Perception of Nursing Students and Preceptors about Factors Influencing the Clinical Performance of Nursing Students

Abstract

The mastery of clinical skills must be a key component of courses leading to registration of nurses,as clinical performance of today's nursing students holds a lot for the future of Nursing profession. The aim of the study is to identify the perception of nursing students and their preceptors about factors facilitating and inhibiting clinical performance of nursing students.A descriptive design was conducted among 400 and 500 level students of the department of Nursing science, University of Maiduguri and Nurses in all medical, surgical, obstetrics and gynecology wards of university of Maiduguri Teaching Hospital. A self developed questionnaire was used to collect data from the respondents by the researcher, the questionnaires were analyzed using SPSS version 17.0.Hypothesis was tested using chi-square. The following factors were identified as facilitators of clinical performance by the students and preceptors; Preceptorship and mentorship, good relationship with nurses, quality supervision, simulation, peer teaching, and learning in an effective clinical environment. The following factors were identified as inhibiting clinical performance; High levels of stress and anxiety, Poor interpersonal relationship,Theory-practice-gap,Inadequate clinical time,overcrowded clinical facilities,shortage of equipment and staff, and lack of feedback. The first null hypothesis stated that there is no significant relationship between perception of factors facilitating clinical performance and grade in last clinical experience examination and it was rejected because calculated chisquare (10.155) was greater than chi square table value(9.488) at 0.05 level of significance and 4df , the second null hypothesis which stated that there is no relationship between perception of factors inhibiting clinical performance and grade in last clinical experience examination which was accepted as calculated chi square (4.561) was less than chi-square table value(9.488) at 0.05 level of significance and 4df, thus null hypothesis accepted. If nursing as a profession must continue to thrive for years to come then it is recommended that Nursing departments and faculties must ensure they graduate clinically competent nurses capable of providing care in a variety of settings.

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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 4, Issue 5 Ver. II (Sep. - Oct. 2015), PP 57-69
www.iosrjournals.org
DOI: 10.9790/1959-04525769 www.iosrjournals.org 57 | Page
Perception of Nursing Students and Preceptors about Factors
Influencing the Clinical Performance of Nursing Students
1Gloria Joseph Dlama,2OyetundeModupe,1Ali Umar
1.Department of Nursing,Abubakar Tafawa Balewa University Teaching Hospital,Bauchi, Nigeria
2.Department of Nursing,Faculty of Clinical Sciences,College of medicine, University of Ibadan,Nigeria
Corresponding Author- Gloria Joseph Dlama. Email:glo_kool@yahoo.com . phone number: +2318130582720
Abstract: The mastery of clinical skills must be a key component of courses leading to registration of nurses,as
clinical performance of today’s nursing students holds a lot for the future of Nursing profession. The aim of the
study is to identify the perception of nursing students and their preceptors about factors facilitating and
inhibiting clinical performance of nursing students.A descriptive design was conducted among 400 and 500
level students of the department of Nursing science, University of Maiduguri and Nurses in all medical,
surgical, obstetrics and gynecology wards of university of Maiduguri Teaching Hospital. A self developed
questionnaire was used to collect data from the respondents by the researcher, the questionnaires were
analyzed using SPSS version 17.0.Hypothesis was tested using chi-square. The following factors were identified
as facilitators of clinical performance by the students and preceptors; Preceptorship and mentorship, good
relationship with nurses, quality supervision, simulation, peer teaching, and learning in an effective clinical
environment. The following factors were identified as inhibiting clinical performance; High levels of stress and
anxiety, Poor interpersonal relationship,Theory-practice-gap,Inadequate clinical time,overcrowded clinical
facilities,shortage of equipment and staff, and lack of feedback. The first null hypothesis stated that there is no
significant relationship between perception of factors facilitating clinical performance and grade in last
clinical experience examination and it was rejected because calculated chisquare (10.155) was greater than
chi square table value(9.488) at 0.05 level of significance and 4df , the second null hypothesis which stated that
there is no relationship between perception of factors inhibiting clinical performance and grade in last clinical
experience examination which was accepted as calculated chi square (4.561) was less than chi-square table
value(9.488) at 0.05 level of significance and 4df, thus null hypothesis accepted. If nursing as a profession must
continue to thrive for years to come then it is recommended that Nursing departments and faculties must ensure
they graduate clinically competent nurses capable of providing care in a variety of settings.
