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Facilitating the Development of Clinical Competence in a Low-Resource Setting: Perceptions and Challenges of Nurse Educators

David Abdulai Salifu orcid  -  School of Nursing and Midwifery, University for Development Studies, Ghana
Yolande Heymans orcid  -  Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
*Christmal Dela Christmals orcid  -  Centre for Health Professions Education, Faculty of Health Sciences, North-West University, South Africa
Open Access Copyright (c) 2022 Nurse Media Journal of Nursing
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Background: The inability of nursing education institutions, particularly in low-resource settings to train competent nurses has been partly attributed to the challenges faced by nurse educators in the teaching of practical skills and in facilitating the development of clinical competence. Unfortunately, the perceptions and challenges faced by nurse educators in clinical nursing educationin diploma nursing education in low-resource settings have not been explored.

Purpose: This study aimed to explore and describe the perceptions and challenges of nurse educators in the teaching of practical skills and in facilitating the development of clinical competence in diploma nursing education in Ghana, a low-resource setting. 

Methods: A qualitative descriptive design was used in this study. Nine nurse educators tasked with teaching practical skills and facilitating the development of clinical competence from three accredited diploma-awarding public nursing colleges – one in each of the three geographical zones of Ghana – were purposively sampled and interviewed using a semi-structured interview guide. The data were  analysed with the aid of ATLAS.ti software through the thematic framework approach of qualitative data analysis.

Results: Four themes, namely nurse educator and student factors, skills learning environment factors, institutional challenges, and regulatory issues, were identified and described the challenges of practical skills teaching and clinical competence development confronting nurse educators in the study setting.

Conclusion: To address these challenges, policy measures should be implemented to ensure adequate national investment in nursing education and incentives to promote nurse educator development and performance. Nurse educators and their labour union should therefore strongly advocate for this transformation in nursing education.
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Keywords: Clinical competence; clinical nursing education; low-resource setting; nurse educators; qualitative descriptive

Article Metrics:

