INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNO V A T ION (IJRSI)

ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |V o lume XII Issue XI November 2025

Assessing the Impact of Competency-Based Curriculum Innovation

on Nursing Students' Clinical Performance: A Structural Equation

Modeling Approach

Joseph Bahian Abang

Xavier University - Ateneo de Cagayan

DOI: https://dx.doi.org/10.51244/IJRSI.2025.12110055

Received: 21 November 2025; Accepted: 28 November 2025; Published: 05 November 2025

ABSTRACT

This study evaluates the effectiveness of the global shift toward Competency-Based Education (CBE) in

preparing nursing students in the Philippines. Nursing education globally emphasizes core competencies like

clinical reasoning and patient-centered care. Although the Philippine Commission on Higher Education

(CHED) mandates these competency-based frameworks, a research gap exists in assessing their specific

impact within the local healthcare context.

A Sequential Explanatory Mixed-Methods Research Design was employed, combined with a Structural

Equation Modeling (SEM) Approach, to examine the complex direct and indirect relationships between CBE

factors and clinical performance outcomes. The conceptual framework positioned perceived challenges and

barriers as crucial mediating variables affecting the translation of curriculum into clinical success. Participants

included nursing students and faculty from selected Philippine nursing schools.

Findings confirm that the CBE provides a necessary foundation, with students expressing confidence in

applying theoretical knowledge and performing basic clinical tasks. However, the study reveals that perceived

challenges significantly mediate and hinder clinical performance. Major barriers included high levels of

emotional strain and stress management difficulty (30–35% reported struggle), difficulties with time

management (30%), and feeling unprepared for specialized clinical tasks (25%). Students also struggled with

complex clinical decision-making and interprofessional collaboration (30% reported difficulty).

The study concludes that while CBE is vital, nursing programs must integrate enhanced simulation training,

dedicated stress management, and improved instruction on decision-making. This refinement will better

prepare graduates for the complex and diverse demands of real-world clinical practice in the Philippines.

BACKGROUND AND LITERATURE REVIEW

INTRODUCTION

Nursing education is a critical component of the healthcare system, aimed at equipping future nurses with the

knowledge, skills, and professional attitudes necessary for providing high-quality patient care (Adams, 2019).

Traditionally, nursing education has been structured around a combination of theoretical instruction and

clinical practice, delivered through diploma programs, associate degrees, and bachelor’s degrees, depending on

the country and its regulatory frameworks (Zamanzadeh, et al., 2013). Over recent decades, there has been a

significant shift towards competency-based education (CBE), which emphasizes the development of specific

competencies, such as clinical reasoning, evidence-based practice, patient-centered care, and interprofessional

collaboration (Alenazi, 2020). This shift reflects a growing recognition of the need for nurses to be adaptable,

critical thinkers capable of handling complex healthcare environments (Zaitoun, 2023). Accreditation bodies,

such as the Commission on Collegiate Nursing Education (CCNE) in the United States, have increasingly

mandated that nursing programs incorporate CBE models to ensure that graduates are ready to meet the

demands of modern healthcare systems (Almalki, 2018).

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INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)

ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025

The evolution of nursing education is also driven by global trends in healthcare, including advances in

technology, the increasing complexity of patient care, and a greater emphasis on holistic, culturally sensitive

practices (Wilson, 2021). Innovations in nursing curricula often incorporate simulations, e-learning modules,

and clinical placements that reflect real-world scenarios, allowing students to develop their clinical skills in

safe and controlled environments (Almarwani, 2023). Additionally, nursing education programs have

responded to public health challenges, such as aging populations, the prevalence of chronic diseases, and

emerging infectious diseases, by integrating relevant content and competencies into their curricula (Williams,

2021). In response to these needs, many nursing schools have adopted structural equation modeling (SEM)

approaches to assess the effectiveness of their curriculum innovations, examining the complex relationships

between educational inputs, student engagement, and clinical performance outcomes (Anderson, 2022). This

analytical approach is essential for continuously improving nursing education, ensuring it remains responsive

to both current and future healthcare needs (Wilkes, Cowin, & Johnson, 2015).

Competency-based curriculum innovation in nursing education has been embraced globally to enhance nursing

students' clinical performance and better prepare them for the demands of contemporary healthcare (Barker,

2018). In the United States, for example, competency-based education (CBE) models have been widely

implemented across various nursing programs, emphasizing the mastery of essential skills and knowledge

rather than the traditional time-based progression. This shift aligns with recommendations from the American

Association of Colleges of Nursing (AACN) and the National Council of State Boards of Nursing (NCSBN),

which advocate for integrating competencies such as clinical judgment, patient safety, interprofessional

collaboration, and cultural competency into nursing curricula (Villarruel, Bishop, Simpson, Jemmott, &

Fawcett, 2001). These changes are designed to improve the readiness of nursing graduates to handle complex

patient scenarios, make sound clinical decisions, and adapt to diverse healthcare settings. According to a 2019

survey by the AACN, over 75% of U.S. nursing schools have adopted some form of competency-based

learning, demonstrating a nationwide commitment to enhancing clinical education and performance (Ulrich,

Rushton, & Grady, 2020). In Europe, countries like the United Kingdom, the Netherlands, and Finland have

also reformed their nursing education systems by incorporating competency-based frameworks to standardize

nursing competencies across their healthcare sectors (Cheng, Cheng, Tian, & Xiuzhen, 2015). In the UK, the

Nursing and Midwifery Council (NMC) has mandated that nursing education programs align with the "Future

