Clinical Learning Environment as a Predictor of Clinical Skills Development Among Nursing Students in Private Higher Education Institutions
DOI:
https://doi.org/10.5281/zenodo.21512874Keywords:
Clinical learning environment; Clinical competence; Nursing students; Preceptor leadership; Nursing education; Clinical educationAbstract
The clinical learning environment is fundamental to developing nursing students' competence; however, its influence on clinical skills development remains underexplored in private higher education institutions. This quantitative, cross-sectional correlational study aimed to determine the relationship between the clinical learning environment and clinical skills development among nursing students. Data were collected from 598 Level III and Level IV nursing students enrolled in three private higher education institutions in Iligan City, Philippines, using a validated researcher-made questionnaire. Descriptive statistics, Pearson's correlation, and regression analysis were employed to analyze the data. The findings revealed that the overall clinical learning environment was perceived to be at a high level (M = 4.21, SD = 0.55), with preceptor leadership obtaining the highest mean score (M = 4.26, SD = 0.65), followed by workload (M = 4.20, SD = 0.61) and resource availability (M = 4.18, SD = 0.60). Likewise, the respondents reported a high level of clinical skills development (M = 4.19), with confidence (M = 4.24) receiving the highest rating, followed by competence (M = 4.22), procedural accuracy (M = 4.21), and critical thinking (M = 4.09). A strong, statistically significant positive relationship was found between the overall clinical learning environment and clinical skills development (r = .747, p < .001), with workload exhibiting the strongest association (r = .712). These findings indicate that a supportive clinical learning environment significantly enhances nursing students' competence and readiness for professional practice. The study recommends strengthening clinical partnerships, balancing student workloads, expanding preceptor development programs, and improving access to digital learning resources to further optimize clinical education.
Downloads
References
AACCUP. (2022). Accreditation instruments and guidelines. Accrediting Agency of Chartered Colleges and Universities in the Philippines.
Abulon, E., & Magno, C. (2021). Curriculum alignment and learner competence in nursing education. Philippine Journal of Education, 98(2), 45–60.
Aguirre, J., Santos, L., & Dizon, M. (2022). Simulation-based learning and clinical judgment among nursing students: A quasi-experimental study. Nurse Education Today, 116, Article 105435. https://doi.org/10.1016/j.nedt.2022.105435
Alharbi, A. (2020). Learning motivation and engagement among undergraduate nursing students. Journal of Nursing Education and Practice, 10(5), 56–63.
Alharbi, A., & Almutairi, N. (2022). Digital literacy skills and simulation readiness among nursing students. Nurse Education Today, 112, Article 105335. https://doi.org/10.1016/j.nedt.2022.105335
Alhowaymel, F., Alharbi, O., & Alenzi, A. (2025). Empowerment, self-efficacy, and clinical judgment among nursing students: A predictive model. BMC Nursing, 24, Article 54. https://doi.org/10.1186/s12912-025-00054-0
Ali, S., Kumar, R., & Reyes, M. (2023). Curriculum integration and student preparedness in clinical nursing education. Journal of Nursing Education and Practice, 13(2), 22–34.
Ali, Z., Hassan, A., & Qureshi, R. (2022). Resource availability and its impact on nursing students’ clinical learning. International Journal of Nursing Practice, 28(1), Article e12990. https://doi.org/10.1111/ijn.12990
Alipour, N., Jafari, S., & Heidari, H. (2023). Self-directed learning and clinical competence among internship nursing students: A structural equation model. Journal of Nursing Management, 31(4), 785–794. https://doi.org/10.1111/jonm.13785
Alkhelaiwi, A., Mohammed, S., & Khan, F. (2024). High-fidelity simulation and clinical competence in undergraduate nursing. Clinical Simulation in Nursing, 74, 25–32. https://doi.org/10.1016/j.ecns.2023.101425
Alqahtani, N., & Rajkhan, A. (2020). Self-efficacy and academic performance among nursing students. Journal of Nursing Education, 59(6), 333–339. https://doi.org/10.3928/01484834-20200520-04
Alrashidi, N., Pasayan, E., & Alrashedi, M. (2023). Simulation-based training and procedural competence among nursing students: A systematic review. BMC Medical Education, 23, Article 815. https://doi.org/10.1186/s12909-023-04815-w
Ang, M., & Uy, K. (2023). Emotional resilience and clinical readiness among Filipino nursing students: A structural equation modeling analysis. Nurse Education Today, 121, Article 105709. https://doi.org/10.1016/j.nedt.2022.105709
Arribas-Marín, J., Avellaneda, A., & Trenchs, M. (2024). Development and validation of a self-efficacy scale for nursing competencies. BMC Nursing, 23, Article 115. https://doi.org/10.1186/s12912-024-01115-0
Ataro, G., Misganaw, E., & Tadesse, F. (2024). Predictors of clinical competence among nursing students: A multi-institutional study. Nurse Education Today, 131, Article 105801. https://doi.org/10.1016/j.nedt.2023.105801
Ayalew, M., & Mersha, A. (2022). Self-efficacy and motivation as predictors of clinical competence: A structural equation model. BMC Nursing, 21, Article 243. https://doi.org/10.1186/s12912-022-01021-7
Azad, A., Kim, Y., & Choi, H. (2025). Curriculum alignment in competency-based nursing education: A scoping review. Nurse Education in Practice, 75, Article 103738. https://doi.org/10.1016/j.nepr.2024.103738
Baclig, M., Santos, E., & Roldan, J. (2022). Emotional resilience and clinical performance among Filipino nursing students. Philippine Journal of Nursing, 92(1), 22–31.
