Satisfaction and Organizational Culture in Clinical Learning Environments for Nursing Students: An Integrative Review

Authors

  • Maria del Mar Martí-Ejarque Departamento de Enfermeria Fundamental y Clínica. Facultad de Enfermería.Universitat de Barcelona/ Investigación y Docencia. Hospital Universitari Sagrat Cor, Grupo Quirónsalud Spain https://orcid.org/0000-0002-0363-3327
  • Maria Antonia Martínez-Momblan Departamento de Enfermería Fundamental y Clínica. Facultad de Enfermería. Universitat de Barcelona Spain https://orcid.org/0000-0002-5364-5270
  • Cecilia Cuzco-Cabellos Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería. Universitat de Barcelona Spain https://orcid.org/0000-0003-2201-4879
  • Sergio Alonso-Fernández Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería. Universitat de Barcelona Spain https://orcid.org/0000-0001-6969-9380

DOI:

https://doi.org/10.24310/rep.10.2.2025.22068

Keywords:

External practices, Nursing, Mentoring, Literature review, University teaching

Abstract

The study aims to identify the characteristics of clinical learning environments for nursing students. The method consists of a literature review based on the Whittemore and Knafl model. Articles published between 2010 and 2020 that analysed clinical nursing learning environments using validated tools and/or studied the satisfaction of those involved in learning were included. Forty-four studies were selected. Aspects of the clinical learning environment were identified, both at the institutional level (macroenvironment) and at the unit level (microenvironment), as well as the agents involved in the learning process. Among the results, we found that there is a fragmented view of the environments, as the studies focus on isolated aspects of the context or its agents. After analysis, it was observed that the relationship between the different organisational levels, from management to clinical staff, is a key element for successful learning, as it facilitates a collaborative culture that enhances teaching and the integration of students into the clinical environment.

Downloads

Download data is not yet available.

Publication Facts

Metric
This article
Other articles
Peer reviewers 
1
2.4

Reviewer profiles  N/A

Author statements

Author statements
This article
Other articles
Data availability 
N/A
16%
External funding 
N/A
32%
Competing interests 
N/A
11%
Metric
This journal
Other journals
Articles accepted 
59%
33%
Days to publication 
178
145

Indexed in

Editor & editorial board
profiles
Academic society 
N/A
Publisher 
Universidad de Málaga

Author Biographies

Maria del Mar Martí-Ejarque, Departamento de Enfermeria Fundamental y Clínica. Facultad de Enfermería.Universitat de Barcelona/ Investigación y Docencia. Hospital Universitari Sagrat Cor, Grupo Quirónsalud

Enfermera. Máster en Educación Médica y Máster en Investigación Clínica. Coordinadora de Investigación y Docencia del Hospital Universitari Sagrat Cor. Profesora Asociada M´édica y Doctoranda de la Facultad de Enfermería de la Universitat de Barcelona. Miembro del CEIm Quirónsalud Cataluña. Miembro del Comité Científico de la Asociación Española de Enfermería Quirúrgica.

Coordinadora e Investigadora Principal de Estudios Clínicos Nacionales e Internacionales (Grupo de Investigación Globalsurg de la Universidad de Birmingham, Clinicgram (EUCLIDES-01), Population Health Research Institute (COP-AF). Revisora por pares de las revistas Educación Médica y BMC Nursing

Maria Antonia Martínez-Momblan, Departamento de Enfermería Fundamental y Clínica. Facultad de Enfermería. Universitat de Barcelona

Profesora agregada de la Facultad de Enfermería de la Universidad de Barcelona. Miembro de la Cátedra UB-COIB y miembro adscrito al Centro Biomédico de Enfermedades Raras (CIBERER-747). Publicados 79 artículos, 78 en JCR (32 Q1; 20 Q2; 12 Q3 y 14 Q4), teniendo en 28 autoría relevante (4 Q1;9 Q2; 5 Q3; 10 Q4) , a nivel de proyectos de investigación he colaborado en 53 proyectos competitivos nacionales, 1 proyecto europeo, 23 territoriales y 21 institucionales, 8 como IP. Participación en 223 Congresos Nacionales e Internacionales, 6 de los cuales fueron premiados. Actualmente Directora del Comité Científico de la Asociación Española de Enfermería en Cardiología (AEEC), así como miembro revisor de las Guías Españolas en Cardiología.