Key Words:[Clinical performance, Perception, Nursing profession, Experience]
I. Introduction
Nursing and Midwifery education in Nigeria involves a systematic direction and guidance of student in
an institution approved by the nursing and midwifery council of Nigeria, preparing students to function as
members of interdisciplinary and intersectorial teams, with the function of graduating Registered Nurses (RN)
and Registered midwives(RM) who have the ability and knowledge to care for clients in a variety of settings1.
The programme develops the students‟ affective, cognitive and psychomotor skills in problem solving1, .In order
to achieve this aim, exposure to clinical practice during training becomes imperative1,2.It is during their clinical
placement that students are expected to develop the relevant knowledge, skills and competence for their
professionalrole3,13.
Subscribing to the notion that nursing is an action profession and that nurses learn by doing, means the
mastery of clinical skills must be a key component of courses leading to registration of nurses4,5. However this
critical aspect of nursing education seems to have posed great challenges for students and trainers alike,with
final year nursing students experiencing apprehension and lack of confidence in fulfilling the expectations and
responsibilities of professional nursing 6,8.
With the dynamic and uncertain nature of the healthcare environment, nursing students must brace up
to face challenges as they develop themselves to become better graduate nurses and maintain a competent
practice to assess patients‟ physical, social and psychological health in a rapidly changing and challenging
environment9,10. It then becomes imperative to understand the perception of preceptors about various factors
influencing effective clinical performance of nursing students; which is “an essential component in preparation
for the reality of their professional role” 11. Since it is apparent that student nurses whether learning to nurse in
an apprentice style course or in a tertiary programme consider clinical learning a significant component of their
education 12,17.

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 58 | Page
II. Materials And Methods
The study is a descriptive design conducted among 400 and 500 levelstudents as at 2011/2012
academic session in the department of Nursing Science University of Maiduguri and Registered Nurses at
University of Maiduguri Teaching Hospital, Borno State,Nigeria. 95 %(n=98) nursing students and 80% (n=95)
Nurses were selected using convenience samplingwith a total sample size of 193 subjects. Ethical clearance was
obtained from university of Maiduguri and university of Maiduguri Teaching Hospital‟s ethical committee. All
participants were informed about the objective of the study, consent obtained before proceeding to answer the
questions and participants were assured of confidentiality of information provided and participation was
voluntarily.A self developed questionnaire was used for data collection. The nurses‟ questionnaire consisted of
four sections.A = Socio Demographic data, B = Perception of factors facilitating effective clinical performance
C = Perception of factors inhibiting effective clinical performance ,D = Perceived rating of clinical performance
of nursing students. The questionnaire consists of 38 items, with 32 close ended questions using the Likert scale
and 6 open ended questions. The questionnaire for the nursing students consists of three sections: A = Socio
Demographic data, B = Perception of factors Facilitating effective clinical performance,C = Perception of
factors inhibiting effective clinical performance .Made up of 33 questions, 26 close ended questions, using the
Likert scale and 7 open ended questions.
The questionnaire was assessed by a lecturer for face and content validity, for reliability a pilot study
was conducted in the School of Nursing, University Of Maiduguri Teaching Hospital Borno state Nigeria. The
questionnaires were self-administered by the researcher with the help of two other colleagues who were trained
by the researcher before meeting the respondents. The distribution, filling and retrieval were carried out over a
period of two weeks. Out of 98 questionnaires for the students 95 were retrieved (96% ,retrieval rate) and n= 93
were used for analysis, while for the nurses, n= 88 were retrieved out of n=95 but only n=53 were correctly
answered (55.7% , retrieval rate) and n= 43 useable for analysis. The questionnaires were coded and data
entered into statistical package for social sciences (SPSS) version 17.0 for windows and data analyzed using
descriptive statistics, chi-square was used in testing hypothesis and data were presented using tables and charts.
III. Result
Table 1 Socio-Demographic Data Of Nurses
Variables
Frequency
Percentage (%)
1.
Gender
Male
12
29.3
Female
29
70.7
Total
41
100
2.
Marital status
Single
6
15
Married
34
85
Total
40
100
3.
Religion
Christian
16
39
Muslim
25
61
Total
41
100
4.
Cadre
NO II
14
35
NO I
10
25
SNO
5
12.5
PNO
4
10
ACNO&Above
7
17.5
Total
40
100
5.
Educational qualification
Diploma
21
63.6
Degree
10
30.3
Masters and Above
2
6.1
Total
33
100
6.
