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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Research

Development of Teaching Efficacy Scale to Evaluate Clinical Nursing Instructors

Inhee Park1, Yeon Ok Suh2
Korean Journal of Adult Nursing 2018;30(1):18-29.
Published online: February 18, 2018

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Corresponding author: Suh, Yeon Ok https://orcid.org/0000-0001-6273-6652 School of Nursing, Soonchunhyang University, 31 Soonchunhyang 6th Rd, Dongnam-gu, Cheonan 31151, Korea. Tel: +82-41-570-2497, Fax: +82-41-570-2498, E-mail: yeonok@sch.ac.kr
- This manuscript is a condensed form of the first author's doctoral dissertation from Soonchunhyang University.
- This study was supported by the Soonchunhyang University Research Fund in 2017.
• Received: August 25, 2017   • Accepted: February 5, 2018

© 2018 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this methodological study was to develop a teaching efficacy scale for clinical nursing instructors and to establish its validity and reliability.
  • Methods
    Based on the literature review and focus group interviews, the attributes of the roles and capabilities of clinical nursing instructors were identified and a scale was developed. The content validity test and preparatory investigation were conducted to produce a total of 54 questions of the study.
  • Results
    Factor analysis indicated six factors whose eigenvalue was 1 or greater. Cumulative dis-persion explained by the factors was the combined 67.3%. In the final analysis, forty-two questions were selected. The “ Student instruction” factor showed high loadings with 12 questions and explained 17.4% of total variance. The “ Teaching improvement” factor was loaded with 9 questions; “ Application of Teaching and Learning” 7 questions; “ Interpersonal relationship and communication,” 7 questions; “ Clinical judgement” 4 questions; “ Clinical skill instruction” 3 questions. The overall reliability of the tools measured with Cronbach's was .97.
  • Conclusion
    All these findings confirmed that the teaching efficacy scale for clinical nursing instructors have content validity, construct validity, and criterion-related validity, and all questions are internally consistent and reliable.
  • Key Words: Nursing; Teaching; Students
Table 1.
Final Component Derivation Process
Sub-range Focus group topics Literature review Final sub-factor
Belief in nursing Leadership as an educator Leadership Leadership as a nursing educator
Role satisfaction as a nursing educator
Clinical knowledge as a leader
Wealth of clinical education experiences Clinical judgment ability Clinical judgment ability Clinical judgment ability
Ability to cope and explain clinical situations
Pride in the context of clinical judgment
Necessity of building up communication relationship between instructors of nursing school and clinical nurses Communication ability Communication ability Communication ability
Lack of communication with students
Teaching stress Emotional stability Emotional stability Emotional stability
Fear to teach
Burden of students
Clinical skill confidence Clinical skill Clinical skill Clinical skill
Nursing skill capabilities
Giving yourself the opportunity to experience nursing skills
First place to learn difficulties Adjustments to the clinical learning environment Adjustments to the clinical learning environment Adjustments to the clinical learning environment
Friendly environment
Education according to clinical situation
Integrated education of knowledge and practice Teaching method Teaching method Teaching method development
Customized training
My own know-how
Preparing for clinical practice Ability to use information resources Self development  
Latest medical issues
Attending workshops
Appropriate questions Student assessment ability Student performance evaluation  
Objective assessment
Your own fair standards in evaluation
Flexibility in evaluation
Learning objective awareness Self-control as a teacher    
Using different nursing books at each school
Self-reflection after education
Preparing for clinical practice
Attitude of student guidance Pride in role models Pride in role models Pride in role models
Enthusiastic teaching
Preceptor qualification
Mentor's relationship
A good impression of nursing
Ethical mind
Mind of honesty
Table 2.
General Characteristics of Participants (N=317)
Characteristics Categories n (%) or M± SD
Gender Female 298 (94.0)
Male 19 (6.0)
Age (year)   35.98±7.64
≤29 99 (31.2)
30~39 109 (34.4)
≥40 109 (34.4)
Organization region Seoul 64 (20.2)
Metropolitan 71 (22.4)
Micropolitan 182 (57.4)
Working hospital General hospital 95 (30.0)
University hospital 222 (70.0)
Educational level Bachelor 212 (66.9)
Master 91 (28.7)
≥ Doctoral courses 14 (4.4)
Role Head nurse 47 (14.8)
Charge nurse 52 (16.4)
Staff nurse 218 (68.8)
Months of clinical experiences Clinical career 157.68±92.76
Clinical teaching career 107.61±83.74
Table 3.
Factor Analysis and Reliability (N=317)
Factor No Items Factor loading
1 2 3 4 5 6
Factor 1 1 49. I can allow students to participate actively in clinical practice. 0.71 0.11 0.21 0.23 0.02 0.34
  Student instruction (Cronbach's ⍺=.95) 2 52. I can provide students with exercises consistent with clinical practice goals. 0.70 0.29 0.20 0.23 0.19 0.08
3 45. I do not evaluate students with prejudice. 0.69 0.12 0.03 0.17 0.21 0.15
4 51. I am clearly aware of my clinical practice goals. 0.67 0.31 0.26 0.22 0.25 0.04