Cecilia Cuzco-Cabellos, Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería. Universitat de Barcelona

Enfermera con más de 20 años de experiencia en Cuidados Intensivos. Actualmente gestora de pacientes en Hospital Clínic Barcelona. Doctora en Enfermería y Salud por la Universidad de Barcelona, Cum Laude. Master Oficial en Liderazgo y Gestión de Servicios Enfermeros y Master Oficial en Enfermo Crítico y Emergencias de la Universidad de Barcelona.  Investigadora Postdoctoral (R2) en el Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS). Profesora Agregada en la Facultad de Enfermería de la Universidad de Barcelona. Miembro del Comité de Ética y de Investigación con medicamentos del Hospital Clínic Barcelona y miembro del grupo de Investigación de la Generalitat AGAUR 2021 SGR 01560."Grup de cures a la gent gran dependent (CGGD)"

Sergio Alonso-Fernández, Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería. Universitat de Barcelona

Profesor lector del Departamento de Enfermería Fundamental y Clínica de la Facultad de Enfermería de la Universidad de Barcelona. Especialista en Enfermería Pediátrica y Máster en Metodología de Investigación. Enfermero del Área de Investigación e Innovación en Cuidados Enfermeros del Hospital Universitario Germans Trias i Pujol en el periodo 2014-2021. Proyectos: 33 financiados, 13 no financiados, 6 como IP. Publicaciones: 29 artículos publicados, 17 en revistas JCR: 6 Q1; 8 Q2, 1 Q3, 2 Q4. 3 libros como coautor. Miembro del Grup de Recerca en Infermeria (GRIN) (exp AGAUR SGR 664), Instituto de Investigación Biomédica de Bellvitge (IDIBELL). Revisor de la Revistas científicas: (Enfermería Intensiva, Midwifery, JAN, etc). Miembro de CEI Acreditado y Evaluador Interno en diferentes convocatorias competitivas (priorización PERIS, becas COIB, Consejo General de Enfermería).

References

Alves, E., & Cogo, A. (2014). Nursing students’ perception of learning process in a hospital setting. Gaúcha Enferm, 35(1), 102–109. https://doi.org/10.1590/1983-1447.2014.01.42870

Arkan, B., Ordin, Y., & Yilmaz, D. (2018). Undergraduate nursing students’ experience related to their clinical learning environment and factors affecting to their clinical learning process. Nurse Education in Practice, 29, 127–132. https://doi.org/10.1016/j.nepr.2017.12.005

Beal, J. A., & Riley, J. M. (2019). Best organizational practices that foster scholarly nursing practice in Magnet® hospitals. Journal of Professional Nursing, 35(3), 187–194. https://doi.org/10.1016/j.profnurs.2019.01.001

Bisholt, B., Ohlsson, U., Engström, A. K., Johansson, A. S., & Gustafsson, M. (2014). Nursing students’ assessment of the learning environment in different clinical settings. Nurse Education in Practice, 14(3), 304–310. https://doi.org/10.1016/j.nepr.2013.11.005

Bourgeois, S., Drayton, N., & Brown, A. M. (2011). An innovative model of supportive clinical teaching and learning for undergraduate nursing students: The cluster model. Nurse Education in Practice, 11(2), 114–118. https://doi.org/10.1016/j.nepr.2010.11.005

Chan, A., Tang, F., Choi, K. C., Liu, T., & Taylor-Piliae, R. E. (2018). Clinical learning experiences of nursing students using an innovative clinical partnership model: A non-randomized controlled trial. Nurse Education Today, 68, 121–127. https://doi.org/10.1016/j.nedt.2018.06.001

Chuan, O. L., & Barnett, T. (2012). Student, tutor and staff nurse perceptions of the clinical learning environment. Nurse Education in Practice, 12(4), 192–197. https://doi.org/10.1016/j.nepr.2012.01.003

Congdon, G., Baker, T., & Cheesman, A. (2013). Enhancing the strategic management of practice learning through the introduction of the role of Learning Environment Manager. Nurse Education in Practice, 13(2), 137–141. https://doi.org/10.1016/j.nepr.2012.08.005