Age
29 and below
11
26.2
30-39
12
28.6
40-49
16
38.1
Above 49
3
7.1
Total
42
100

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 59 | Page
Result: Table1 ,Shows the Demographic data of Nurses who participated in the study: there were 29
females(70.7%) and 29.3%(12) males, 15%(6) were singles,85%(34) were married 63.6%(21) are Diploma
holders,30.3%(10) have a Degree and 6.1%(2) have masters,39%(16) were Christians, 61%(25) were
Muslims,35%(14) were NOII,25%(10)-NOI,12.5%(5)-SNO,10%(4) PNO, 17.5%(7) were
ACNO&Above,26.2%(11) were of ages 29 and below, 28.6%(12) were in the range of 30-39, 38.1%(16)
ranged from 40-49 years,7.1%(3) were above 49 years.
Table 2: Nurses Perception of Clinical performance of Nursing students on their ward
s/no
Variables
Frequency
Percentage(%)
1.
Below standard
6
14
2.
Fair
18
42
3.
Ready to learn
4
9.3
4.
Satisfactory
3
6.9
5.
Good
3
6.9
6.
Undecided
9
20.9
Total
43
100
Result: 14%(6) perceived the performance of the students as being below standard, 42%(18) perceived
their performance as being just fair,9.3%(4) perceived the students are ready to learn,6.9%(3) perceived their
performance as satisfactory and good, while 20.9%(9) were undecided about their perception of the students
performance.
Table3: Nurses Perception of students’ performance in certain areas during clinical posting
Variables
Frequency
Percentage(%)
30) student midwives demonstrates responsibility accountability for client care during posting
Positive perception
22
51.2
Negative perception
15
34.9
Undecided
6
13.9
Total
43
100
31) Students adhere to ethical practice standards and codes during procedures and interaction
with clients
Positive perception
21
48.8
Negative perception
14
32.6
Undecided
8
18.6
Total
43
100
32) Students use good time management skills in regard to all aspects of patient care.
Positive perception
15
34.9
Negative perception
16
37.2
Undecided
12
27.9
Total
43
100
33) Students are able to complete assessment that includes a review of systems, and documents
accurately during their clinical posting.
Positive perception
18
42
Negative perception
20
46.5
Undecided
5
11.6
Total
43
100
34) Students carryout aseptic techniques during procedures
Positive perception
27
62.8
Negative perception
11
25.6
Undecided
5
11.6
Total
43
100
35) Diagnostic procedures such as vital signs, urine test (all methods) are carried out rightly on
patients by students during postings.
Positive perception
14
32.6
Negative perception
25
58.1
Undecided
4
9.3
Total
43
100
Result: 51.2%(22) perceived that nursing students demonstrate responsibility for client care,48.8%(21)
had a positive perception about students adherence to ethical standards during procedures, 37.2%(16) had a
negative perception about students use of good time management skills in caring for patients,46.5%(20)
disagreed that nursing students completes assessment and documents sccurately,62.8%(27) agreed that students
carry out aseptic techniques while still 58.1%(25) perceived that students were unable to carry out certain
diagnostic procedures during postings.

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 60 | Page
Table 4: Rating of clinical performance of nursing students on a scale of 1-10 by Nurses
s/no
Variables
Frequency
Percentage (%)
1
2.0
3
7
2
3.0
7
16.3
3
4.0
9
20.9
4
5.0
8
18.6
5
6.0
4
9.3
6
7.0
2
4.7
7
8.0
1
2.3
8
Undecided
9
20.9
Total
43
100
Result:7%(3) rated the students: 2/10,16.3%(7) rated them 3/10,20.9(9)rated them 4/10,18.6%(8)
rated the students 5/10,9.3%(4) rated them 6/10,4.7%(2) rated 7/10,2.3%(1) rated them 8/10and 20.9%(9) were
undecided at the time of study.
Table 5: Nurses perception of factors inhibiting effective clinical performance
Variables
Frequency
Percentage(%)
21. High levels of stress and anxiety impede concentration, memory and problem solving
ability which adversely affects learning
Positive perception
37
86
Negative perception
2
4.6
Undecided
4
9.3
Total
43
100
22. Imparting knowledge gained by years of experience can be difficult and frustrating for
the preceptor and novice alike
Positive perception
17
39.6
Negative perception
13
30.2
Undecided
13
30.2
Total
43
100
23. What is taught in the classroom is not fully applicable to the clinical situation (theory-
practice gap )
Positive perception
26
60.5
Negative perception
9
20.9
Undecided
8
18.6
Total
43
100
24. Constant rotation of students, places more demand on clinical staff due to an
inadequate clinical time for the students.
Positive perception
21
49
Negative perception
14
32.5
Undecided
8
18.6
Total
43
100
25. When students are allocated to the same clinical area in large numbers teaching and
learning are negatively affected.
