L'implementazione del questionario CLES+T nei corsi di laurea in infermieristica italiani per la valutazione dell'ambiente clinico d'apprendimento da parte degli studenti: un protocollo di studio
10.54103/dn/22520
BACKGROUND: La formazione in ambito clinico rappresenta una tappa fondamentale del percorso universitario degli studenti delle professioni sanitarie e mediche. Nella formazione degli studenti di infermieristica tutto questo è enfatizzato stante come, per ogni tirocinio, abbiano l'opportunità di arricchirsi di esperienza pratica e di confrontarsi di persona con diverse realtà lavorative. Sulla base di queste esperienze, è pertanto fondamentale effettuare una valutazione periodica degli ambienti di tirocinio.OBIETTIVI: L'obiettivo principale di questo lavoro è l'implementazione di uno strumento di valutazione dell'ambiente di formazione clinica per garantire un feedback rispetto alla strutture sanitarie adibite a sedi di tirocinio degli studenti al fine di migliorare la qualità della formazione clinica universitaria.METODO: Questo protocollo di ricerca descrive uno studio osservazionale, con reclutamento formale di vari corsi di laurea in infermieristica per poi includere gli studenti dei vari anni accademici. Lo studio prevede l'applicazione del questionario CLES+T da parte dei corsi di laurea partecipanti, inizialmente per avere una visione d'insieme, valutandone successivamente l'implementazione come possibile strumento di valutazione permanente.RISULTATI ATTESI: Dallo studio descritto in questo protocollo di studio ci si aspetta che la popolazione partecipante consideri il questionario come un modo per analizzare criticamente l'ambiente clinico. Ci si aspetta un'ampia partecipazione degli studenti di infermieristica e un buon feedback degli ambienti esaminati.
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2785-7263
22520
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Gianluigi Carfora
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Dissertation Nursing
Ambiente clinico
L'implementazione del questionario CLES+T nei corsi di laurea in infermieristica italiani per la valutazione dell'ambiente clinico d'apprendimento da parte degli studenti: un protocollo di studio
Text.Serial.Journal
https://riviste.unimi.it/index.php/dissertationnursing
3
Protocolli
2024-04-03
2024-02-13
2024-07-31
2024-04-04
DN
Gianluigi Carfora
2024/04/03
10.54103/dn/22520
U.O. Psichiatria, Ospedale Umberto I, Roma
2785-7263
2
Ambiente clinico
en
R Core Team. R: A Language and environment for statistical computing. USA; 2021. (R).
The implementation of CLES+T questionnaire in the Italian nursing bachelor’s degree program for the evaluation of clinical learning environment by nursing students: a study protocol
https://riviste.unimi.it/index.php/dissertationnursing/article/download/22520/20415
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          ISSN: 2785-7263                                                                                            DOI: 10.54103/dn/22520




             DISSERTATION NURSING®
              Journal Homepage: https://riviste.unimi.it/index.php/dissertationnursing

Study Protocol

 The implementation of CLES+T questionnaire in the Italian
nursing bachelor’s degree program for the evaluation of clinical
  learning environment by nursing students: a study protocol
                   1,2                       1,2                       2,3
Pasquale Fava            , Laura Carocci         , Carfora Gianluigi
1 LocalHealth Authority of Latina, Rome, Italy
2 Sapienza University of Rome, Rome, Italy
3 Psychiatry Service, Umberto I Hospital, Rome, Italy




Findings:                                            ABSTRACT

This study protocol describes the application        BACKGROUND: Education in clinical settings represents a crucial step in
of the CLES+T questionnaire in some                  the university process for students on degree courses in the health and medical
Bachelor School of Nursing for the                   professions. In nursing education, this is emphasised, as they have the
evaluation of clinical training environments.
                                                     opportunity to gain practical experience and come face-to-face with different
                                                     working realities during each clinical placement. Based on these experiences, it
                                                     is therefore essential to carry out a periodic evaluation of the internship
                                                     settings.

                                                     OBJECTIVES: The main objective of this work is to implement an
                                                     evaluation tool for the clinical training environment to provide feedback
                                                     concerning student placement locations and improve the quality of university
                                                     clinical training.


