An Assessment of Factors Influencing Clinical Learning Among Diploma Nursing Students at Moi Teaching and Referral Hospital Eldoret, Kenya

Abstract

Clinical learning is a critical component of nursing education worldwide, enabling students to develop practical skills through supervised patient care. Globally and regionally, nursing students face challenges such as inadequate supervision, resource shortages, and a persistent theory-practice gap, particularly in low- and middle-income countries. In Kenya, despite nurses demonstrating strong overall competencies, diploma nursing students often underperform in clinical placements compared to theoretical assessments, highlighting a pressing need for context-specific investigation. This study assessed factors influencing clinical learning among 304 diploma nursing students at Moi Teaching and Referral Hospital (MTRH), Kenya. The objectives were to: (a) identify student-related factors; (b) evaluate training institution-related factors; (c) examine clinical setting-related influences; and (d) explore students’ experiences with the preceptorship model. Using an explanatory sequential mixed-methods design, the study samples 304 nursing students by census sampling to complete questionnaires as well as 24 students participating in a total of 4 Focus Group Discussions (FGD). Quantitative data were analyzed with SPSS version 27 using descriptive statistics, chi-square tests for associations, and multivariate regression to identify predictors of clinical performance (p ≤ 0.05). Qualitative data underwent thematic analysis to enrich understanding of preceptorship experiences. Among the 304 respondents, key quantitative findings included: 37.83% (n=115) strongly disagreed that clinical supervision was adequate (χ²=15.7, p=0.001); 36.51% (n=111) reported ineffective teaching methods (χ²=12.4, p=0.004); and 33.88% (n=103) experienced poor cooperation with clinical staff (χ²=10.8, p=0.013). Anxiety and financial constraints were notable student-related barriers (anxiety χ²=11.5, p=0.009). Regression analysis revealed that training institution-related (β=0.32, p=0.002) and clinical setting-related factors (β=0.28, p=0.005) significantly predicted clinical performance, explaining 12.5% of variance (R²=0.125, F=7.64, p=0.003). Qualitative themes included supportive preceptorship fostering confidence and skills, resource limitations such as PPE shortages, and the persistent theory-practice gap due to inconsistent clinical guidance. In conclusion, inadequate supervision, poor teaching methods, and resource scarcity are significant barriers to effective clinical learning at MTRH. Strengthening supervision, enhancing teaching strategies, and improving clinical resources are essential to bridge the theory-practice gap and improve nursing students’ clinical competence.