Positive perception
23
53.4
Negative perception
14
32.6
Undecided
6
14.0
Total
43
100
26. Shortage of equipment and staff are obstacles to the facilitation of student nurses
learning in clinical care.
Positive perception
34
79.1
Negative perception
5
11.6
Undecided
4
9.3
Total
43
100
27. Due to staff shortage midwives and nurses in the wards had no other option but to
direct their energy to the needs of patients.
Positive perception
28
65.1
Negative perception
5
11.6
Undecided
10
23.3
Total
43
100
28. Lack of feedback is perceived in a negative manner and students failed to understand
areas where improvement was needed, offering no opportunity to improve performance.
Positive perception
25
58.1
Negative perception
7
16.3
Undecided
11
25.6
Total
43
100

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 61 | Page
Result: 86%(37) preceptors perceived high levels of stress and anxiety as an inhibiting factor and
39.6%(17) perceived that imparting knowledge gained by years of experience can be difficult and frustrating for
the preceptors and students alike,60.5%(26) perceived theory-practice gap as an inhibiting factor,49%(21)
agreed that in adequate clinical time was a negative factor, while 53.4% (23) felt overcrowded clinical area
affected learning negatively,79.1%(34) perceived shortage of equipment and staff as obstacles to students
learning,65.1%(28) agreed that due to staff shortage, nurses in the wards had no option but to direct their energy
to patients needs,58.1%(25) perceived lack of feedback as an inhibiting factor.
Table 6: Other factors Nurses perceive as inhibiting clinical performance of Nursing students
S/no
Factors
Frequency
Percentage
(%)
1
Negative attitude of students
12
52.2
2
Lack of interest in Nursing
8
34.8
3
University environment not conducive for studying Nursing
2
8.7
4
Inadequate clinical posting
1
4.4
Total
23
100
Result:52.2%(12) preceptors identified that students negative attitude affected their learning
negatively,34.8%(8) perceived that students lack of interest in Nursing affected them negatively, and still
8.7%(2) said the university environment was not really conclusive for studying Nursing,4.4%(1) said the
students are having inadequate clinical posting which affects them negatively.
Table 7: Ways in which Nurses perceive they can positively influence clinical performance of Nursing
students
s/no
Variables
Frequency
Percentage(%)
1
Allowing students carry out various procedures under supervision
6
13.9
2
Providing adequate equipment
2
4.7
3
Teaching and asking questions
15
34.9
4
Giving them more time to learn
5
11.6
5
Motivation
4
9.3
6
Undecided
11
25.6
Total
43
100
Result: 13.9%(6) said that allowing students to carry out procedures under supervision will positively
influence their learning,4.7%(2) perceived that providing adequate equipment will facilitate learning,34.9%(15)
said when students are taught in the ward and allowed to ask questions it will enhance their learning,11.6%(5)
perceived that giving the students more time to learn positively influences learning,9.3%(4) perceived providing
motivational factors will enhance learning,25.6%(11) were undecided about their roles in influencing students
clinical performance.
Table 8: Nursing Students ResponseSocio-Demographic Data
S/no
Variables
Frequency
Percentage (%)
1.
Gender
Male
33
35.5
Female
60
64.5
Total
93
100
2.
Level
400
42
46.7
500
48
53.3
Total
90
100
3.
Mode of entry
UME
46
51.1
Remedial
22
24.4
Direct entry
22
24.4
Total
90
100
4.
Age as at last birthday
20-29
62
79.5
30-39
12
15.4
40-49
3
3.8
Above 50
1
1.3
Total
78
100
5.
Religion
Christian
44
47.8
Muslim
48
52.2

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 62 | Page
Total
92
100
6.
Marital status
Single
53
59.6
Married
35
39.3
Divorced
1
1.1
Total
89
100
4.
Grade in last clinical examination
A
16
17.2
B
38
40.8
C
30
32.3
D
2
2.2
Others
7
7.5
Total
93
100
Result: 64.5%(60) of the respondents were females and 35.5% (33) were male, 46.7%(42) were 400Level
students, 53.3%,(48) were in 500Level. 51.1%(46) were admitted through UME, 24.4%(22) each were admitted
through Remedial and Direct entry. The respondents age as at their last birthday were: 20-29(62,79.5%),30-39(
12,15.4%)40-49(3,3.8%)Above 50(1,1.3%).