5 50. I can provide appropriate feedback on student responses. 0.66 0.26 0.16 0.29 0.19 0.21
6 47. I can instruct students to have a positive image of the nurse. 0.65 0.22 0.09 0.34 0.19 0.25
7 54. I can provide an intimate clinical practice environment with students. 0.65 0.20 0.06 0.39 0.14 0.16
8 44. I can evaluate objectively by using various methods. 0.63 0.46 0.22 0.07 0.17 0.16
9 48. I can motivate students not interested in clinical practice. 0.63 0.13 0.20 0.34 -0.09 0.30
10 46. I can use the Q & A method when evaluating students. 0.63 0.33 0.20 0.01 0.30 0.21
11 53. I can systematically give orientation on clinical practice. 0.59 0.41 0.36 0.11 0.18 0.11
12 43. I can assign appropriate assignments that are suitable for the clinical situation to students. 0.54 0.39 0.28 0.13 0.32 0.05
Factor 2 13 34. I can prepare my own study materials for practice. 0.32 0.62 0.31 0.16 0.20 0.03
Teaching improvement (Cronbach's ⍺=.93) 14 39. I attend conferences and workshops to improve my teaching skill. 0.26 0.61 0.12 0.28 0.07 0.19
15 41. I am constantly learning about the field of teaching. 0.27 0.59 0.18 0.15 0.32 0.27
16 38. I can apply the latest medical issues to clinical practice. 0.34 0.57 0.29 0.22 0.05 0.29
17 33. I can instruct students to respond appropriately under any clinical circumstances. 0.30 0.55 0.28 0.19 0.25 0.30
18 40. I have enough knowledge of my major. 0.37 0.54 0.26 0.12 0.27 0.30
19 35. I follow the instructions of the clinical practice guide. 0.37 0.53 0.31 0.22 0.33 0.04
20 36. I can introduce my teaching method to other clinical instructors. 0.35 0.53 0.34 0.29 0.13 0.05
21 37. I can answer unexpected students' questions. 0.41 0.46 0.31 0.19 0.24 0.37
Factor 3 22 4. I can instruct practice suitable for individual student's abilities. 0.15 0.23 0.72 0.26 0.01 0.19
Application of teaching and learning (Cronbach's ⍺=.91) 23 3. I can instruct students through integration of theory and practice. 0.23 0.18 0.72 0.15 0.29 0.19
24 5. I know proper teaching method suitable for clinical situation. 0.10 0.36 0.70 0.24 0.05 0.14
25 1. I have sufficient clinical experiences to guide clinical practice. 0.25 0.08 0.66 0.14 0.37 0.23
26 2. I have my own know-how to guide clinical practice. 0.20 0.30 0.65 0.27 0.20 -0.07
27 6. I can teach students how to analyze clinical data. 0.16 0.32 0.58 0.16 0.02 0.40
28 7. I have clinical problem solving abilities. 0.22 0.14 0.55 0.19 0.46 0.19
Factor 4 29 12. I can keep good relationship with students. 0.24 0.19 0.10 0.72 0.09 0.20
Interpersonal relationship & communication (Cronbach's ⍺=.89) 20 9. I enthusiastically teach students. 0.28 0.16 0.22 0.66 0.11 0.21
31 10. I teach students with patience. 0.30 -0.03 0.26 0.62 0.25 -0.04
32 14. I check and correct missing parts after teaching. 0.22 0.34 0.28 0.57 0.21 0.01
33 16. I discuss practice contents with clinical instructor. (ex: professor, chief nurse, nurse) 0.13 0.45 0.33 0.55 0.19 0.10
34 15. I easily communicate with clinical instructor. (ex: professor, chief nurse, nurse) 0.18 0.48 0.29 0.54 0.18 0.18
35 17. I can talk with patients or students about any situations. 0.24 0.23 0.27 0.50 0.22 0.28
Factor 5 36 20. I can respond immediately if a risky situation arises. 0.26 0.23 0.17 0.18 0.75 0.13
Clinical judgement (Cronbach's ⍺=.85) 37 19. I can distinguish what I can do with what I can't do. 0.20 0.27 0.21 0.33 0.65 0.13
38 32. I can provide students with real-life clinical cases and experiences. 0.36 0.28 0.23 0.26 0.47 0.20
39 18. I can handle any task exactly. 0.26 0.35 0.26 0.34 0.41 0.30
Factor 6 40 26. I actively instruct students's clinical skills. 0.36 0.20 0.20 0.24 0.12 0.71
Clinical skill instruction (Cronbach's ⍺=.87) 41 27. I can instruct students to experience their own clinical skill under supervision. 0.35 0.23 0.25 0.14 0.18 0.64
42 25. I am confident in clinical skill. 0.32 0.18 0.25 0.16 0.40 0.59
  Eigenvalue 7.31 5.38 5.06 4.30 3.27 2.94
  Variance (%) 17.41 12.81 12.05 10.25 7.79 7.00
  Accumulative variance (%) 17.41 30.22 42.26 52.51 60.30 67.30
Kaiser-Meyer-Olkin (KMO)=.97; Bartlett's test of sphericity χ2=10,568.93 (p＜.001) Cronbach's=.97
Table 4.
Concurrent Validity Results (N=317)
Variables Student instruction Teaching improvement Application of teaching and learning Interpersonal relationship & communication Clinical judgement Clinical skill instruction
r (p) r (p) r (p) r (p) r (p) r (p)
Confidence of major knowledge .75 .76 .65 .67 .71 .58
(＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)
Regulation of instructive strategy .74 .71 .57 .70 .63 .54
(＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)
Leadership for student .68 .61 .51 .64 .58 .48
(＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)
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    Development of Teaching Efficacy Scale to Evaluate Clinical Nursing Instructors
    Korean J Adult Nurs. 2018;30(1):18-29.   Published online February 28, 2018
    DOI: https://doi.org/10.7475/kjan.2018.30.1.18
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    Development of Teaching Efficacy Scale to Evaluate Clinical Nursing Instructors
    Korean J Adult Nurs. 2018;30(1):18-29.   Published online February 28, 2018
    DOI: https://doi.org/10.7475/kjan.2018.30.1.18
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    Development of Teaching Efficacy Scale to Evaluate Clinical Nursing Instructors
    Development of Teaching Efficacy Scale to Evaluate Clinical Nursing Instructors

