The Impact of Clinical Nurse Instructor’s Practices on Clinical Performance among Bachelor of Science in Nursing Students in Kenya

Abstract

Clinical teaching is a major component of nursing education. The training of Bachelor of Science Nursing (BScN) students entails clinical nurse instructors to help students translate theoretical knowledge into clinical skills and attitudes needed in the nursing profession. Over the decades employers have raised concerns about BScN nurses lacking adequate clinical skills and behavioral abilities required for safe patient care. In Kenya, there has been increasing concerns about BScN students graduating from universities not ready for clinical practice raising questions on the quality of clinical instruction. The purpose of this study was to examine the influence of clinical nurse instructor practices on clinical performance among BScN students in Kenya. The study was conducted in Kenyan universities between June and July 2019. It employed descriptive cross -sectional survey design and the target population were third year BScN (direct entry) students and clinical nurse instructors from public, private and faith- based universities in Kenya. A sample of five Universities was selected using stratified random sampling technique. Respondents were selected using simple random sampling. The study sample was 170 respondents comprising 160 third- year BScN students (direct Entry) and 10 clinical nurse instructors. Data were collected using self- administered questionnaire and interview guide. Questionnaire was pretested and interview guide reviewed by two experts. BScN students filled the questionnaire and clinical instructors were interviewed. Qualitative data was organized into themes then analyzed using content data analysis. Quantitative data were analyzed through descriptive statistics using the statistical Package for Social Sciences (SPSS)version 24 for windows. Data presented in tables, graphs and charts. Chi- square test, multiple regression and correlation test analyses were used to test association between independent and dependent variables at (95%) confidence level with significant level of 0.05. Findings revealed performance between gender was not of statistical significance (P= 0.252). Findings showed demonstration strategy was the most preferred clinical teaching strategy in Kenyan universities with 95% response rate. Clinical assessment strategies 131(84%) students and 4(40%) Instructors showed measured competencies (KAP) while Procedure manual and student training file required review (60%). Chi- square test findings revealed problem-based teaching statistically significantly influenced student clinical assessment scores (p=0.003). Findings showed students who had no opportunity to practice problem solving techniques had higher clinical assessment scores than those who did and this was statistically significant (χ²=8.618, df=1, P=0.003). Multiple regression analysis revealed Clinical Conferencing (p=0.001), Institution (p=0.007) and Clinical portfolios (p=0.030) statistically significantly predicted student clinical assessment scores. Correlation analysis showed positive relationship between independent and dependent variables, F (11, 146) =4.261, p<0.001. These accounted for 24.1% variability in the clinical assessment scores. Clinical, assessment strategies and role modeling contributed to performance scores positively but not statistically significantly p = 0.517, p=0.345) respectively. The study recommends all universities in Kenya teaching BScN students to adopt problem-based strategy, clinical conferencing and clinical portfolio teaching strategies for good results. The study recommends review of procedure manual and student training file by nursing education regulatory body. The study recommends further studies on student factors influencing clinical performance and clinical instructors’ competence.