44(47.8%) of the Respondents were Christians while 48(52.2%) were Muslims. 53(59.6%) of the respondents
were single,35(39.3%) were married ,1(1.1%) was divorced. Grades obtained, their numbers and percentages
A(16,17.2%)B(38,40.8%)C(30,32.3%)D(2,2.2%)Others(7,7.5%)
Table 9: Students perception of factors facilitating effective clinical performance
Variables
Frequency
Percentage (%)
8. Nursing students need a lot of clinical experience to develop skills and
understanding of patient care.
Positive perception
91
97.8
Negative perception
_
_
Undecided
2
2.2
Total
93
100
9. Student nurses are Novice and need to be taught general rules to help
perform task.
Positive perception
74
79.5
Negative perception
9
9.7
Undecided
10
10.8
Total
93
100
10. Preceptors help nursing students deal with the uncertainty of the clinical
setting which is inherent to gaining proficiency
Positive perception
76
81.7
Negative perception
6
6.5
Undecided
11
11.8
Total
93
100
11. Developing preceptorship and mentorship program within the hospital will
be an effective way to integrate and support the student nurse.
Positive perception
82
88.1
Negative perception
5
5.4
Undecided
6
6.5
Total
93
100
12. A good relationship with nurses, peers and quality supervision facilitates
learning in the clinical field.
Positive perception
92
98.9
Negative perception
1
1.1
Undecided
_
_
Total
93
100
13. Attitudes of students as shown by their Desire to learn, motivation and
willingness influence the success of clinical placement
Positive perception
82
88.2
Negative perception
3
3.2
Undecided
8
8.6
Total
93
100
14. Simulation/use of automated models allows students to practice in a safe
environment and seeing the consequences when wrong decisions are made.
Positive perception
86
92.4
Negative perception
2
2.2

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 63 | Page
Undecided
5
5.4
Total
93
100
15. Preceptors and mentors provide lifelong lessons that ensure the quality of
knowledge within the midwifery profession will remain strong for years to
come.
Positive perception
76
81.7
Negative perception
3
3.2
Undecided
14
15.1
Total
93
100
16. The clinical environment, influence students confidence, competence and
satisfaction with placements and the degree to which their experiences are
regarded as positive
Positive perception
82
88.1
Negative perception
5
5.4
Undecided
6
6.5
Total
93
100
17. Practical knowledge and personal experiences are cornerstones for
integrating theoretical knowledge and skills which are a major reason for
clinical placements
Positive perception
84
90.3
Negative perception
2
2.2
Undecided
7
7.5
Total
93
100
18.Peer learning will be a valuable strategy for teaching and learning in the
clinical field
Positive perception
84
90.3
Negative perception
3
3.2
Undecided
6
6.5
Total
93
100
19. An effective clinical learning environment should encourage the student
midwive to take responsibility for their learning and actively seek out
opportunities for learning
Positive perception
90
96.8
Negative perception
2
2.1
Undecided
1
1.1
Total
93
100
Result:97.8%(91) agreed that they need a lot of clinical experience,79.5%(74) agreed that students are
novice, who need to be taught general rules and 81.7%(76) perceived that preceptors help students deal with the
uncertainty of the clinical setting, the same number perceive that preceptors and mentors provide lifelong
lessons,88.1%(82) perceived that developing preceptorship and mentorship programme will be a good way to
integrate the student, same percentage perceived an effective clinical environment gives students a positive
experience,98.9%(92) perceived a good relationship and quality supervision positively facilitates learning,
attitudes of students as shown by their desire to learn was perceived as a facilitating factor by 88.2%(82)
,92.4%(86) perceived simulation as a facilitating factor,90.3%(84) considered practical knowledge as
cornerstone for experience, same number perceived peer learning as a facilitating factor in the clinical
field,96.8%(90) perceived an effective clinical learning environment will encourage students to take
responsibility for learning.
Table 10: Other factors students perceive will facilitate their clinical performance
s/no
Factors
Frequency
Percentage (%)
1
Punctuality in clinical
6
18.1
2
Adequate facility and mobility to clinical posting
12
36.4
3
Teaching ideal procedures and asking questions when in doubt
4
12.1
4
Respect for midwives and nurses on the wards
3
9.1
5
Accommodation in the clinical area
2
6.1
6
Incentives
3
9.1
7
Graduate nurses should guide students on the wards
3
9.1
Total
33
100
Result: 18.1%(6) students said punctuality in posting will positively influence clinical
performance,36.4%(12) perceived having a means of mobility to clinical area will be a facilitating
factor,12.1%(4) perceived being taught the ideal procedure as positive way to aid learning in the clinical
field9.1%(3) each stated respect for nurses and midwives, use of incentives, and having graduate nurses to guide
students on wards will facilitate clinical performance, and 6.1%(2) perceived having accommodation in the
clinical area as a facilitating factor.