                                                     METHOD: This research study protocol describe an observational study,
                                                     with formal recruitment of nursing degree courses and subsequently inclusion
                                                     of students from the differemt academic years. The study involves the
                                                     application of the CLES+T questionnaire in participating degree courses to be
                                                     able to have an overall vision and subsequently assessing its implementation as
                                                     a possible permanent evaluation tool.

                                                     EXPECTED RESULTS: It is expected, from the study described in this
                                                     protocol, that the participating population will consider the questionnaire as a
                                                     way of critically analysing the clinical environment. A broad participation of
                                                     the nursing student population and good feedback of the examined
                                                     environments is expected.


             KEYWORDS: CLES+T, Nursing education, Evaluation, Nursing Degree, Clinical Learning Enrivonment

          Corresponding author:                                              1                              Submission received: 13/02/2024
          Pasquale Fava: pasquale.fava@uniroma1.it                                                   End of Peer Review process: 13/03/2024
          Ospedale Santa Maria Goretti,                                                                               Accepted: 15/03/2024
          via Lucia Scaravelli 04100 Latina (LT)
                                                                                  This work is licensed under a Creative Commons
             Dissertation Nursing V.3, N.2 (07/2024)                              Attribution-NonCommercial-NoDerivatives 4.0 nternational
          ISSN: 2785-7263                                                                                             DOI: 10.54103/dn/22520




             DISSERTATION NURSING®
             Journal Homepage: https://riviste.unimi.it/index.php/dissertationnursing

Protocollo di studio
L'implementazione del questionario CLES+T nei corsi di laurea in
   infermieristica italiani per la valutazione dell'ambiente clinico
 d'apprendimento da parte degli studenti: un protocollo di studio
                  1,2                        1,2                         2,3
Pasquale Fava           , Laura Carocci            , Carfora Gianluigi
1 ASL  Latina, Roma
2 Sapienza  Università di Roma, Roma
3 Servizio di Psichiatria, Ospedale Umberto I, Roma



                                                        ABSTRACT
Riscontri:                                              BACKGROUND: La formazione in ambito clinico rappresenta una tappa
Questo protocollo di studio descrive                    fondamentale del percorso universitario degli studenti delle professioni
l’applicazione del questionario CLES+T in               sanitarie e mediche. Nella formazione degli studenti di infermieristica tutto
alcuni corsi di Laurea in Infermieristica per la        questo è enfatizzato stante come, per ogni tirocinio, abbiano l'opportunità
valutazione degli ambienti di formazione
clinica.                                                di arricchirsi di esperienza pratica e di confrontarsi di persona con diverse
                                                        realtà lavorative. Sulla base di queste esperienze, è pertanto fondamentale
                                                        effettuare una valutazione periodica degli ambienti di tirocinio.

                                                        OBIETTIVI: L'obiettivo principale di questo lavoro è l'implementazione
                                                        di uno strumento di valutazione dell'ambiente di formazione clinica per
                                                        garantire un feedback rispetto alla strutture sanitarie adibite a sedi di
                                                        tirocinio degli studenti al fine di migliorare la qualità della formazione
                                                        clinica universitaria.

                                                        METODO: Questo protocollo di ricerca descrive uno studio
                                                        osservazionale, con reclutamento formale di vari corsi di laurea in
                                                        infermieristica al fine di includere gli studenti dei vari anni accademici. Lo
                                                        studio prevede l'applicazione del questionario CLES+T da parte dei corsi di
                                                        laurea partecipanti per avere inizialmente una visione d'insieme, valutando
                                                        successivamente l'implementazione dello strumento come possibile
                                                        strumento di valutazione permanente.

                                                        RISULTATI ATTESI: Dallo studio, descritto in questo protocollo, ci si
                                                        aspetta che la popolazione partecipante consideri il questionario come un
                                                        modo per analizzare criticamente l'ambiente clinico. Ci si aspetta un'ampia
                                                        partecipazione degli studenti di infermieristica e un buon feedback degli
                                                        ambienti esaminati.
        KEYWORDS: CLES+T, Formazione infermieristica, Valutazione, Corso di laurea in infermieristica, Apprendimento clinico


