Multilevel perspectives in clinical learning environments' assessment: An insight on levels involved in planning nursing education

Background: Clinical learning in nursing education is workplace-based and it involves both learning and organizational factors. Students could experience these factors both at individual and at group level. This study aimed to assess clinical learning environment as a multilevel phenomenon, by grouping students’ perceptions at different organizational levels. Method: A cross-sectional multilevel design has been conducted. 3 Italian Universities, 6 Hospitals and 73 wards have been involved in the study during 2013. Wards with at least 3 attending nursing students have been included. The sample involved 597 nursing students (average age 23.1 years, SD = 4.67 years; 72.6% females; 27.2% attending first year; 31.7% second year; 41.1% third year). Clinical Learning Environment and Supervision plus Nurse teacher ( CLES+T ) scale has been administered. Intraclass Correlation Coefficients (ICC) have been estimated at ward, at hospital and at University level. Results: All ICCs scores were above 0.10 and they indicated clinical learning environment as a multilevel phenomenon. The most pertinent level to multilevel research was the ward level. The nurse teacher scale was pertinent to Hospital and University level. Conclusions: Clinical learning environment is a multilevel phenomenon. These findings could enhance research develop ment in this field of studies. Practical implications suggest multilevel approach in order to detect the most effective organizational level to improve educational intervention.