions presented challenges as shown in Tables 5-7,
with lower mean scores indicating areas of concern such as
repetitive tasks and limited decision-making opportunities
for students. Comparisons with studies from other regions
highlight consistent issues across different contexts,
emphasizing the need for innovative teaching approaches
and tailored learning experiences.
Supervision emerged as a crucial aspect, with
respondents generally agreeing on receiving continuous
feedback from clinical supervisors. However, disparities in
perception levels were observed across studies, suggesting
variations in supervision quality and effectiveness.
Overall, the findings underscore the importance of
addressing areas of concern while building on existing
strengths to enhance the clinical learning environment for
nursing students. By focusing on personalized support, active
student involvement, and effective supervision practices,
nursing education programs can optimize the learning
experience and better prepare students for their future roles
in healthcare.
Conclusion
In conclusion, this study offers valuable insights into
nursing students’ perceptions of the clinical learning
environment, highlighting both strengths and areas for
improvement across various dimensions. The findings
underscore the significance of organizational effectiveness,
supervision quality, and student engagement in shaping
the overall learning experience. The positive perceptions
regarding punctuality, clear assignments, and continuous
feedback underscore the strengths of the clinical placements
under investigation. However, the study also identifies areas
for enhancement, particularly in individualized supervision
and mitigating distractions during supervision sessions.
Moreover, the variability in perceptions across different
dimensions of the clinical learning environment emphasizes
the complex nature of student experiences. While student
involvement and task orientation received commendable
scores, challenges in individualization suggest the need for
tailored approaches to cater to diverse learning needs.
Overall,thestudyindicatesagenerallypositiveperception
of the clinical learning environment among nursing students,
alongside identifiable areas for improvement. Addressing
these areas holds the potential to foster a more supportive,
engaging, and effective learning environment. Looking ahead,
it is crucial for nursing educators and clinical supervisors
to integrate these findings into curriculum development,
supervision practices, and organizational management. By
addressing identified areas for improvement and leveraging
existing strengths, nursing education programs can better
equip students for their future roles as competent and
empathetic healthcare professionals.
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