         Corresponding author:                                                 2                             Submission received: 13/02/2024
         Pasquale Fava: pasquale.fava@uniroma1.it                                                     End of Peer Review process: 13/03/2024
         Ospedale Santa Maria Goretti,                                                                                 Accepted: 15/03/2024
         via Lucia Scaravelli 04100 Latina (LT)
                                                                                   This work is licensed under a Creative Commons
             Dissertation Nursing V.3, N.2 (07/2024)                               Attribution-NonCommercial-NoDerivatives 4.0 nternational
       ISSN: 2785-7263                                                                                DOI: 10.54103/dn/22520




         DISSERTATION NURSING®
          Journal Homepage: https://riviste.unimi.it/index.php/dissertationnursing



BACKGROUND AND RATIONALE                                       high quality of services and care provided and
                                                               supervise and optimize university training processes
Clinical training in the nursing profession, commonly
                                                               in the healthcare sector(5). Specifically, in the practical
defined as "practical" clinical training, has always had
                                                               training, nursing staff adequately evaluate nursing
high importance in the context of academic training.
                                                               students through ad hoc objective evaluation
The traineeship is not only a means to have a first
                                                               questionnaires when they carry out practical activities.
approach and a plenary vision of the professional
                                                               This type of evaluation is not uniform throughout
world that one wishes to undertake, but it allows a
                                                               Italy but is discretionally handled by individual
practical implementation of the theoretical notions
                                                               universities.
addressed during frontal (or distance) lessons and,
                                                               However, as far as the practical training environment
therefore, an initial development of practical skills.
                                                               is concerned, there is no uniform institutional-level
Scientific literature has long proven the high
                                                               evaluation process to verify whether the internship
importance of this university training step through
                                                               environment suits the student population and
clinical studies spread throughout the world. It must
                                                               whether students can benefit from such training
be taken into consideration that university practical
                                                               environments. This lack creates the need to consider
training for nurses has undergone changes and
                                                               the student population's subjective point of view to
improvements over time to accommodate intrinsic
                                                               evaluate the internship environment to strengthen or
incidental factors (such as disabilities, Specific
                                                               intervene where necessary in training activities in
Learning Disorders (SLD), needs of the student
                                                               healthcare facilities. A clinical training environment
population, and more) and extrinsic incident factors
                                                               should reflect specific characteristics: physical space,
(such as social events of various kinds, as well as
                                                               psychosocial factors and interactions, organizational
emergency contexts such as that of the 2020 Sars-
                                                               culture, and teaching, and learning components.
Cov2 pandemic) (1,2).
                                                               These attributes often determine the achievement of
This type of nurse training in Italy has evolved from
                                                               learning outcomes and student self-confidence(6).
training through regional training schools to the
                                                               In terms of this conceptual background, several
present day. Historically, a major change and increase
                                                               instruments have been developed in the last two
in the quality standards of practical training for
                                                               decades for this objective. From 1995, Dunn and
nursing students occurred in 1992 with legislative
                                                               Burnett (7) to 2008, with Saarikoski et al. (8), six
decree no. 502(3) (subsequently modified with
                                                               assessment tools were developed (one of them was
Legislative Decree 517/1999(4)). With this legislation,
                                                               updated). All these tools analyze the primary
a process of agreement was created between the
                                                               constructs for the assessment of clinical learning.
Italian regions and universities, aiming to maintain a
                                                               However, at the same time, they have several
      Corresponding author:                                3                                 Submission received: 13/02/2024
      Pasquale Fava: pasquale.fava@uniroma1.it                                        End of Peer Review process: 13/03/2024
      Ospedale Santa Maria Goretti,                                                                    Accepted: 15/03/2024
      via Lucia Scaravelli 04100 Latina (LT)
                                                                   This work is licensed under a Creative Commons
         Dissertation Nursing V.3, N.2 (07/2024)                   Attribution-NonCommercial-NoDerivatives 4.0 nternational
       ISSN: 2785-7263                                                                                     DOI: 10.54103/dn/22520