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 64 | Page
Table 11: Students’ perception of factors inhibiting their clinical performance
Variables
Frequency
Percentage(%)
21) High levels of stress and anxiety impede concentration, memory and problem solving
ability which adversely affects learning
Positive perception
88
94.6
Negative perception
3
3.2
Undecided
2
2.2
Total
93
100
22) Poor interpersonal relations and communication between students, registered
nurses,midwives and lecturers, creates stumbling blocks in the guidance of student
midwives.
Positive perception
87
93.5
Negative perception
2
2.2
Undecided
4
4.3
Total
93
100
23) Imparting knowledge gained by years of experience can be difficult and frustrating for
the preceptors and students alike
Positive perception
37
39.8
Negative perception
42
45.2
Undecided
14
15.0
Total
93
100
24) What is taught in the classroom is not fully applicable to the clinical situation (theory-
practice gap).
Positive perception
73
78.5
Negative perception
15
16.1
Undecided
5
5.4
Total
93
100
25) Constant rotation of students, places more demand on clinical staff due to an
inadequate clinical time for the students.
Positive perception
67
72.0
Negative perception
12
13.0
Undecided
14
15.0
Total
93
100
26) When students are allocated to the same clinical area in large numbers teaching and
learning are negatively affected.
Positive perception
77
83
Negative perception
9
9.7
Undecided
7
7.5
Total
93
100
27) Shortage of equipment and staff are obstacles to the facilitation of students learning in
clinical area.
Positive perception
87
93.6
Negative perception
3
3.2
Undecided
3
3.2
Total
93
100
28) Due to staff shortage nurses and midwives in the wards had no other option but to
direct their energy to the needs of patients.
Positive perception
68
73.1
Negative perception
17
18.3
Undecided
8
8.6
Total
93
100
29) Lack of feedback is perceived in a negative manner and students failed to understand
areas where improvement was needed, offering no opportunity to improve performance.
Positive perception
77
82.8
Negative perception
8
8.6
Undecided
8
8.6
Total
93
100
Result: 94.6%(88) perceived high levels of stress and anxiety adversely affects learning, poor
relationship between students, nurses, and lecturers was perceived negatively by 93.5%(87),theory-practice was
perceived as an inhibiting factor by 78.5%(73) of the students, inadequate clinical time was agreed by 72%(67)
of the students, allocated to same clinical area in large numbers affects clinical learning negatively as agreed by
83%(77) students,73%(68) perceived that due to shortage of staff nurses had no time for students, lack of
feedback was perceived negatively by 82.8%(77) of the students.

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 65 | Page
Table 12: Other factors students identified as inhibiting their effective clinical performance
s/no
Factors
Frequency
Percentage
(%)
1
Having lectures and clinical experience at the same time
8
31
2
Financial constraint
3
11.5
3
No mobility to clinical site
4
15.3
4
Students not allowed to perform basic procedures
2
7.7
5
Students lack of interest in Nursing
2
7.7
6
Poor relationship with nurses and other health care personnel
4
15.3
7
Culture and language barrier
3
11.5
Total
26
100
Result: 31%(8) students perceived having lectures and clinical experience at the same time as an
inhibiting factor to effective clinical performance,11.5%(3) each perceived financial constraint and
culture/language barrier as an inhibiting factor,15.3%(4) perceived absence of mobility to clinical area
negatively affected their learning, the same number perceived poor relationship with nurses and midwives and
other health care personnel was an inhibiting factor to clinical learning,7.7%(2) each identified their lack of
interest in nursing affects their clinical performance negatively and students not being allowed to carry out basic
procedures affected them negatively
Table 13: Students responses to open ended questions on factors inhibiting clinical performance
Questions
Frequency
Percentage(%)
30) Do ward midwives allow you to carry out procedures on patient?
Yes
60
65.2
No
11
12.0
Sometimes
21
22.8
Total
92
100
31) Do they supervise you during performance of such procedures?
Yes
40
43.0
No
31
33.3
Sometimes
22
23.7
Total
93
100
32) How were you treated when you made mistakes?
Politely and properly corrected
35
43.2
Fairly
3
3.7
Embarrassed in front of all
40
49.4
Punishment
2
2.5
Mocked
1
1.2
Total
81
100
Result:65.2%(60) students said they were allowed to carry out procedures on patients in the ward, only
43%(40) said they were supervised during such procedures,43.2%(35) were corrected politely when they made
mistakes,49.4%(40) said they were embarrassed by the nurses when they made mistakes,3.7%(3) were treated
fairly,2.5%(2) said they were punished when they made mistakes and 1.2%(1) received mockery for mistakes
made.

