An Educational Model for Developing Clinical Competency among Undergraduate Nursing Students: A Structural Equation Modeling Study
Article Sidebar
Main Article Content
Abstract
Background and Aim: Contemporary healthcare requires nursing graduates capable of delivering safe, high-quality patient care. Understanding how personal, academic, instructional, and clinical-environment factors influence nursing students’ clinical skills is essential. This study examined the relationships between these factors and clinical competency development.
Materials and Methods: A descriptive-correlational, causal-comparative design incorporating structural equation modeling (SEM) was employed. Participants were 598 nursing students from three private higher education institutions in Iligan City, Philippines. Data were collected using a pilot-tested, validated researcher-developed questionnaire. Pearson correlation, multiple regression, confirmatory factor analysis (CFA), and SEM were performed using SPSS 29 and AMOS 29, with significance established at p < .05.
Results: All predictor domains significantly influenced clinical skills development. The clinical environment demonstrated the strongest correlation with clinical skills (r = .747, p < .001). In multiple regression analysis, assessment emerged as the strongest predictor (β = .350), while the model explained 63.4% of the variance in clinical skills development (R² = .634). SEM identified the clinical environment as having the largest direct effect (β = .562). The model demonstrated good fit (CFI = .996; RMSEA = .032).
Conclusion: The findings support the Apal Clinical Competency Development Model (ACCDM) as an integrated framework for explaining nursing students’ clinical skills development. The model provides a basis for evidence-informed curriculum redesign, competency-based assessment, simulation, digital learning, initiatives strengthening student self-efficacy, and improvements in clinical instruction. Its application may help nursing institutions create supportive learning environments and prepare graduates to meet standards for safe, competent, high-quality professional practice.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright and License
Copyright of all articles published in the Journal of Education and Learning Reviews (JELR) is retained by the author(s).
All articles are distributed under the Creative Commons Attribution–NonCommercial–NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). Users may read, download, copy, distribute, and share the content for non-commercial purposes with proper attribution.
Modification, adaptation, or commercial use of the content is not permitted.
License details: https://creativecommons.org/licenses/by-nc-nd/4.0/
References
Al Thobaity, A., & Alshammari, F. (2020). Nurses on the frontline against the COVID-19 pandemic: An integrative review. Dubai Medical Journal, 3(3), 87–92. https://doi.org/10.1159/000509361
Arribas-Marín, J., Plumed-Moreno, C., & Hernández-Franco, V. (2024). Self-efficacy in nursing competencies during students’ clinical practicum: The development of a self-assessment scale. Nursing Reports, 14(3), 2327–2339. https://doi.org/10.3390/nursrep14030172
Bandura, A. (2006). Toward a psychology of human agency. Perspectives on Psychological Science, 1(2), 164–180. https://doi.org/10.1111/j.1745-6916.2006.00011.x
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.
Berdida, D. J. E., & Grande, R. A. N. (2023). Academic stress, COVID-19 anxiety, and quality of life among nursing students: The mediating role of resilience. International Nursing Review, 70(1), 34–42. https://doi.org/10.1111/inr.12774
Biggs, J., Tang, C., & Kennedy, G. (2022). Teaching for quality learning at university: What the student does (5th ed.). Open University Press.
Cant, R. P., & Cooper, S. J. (2017). Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review. Nurse Education Today, 49, 63–71. https://doi.org/10.1016/j.nedt.2016.11.015
Chan, D. S. K., Chan, Z. C. Y., & Chow, M. C. M. (2023). Clinical learning environments and nursing students’ competence: A systematic review. Nurse Education in Practice, 67, Article 103558. https://doi.org/10.1016/j.nepr.2023.103558
Chang, C.-Y., Kao, B.-H., & Hwang, G.-H. (2022). Development of a flipped contextual game-based learning system to enhance nursing students’ clinical skills and learning engagement. Computers & Education, 182, Article 104464. https://doi.org/10.1016/j.compedu.2022.104464
Commission on Higher Education. (2017). CHED Memorandum Order No. 15, series of 2017: Policies, standards and guidelines for the Bachelor of Science in Nursing (BSN) program. https://ched.gov.ph/wp-content/uploads/2017/10/CMO-15-s-2017.pdf
Flott, E. A., & Linden, L. (2022). The clinical learning environment in nursing education: A concept analysis update. Journal of Clinical Nursing, 31(21–22), 3045–3058. https://doi.org/10.1111/jocn.16138
Flott, E. A., & Linden, L. (2022). The clinical learning environment in nursing education: A concept analysis update. Journal of Clinical Nursing, 31(21–22), 3045–3058. https://doi.org/10.1111/jocn.16138
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate data analysis (8th ed.). Cengage.
