title: Nepalese undergraduate nursing students' perceptions of the clinical learning environment, supervision and nurse teachers: A questionnaire survey.
abstract: BACKGROUND
  Clinical practice enables nursing students to acquire essential professional skills, but little is known about nursing students' perceptions of the clinical learning environment (CLE) in Nepal.
  
  
  OBJECTIVE
  To examine Nepalese nursing students' perceptions regarding the CLE and supervision.
  
  
  METHODS
  A cross-sectional questionnaire design was used.
  
  
  METHODS
  Government and private hospitals in Nepal where the undergraduate nursing college students undertook their clinical practice.
  
  
  METHODS
  Students with clinical practice experience were recruited from years 2-4 of the B.Sc. nursing program in Nepal (n=350). The final sample comprised 263 students.
  
  
  METHODS
  A self-administered questionnaire including demographic characteristics, latest clinical practice site, and general satisfaction was administered February-March 2014. The previously validated Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale was used in the questionnaire. The analytical approach used exploratory factor analysis, assessments of the scale and sub-dimension reliability, correlations of factors between scale sub-dimensions, and multiple regression analysis.
  
  
  RESULTS
  Students' practicum satisfaction level at government hospitals was significantly higher than those at private hospitals (p<0.0001). Five factors explained 85.7% of the variance, with minor factorial structure differences compared with the original scale. Reliability was confirmed (Cronbach's alpha=0.93 for total scale, 0.76-0.92 for sub-dimensions). Inter-correlations between the five original sub-dimensions were 0.27-0.68 (p<0.0001). Students undertaking their practicum in private hospitals evaluated their clinical placements significantly more negatively on most sub-dimensions than those in government hospitals. Multiple regression analysis revealed a significant positive relationship between satisfaction and pedagogical atmosphere (p<0.0001).
  
  
  CONCLUSIONS
  This is the first study to investigate nursing students' perceptions of the CLE in undergraduate nursing programs in Nepal. Students were satisfied with the CLE overall, but satisfaction varied by practicum hospital sector. The most influential factor explaining satisfaction was pedagogical atmosphere.
authors.affiliation: Department of Medical Education and General Medicine, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan. Electronic address: bijeta@frontier.hokudai.ac.jp.
authors.forename: Bijeta
authors.initials: B
authors.lastname: Nepal
authors.affiliation: Center for Medical Education, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan. Electronic address: tktmk@med.hokudai.ne.jp.
authors.forename: Kikuko
authors.initials: K
authors.lastname: Taketomi
authors.affiliation: Department of Biostatistics, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan. Electronic address: ito-ym@med.hokudai.ac.jp.
authors.forename: Yoichi M
authors.initials: YM
authors.lastname: Ito
authors.affiliation: Center for Medical Education, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan. Electronic address: kohanawa@med.hokudai.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kohanawa
authors.affiliation: Center for Medical Education, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan. Electronic address: kawabata@med.hokudai.ac.jp.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Kawabata
authors.affiliation: R&D Laboratory for Innovative Biotherapeutics, Graduate School of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: tmiciko@med.kyushu-u.ac.jp.
authors.forename: Michiko
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Center for Medical Education, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan. Electronic address: jotaki@med.hokudai.ac.jp.
authors.forename: Junji
authors.initials: J
authors.lastname: Otaki
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004508:Education, Nursing, Baccalaureate; D005181:Faculty, Nursing; D005260:Female; D006761:Hospitals; D006801:Humans; D007858:Learning; D009390:Nepal; D015402:Nursing Education Research; D009745:Nursing, Supervisory; D010549:Personal Satisfaction; D011231:Preceptorship / Q000379:methods*; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Clinical environment; Clinical supervision; Nepal; Nursing education; Nursing education research; Nursing students; Questionnaire; Teaching methods