Predicting Clinical Skills Development Among Nursing Students: The Role of Personal, Instructional, Academic, and Clinical Environment Factors
DOI:
https://doi.org/10.5281/zenodo.21584974Keywords:
Clinical skills development; Nursing education; Clinical competence; Competency-based education; Clinical learning environment; Self-efficacy; Simulation-based learning; Digital literacyAbstract
Modern day healthcare systems require nursing graduates to possess quality clinical competence, critical thinking, and flexibility. One way to improve competency-based nursing education is to understand what factors predict the development of clinical skills and prepare students to enter the workforce. The study explored and identified the predictors of clinical skills development of nursing students in private higher education institutions. This study adopted a quantitative cross-sectional predictive correlational framework to a population of 598 Level III and IV nursing students in three private HEIs in Iligan City, Philippines. A validated questionnaire developed by the researchers was used to measure predictors related to the personal, instructional, academic, and clinical environments, as well as the development of clinical skills. At a 0.05 level of significance, descriptive statistics, Pearson correlation, and multiple regression were performed. High perceptions of predictors and indicators of clinical skills development were shown by all the nursing students. All predictors included in the study were significantly related to the clinical skills development. The strongest predictor of clinical skills development in the study was assessment, followed by self-efficacy, digital literacy, simulation exposure, and quality of supervision. Preparation for clinical practice was shown to be the result of a combination of quality academic and instructional support, as well as personal and clinical readiness. Assessment of clinical skills development is a complex process that includes a number of inter-related educational and personal components.
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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. https://doi.org/10.5430/jnep.v10n5p56
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/s12912-025-02688-y
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. https://doi.org/10.5430/jnep.v13n2p22
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.13885
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.2023.101488
Alqahtani, N., & Rajkhan, A. (2020). Self-efficacy and academic performance among nursing students. Journal of Nursing Education, 59(6), 333–339. https://doi.org/10.3928/01484834-20200520-07
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/s12909-023-04788-0
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/s12912-024-01780-3
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.v12i1.42312
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.17120
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.2020.12.004
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.14304
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.0000000000000720
CHED. (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.
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.2019.12.003
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/s12912-021-00680-4
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/10.3928/01484834-20221212-04
Commission on Higher Education. (2022). National Budget Circular (NBC) No. 461: Revised compensation and position classification plan. Commission on Higher Education.
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, Republic Act No. 10173. (2012). Official Gazette of the Republic of the Philippines. 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/s12912-020-00448-4
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., 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/s12912-023-01280-9
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. (2022). 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. 1–18). Ubiquity Press. https://doi.org/10.5334/bcv.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
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-x
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