International Council of Nurses. (2021). The ICN code of ethics for nurses. https://www.icn.ch/sites/default/files/2023-06/ICN_Code-of-Ethics_EN_Web.pdf
Kaihlanen, A.-M., Salminen, L., Koskinen, S., Leino-Kilpi, H., & Numminen, O. (2023). Competence development of nursing students during clinical practice: An integrative review. Nurse Education in Practice, 69, Article 103621. https://doi.org/10.1016/j.nepr.2023.103621
Kavanagh, J. M., & Sharpnack, P. A. (2021). Crisis in competency: The strategic and ethical imperative to assess new graduate nurses. Nursing Education Perspectives, 42(5), 272–274. https://doi.org/10.1097/01.NEP.0000000000000868
Kline, R. B. (2023). Principles and practice of structural equation modeling (5th ed.). Guilford Press.
Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Prentice Hall.
Koukourikos, K., Tsaloglidou, A., Kourkouta, L., Papathanasiou, I. V., Iliadis, C., Fratzana, A., & Panagiotou, A. (2021). Simulation in clinical nursing education. Acta Informatica Medica, 29(1), 15–20. https://doi.org/10.5455/aim.2021.29.15-20
Labrague, L. J., de los Santos, J. A. A., & Falguera, C. C. (2021). Self-efficacy and resilience among nursing students: A cross-sectional study. Nurse Education in Practice, 52, Article 103014. https://doi.org/10.1016/j.nepr.2021.103014
Levett-Jones, T., Workneh, G., & O’Brien, A. (2022). The ‘Belongingness’ Scale—Clinical Placement: A tool to evaluate nursing students’ experiences of clinical environments. Journal of Advanced Nursing, 78(11), 3890–3901. https://doi.org/10.1111/jan.15372
Nguyen, H. T., Rodríguez-Monforte, C., & Vital-López, L. (2023). Critical thinking development and self-efficacy among undergraduate nursing students in blended learning spaces. BMC Nursing, 22, Article 145. https://doi.org/10.1186/s12912-023-01305-z
Ortiz, M. A., Ridad, J. B., & Berdida, D. J. E. (2024). Predictors of psychological well-being and academic burnout among nursing students during clinical transitions. Nurse Education in Practice, 74, Article 103852. https://doi.org/10.1016/j.nepr.2023.103852
Ridad, G. S., Angintaopan, H. S., Ayunan, P. H. M. K., & Manalocon, S. (2024). Stressors and coping strategies as perceived among nursing students during related learning experience (RLE). Nurse Media Journal of Nursing, 14(1), 1–15. https://doi.org/10.14710/nmjn.v14i1.53987
Rodríguez-García, M. C., Suliman, M., & Warshawski, S. (2022). The role of clinical educators as professional role models and their impact on student clinical self-efficacy. Nurse Education Today, 109, Article 105211. https://doi.org/10.1016/j.nedt.2021.105211
Shorey, S., Ang, E., Lau, T. C., Chui, C. K., & Tam, W. W. S. (2023). Self-efficacy in nursing education: A systematic review of its influence on nursing students’ learning and clinical competence. Nurse Education Today, 122, Article 105719.
Sulosaari, V., Kajander-Unkuri, S., Lakanmaan, R.-L., & Leino-Kilpi, H. (2022). Factors associated with nursing students’ competence: A systematic review. Nurse Education Today, 110, Article 105260. https://doi.org/10.1016/j.nedt.2021.105260
Uppor, W., Klunklin, A., Viseskul, N., Skulphan, S., & Turale, S. (2023). Designing simulation scenarios to enhance nursing students’ clinical judgment: A qualitative study. Pacific Rim International Journal of Nursing Research, 27(3), 445–456. https://doi.org/10.60099/prijnr.2023.262509
Warshawski, S. (2022). Academic self-efficacy, resilience and social support among first-year Israeli nursing students learning in online environments during the COVID-19 pandemic. Nurse Education Today, 110, Article 105267. https://doi.org/10.1016/j.nedt.2022.105267
Yardley, S., Teunissen, P. W., & Dornan, T. (2012). Experiential learning: Transforming theory into practice. Medical Teacher, 34(2), 161–164. https://doi.org/10.3109/0142159X.2012.643264