Bandura, A. (2020). Social cognitive theory: An agentic perspective. Routledge. (Original work published 1986)
Bautista, M., & Ignacio, J. (2022). Academic factors influencing clinical learning among nursing students. Nurse Media Journal of Nursing, 12(1), 45–59. https://doi.org/10.14710/nmjn.v12i1.4559
Benner, P. (2020). From novice to expert: Excellence and power in clinical nursing practice. Pearson. (Original work published 1984)
Berg, L., Hansen, T., & Nilsson, M. (2024). Organizational support and preceptor leadership effectiveness in clinical education. Nurse Education Today, 120, Article 105674. https://doi.org/10.1016/j.nedt.2023.105674
Biagioli, V., Albanesi, B., & Barbieri, G. (2025). Competence-related self-efficacy and preparedness for practice among undergraduate nursing students. Journal of Clinical Nursing, 34(2), 118–129. https://doi.org/10.1111/jocn.17123
Brown, T., Villareal, C., & Martin, J. (2021). Simulation-based training for high-acuity care: Student outcomes and confidence. Clinical Simulation in Nursing, 53, 42–49. https://doi.org/10.1016/j.ecns.2021.01.008
Caballero, R., Santos, B., & Velasco, L. (2022). Personal attributes and clinical performance among nursing students. Nurse Education Today, 117, Article 105486. https://doi.org/10.1016/j.nedt.2022.105486
Cant, R., & Cooper, S. (2020). Use of simulation to improve clinical skills in undergraduate nursing: A systematic review. Journal of Advanced Nursing, 76(4), 1111–1125. https://doi.org/10.1111/jan.14316
Capili, B., & Javier, A. (2023). Resource adequacy and clinical performance among nursing students in Philippine hospitals. Journal of Nursing Practice, 13(3), 150–158.
Cardini, C., Rivera, J., & Slater, E. (2024). Low-cost simulation strategies to enhance clinical preparedness. Simulation in Healthcare, 19(1), 65–72. https://doi.org/10.1097/SIH.0000000000000721
Commission on Higher Education. (2017). CHED Memorandum Order No. 15, s. 2017: Revised policies and standards for the Bachelor of Science in Nursing (BSN) program.
Commission on Higher Education. (2022). National Budget Circular (NBC) No. 461: Revised compensation and position classification plan.
Chen, R. (2020). Metacognition and nursing student competency: A predictive model. Journal of Professional Nursing, 36(4), 250–257. https://doi.org/10.1016/j.profnurs.2020.01.005
Choi, H., Kim, M., & Lee, D. (2021). Learning flow, self-efficacy and satisfaction in virtual clinical simulation. BMC Nursing, 22, Article 454. https://doi.org/10.1186/s12912-021-00712-1
Choi, J., Park, S., & Min, H. (2023). Virtual simulation and self-efficacy among undergraduate nursing students. Journal of Nursing Education, 62(2), 101–108. https://doi.org/10.3928/01484834-20221212-03
Crisostomo, L., & Alcoran, M. (2020). Academic stress and clinical performance among nursing students. Philippine Journal of Nursing, 90(2), 31–42.
