Validity and reliability of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T), Turkish version 1

ABSTRACT Aim: A methodological type of study was conducted for the purpose of investigating the validity and reliability of the Turkish version of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale of the clinical learning environment of students, clinical nurses, and educators. Methods: Sample was comprised of 602 Turkish nursing students with clinical practice experience at the hospital. The CLES+T, developed by Saarikoski, was used for data collection. Language equivalency, internal consistency, item-total correlation, and structure validity were conducted within the scope of the validity and reliability study on the CLES +T scale. Results: It was determined that item-total correlations of four items were lower than 0.30, and those items were removed from the scale as a result of item analysis. The Cronbach’s alpha value of the scale was 0.93-0.99; item total point correlations of the scale varied between 0.45 and 0.66; six factors were identified in the CLES+T factor analysis study, with a total variance explained by these six factors of 64%. Conclusion: According to the findings of the research, the CLES+T Turkish version was found to be a valid and reliable scale, which can be used to evaluate satisfaction of nursing students with their clinical education in Turkey.


Introduction
Clinical education is a process that provides the student with the opportunity to practice his/her theoretical knowledge, gain professional identity, and learn by practice; thus, it is crucial in nursing education programs (1) . Clinical practice fields enable the students to combine their cognitive, psychomotor, and affection skills and contribute to the development of these competencies (2) . In order for the students to be able to benefit from these opportunities, clinical learning environments must be designed in a way that serve these ends, and the students must be supported.
Clinical learning and clinical learning environments have been subjects of research since 1990 (3) . The clinical learning environment plays a crucial role, especially in the clinical education of nursing students (4)(5)(6) . The clinical learning environment includes attributes of the clinical work setting which nurses perceive to influence their professional development (7) . Employee and student relationships and significant learning situations in the clinical learning environment constitute the pedagogical atmosphere of the clinic (8) . Good relationships between individuals, support, and feedback affect the clinical learning environment, and are important for positive learning (9)(10) . Numerous studies emphasize that the clinical environment is crucial in learning and learning outcomes (8,11) . One study discovered that a supportive learning environment creates a significant difference in students' learning. The pedagogical atmosphere of the service affects the learning process and competencies.
It has been emphasized that the skills of problem solving and asking questions would develop in a positive pedagogical atmosphere (3,(12)(13) . A collaborative leadership style, less hierarchical structure, and positive team spirit allow nursing students to feel that they are supported in uncertainties (3,6) . The acceptance of nursing students as "team members" in the clinical environment, and consideration of student opinions and experiences in the solution of problems, contributes to their professional development (14) . This critical thinking and mutually innovative atmosphere may influence nursing care and quality, thus it would also be reflected in the patientnurse relationships (14) .
The learning environment is also related to the psychosocial environment of the health service. The most important feature of a good learning environment is the presence of trust from the perspective of the student. A just environment is possible by seeing the students as part of the problem solving process, and improving the culture of tolerance for mistakes (3,15) .
During the period of clinical education, which is the basic part of nursing education, nurse educators especially are essential factors. Competency of nurse educators is the most important factor that determines the quality of the education. For this reason, nurse educators play a crucial role in both education and clinical practice (16) . Therefore, having nurse educators who are well-equipped, positive role models, with awareness and experience, is important in order to achieve practice purposes (17) . Numerous studies indicate that students who spend their clinical education with experienced and professional teaching staff and nurses adjust more easily to the clinic, develop a better concept of the professional role (18) , develop critical thinking abilities, have improved self-sufficiency, (18) and communication skills (19) . Additionally, research emphasizes that the collaboration between educators and clinical nurses is also important in a good clinical learning environment (14,(20)(21) . Nurse educators and clinical nurses are the primary responsible agents for different learning experiences (16,22) .
It has been stated that clinical nurse supervision is also crucial during the clinical practice process in student competency (23)(24) . The concept of the clinical nurse has been used in the meaning of unifying and supporting nursing students. For example, they are people who teach and evaluate practice skills, complement the clinical knowledge of nursing students, provide feedback, help them to perform analysis between theory and practice, are a role model, and in addition, help students to socialize.
According to Löfmark and Wikblad, negative attitudes and behaviors of clinical nurses affects the learning process of nursing students. There is evidence regarding the exact importance of one-to-one education for the learning and development of students in clinical practice (23) . Generally, the clinical nurse is responsible for the supervision of the students. Similarly, whether the service culture is  found to be statistically significant.
As a result of item analysis, it was determined that item-total correlations of four items (10,12,13,14) were <0.30, and those items were removed from the scale which then totaled 30 items and was composed of six subscales. We have shown this study, and the study of Saarikoski's (2008) item subscales, in Table 1. Relationship between student, mentor, and nurse teacher (18)(19)(20)(21)(22)(23) The Saarikoski's scale, but in our scale these items are named as "Relationship between student, mentor, and nurse teacher". Thus, in our study, factor 6 was named "Relationship between student, mentor, and nurse teacher". The total variance explained by the six factors was 64%. Factor 1 accounted for 18% of response variance, factor 2 for 14%, factor 3 for 10%, factor 4 for 8%, factor 5 for 7%, and factor 6 for 7%.     found the explanation percentage of 64 (25) .
We tried to justify the reasons for the differences in scales (20). In another study conducted in nine European countries, the Cronbach's alpha coefficient was found to be between 0.96-0.83 for the sub-scales. As a result, we can conclude that the findings of our study are reliable, in consideration of the previous findings. , the corrected item-total correlation ranged from 0.36 to 0.92 (31) .

Conclusion
The CLES+T scale, the validity and reliability of which has been confirmed in the Turkish version, can be used in the evaluation of the satisfaction of student nurses with the clinical environment, clinical nurses, and nurse educators. This enables clinical education to be evaluated from the student's perspective, and the quality of education can be improved.
Limitation of the study: The primary restriction of this research is the use of students from only two health colleges in the sampling.