A total of 313 questionnaires were collected. The total mean of perceived clinical training was 129.95±17.93 for BS students of nursing. Seeing that 35 points are devoted to each category, the maximum and minimum score obtained in this study pertained to the categories “students’ participation in clinical activities” and “the use of educational innovations in clinical training”. Our findings indicated that the nursing students ranked “clarity of students’ clinical duties” as second, “respecting students” as third, “students’ satisfaction” as fourth, and “noting individual differences among the students” as fifth (Table 1).

Table 1: Mean and SD of total score of perceived clinical setting and its categories in BS nursing students in 2016

In this study, most of the study units were female (55.59%), single (90.09%), and without a history of hospital work (73.48%). ANOVA showed that students’ gender was significantly correlated with total score of perceived clinical environment so that the mean total score of perceived clinical setting was significantly greater in male students than in female students (P=0.024); however, students’ gender (P=0.881) and a history of hospital work (P=0.916) were not significantly correlated with total score of clinical training setting (Table 2).

Table 2: Absolute and relative frequencies of students’ demographic information and the correlation between this information and total score of perceived clinical setting in BS nursing students in 2016

The results of this study demonstrated that the means of obtained scores for the status of clinical learning environment in various areas were different so that “Student Involvement” obtained the highest score. With this category, we mean students’ struggle for engaging themselves in patients’ affairs, creation of constructive relations between students and trainers and between students and personnel, and participation in ward reports and rounds. Austin’s theory (1984) is one of the theories that emphasizes student’s participation in training. He defines student’s participation as the rate of mental and physical energy spent by a student on knowledge acquisition. He considers this participation as a spectrum which varies from one time to another and from student to student. In this theory, participation consists of three components: input, environment, and output while environment is defined as all the experiences acquired by a student during their education (Johnson, 2015). The findings of this study showed that the greatest score obtained for this category belonged to the item “I put effort into what I do” while the smallest score belonged to the item “The preceptor(s) talk rather than listen to me”. On the basis of the studies conducted so far, instructors’ performance is one of the most influential factors contributing to effective clinical education. This is because the instructors are those who transfer their knowledge and experience to students through applying effective communication strategies. So, it can be said that the instructors are the linking bridge between theory and clinical practice(Moosavi et al., 2017). Hence, in planning effective programs for improving clinical training, special attention should be given to trainers and their performance (Baraz Pordanjani et al., 2009). Moreover, our results indicated that the category “Task Orientation” ranked second among the six categories. This category indicates how far the ward activities have been clear and well-organized. Furthermore, our findings revealed that the highest score obtained in this study belonged to the item “Getting work done is important in this setting” while the lowest score belonged to the item “This is a disorganized clinical placement” in this category. Another study carried out in Iran, enumerated the strong points of clinical education from nursing and midwifery students’ point of view as follows: clarity of students’ duties in the ward, presentation of lesson objectives in the first day of clinical training, training in the line of achieving these goals, and students’ awareness of assessment and evaluation method in the first day of clinical training (Delaram, 2006). Nonetheless, in another study, the Iranian nursing students reported lack of clarity of students’ duties as the major problem in clinical training (JAHANMIRI et al., 2004).

In this study, the category “Personalization” ranked third. This category deals with the opportunities devoted to interactions between students and instructors and the importance of noting the individual differences among the students’ learning styles (Serena and Anna, 2009). In the studies by (Pakpour et al., 2015) and (Ip and Chan, 2005), this category ranked first while it ranked second in (Moh’d Alraja, 2011)’s study. Additionally, the results demonstrated that the greatest score belonged to the item “The preceptor(s) try his/her very best to help me” while the smallest score belonged to the item “The preceptor(s) do not bother with my feelings”. In fact, the students highlight the human relations in clinical education and emphasize the need for respect for students, support, and being perceived by trainers(Boozaripour et al., 2017, Masoumpoor et al., 2015). In Rosenkoter’s study, respect for students and showing of this respect for students during education is considered as the ethical codes for nursing trainers (Rosenkoetter and Milstead, 2010).

Findings indicated that the category “Satisfaction” ranked fourth among the six categories. Studies show that satisfaction with the status of clinical education is very important and varies with respect to time and place (Salimi et al., 2012). This category is concerned with wasting of time in clinical training, the interest for coming to the clinical training, and on the contrary, boring clinical environment and dulling time of training. The results showed that the highest score was obtained by the item “I look forward to attending clinical placement” while the item “I enjoy coming to this clinical setting” scored lowest.

This finding can indicate that the students would have sufficient enthusiasm for clinical work provided that the clinical setting is promoted and attractive conditions are created such as fostering students’ interest in working in a clinical climate. In Serena’s study, the students expressed their satisfaction with clinical training and did not look at it as waste of time (Serena and Anna, 2009). Another study in Iran also reported satisfaction with training planning and goals to be at the moderate to good level (Fotoukian et al., 2013). In the study by (Vahabi et al., 2011), the students reported the quality of clinical training in the category of clinical trainers’ performance at the relatively appropriate level. Moreover, in the study by (Manoochehri et al.), the mean score of satisfaction was significantly higher in females compared to males (P=0.002).