Data Privacy Act of 2012, Rep. Act No. 10173. (2012). https://www.officialgazette.gov.ph/2012/08/15/republic-act-no-10173/
El-Gazar, M., Hassan, A., & Taha, M. (2024). Digital readiness and academic motivation among nursing students: Implications for blended learning. Nurse Education Today, 129, Article 105688. https://doi.org/10.1016/j.nedt.2023.105688
Eticha, T., & Berhane, L. (2020). Clinical learning environment and competence among nursing students. BMC Nursing, 19, Article 56. https://doi.org/10.1186/s12912-020-00448-z
Gamboa, G., & Castillo, R. (2022). Competency-based assessments and clinical judgment among nursing students. Philippine Journal of Nursing Education, 5(1), 34–46.
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2021). Multivariate data analysis (9th ed.). Cengage Learning.
Hu, X. (2022). Artificial intelligence and learning analytics in teacher education: A systematic review. Education Sciences, 12(8), Article 569. https://doi.org/10.3390/educsci12080569
Hu, X., Zhang, Y., Zhang, L., & Liu, Y. (2022). Application and effectiveness of Entrustable Professional Activities (EPAs) in clinical nursing education: A systematic review. BMC Nursing, 21(1), Article 185. https://doi.org/10.1186/s12912-022-00965-0
Kline, R. B. (2020). Principles and practice of structural equation modeling (4th ed.). Guilford Press.
Liu, Y., Wang, X., Chen, Y., & Zhang, H. (2024). Evaluating competency-based education outcomes in medical residency programs: A multi-center prospective study. Medical Teacher, 46(3), 312–320. https://doi.org/10.1080/0142159X.2023.2281405
Mashayekh, M., Hosseini, M., & Khorasani, A. (2024). Assessing clinical reasoning and decision-making skills in health sciences students through simulation: A cross-sectional study. BMC Medical Education, 24(1), Article 112. https://doi.org/10.1186/s12909-024-05085-w
McGaghie, W. C., Harris, I. B., & Wayne, D. B. (2022). Mastery learning in healthcare professions education. Academic Medicine, 97(6), 795–802. https://doi.org/10.1097/ACM.0000000000004652
Nguyen, T. T., Tran, K. V., & Le, P. H. (2023). Digital transformation in medical education: Student engagement and learning outcomes in hybrid learning environments. Computers & Education, 198, Article 104760. https://doi.org/10.1016/j.compedu.2023.104760
Ortiz, R., Garcia, A., & Martinez, S. (2024). Implementation of objective structured clinical examinations (OSCEs) in undergraduate nursing curricula: Challenges and best practices. Nurse Education Today, 133, Article 106045. https://doi.org/10.1016/j.nedt.2023.106045
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Shahzeydi, A., Yamani, N., & Amini, M. (2024). Faculty development interventions in competency-based medical education: A scoping review. Journal of Education and Health Promotion, 13(1), Article 45. https://doi.org/10.4103/jehp.jehp_891_23
Shen, X., & Liu, Y. (2023). Resilience, self-efficacy, and coping among nursing students in clinical settings. BMC Nursing, 22, Article 114. https://doi.org/10.1186/s12912-023-01280-y
Sweet, L., & Broadbent, J. (2017). Nursing students' perceptions of the qualities of a clinical facilitator that enhance learning. Nurse Education in Practice, 22, 30–36. https://doi.org/10.1016/j.nepr.2016.11.007
ten Cate, O., & Hennus, M. P. (2024). Entrustable professional activities and entrustment decision-making for competency-based education in the health professions: An introduction. In O. ten Cate, V. C. Burch, H. C. Chen, F. C. Chou, & M. P. Hennus (Eds.), Entrustable professional activities and entrustment decision-making in health professions education (pp. 3–14). Ubiquity Press. https://doi.org/10.5334/bdc.a
Uppor, N., Kumar, S., & Rajan, R. (2024). Workplace-based assessment tools in postgraduate clinical training: Reliability and feasibility evaluation. Medical Education Online, 29(1), Article 2301122. https://doi.org/10.1080/10872981.2023.2301122
Warshawski, S. (2022). Academic self-efficacy, resilience and social support among first-year Israeli nursing students learning in online environments during COVID-19 pandemic. Nurse Education Today, 110, Article 105267. https://doi.org/10.1016/j.nedt.2022.105267
Workneh, M., Kassa, M., Mihrete, S., Belege, F., Nigussie, J., Goshiy, D., & Biset, G. (2024). Level of clinical competency and associated factors of nursing students in Ethiopia: Systematic review and meta-analysis [Preprint]. Research Square. https://doi.org/10.21203/rs.3.rs-4387086/v1
Zou, M., Chen, H., & Gao, Y. (2023). Self-efficacy, resilience, and engagement among nursing students during clinical practice. BMC Nursing, 22, Article 310. https://doi.org/10.1186/s12912-023-01478-0
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
