Mansutti Irene, Saiani Luisa, Grassetti Luca, Palese Alvisa
Department of Biological and Medical Sciences, Udine University, Italy.
Department of Diagnositics and Public Health, Verona University, Italy.
Int J Nurs Stud. 2017 Mar;68:60-72. doi: 10.1016/j.ijnurstu.2017.01.001. Epub 2017 Jan 4.
The clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date.
The aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available.
A systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines).
The Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016.
The included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used.
The search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated.
Clinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement.
临床学习环境是护理教育路径的基础，能够影响学习过程和结果。护理教育领域已开发出多种工具，旨在评估临床学习环境的质量；然而，迄今为止，尚未对这些研究的心理测量特性和方法学质量进行系统评价。
本研究的目的是：1）识别用于评估护理教育中临床学习环境的经过验证的工具；2）严格评估用于估计心理测量特性的方法学质量；3）比较现有工具的心理测量特性。
对文献进行系统评价（使用系统评价和荟萃分析的首选报告项目指南），并对心理测量特性的方法学质量进行评估（使用基于共识的健康测量工具选择标准指南）。
检索了Medline和CINAHL数据库。符合条件的研究需满足以下标准：a）评估临床学习环境质量的工具的验证研究；b）在护理教育中；c）以英文或意大利文发表；d）2016年4月之前。
对纳入的研究进行测量的心理测量特性的方法学质量评估，然后在心理测量特性和所用过程的方法学质量方面进行比较。
检索策略共产生26项研究和8种临床学习环境评估工具。每种工具都估计了多种心理测量特性，所用方法的质量各不相同。概念和结构效度在其重要性方面评估不足，很少由目标人群（护理学生）进行判断。一些特性很少被考虑（如信度、测量误差、效标效度），而其他特性则经常被估计，但使用不同的系数和统计分析（如内部一致性、结构效度），因此难以在不同工具之间进行比较。此外，大多数研究中特性评估所采用的方法学质量较差或一般，影响了所估计的心理测量值的可靠性。
临床学习实习是培养未来护理人员的关键策略：强烈建议使用评估环境质量及其促进有效学习能力的工具。需要采用质量更高的研究方法来估计心理测量特性的研究，以支持护理教育工作者进行临床实习认证和质量改进。