Díaz, C. (2018). Qualitative research and thematic content analysis. Intellectual orientation of Universum journal. Revista General de Información y Documentación, 28(1), 119–142. https://doi.org/10.5209/RGID.60813

Dimitriadou, M., Papastavrou, E., Efstathiou, G., & Theodorou, M. (2015). Baccalaureate nursing students’ perceptions of learning and supervision in the clinical environment. Nursing and Health Sciences, 17, 236–242. https://doi.org/10.1111/nhs.12174

D’Souza, M. S., Karkada, S. N., Parahoo, K., & Venkatesaperumal, R. (2015). Perception of and satisfaction with the clinical learning environment among nursing students. Nurse Education Today, 35(6), 833–840. https://doi.org/10.1016/j.nedt.2015.02.005

Engström, M., Löfmark, A., Ugland Vae, K. J., & Mårtensson, G. (2017). Nursing students’ perceptions of using the Clinical Education Assessment tool AssCE and their overall perceptions of the clinical learning environment - A cross-sectional correlational study. Nurse Education Today, 51, 63–67. https://doi.org/10.1016/j.nedt.2017.01.009

European Parliament and the Council of the European Union. (2013). Directive 2013/55/EU of the European Parliament and of the Council of 20 November 2013 amending Directive 2005/36/EC on the recognition of professional qualifications and Regulation. Official Journal of the European Union, 354, 132–170.

Flott, E. A., & Linden, L. (2016). The clinical learning environment in nursing education: a concept analysis. Journal of Advanced Nursing, 72(3), 501–513. https://doi.org/10.1111/jan.12861

Günay, U., & Kılınç, G. (2018). The transfer of theoretical knowledge to clinical practice by nursing students and the difficulties they experience: A qualitative study. Nurse Education Today, 65, 81–86. https://doi.org/10.1016/j.nedt.2018.02.031

Gurková, E., Žiaková, K., Cibríková, S., Magurová, D., Hudáková, A., & Mrosková, S. (2016). Factors influencing the effectiveness of clinical learning environment in nursing education. Central European Journal of Nursing and Midwifery, 7(3), 470–475. https://doi.org/10.15452/CEJNM.2016.07.0017

Hegenbarth, M., Rawe, S., Murray, L., Arnaert, A., & Chambers-Evans, J. (2015). Establishing and maintaining the clinical learning environment for nursing students: A qualitative study. Nurse Education Today, 35(2), 304–309. https://doi.org/10.1016/j.nedt.2014.10.002

Henderson, A., Cooke, M., Creedy, D., & Walker, R. (2012). Nursing students’ perceptions of learning in practice environments: A review. Nurse Education Today, 32(3), 299–302. https://doi.org/10.1016/j.nedt.2011.03.010

Henriksen, N., Normann, H. K., & Skaalvik, M. W. (2012). Development and testing of the Norwegian version of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. International Journal of Nursing Education Scholarship, 9. https://doi.org/10.1515/1548-923X.2239

Hooven, K. (2014). Evaluation of Instruments Developed to Measure the Clinical Learning Environment. Nurse Educator, 39(6), 316–320. https://doi.org/10.1097/NNE.0000000000000076

Hooven, K. (2015). Nursing Students’ Qualitative Experiences in the Medical – Surgical Clinical Learning Environment: A Cross-Cultural Integrative Review. Journal of Nursing Education, 54(8), 421–429. https://doi.org/10.3928/01484834-20150717-01

Hooven, K. (2017). Development and testing of the collaboration in the clinical learning environment tool. Journal of Nursing Measurement, 25(2), 353–369. https://doi.org/10.1891/1061-3749.25.2.353

Jamshidi, N., Molazem, Z., Sharif, F., Torabizadeh, C., & Kalyani, M. N. (2016). The Challenges of Nursing Students in the Clinical Learning Environment: A Qualitative Study. The Scientific World Journal, 2016, 1–7. https://doi.org/10.1155/2016/1846178