    Final Component Derivation Process

    Sub-range Focus group topics Literature review Final sub-factor
    Belief in nursing Leadership as an educator Leadership Leadership as a nursing educator
    Role satisfaction as a nursing educator
    Clinical knowledge as a leader
    Wealth of clinical education experiences Clinical judgment ability Clinical judgment ability Clinical judgment ability
    Ability to cope and explain clinical situations
    Pride in the context of clinical judgment
    Necessity of building up communication relationship between instructors of nursing school and clinical nurses Communication ability Communication ability Communication ability
    Lack of communication with students
    Teaching stress Emotional stability Emotional stability Emotional stability
    Fear to teach
    Burden of students
    Clinical skill confidence Clinical skill Clinical skill Clinical skill
    Nursing skill capabilities
    Giving yourself the opportunity to experience nursing skills
    First place to learn difficulties Adjustments to the clinical learning environment Adjustments to the clinical learning environment Adjustments to the clinical learning environment
    Friendly environment
    Education according to clinical situation
    Integrated education of knowledge and practice Teaching method Teaching method Teaching method development
    Customized training
    My own know-how
    Preparing for clinical practice Ability to use information resources Self development  
    Latest medical issues
    Attending workshops
    Appropriate questions Student assessment ability Student performance evaluation  
    Objective assessment
    Your own fair standards in evaluation
    Flexibility in evaluation
    Learning objective awareness Self-control as a teacher    
    Using different nursing books at each school
    Self-reflection after education
    Preparing for clinical practice
    Attitude of student guidance Pride in role models Pride in role models Pride in role models
    Enthusiastic teaching
    Preceptor qualification
    Mentor's relationship
    A good impression of nursing
    Ethical mind
    Mind of honesty

