Learning in clinical practice: Factors, outcomes, and challenges in clinical nursing education - A scoping review

Clinical learning environments (CLEs) are critical components of nursing education, as they influence skill acquisition, professional identity development, and learning outcomes.

The aim was to systematically map the evidence regarding (1) factors of CLE that affect learning outcomes in higher nursing education, (2) the barriers and facilitators to implementing favourable CLEs, and (3) the outcomes, outcome measurement instruments, and possible effects of the CLE.

A scoping review was conducted, including evidence published between 2001 and 2024, using seven databases via EBSCOhost (CINAHL, ERIC, MEDLINE, APA PsycArticles, APA PsycInfo, and Teacher Reference Centre). The reference lists of all included articles were searched manually. Data were independently extracted using a predefined table and synthesized by thematic analysis.

One hundred studies were included: 80 descriptive studies, 11 intervention studies and nine reviews. Four overarching factors were identified, influencing the CLE of nursing students: (1) physical learning environment, (2) guidance and education, (3) cooperation between university and hospital, and (4) interprofessional relationships. We identified outcomes in 16 different areas, most often measured by unstandardized instruments. Barriers and facilitators were categorized into four categories: 1) university-clinical cooperation, (2) placement design, (3) roles and responsibilities, and (4) educational mentorship concepts.

The findings indicate that many studies were conducted addressing various aspects of the CLE in nursing education. However, the majority of studies were descriptive, and there is an urgent need to investigate the effects of interventions to enhance the CLE to improve nursing students' learning outcomes. Most studies look at student perception; few focus on assessing clinical skills. Further research is needed to examine the interplay of clinical skills, CLEs and student perception.