Kaldal, M. H., Kristiansen, J., & Uhrenfeldt, L. (2018). Nursing students experienced personal inadequacy, vulnerability and transformation during their patient care encounter: A qualitative meta-synthesis. Nurse Education Today, 64, 99–107. https://doi.org/10.1016/j.nedt.2018.02.008

Kamphinda, S., & Chilemba, E. B. (2019). Clinical supervision and support: Perspectives of undergraduate nursing students on their clinical learning environment in Malawi. Curationis, 42(1), 1–10. https://doi.org/10.4102/curationis.v42i1.1812

Koontz, A. M., Mallory, J. L., Burns, J. A., & Chapman, S. (2010). Staff nurses and students: the good, the bad, and the ugly. Medsurg Nursing : Official Journal of the Academy of Medical-Surgical Nurses, 19(4), 240–245.

Korhonen, H., Tuomikoski, A., Oikarainen, A., Kääriäinen, M., Elo, S., Kyngäs, H., Liikanen, E., & Mikkonen, K. (2019). Culturally and linguistically diverse healthcare students’ experiences of the clinical learning environment and mentoring: A qualitative study. Nurse Education in Practice, 41, 1–7. https://doi.org/10.1016/j.nepr.2019.102637

Liljedahl, M., Björck, E., Kalén, S., Ponzer, S., & Laksov, K. B. (2016). To belong or not to belong: nursing students’ interactions with clinical learning environments – an observational study. BMC Medical Education, 16, 197–207. https://doi.org/10.1186/s12909-016-0721-2

Lovecchio, C. P., DiMattio, M. J. K., & Hudacek, S. (2012). Clinical liaison nurse model in a community hospital: A unique academic-practice partnership that strengthens clinical nursing education. Journal of Nursing Education, 51(11), 609–615. https://doi.org/10.3928/01484834-20121005-02

Lovecchio, C. P., Di Mattio, M. J. K., & Hudacek, S. (2015). Predictors of undergraduate nursing student satisfaction with clinical learning environment: A secondary analysis. Nursing Education Perspectives, 36(4), 252–254. https://doi.org/10.5480/13-1266

Mamaghani, E. A., Rahmani, A., Hassankhani, H., Zamanzadeh, V., Campbell, S., Fast, O., & Irajpour, A. (2018). Experiences of Iranian Nursing Students Regarding Their Clinical Learning Environment. Asian Nursing Research, 12(3), 216–222. https://doi.org/10.1016/j.anr.2018.08.005

Mikkonen, K., Merilainen, M., & Tomietto, M. (2020). Empirical model of clinical learning environment and mentoring of culturally and linguistically diverse nursing students. Journal of Clinical Nursing, 29, 653–661. https://doi.org/10.1111/jocn.15112

Murray, T. A., Crain, C., Meyer, G. A., McDonough, M. E., & Schweiss, D. M. (2010). Building bridges: An innovative academic-service partnership. Nursing Outlook, 58(5), 252–260. https://doi.org/10.1016/j.outlook.2010.07.004

Nepal, B., Taketomi, K., Ito, Y. M., Kohanawa, M., Kawabata, H., Tanaka, M., & Otaki, J. (2016). Nepalese undergraduate nursing students’ perceptions of the clinical learning environment, supervision and nurse teachers: A questionnaire survey. Nurse Education Today, 39, 181–188. https://doi.org/10.1016/j.nedt.2016.01.006

Newton, J. M., Jolly, B. C., Ockerby, C. M., & Cross, W. M. (2010). Clinical Learning Environment Inventory: factor analysis. Journal of Advanced Nursing, 66(6), 1371–1381. https://doi.org/10.1111/j.1365-2648.2010.05303.x

O’Mara, L., Mcdonald, J., Gillespie, M., Brown, H., & Miles, L. (2014). Challenging clinical learning environments: Experiences of undergraduate nursing students. Nurse Education in Practice, 14(2), 208–213. https://doi.org/10.1016/j.nepr.2013.08.012

Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan - a web and mobile app for systematic reviews. Systematic Reviews. https://doi.org/10.1186/s13643-016-0384-4

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Systematic Reviews, 89, 1–11. https://doi.org/10.1016/j.ijsu.2021.105906