    General Characteristics of Participants (N=317)

    Characteristics Categories n (%) or M± SD
    Gender Female 298 (94.0)
    Male 19 (6.0)
    Age (year)   35.98±7.64
    ≤29 99 (31.2)
    30~39 109 (34.4)
    ≥40 109 (34.4)
    Organization region Seoul 64 (20.2)
    Metropolitan 71 (22.4)
    Micropolitan 182 (57.4)
    Working hospital General hospital 95 (30.0)
    University hospital 222 (70.0)
    Educational level Bachelor 212 (66.9)
    Master 91 (28.7)
    ≥ Doctoral courses 14 (4.4)
    Role Head nurse 47 (14.8)
    Charge nurse 52 (16.4)
    Staff nurse 218 (68.8)
    Months of clinical experiences Clinical career 157.68±92.76
    Clinical teaching career 107.61±83.74

    Factor Analysis and Reliability (N=317)

    Factor No Items Factor loading
    1 2 3 4 5 6
    Factor 1 1 49. I can allow students to participate actively in clinical practice. 0.71 0.11 0.21 0.23 0.02 0.34
      Student instruction (Cronbach's ⍺=.95) 2 52. I can provide students with exercises consistent with clinical practice goals. 0.70 0.29 0.20 0.23 0.19 0.08
    3 45. I do not evaluate students with prejudice. 0.69 0.12 0.03 0.17 0.21 0.15
    4 51. I am clearly aware of my clinical practice goals. 0.67 0.31 0.26 0.22 0.25 0.04
    5 50. I can provide appropriate feedback on student responses. 0.66 0.26 0.16 0.29 0.19 0.21
    6 47. I can instruct students to have a positive image of the nurse. 0.65 0.22 0.09 0.34 0.19 0.25
    7 54. I can provide an intimate clinical practice environment with students. 0.65 0.20 0.06 0.39 0.14 0.16
    8 44. I can evaluate objectively by using various methods. 0.63 0.46 0.22 0.07 0.17 0.16
    9 48. I can motivate students not interested in clinical practice. 0.63 0.13 0.20 0.34 -0.09 0.30
    10 46. I can use the Q & A method when evaluating students. 0.63 0.33 0.20 0.01 0.30 0.21
    11 53. I can systematically give orientation on clinical practice. 0.59 0.41 0.36 0.11 0.18 0.11
    12 43. I can assign appropriate assignments that are suitable for the clinical situation to students. 0.54 0.39 0.28 0.13 0.32 0.05
    Factor 2 13 34. I can prepare my own study materials for practice. 0.32 0.62 0.31 0.16 0.20 0.03
    Teaching improvement (Cronbach's ⍺=.93) 14 39. I attend conferences and workshops to improve my teaching skill. 0.26 0.61 0.12 0.28 0.07 0.19
    15 41. I am constantly learning about the field of teaching. 0.27 0.59 0.18 0.15 0.32 0.27
    16 38. I can apply the latest medical issues to clinical practice. 0.34 0.57 0.29 0.22 0.05 0.29
    17 33. I can instruct students to respond appropriately under any clinical circumstances. 0.30 0.55 0.28 0.19 0.25 0.30
    18 40. I have enough knowledge of my major. 0.37 0.54 0.26 0.12 0.27 0.30
    19 35. I follow the instructions of the clinical practice guide. 0.37 0.53 0.31 0.22 0.33 0.04
    20 36. I can introduce my teaching method to other clinical instructors. 0.35 0.53 0.34 0.29 0.13 0.05
    21 37. I can answer unexpected students' questions. 0.41 0.46 0.31 0.19 0.24 0.37
    Factor 3 22 4. I can instruct practice suitable for individual student's abilities. 0.15 0.23 0.72 0.26 0.01 0.19
    Application of teaching and learning (Cronbach's ⍺=.91) 23 3. I can instruct students through integration of theory and practice. 0.23 0.18 0.72 0.15 0.29 0.19