The category “Individualization” ranked fifth among six categories. This category deals with noting students’ interests, individual differences among the students, and permitting independent decision-making by students. This category ranked fifth in the studies by Berntsen and Ip (Berntsen and Bjørk, 2010, Ip and Chan, 2005). The findings of this study showed that the item “I am allowed to negotiate my workload” scored highest while the item “I am expected to do the work in the same way as other students” scored lowest indicating that trainers and the clinical staff note individual differences among the students in the clinical environment. One of the factors that affect learning is the style of learning. People use different styles of learning dependent on their individual differences. The learning style may be defined as the method used by individuals to organize and process new knowledge and experiences in their minds. The point that some trainees do not learn well despite the teachings of good trainers may indicate that different learners have different priorities in learning (McLeod, 2006), that is, they acquire and process information in different ways proportional to their individual differences: seeing, hearing, reflection and practice, analysis, and imagination (Mills, 2002). Regarding the results of this study and the fifth rank among six categories of this Inventory, it appears that attention ought to be focused more on individual differences among the students. Students of nursing and midwifery, due to the nature of their discipline and professional importance, require a special type of practical training which demands trainers and instructors to use various methods of teaching. Consequently, an awareness of students’ characteristics and needs in the teaching-learning process aids the trainer in the logical designing of training and teaching. Various studies have indicated a significant correlation between gender and learning styles. The dominant learning style among the girls is the reading-writing style while that of boys is the auditory style. A meta-analysis study that investigated the dominant learning style among the nursing students, reported that the dominant learning styles among the Iranian nursing students were convergent, attractive, divergent, and conformant, respectively (Mohammadi I, 2013).

The category “Teaching Innovation” ranked sixth, i.e., the last rank, from BS nursing students’ perspective in our study of clinical learning environment. This category indicates the degree to which the trainer designs clinical experiences, teaching methods, and learning activities in an innovative, attractive, and productive manner. The results of this study demonstrated that the greatest score was obtained by the item “The preceptor(s) used different teaching methods to guide me” while the item “New ideas are seldom tried out” scored lowest. Presently, most famous universities around the world are seeking teaching methods that lead to promoted clinical decision-making and continual student-centered learning (Magnussen et al., 2000). The relationship between nursing education and nursing services is constantly increasing in nursing pedagogy (Jarvis, 1987). Nursing education can be a dynamic process if it violates the limitations in time and place and moves towards innovations, developments, and the use of innovative approaches and methods in teaching and learning (Shabani, 1995). In other words, the selection of a suitable teaching method is one of the most important measures in the implementation of educational curricula. This is because successful and efficient learning is mostly the result of effective teaching and training (Baghaie and ATRKAR, 2003). The results of our study and the last rank of this category may serve as a warning against lack of innovations in nursing education. The acquisition of the least score by this category indicated that students are less frequently exposed to interesting learning experiences and innovative creative teaching methods in the course of their clinical education.

The success of nursing educational programs depends on the efficacy and sufficiency of clinical experiences. The pedagogic programs at any level and rate, struggle to come close to the appropriate defined standards for any teaching-learning activity. The identification of the problems present in the clinical training and taking some measures to correct them would foster the quality of nursing services. This may enable the authorities and parties involved in education to gain a correct picture of the present situations in clinical settings and acquire a proper landscape of the future. Clinical training is a dynamic process in which the students apply their learned concepts in interaction with the clinical environment. Today, considering the rapid changes in the healthcare settings, if richer clinical training is provided, the nurses will be more efficient and skilled in the near future. To achieve efficient clinical training, it is mandatory to assess the present status of training continuously, identify the weak and strong points of the field, and evaluate the quality of training and education. In this way, the defined standards may be assessed and operationalized. One of the diagnostic tools in this regard is the investigation of the clinical setting. An acceptable clinical environment for professional preparation of nursing students for the future may be created by the cooperation between trainers and clinical staff. Better results of clinical training may be obtained by some attempts to make useful changes in the clinical environment to adjust it more to the students’ preferences. Our findings showed that more work should be done to provide a healthy learning environment for nursing students. The burden of such a work is laid on the shoulders of scholars, trainers, and nurse managers.

The devotion of lower scores to the categories like “the use of innovation in education”, “clarity of students’ clinical duties”, and “noting individual differences in learning among the students” showed that these were among the important issues noted by students. This demands more accuracy in decision-making by educational policy-makers. In this study, the category students’ struggle to engage themselves in patients’ affairs ranked first indicating that it had its roots in the cultural and religious context of Iran. Iran is a country where nursing and patient care are holy issues.