title: Influences of Sociocultural Factors Within the Clinical Learning Environment on Students' Perceptions of Learning: An Integrative Review.
abstract: A persistent deficit in new graduate nurses' clinical reasoning skill exists. Clinical reasoning is best learned in the sociocultural clinical learning environment (CLE), yet many CLEs fail to engage nursing students in the cognitive work of nursing that promotes development of clinical reasoning. Despite two decades of recommendations to improve CLEs based on students' perceptions of learning, widespread improvement remains elusive.
  
  
  OBJECTIVE
  The aim of this review was to synthesize what is known about the influence of sociocultural factors in the acute-care CLE on prelicensure nursing students' perceptions of learning, for the purpose of identifying factors that when modified may promote improvement of clinical reasoning skill.
  
  
  METHODS
  The integrative review methodology was used to synthesize and identify gaps in evidence on students' perceptions of learning in the acute-care CLE.
  
  
  RESULTS
  Global commonalities exist in the impact of the sociocultural CLE on students' perceptions of learning, including overall sociocultural atmosphere, membership in the health care team, supervisory relationships, peer relationships, and clinical education structure.
  
  
  CONCLUSIONS
  This review provides evidence that modification of CLE factors and examination of their influence on measurable learning outcomes such as clinical reasoning are the necessary next steps to facilitate improvement of new graduate nurses' clinical reasoning skill.
authors.affiliation: Prespecialty Level Director, Vanderbilt University School of Nursing, Nashville, TN. Electronic address: mary.a.jessee@vanderbilt.edu.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Jessee
mesh_terms: D002983:Clinical Competence; D004508:Education, Nursing, Baccalaureate; D006801:Humans; D007858:Learning; D015402:Nursing Education Research; D013338:Students, Nursing / Q000523:psychology*; D013850:Thinking
keywords: Clinical learning environment; Clinical reasoning; Nursing education; Perceptions