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 66 | Page
Result: 14.1%(11) out of the 16 students that had an “A” grade had a negative perception of the
facilitating factors ,while the remaining 6.4%(5) had a positive perception,14.1%(11) out of 28 students that had
a „B‟ grade had anegative perception of facilitating factors,21.8%(17) had a positive perception,15.4%(12) of
the students who had „c‟ perceived the facilitating factors negatively and 19.2%(15) had a positive perception of
these factors, one student(1.3%) with „‟D‟‟ also perceived the facilitating factors negatively, among the students
with the other grades all 7.7%(6) had a positive perception of the facilitating factors.
. Figure 1 Relationship between clinical performance and perception of inhibiting factors
IV. Testing Of Hypotheses
Hypothesis 1: There is no significant relationship between perception of factors facilitating clinical performance
and grade in last clinical experience examination.
Table 16 : Chi-square Test Hypotheses 1
Pearson X2 Value
df
10.155
4
X2C(10.155) >X2 T, (9.488), P value= 0.05 and 4df, Null hypothesis is rejected and restated as there is
significant relationship between perception of factors facilitating clinical performance of nursing students and
grade in last clinical experience examination
Table 14: Relationship between clinical performance and perception of factors facilitating clinical
performanceCrosstabulation: Grade in last clinical experience examination versus perception of
facilitating factors
perception
Grade in last
clinical
experience
examination
Negative perception
Positive perception
Total
A
Count
11
5
16
% of Total
14.1%
6.4%
20.5%
B
Count
11
17
28
% of Total
14.1%
21.8%
35.9%
C
Count
12
15
27
% of Total
15.4%
19.2%
34.6%
D
Count
1
0
1
% of Total
1.3%
.0%
1.3%
0thers
Count
0
6
6
% of Total
.0%
7.7%
7.7%
Total
Count
35
43
78
% of Total
44.9%
55.1%
100.0%

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 67 | Page
Hypothesis 2.There is no significant relationship between perception of factors inhibiting clinical performance
and grade in last clinical experience examination
Table 17: Hypothesis 2
Pearson X2 Value
df
4.561
4
X2C (4.561) < X2 T(9.488) P value= 0.05 and 4df. The null hypothesis is accepted.
V. Discussion
Objective one:On exploring the nurses perception of clinical performance of the nursing students,various
responses were obtained, 53%(18) of the nurses perceived the clinical performance of the students as being fair,
17.6% (6) said it was below standard while only 8.8% (3) perceived their performance as being satisfactory and
good, these are not in agreement with other findings which stated that undergraduate nursing programs are
successful at achieving their aim4. When asked to rate the clinical performance of nursing students on a scale of
1-10, majority of the nurses 26.5%(9) rated them 4/10,this was for both 400 and 500 level. 37.2% (16) perceived
students do not use good time management skills in regard to all aspects of nursing care, however 62.8%(27)
agreed that students carried out aseptic techniques rightly and 48.8%(21) also had a positive perception about
students adherence to ethical practice standards and codes during procedures.
Objective two:The students and preceptors identified the following factors as facilitating clinical performance
thus:Preceptorship and Mentorship; (76) 81.7% of the students and (27) 62.7% perceived that preceptors help
nursing students deal with the uncertainty of the clinical setting and the same percentage of the students
affirmed that preceptors and mentors provide lifelong lessons that ensure the quality of knowledge within the
profession will remain strong for years to come, these concurs with the findings which showed that ”Clinical
preceptorshipprograms, in collaboration with clinical agencies and educational institutions, have been
documented as effective and innovative means of facilitating student learning”19.
A good relationship with nurses, peers and quality supervision was reported by 98.9% (92) of students
and 93% of preceptors as a facilitating factor in clinical performance these findings concur with another finding
whichemphasized the importance of motivational factors such as relationship with supervisors, supervision
received, policy and administration as facilitators of clinical performance19.
Simulation/ use of automated models was perceived by 92.4%(86) of the students and 67.4%(29)
preceptors as facilitators of clinical performance as described in another study21 “ use of human patient
simulators in Nursing education is an excellent tool to measure competency in the application of knowledge and
technical skills which enhances prior learning”. 98.9%(91) students agreed that they need a lot of clinical
experience to develop competence and 79.1%(74) concurred with Patricia Benner that they are Novice and need
to be taught general rules to help perform task.
