Assessment of factors associated with the acquisition of clinical competencies among undergraduate nursing students in government and private universities in Uganda

Abstract

Background: Like many developing countries, Uganda faces significant challenges in ensuring that undergraduate nursing students acquire essential clinical competencies. These competencies include medication administration, patient assessment, critical thinking, and decision-making, fundamental to safe and high-quality patient care. However, research indicates that many nursing students in both government and private universities struggle to develop these competencies effectively. Several factors contribute to this challenge, including inadequate clinical training, limited supervision, resource constraints, and variations in the quality of clinical instruction. Students report difficulties translating theoretical knowledge into practical skills, leading to frustration, low self-confidence, and poor clinical judgment. This competency acquisition gap affects students' readiness for professional practice and poses a risk to patient safety and quality of care. Identifying the factors associated with acquiring clinical competencies among undergraduate nursing students is crucial for developing targeted interventions that enhance nursing education and clinical training in government and private universities. Objective: The main objective of this study was to assess the factors affecting the acquisition of clinical competencies among undergraduate nursing students in government and private universities in Uganda. Methods: The study site was at the eight government and private universities from Uganda’s central and western parts. The study employed a descriptive research design incorporating quantitative and qualitative methods. The participants included 108 students, 8 HODs, and 48 supervisors. Probability and non-probability sampling were done, and a sampling frame was used to select the universities and distribute the participants to the eight selected universities. Self-administered questionnaires were used after piloting. They were measured against the World Federation of Medical Education Global Standards for Quality Improvement. Cronbach’s alpha, median, and interquartile range were calculated using IBM SPSS 22. A P-value less or equal to 0.05 was taken as statistically significant. Results are presented in frequencies, pie charts, percentages, and tables. Qualitative data was thematically analyzed. Chi-square tests were conducted to assess associations between variables. Results: The study showed that the acquisition of clinical competencies is positively correlated with preceptors’ participation (r=0.783) (p=0.000), students’ perceptions (r=0.775) (p=0.000), Institutional factors(r=0.668) (p=0.000), and the clinical learning environment (r=0.556) (p=0.000). The study further shows that 69.9% (n=70) had adequate clinical learning experience, while 31% (n=31) had inadequate clinical learning experience. This implies moderate student supervision and an unfavorable clinical learning environment. Conclusion: Competency acquisition among student nurses is positively influenced by the active involvement of preceptors, students' perceptions, institutional factors, and a supportive clinical learning environment. Adequate clinical experience is critical to developing competent nursing students, thus requiring more time for clinical practice. Overcrowding, inadequate supervision and feedback, and limited resources result in incompetencies. This results in lower-quality patient care, potentially leading to increased morbidity and mortality. Recommendations: Nursing students should receive more time to practice in clinical settings, and resource availability should be improved. Overcrowding in clinical settings should be monitored and reduced, and supervision and feedback should be provided.