          DISSERTATION NURSING®
           Journal Homepage: https://riviste.unimi.it/index.php/dissertationnursing



limitations: they partially intercept the presence of all           be applied. (11)
the elements capable of influencing the effectiveness               AIM
of clinical learning, stimulate little critical evaluation          The objectives of the study described in this protocol

of learning experiences, do not differentiate the                   are as follows:

different models of tutoring, and they do not measure                  Permit all the nursing students of each study
the quality of environments in hospital settings. Of                    academic year to give their P.O.V. (point of
these tools introduced, some have been translated                       view) about the clinical learning environment.
into Italian (9). The CLES+T (Clinical Learning                        To have an overall image of the nursing students'
Environment and Supervision + Nurse Teacher) by                         perception of the clinical learning environment,
Saarikoski et al. (8) is currently considered a gold                    from a single bachelor's degree (between each
standard in the literature, validated and translated in                 study academic year) until to compare with all the
multiple international settings, and analyses the topic                 bachelor’s degrees that join this study protocol.
based on 34 items. This questionnaire structures the                   To investigate and evaluate all the clinical
item analysis using a 5-step continuum scale.                           learning environments that will be included in
In Italy, several study groups have used CLES+T to                      the study protocol and, where necessary,
implement research studies on students' perceptions                     intervene with proactive methods for developing
of the apprenticeship training environment. In 2013                     and improving the workplace for future students.
at the university of Modena and Reggio Emilia, the
CLES+T was administered to a sample of 179                          Design
students; from this study, it was found that their                  The type of study that will be performed is an
views on the clinical environment corresponded                      observational study, where all the nursing bachelor's
similarly to their final internship evaluation, that the            degrees that participate could give their students the
instrument in question can be helpful in the                        CLES+T questionnaire. For this study protocol, the
exploration      of     clinical     environments   and   for       SPIRIT Statement for Clinical Trial Protocol) was
highlighting potential criticalities, while as a limitation         applied (12).
the researchers reiterated the lack of comparison with
other university realities (10). Already in the past, in a
validation study of the assessment tool in the Italian              METHODS

language, it was emphasized that the tool has
                                                                    Study setting
international consistency and culturally sensitive
                                                                    The study will be carried out on all those nursing
characteristics, as well as the need for analysis of
                                                                    bachelor's degrees courses which presents an
more clinical realities where the assessment tool can
                                                                    affiliated healthcare structure as a clinical learning
       Corresponding author:                                    4                                 Submission received: 13/02/2024
       Pasquale Fava: pasquale.fava@uniroma1.it                                            End of Peer Review process: 13/03/2024
       Ospedale Santa Maria Goretti,                                                                        Accepted: 15/03/2024
       via Lucia Scaravelli 04100 Latina (LT)
                                                                        This work is licensed under a Creative Commons
          Dissertation Nursing V.3, N.2 (07/2024)                       Attribution-NonCommercial-NoDerivatives 4.0 nternational
        ISSN: 2785-7263                                                                                  DOI: 10.54103/dn/22520




           DISSERTATION NURSING®
            Journal Homepage: https://riviste.unimi.it/index.php/dissertationnursing



environment and who will accept to be involved in               done with the contribution of the bachelor's director
the project.                                                    and didactic director of every nursing bachelor degree
                                                                involved.
Eligibility criteria                                            Data collection and management
Inclusion criteria: All bachelor nursing students can
                                                                Plans for assessment and collection of outcomes
participate in the study, regardless of their academic
                                                                Once the student population has been recruited for
year.
                                                                the      various          academic            years,        the   CLES+T
Exclusion criteria: Nursing students next to graduation
                                                                questionnaire (Italian version) is administered with
cannot participate due to their inability to have other
                                                                accompanying framing questions for the sample
experiences in the clinical learning environment.
                                                                population          (general         data,      information       on   the
Who will take informed consent?                                 placement step...) at the end of each placement step.
The informed consent, where they are being                      This process is carried out for an entire academic year
collected, will be conserved by the study researchers,          to evaluate all the students and all the clinical learning
as dictated by the Good Clinical Practices.                     environments involved.