  1. Adams, W. C. (2015). Conducting semi‐structured interviews. In: Wholey, J. S., Hartry, H. P. and Newcomer, K. E., (Eds.), Handbook of practical program evaluation (pp.492-505). Jossey-Bass, San Francisco.
  2. Agha, S., Ahamrani, A. Y., & Khan, M. A. (2015). Satisfaction of medical students with simulation-based learning. Saudi Medical Journal, 36(6), 731–736.
  3. Anim-boamah, O., Christmals, C. Dela, & Armstrong, S. J. (2021). Nursing students’ experiences on clinical competency assessment in Ghana. Nurse Media Journal of Nursing, 11(3), 278–293.
  4. Aqel, A. A., & Ahmad, M. M. (2014). High-fidelity stimulation effects on CPR knowledge, skills, acquisition, and retention in nursing students. Worldviews on Evidence-Based Nursing, 11(6), 394–400
  5. Asamani, J. A., Amertil, N. P., Ismaila, H., & Orem, J. N. (2020). The imperative of evidence-based health workforce planning and implementation: Lessons from nurses and midwives unemployment crisis in Ghana. Human Resources for Health, 18(16).
  6. Baye, Y., Demeke, T., Birhan, N., Semahegn, A., & Birhanu, S. (2020). Nurses’ work-related stress and associated factors in governmental hospitals in Harar, Eastern Ethiopia: A cross-sectional study. PLoS ONE, 15(8), 1–12.
  7. Begley, T. (2007). Who am I now? The experience of being a post-registration children’s student nurse in the first clinical placement. Nurse Education Today, 27(5), 375–381.
  8. Bell, S. A., Rominski, S., Bam, V., Donkor, E., & Lori, J. (2013). Analysis of nursing education in Ghana: Priorities for scaling-up the nursing workforce. Nursing and Health Sciences, 15(2), 244–249.
  9. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. Jossey-Bass, San Francisco
  10. Benton, D. (2012). Advocating globally to shape policy and strengthen nursing’s influence. The Online Journal of Issues in Nursing, 17(1).
  11. Bokonji, D., Ra, M., Ma, S., Oru, M., Rybarova, L., Vidovi, K., Drieghe, B., Wieren, J. Van, Çurçija, E., & Seiti, L. (2019). Competence-based curriculum development in nursing education: A story from the Western Balkans. Nursing Education Perspective, 40(6) 28–30.
  12. Brink, H., Van Der Walt, C., & Van Rensburg, G. (2017). Fundamentals of research methodology for health care professionals (4th ed.). Juta and Company Ltd: Cape Town
  13. Bvumbwe, T., & Mtshali, N. G. (2018a). Transforming nursing education to strengthen health system in Malawi: An exploratory study. Open Nursing Journal, 12(1), 93–105.
  14. Bvumbwe, T., & Mtshali, N. (2018b). Nursing education challenges and solutions in Sub Saharan Africa: An integrative review. BMC Nursing, 17(3), 1–11.
  15. Christmals, C. D., Aziato, L., & Rispel, L. C. (2021). Perceptions of the functioning and effectiveness of nursing regulators in Ghana and South Africa: A cross-sectional study. BMJ Open, 11, 50580.
  16. Clapper, T. C. (2011). Interference in learning: What curriculum developers need to know. Clinical Simulation in Nursing, 7(3), e77–e80.
  17. Cook, D. A., Brydges, R., Hamstra, S. J., Zendejas, B., Wang, A. T., Erwin, P. J., & Hatala, R. (2012). Comparative effectiveness of technology-enhanced simulation versus other instructional methods. Society for Simulation in Healthcare, 7(5), 308–320.
  18. Dahlke, S., O’Connor, M., Hannesson, T., & Cheetham, K. (2016). Understanding clinical nursing education: An exploratory study. Nurse Education in Practice, 17, 145–152.
  19. Eta, V. E. A., Atanga, M. B. S., Atashili, J., & D’Cruz, G. (2011). Nurses and challenges faced as clinical educators: A survey of a group of nurses in Cameroon. Pan African Medical Journal, 8, 1–8.
  20. Farzi, S., Shahriari, M., & Farzi, S. (2018). Exploring the challenges of clinical education in nursing and strategies to improve it: A qualitative study. Journal of Education and Health Promotion, 7, 115.
  21. Frehywot, S., Vovides, Y., Talib, Z., Mikhail, N., Ross, H., Wohltjen, H., Bedada, S., Korhumel, K., Koumare, A. K., & Scott, J. (2013). E-learning in medical education in resource constrained low- and middle-income countries. Human Resources for Health, 11(1), 1–15.
  22. Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., Fineberg, H., Garcia, P., Ke, Y., Kelley, P., Kistnasamy, B., Meleis, A., Naylor, D., Pablos-Mendez, A., Reddy, S., Scrimshaw, S., Sepulveda, J., Serwadda, D., & Zurayk, H. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet, 376(9756), 1923–1958.
  23. Global Alliance for Leadership in Nursing Education and Science (GANES). (2011). Investing in nursing education to advance global health.
  24. Hill, L., & Williams, E. P. (2017). Contemporary models for clinical nursing education. Hattiesburg, Mississippi, USA: Sigma Repository
  25. Hussein, M. T. E., & Osuji, J. (2016). Bridging the theory-practice dichotomy in nursing: The role of nurse educators. Journal of Nursing Education and Practice, 7(3), 20–25.
  26. Inayat, S., Younas, A., Sundus, A., & Khan, F. H. (2020). Nursing students’ preparedness and practice in critical care settings: A scoping review. Journal of Professional Nursing, 37(1).
  27. Jamshidi, N., Molazem, Z., Sharif, F., Torabizadeh, C., & Kalyani, M. N. (2016). The challenges of nursing students in the clinical learning environment: A Qualitative study. The Scientific World Journal, 2016, 1846178.