93% (40) of the preceptors and 90.3% (84) of the students‟concurred with a study49 about positive
outcomes on the effectiveness of peer teaching and learning as it increased students‟ confidence in clinical
practice.An effective clinical learning environment was identified as a facilitator of clinical learning by (96.8%)
90 students and 83.7%(36) preceptors, this agrees with another study46, that an effective learning environment
fosters critical thinking and judgment, allowing students to ask questions without fear, guilt or feeling disloyal.
(88.2%) 82 students noted that their attitude as shown by their desire to learn, motivation and willingness
influences the success of clinical placement.
Factors perceived by preceptors and students as inhibiting effective clinical performance. The factor
with the highest ranking by both respondents as inhibiting clinical performance was: high levels of stress and
anxiety, this agrees with numerous authors9,12,15,25, who indicated that during the preparatory process students at
all educational levels, within all kinds of undergraduate nursing programs reports high levels of stress and
anxiety in the clinical learning environment18 these findings reported that clinical experience is the most
stressful and anxiety provoking component of the undergraduate nursing programme18,19.
Poor interpersonal relationship between students, nurses and lecturers was identified to create a
stumbling block in the guidance of student nurses during clinical placement which concurs with another
findings2
Theory practice gap was perceived in a negative manner 78.5%(73) of the students agreed that what is
taught in the classroom is not fully applicable to the clinical situation. 53.4%(23) of the preceptors concur with
the students, this is in keeping with anotherfinding19who identified the problem of other integrating theory and
practice in selected clinical nursing situations.
Constant rotation of students with inadequate clinical time was regarded as inhibiting factor by
49%(21) of preceptors and 72.1% (67) of the students.77%(83) students and 53.4% (23) preceptors were in
agreement that when student nurses are allocated to the same clinical area in large numbers teaching and
learning were negatively affected. The clinical learning environment should provide teaching and learning

Perception Of Nursing Students And Preceptors About Factors Influencing The Clinical Performance…
DOI: 10.9790/1959-04525769 www.iosrjournals.org 68 | Page
opportunities, space, and equipment health and safety requirements for appropriate placement of student
nurses16.
Shortage of equipment and staff was perceived negatively by 93.6%(87) students and 79.1%(34)
preceptors, the gap between theory and practice is accelerated by the lack of equipment in clinical practice
making it difficult for the registered nurse to teach student nurses, Finally lack of feedback was identified by
82.8%(77) students and 58.1% (25) preceptors as an inhibiting factor, another study stated that constructive
feedback was perceived in a positive manner and offered opportunity to improve performance, therefore when
there is no feedback little opportunity is offered for improvement21.
Objective three: Using the grades of students in the last clinical experience examination as a measure of their
clinical performance, a cross tabulation was made between the grades and perception of facilitating and
inhibiting factors as identified by the students.
It was found that majority of the students had a positive perception of factors facilitating clinical
performance as identified by the preceptors and students except for the students who had “A” grade12.9%(11)
out of 16 had a negative perception of factors identified by both students and preceptors as inhibiting and
facilitating clinical performance ,they perceived those inhibitory factors did not actually inhibit their clinical
performance, nor did the facilitating factors influence them positively.
The first null hypothesis stated there was nosignificant relationship between perception of factors
facilitating clinical performance and grade in last clinical experience examination was tested using chi square
test. X2 C (10.155) >X2T(9.488),P value = 0.05 and 4df, the null hypothesis was rejected and restated.
The second hypothesis stated there was no relationship between perceptionof factors inhibiting clinical
performance and grade in last clinical experience examination. X2C(4.561) <X2 T(9.488) P value=0.05 and4df.
The null hypothesis was accepted as perception of inhibiting factors had no significant effect on the students
grade in last clinical experience examination.
VI. Conclusion
The study found that preceptors perceive the clinical performance of Bachelor Nursing science students
as being below standard, and the following factors identified as facilitators of clinical performance by both
students and preceptors: preceptorship and mentorship, good relationship with nurses, quality supervision,
simulation, peer teaching, and learning in an effective clinical environment. The following factors were
identified as inhibiting clinical performance; high levels of stress and anxiety, poor interpersonal relationship,
theory-practice gap, inadequate clinical time, overcrowded clinical facilities, shortage of equipment and staff,
and lack of feedback. The first null hypothesis which stated there was no significant relationship
betweenperception of factors facilitating clinical performance and grade in clinical examination was rejected
and restated while the second null hypothesis which stated there was no significant relationshipbetween
inhibiting factors and performance was accepted.
Acknowledgement
I wish to acknowledge Dr Oyetunde Modupe for her support to ensure this work is complete
Conflict of interest- Non
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