    24 5. I know proper teaching method suitable for clinical situation. 0.10 0.36 0.70 0.24 0.05 0.14
    25 1. I have sufficient clinical experiences to guide clinical practice. 0.25 0.08 0.66 0.14 0.37 0.23
    26 2. I have my own know-how to guide clinical practice. 0.20 0.30 0.65 0.27 0.20 -0.07
    27 6. I can teach students how to analyze clinical data. 0.16 0.32 0.58 0.16 0.02 0.40
    28 7. I have clinical problem solving abilities. 0.22 0.14 0.55 0.19 0.46 0.19
    Factor 4 29 12. I can keep good relationship with students. 0.24 0.19 0.10 0.72 0.09 0.20
    Interpersonal relationship & communication (Cronbach's ⍺=.89) 20 9. I enthusiastically teach students. 0.28 0.16 0.22 0.66 0.11 0.21
    31 10. I teach students with patience. 0.30 -0.03 0.26 0.62 0.25 -0.04
    32 14. I check and correct missing parts after teaching. 0.22 0.34 0.28 0.57 0.21 0.01
    33 16. I discuss practice contents with clinical instructor. (ex: professor, chief nurse, nurse) 0.13 0.45 0.33 0.55 0.19 0.10
    34 15. I easily communicate with clinical instructor. (ex: professor, chief nurse, nurse) 0.18 0.48 0.29 0.54 0.18 0.18
    35 17. I can talk with patients or students about any situations. 0.24 0.23 0.27 0.50 0.22 0.28
    Factor 5 36 20. I can respond immediately if a risky situation arises. 0.26 0.23 0.17 0.18 0.75 0.13
    Clinical judgement (Cronbach's ⍺=.85) 37 19. I can distinguish what I can do with what I can't do. 0.20 0.27 0.21 0.33 0.65 0.13
    38 32. I can provide students with real-life clinical cases and experiences. 0.36 0.28 0.23 0.26 0.47 0.20
    39 18. I can handle any task exactly. 0.26 0.35 0.26 0.34 0.41 0.30
    Factor 6 40 26. I actively instruct students's clinical skills. 0.36 0.20 0.20 0.24 0.12 0.71
    Clinical skill instruction (Cronbach's ⍺=.87) 41 27. I can instruct students to experience their own clinical skill under supervision. 0.35 0.23 0.25 0.14 0.18 0.64
    42 25. I am confident in clinical skill. 0.32 0.18 0.25 0.16 0.40 0.59
      Eigenvalue 7.31 5.38 5.06 4.30 3.27 2.94
      Variance (%) 17.41 12.81 12.05 10.25 7.79 7.00
      Accumulative variance (%) 17.41 30.22 42.26 52.51 60.30 67.30
    Kaiser-Meyer-Olkin (KMO)=.97; Bartlett's test of sphericity χ2=10,568.93 (p＜.001) Cronbach's=.97

    Concurrent Validity Results (N=317)

    Variables Student instruction Teaching improvement Application of teaching and learning Interpersonal relationship & communication Clinical judgement Clinical skill instruction
    r (p) r (p) r (p) r (p) r (p) r (p)
    Confidence of major knowledge .75 .76 .65 .67 .71 .58
    (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)
    Regulation of instructive strategy .74 .71 .57 .70 .63 .54
    (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)
    Leadership for student .68 .61 .51 .64 .58 .48
    (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)
    Table 1. Final Component Derivation Process

    Table 2. General Characteristics of Participants (N=317)

    Table 3. Factor Analysis and Reliability (N=317)

    Table 4. Concurrent Validity Results (N=317)

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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