A relatively strong emphasis is placed on the importance of clinical learning environment (CLE) in the provision of undergraduate nursing education [1, 2, 3]. This part of training, however, appears to have fundamental significance also in postgraduate nursing education. Developing advanced nursing roles, whether during master studies or various clinically based specialisation programs, requires high quality and effective CLE where trainees are able to advance their competences and increase confidence as independent nursing professionals [4, 5]. Therefore, any instruments which allow one to measure the quality of CLE in postgraduate settings and to identify those CLE elements which need to be addressed and improved are valued. Despite there being several globally available questionnaires for assessing nursing students’ perception of the clinical environment, these are generally used as part of undergraduate education [6]. One of them is the Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T) [7] accepted as a tool commonly used at the international level to evaluate CLE [8]. This scale includes items that enable students to assess five basic elements of clinical learning such as supervision and/or mentorship, role of the nurse teacher, a learning-conducive atmosphere on the ward, nursing care provided on the ward, and the leadership style of the ward manager [7]. Considering the fact that nursing clinical education should be organised in exemplary facilities, where nursing care is conducted according to accepted professional standards, the style of ward management promotes the quality of care and satisfaction of nursing staff, nurse-specialists willingly share their knowledge with nurse-trainees, and the clinical mentor and the nurse teacher are professionals actively involved in the clinical teaching process [4, 9] CLES+T is applicable to monitor postgraduate education provided in the form of clinical training. This helps to keep CLE at an acceptable level, impact nurses’ satisfaction from postgraduate nursing education and thus stimulate nurses to engage in different postgraduate courses in the future [10]. However, to our best knowledge, no study has been developed to utilise the CLES+T scale in the context of postgraduate nursing education. The aim of our research was, therefore, to examine the psychometric properties of the Polish version of the CLES+T instrument in postgraduate settings.
Participation in postgraduate nursing education is considered to be every nurse’s obligation, pursued in order to further one’s competences necessary to ensure the provision of high-quality nursing care in a more independent and confident manner [5, 11]. A broad variety of systems and forms of postgraduate education of nurses exist across the world and many new trends are observed as regards its organisation [12, 13]. It can be organised as university-based program, hospital-based specialisation program, or residency programs offered by healthcare institutions [9, 10]. Furthermore, expectations for promoting the advancement of nursing competences are growing, not only because of demographic challenges such as population ageing, but also due to shortages in healthcare professionals [13]. There is quite ample evidence for the multifaceted nature of benefits offered by nurses’ participation in postgraduate education: it encourages critical thinking, clinical reasoning, and advanced nursing skills; it contributes to patients’ satisfaction and health outcomes, and helps avoid medical errors; finally, it fosters nurses’ professional growth and sense of fulfilment [5, 10, 14, 15, 16].
The development of advanced nursing competences within postgraduate education is more effective if implemented in both theoretical and practical training conditions and if a goal-oriented mentoring of trainees is given a major role in the student’s overall professional development [3]. A considerable part of postgraduate nursing education in a variety of nursing disciplines takes place within clinical environment in the form of practical training [4, 9, 17]. However, there is not much research investigating teaching-learning process and mentoring patterns in the context of postgraduate education [4, 9]. As an example, considering the importance of the quality and governance of clinical learning in nurse practitioner education, Gardner and colleagues [4] are designing the study to provide a theoretically informed clinical educational model to support learning and teaching in advanced specialty postgraduate education. Nyhagen and Strøm [9], on the other hand, using the focus group method, investigated postgraduate students’ perception of one-to-one precepting during critical care education.
It is underlined that nurses need to be educated in CLE, which should help them develop their potential and become advanced practitioners [4, 5]. Here, the role of nurse educators, responsible for building positive learning environments, is highlighted [10]. In addition, considering nurses’ obligation to continue their professional development, their experience regarding CLE and mentoring models have an impact on their decisions and motivation as regards further education [10]. For this reason, CLE elements such as pedagogical atmosphere on the ward or other healthcare facilities, the leadership style of the ward manager, nursing care on the ward, supervisory and/or mentoring patterns, and the role of the nurse teacher, identified and specified by Saarikoski and colleagues [7] in the CLES+T scale, assume central importance and should be monitored with the same attentiveness as in the case of practical training during undergraduate nursing education. This is important also because participants of postgraduate courses are registered working nurses with various levels of professional experience and expectations. Therefore, their perspective is different from that of pre-registration student nurses.
There has been a variety of undergraduate nursing students’ cohorts researched with the use of CLES+T across cultures to evaluate CLE in different clinical settings showing the correlation between well assessed CLE with mentor and nurse teacher role, and nursing students’ satisfaction and outcomes in clinical training [3, 18, 19]. Also complementariness of the CLES+T scale and the Cultural and Linguistic Diversity Scale (CALDs) designed to be used together to assess CLE by the international nursing students was studied [20]. Additionally, all current validation studies of CLES+T resulted in good psychometric properties, providing an opportunity for an effective assessment of CLE in various cultural environments [21, 22, 23, 24].
In Poland, nurses can participate in four nationally regulated forms of postgraduate education, the same for individuals with BSc and Master’s degrees [17, 25]: specialist training in nursing (2 years), qualifying courses (6 months), specialised courses (minimum 4 weeks), and additional training courses (short forms of training). Each of these courses provides nurses with a different range of clinical competences and independence in their professional work with patients [26]. The majority of training hours are delivered in clinical settings, e.g. practical training at specialised centres under the supervision of experienced supervisors and teachers, with a view to fostering the acquisition of specialist, advanced nursing competences in a variety of nursing disciplines [27]. This education is usually provided by accredited centres for nurses and midwives’ postgraduate education, often university based. Compared to Polish system, in the other systems developed internationally the acquisition of advanced clinical competences by nurses is often organised at the Master’s level and concludes with the qualification of Advanced Practice Nurse (APN) across various nursing disciplines [9, 28].
Aim
The aim of the study was to examine the psychometric properties of the Polish version of the Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T) in the context of postgraduate nursing education.