Papathanasiou, I. V, Tsaras, K., & Sarafis, P. (2014). Views and perceptions of nursing students on their clinical learning environment: Teaching and learning. Nurse Education Today, 34, 57–60. https://doi.org/10.1016/j.nedt.2013.02.007

Phuma-Ngaiyaye, E., Bvumbwe, T., & Chipeta, M. C. (2017). Using preceptors to improve nursing students’ clinical learning outcomes: A Malawian students’ perspective. International Journal of Nursing Sciences, 4(2), 164–168. https://doi.org/10.1016/j.ijnss.2017.03.001

Pitkänen, S., Kääriäinen, M., Oikarainen, A., Tuomikoski, A., & Elo, S. (2018). Healthcare students’ evaluation of the clinical learning environment and supervision – a cross-sectional study. Nurse Education Today, 62, 143–149. https://doi.org/10.1016/j.nedt.2018.01.005

Rhodes, M. L., Meyers, C. C., & Underhill, M. L. (2012). Evaluation Outcomes of a Dedicated Education Unit in a Baccalaureate Nursing Program. Journal of Professional Nursing, 28(4), 223–230. https://doi.org/10.1016/j.profnurs.2011.11.019

Saarikoski, M., Isoaho, H., Warne, T., & Leino-kilpi, H. (2008). The nurse teacher in clinical practice : Developing the new sub-dimension to the clinical learning environment and supervision (CLES) scale. International Journal of Nursing Studies, 45(8), 1233–1237. https://doi.org/10.1016/j.ijnurstu.2007.07.009

Serçekus, P., & Baskale, H. (2016). Nursing students’ perceptions about clinical learning environment in Turkey. Nurse Education in Practice, 17, 134–138. https://doi.org/10.1016/j.nepr.2015.12.008

Shinners, J., Harper, M. G., & Dolansky, M. A. (2019). Creating the optimal clinical learning environment. Journal of Continuing Education in Nursing, 50(11), 485–489. https://doi.org/10.3928/00220124-20191015-02

Shivers, E., Hasson, F., & Slater, P. (2017). Pre-registration nursing student’s quality of practice learning: Clinical learning environment inventory (actual) questionnaire. Nurse Education Today, 55, 58–64. https://doi.org/10.1016/j.nedt.2017.05.004

Sundler, A. J., Björk, M., Bisholt, B., Ohlsson, U., Kullén, A., & Gustafsson, M. (2014). Student nurses’ experiences of the clinical learning environment in relation to the organization of supervision: A questionnaire survey. Nurse Education Today, 34(4), 661–666. https://doi.org/10.1016/j.nedt.2013.06.023

Tang, F. W. K., & Chan, A. W. K. (2019a). Learning experience of nursing students in a clinical partnership model: An exploratory qualitative analysis. Nurse Education Today, 75, 6–12. https://doi.org/10.1016/j.nedt.2019.01.003

Taylor, M. A., Brammer, J. D., Cameron, M., & Perrin, C. A. (2015). The sum of all parts: An Australian experience in improving clinical partnerships. Nurse Education Today, 35(2), 297–303. https://doi.org/10.1016/j.nedt.2014.10.003

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042

Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2008). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Journal of Clinical Epidemiology, 61(4), 344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008

Watson, P. B., Seaton, P., Jamieson, I., Mountier, J., Whittle, R., & Saarikoski, M. (2014). Exploratory Factor Analysis of the Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T). Journal of Nursing Measurement, 22(1), 164–180. https://doi.org/10.1891/1061-3749.22.1.164

Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x

Young, K., Godbold, R., & Wood, P. (2019). Nurses’ experiences of learning to care in practice environments: A qualitative study. Nurse Education in Practice, 38, 132–137. https://doi.org/10.1016/j.nepr.2019.06.012

Published

2025-12-26

How to Cite

Martí-Ejarque, M. del M., Martínez-Momblan, M. A., Cuzco-Cabellos, C., & Alonso-Fernández, S. (2025). Satisfaction and Organizational Culture in Clinical Learning Environments for Nursing Students: An Integrative Review. Diario De Practicum, 10(2), 64–78. https://doi.org/10.24310/rep.10.2.2025.22068

Issue

Section

Mycelaneous