THE INFLUENCE OF CLINICAL NURSE INSTRUCTOR PRACTICES ON CLINICAL PERFORMANCE AMONG BACHELOR OF SCIENCE IN NURSING (BSCN) STUDENTS IN KENYA

Abstract

Purpose: The study sought to assess the influence of clinical nurse instructor practices on clinical performance among BScN students in Kenya. It examined the influence of clinical instruction strategies and clinical assessment tools on students’ clinical performance. Methodology: This was a descriptive cross- sectional survey design. The total population of BScN students (direct entry) in the sampled universities was one hundred and eighty four (184). Study sample for students was obtained using Krejcie & Morgan table (1970). Study sample consisted of 160 third year BScN students and 10 clinical nurse instructors from five selected universities in Kenya. Data collection done using structured interview guide and self- administered questionnaires. Nursing students filled the questionnaire, nurse instructors were interviewed. Data was analyzed using descriptive and inferential statistics. Chi- square test, multiple regression and correlation models were used to test association and relationships significance of the variables at 95% confidence level. Findings presented in tables and figures. Findings: The findings of the study revealed 149 (93.1%) students experienced demonstration strategy, 44 (27%) experienced Problem- solving strategy, 57 (35.6%) clinical conferencing and 38 (23.7%) experienced clinical portfolios in clinical placements. Qualitative data findings revealed 10 (100%) Nurse instructors applied demonstration strategy, 8 (80%) clinical conferencing, 3 (30%) problem- solving and 2 (20%) clinical portfolios in clinical teaching. Therefore demonstration was the most preferred clinical teaching strategy in Kenyan universities with 95% response rate. Pertaining clinical assessment tools, quantitative data results showed 131 (84%) agreed tools measured clinical competencies (knowledge, Attitude & Practical skills) while qualitative findings showed only 4 (40%) instructors agreed tools measured competencies (KAP). Nursing procedure manual and student training file required review. ChiSquare test findings revealed Students who did not experience problem- based strategy obtained higher scores compared to those who had problem- based learning. This was statistically significant (χ²=8.618, df=1, p=0.003). Multiple regression model findings showed clinical conferencing, institution, and clinical portfolios statistically significantly predicted student clinical assessment scores (P=0.001, p=0.007, p= 0.030) respectively. Correlation analysis showed positive relationship between independent and dependent variables, F (11, 46) =4.261, p< 0.001. Unique contribution to theory, practice and policy: Experiential theory by David Kolb was used in the study, found applicable and it is recommended for future nursing studies. Author recommends use of clinical conferencing, problem based strategy and portfolios in clinical training of BScN students. Nurse instructors require update on use of conferencing and portfolios in clinical teaching. Evaluation of BScN clinical learning and assessment tools