Sampling                                                        Plans to promote participant retention and
Every nursing bachelor's degree student who wants to            complete follow-up
participate can be part of the sample population.               As a plan to promote participant retention and to
Randomization of the sample is not envisaged as                 complete the survey, the role of the entire teaching
there will have to be a breakdown and analysis of the           staff is essential in order to understand the
data for each academic year and each educational and            importance of the participation of all the nursing
clinical step.                                                  students in the research activity as an instrument of
                                                                development and improvement for the clinical
Recruitment                                                     learning environment and the nursing bachelor's
The first step involves sending an invitation to                degree, not only as a tool for the students' perception.
participate in the study protocol to various nursing
degree courses, first on a regional level and later going       Data management and analysis
to an extra-regional level, to extend the participant           The data collected will be managed and stored via a
population and broaden the comparison process with              cloud system (using GOOGLE FORM with the
other universities and healthcare institutions.                 university account/email), which will also be used to
The student population's recruitment phase will be              administer the questionnaire and catalog the data for
        Corresponding author:                               5                                   Submission received: 13/02/2024
        Pasquale Fava: pasquale.fava@uniroma1.it                                         End of Peer Review process: 13/03/2024
        Ospedale Santa Maria Goretti,                                                                     Accepted: 15/03/2024
        via Lucia Scaravelli 04100 Latina (LT)
                                                                      This work is licensed under a Creative Commons
           Dissertation Nursing V.3, N.2 (07/2024)                    Attribution-NonCommercial-NoDerivatives 4.0 nternational
          ISSN: 2785-7263                                                                                         DOI: 10.54103/dn/22520




             DISSERTATION NURSING®
              Journal Homepage: https://riviste.unimi.it/index.php/dissertationnursing



subsequent statistical analysis. Only fully completed                      2. Alcalà-Albert G et al. Back to Clinical Training
questionnaires will be considered in the analysis.                         during the COVID-19 Pandemic: Perspective of
Statistical analysis of the survey data will be                            Nursing Students. Int J Env Res Public Health.
performed using open-source analysis software                              2022;19(21):1–12.
JAMOVI and JASP(13–15).
                                                                           3. Riordino della disciplina in materia sanitaria, a

Results                                                                    norma dell’articolo 1 della legge 23 ottobre 1992, n.
It is expected from this study protocol that the                           421. Roma: Gazzetta Ufficiale; 1992.
participating          population           will     consider   the
                                                                           4. Disciplina dei rapporti fra Servizio sanitario
questionnaire as a way of critically analyzing the
                                                                           nazionale e università, a norma dell’articolo 6 della
clinical environment. A broad participation of the
                                                                           legge 30 novembre 1998, n.419. Roma: Gazzetta
nursing student population and good feedback of the
                                                                           Ufficiale; 1999.
examined environments is expected.
                                                                           5. Chiellini L. L’intesa tra università, regioni ed
Found Declarations
                                                                           aziende del servizio sanitario nazionale. Il Polit.
This research received no specific funding or grant
                                                                           december 2004;69(3):539–54.
from public, commercial, or not-for-profit funding
agencies.                                                                  6. Flott E, Linden L,. The clinical learning
                                                                           environment in nursing education: a concept analysis.
Competing interests
                                                                           J Adv Nurs. 2016;72(3):501–13.
The authors declare that they have no known
competing financial interests or personal relationships                    7. Dunn S, Burnett P. The development of a clinical
that could have appeared to influence the work                             learning       environment               scale.        J       Adv   Nurs.
reported in this paper.                                                    1995;22(6):1166–73.

                                                                           8. Saarikoski M et al,. The nurse teacher in clinical

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          Corresponding author:                                        6                                 Submission received: 13/02/2024
          Pasquale Fava: pasquale.fava@uniroma1.it                                                End of Peer Review process: 13/03/2024
          Ospedale Santa Maria Goretti,                                                                            Accepted: 15/03/2024
          via Lucia Scaravelli 04100 Latina (LT)
                                                                               This work is licensed under a Creative Commons
             Dissertation Nursing V.3, N.2 (07/2024)                           Attribution-NonCommercial-NoDerivatives 4.0 nternational
       ISSN: 2785-7263                                                                           DOI: 10.54103/dn/22520




         DISSERTATION NURSING®
          Journal Homepage: https://riviste.unimi.it/index.php/dissertationnursing



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      Corresponding author:                               7                             Submission received: 13/02/2024
      Pasquale Fava: pasquale.fava@uniroma1.it                                   End of Peer Review process: 13/03/2024
      Ospedale Santa Maria Goretti,                                                               Accepted: 15/03/2024
      via Lucia Scaravelli 04100 Latina (LT)
                                                              This work is licensed under a Creative Commons
         Dissertation Nursing V.3, N.2 (07/2024)              Attribution-NonCommercial-NoDerivatives 4.0 nternational