  28. Jeffries, P. R. (2005). A framework for designing, implementing, and evaluating: Simulations used as teaching strategies in nursing. Nursing Education Perspectives, 6(2), 96–103.<0096:AFWFDI>2.0.CO;2
  29. Jeffries, P. R. (2016). The NLN Jeffries simulation theory (1st Ed). Wolters Kluwer Health
  30. Kim, J., Park, J., & Shin, S. (2016). Effectiveness of simulation-based nursing education depending on fidelity: A meta- analysis. BMC Medical Education, 16, 1–8.
  31. Kim, S. J., Kim, S., Kang, K.-A., Oh, J., & Lee, M.-N. (2016). Development of a simulation evaluation tool for assessing nursing students’ clinical judgment in caring for children with dehydration. Nurse Education Today, 37, 45–52.
  32. Munangatire, T., & Naidoo, N. (2017). Exploration of high-fidelity simulation: Nurse educators’ perceptions and experiences at a school of nursing in a resource-limited setting. African Journal of Health Professions Education, 9(1), 44–47.
  33. Nehrir, B., Vanaki, Z., Mokhtari Nouri, J., Khademolhosseini, S. M., & Ebadi, A. (2016). Competency in nursing students: A systematic review. International Journal of Travel Medicine and Global Health, 4(1), 3–11.
  34. Nursing and Midwifery Council (NMC). (2018). Future nurse: Standards of proficiency for registered nurses. London, UK: Nursing and Midwifery Council
  35. Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533–544.
  36. Papathanasiou, I. V, Tsaras, K., & Sarafis, P. (2014). Views and perceptions of nursing students on their clinical learning environment: Teaching and learning. Nurse Education Today, 34(1), 57–60.
  37. Pirie, J., Kappus, L., Sudikoff, S. N., & Bhanji, F. (2016). Simulation curriculum development, competency-based education, and continuing professional development. In: Grant V., Cheng, A. (eds), Comprehensive healthcare simulation: Pediatrics (pp. 181-193). Springer, Cham.
  38. Polit, C. T., & Beck, D. F. (2006). Essentials of nursing research: Methods, appraisal, and utilization. Nurse Research, 13(4), 91–92.
  39. Pope, C., Ziebland, S., & Mays, N. (2000). Analyzing qualitative data: Qualitative research in health care. British Medical Journal, 320, 114–116
  40. Rafati, F., Nouhi, E., Sabzevari, S., & Dehghan-Nayeri, N. (2017). Coping strategies of nursing students for dealing with stress in clinical setting: A qualitative study. Electronic Physician, 9(12), 6120–6128.
  41. Salifu, D.A., Gross, J., Salifu, M. A., & Ninnoni, J. P. K. (2019). Experiences and perceptions of the theory-practice gap in nursing in a resource-constrained setting: A qualitative description study. Nursing Open, 6(1), 72–83.
  42. Salifu, D. A., Heymans, Y., & Christmals, C. Dela. (2022). Teaching and learning of clinical competence in Ghana: Experiences of students and post-registration nurses. Healthcare 10(3), 538.
  43. Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334–340.<334::aid-nur9>;2-g
  44. Shin, I., & Kim, J. H. (2013). The effect of problem-based learning in nursing education: A meta- analysis. Advanced Health Science Education Theory Practice, 18(5), 1103–1120.
  45. Spitzer, A., & Perrenoud, B. (2006). Reforms in nursing education across Western Europe: Implementation processes and current status. Journal of Professional Nursing, 22(3), 162–171.
  46. Talley, B. (2006). Nurses and nursing education in Ghana: creating collaborative opportunities. International Nursing Review, 53(1), 47–51.
  47. Voldbjerg, S. L., Gronkjaer, M., Sorensen, E. E., & Hail, E. O. C. (2016). Newly graduated nurses’ use of knowledge sources: A meta-ethnography. Journal of Advanced Nursing, 72(8), 1751–1765.
  48. Watson, R., Hayter, M., & Jackson, D. (2021). Is the PhD well for nursing faculty running dry? Journal of Nursing Management, 29(6), 1349–1350.
  49. Wongpimoln, B., Pholputta, L., Ngernthaisong, C., & Sarnkhaowkhom, C. (2021). Transitional experiences from clinical nurse experts to novice nurse lecturers in the university for local development in Thailand: A phenomenological study. Nurse Media Journal of Nursing, 11(2), 197–209.
  50. World Health Organisation. (2009). Global standards for the initial education of professional nurses and midwives. Geneva, Switzerland: World Health Organisation.
  51. World Health Organisation. (2016). Nurse educator core competencies. Geneva, Switzerland: World Health Organisation
  52. World Health Organisation (2012). Plan of action for scaling up quality nursing and midwifery education and practice for the African region 2012–2022. Brazzaville: WHO Region Office for Africa
  53. World Health Organisation (2013). Transforming and scaling up health professionals’ education and training: World Health Organization guidelines 2013. World Health Organization.;jsessionid=87B4A0ECDDA6510BD2F68A5192F78FC9?sequence=1
  54. World Health Organisation (2018). World health statistics 2018: Monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization
  55. Younas, A., Zeb, H., Aziz, S. B., Sana, S., Albert, J. S., Khan, I. U., Inayat, S., Khan, F. H., & Rasheed, S. P. (2019). Perceived challenges of nurse educators while teaching undergraduate nursing students in Pakistan: An exploratory mixed-methods study. Nurse Education Today, 81(2019), 39–48.

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