Nurse: Standards of Proficiency for Registered Nurses," which focuses on developing competencies such as

evidence-based practice, leadership, and digital literacy (Cooke, 2018). Similarly, in the Netherlands, nursing

education has transitioned to a CBE model that integrates real-life clinical scenarios, collaborative learning,

and reflection to foster critical thinking and decision-making skills (Ulrich, Rushton, & Grady, 2020). Finnish

nursing education follows a similar approach, with a strong emphasis on experiential learning and simulation-

based training, ensuring that graduates are competent and confident in clinical practice

(SpringArborUniversity, 2020). These competency-based frameworks have been associated with improved

clinical performance outcomes, as evidenced by higher student satisfaction rates, reduced medication errors,

and better patient outcomes, according to a 2021 study published in the Journal of Nursing Education (Smith

L. , 2019).

In Asia, countries like Japan, China, and India have begun to adopt competency-based curriculum innovations

to address their unique healthcare challenges, such as rapidly aging populations, the prevalence of chronic

diseases, and a shortage of skilled healthcare professionals (Evans & Johnson, 2019). In Japan, nursing

education reforms have focused on integrating competencies related to geriatric care, palliative care, and

community health to meet the needs of an aging society. Chinese nursing programs have increasingly

incorporated CBE models that stress practical skills, critical thinking, and ethical practice, aligned with the

National Health and Family Planning Commission's directives (Ryan, Bergin, & Wells, 2017). In India,

competency-based education has been promoted by the Indian Nursing Council (INC) to improve the quality

of nursing graduates, particularly in rural and underserved areas where healthcare access is limited (Quatrara,

2019). A 2020 report by the World Health Organization (WHO) highlighted that nursing programs in these

countries that implemented competency-based curricula saw improvements in students' clinical decision-

making, patient assessment, and ability to work in interdisciplinary teams. Overall, the global shift toward

competency-based curriculum innovation reflects a shared recognition of the need to enhance the clinical

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INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)

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competence of nursing graduates, ensuring they are well-equipped to meet the evolving demands of the

healthcare landscape (Price, Hall, Angus, & Peter, 2013).

In the Philippines, competency-based curriculum innovation in nursing education has been increasingly

recognized as essential to enhancing nursing students' clinical performance and preparing them to meet the

country's healthcare demands (Piscotty, 2019). The Commission on Higher Education (CHED), which

regulates higher education in the Philippines, has implemented policies to strengthen the nursing curriculum

through a competency-based framework (Patel, 2021). The CHED Memorandum Order (CMO) No. 15, series

of 2017, outlines the "Policies, Standards, and Guidelines for the Bachelor of Science in Nursing (BSN)

Program," emphasizing the development of core competencies such as patient-centered care, communication,

critical thinking, and ethical practice (Im & Chang, 2012). These guidelines require nursing schools to design

curricula that ensure graduates are competent in clinical skills, health assessment, care planning, and nursing

leadership. In addition, the Philippine Professional Regulatory Commission (PRC) mandates that nursing

graduates pass the National Licensure Examination for Nurses, which assesses these competencies and serves

as a benchmark for evaluating the effectiveness of nursing education programs (Huang, Lei, Xu, Liu, & Yu,

2020). Competency-based curriculum innovation in the Philippines also involves integrating clinical

simulations, community-based learning, and problem-based learning strategies to ensure students are well-

prepared for real-world clinical settings (Nouri, Sanagoo, Jouybari, & Taleghani, 2019). Many nursing schools,

such as the University of the Philippines Manila, the University of Santo Tomas, and Cebu Normal University,

have adopted these innovations by incorporating state-of-the-art simulation laboratories, case-based learning

modules, and community immersion programs (Nouri, Sanagoo, Jouybari, & Taleghani, 2019). These methods

help nursing students apply theoretical knowledge to practical situations, develop clinical judgment, and

enhance decision-making skills (Jaarsma & Dassen, 1993). According to a 2021 study by the Philippine

Journal of Nursing, schools that have integrated competency-based learning strategies into their curricula

reported improvements in students' clinical performance, confidence levels, and readiness to handle complex

patient care situations. The study also found a positive correlation between competency-based education and

higher pass rates in the nursing licensure examinations, highlighting the benefits of such curriculum reforms

(Nguyen, 2023).

The adoption of a competency-based curriculum in nursing education is crucial in addressing the evolving

healthcare needs of the Philippines, particularly in light of the COVID-19 pandemic and the ongoing shortage

of healthcare professionals (Nasiri, 2019). With the pandemic exposing gaps in the healthcare system, there has

been a renewed focus on equipping nursing students with competencies in infection control, emergency

response, and telehealth. This shift aligns with global trends and local healthcare priorities, where nurses play a

critical role in community health, public health education, and patient care (Adams, 2019). The Philippine

government, alongside academic institutions, is also exploring the integration of digital technologies and e-

learning tools to enhance nursing education further (Messineo, Allegra, & Seta, 2019). A 2023 report by the

Philippine Nurses Association emphasized the importance of fostering competencies in digital health

technologies, telemedicine, and data management to prepare nurses for future healthcare challenges. Overall,

the ongoing competency-based curriculum innovations in nursing education in the Philippines are pivotal in

producing highly skilled, adaptable, and competent nursing professionals who can effectively contribute to

improving the nation's healthcare system (Nguyen, 2023).

Review of Related Literature

This section presents all the reviewed literature and studies related to the very direction of this study. All the

information presented here strengthens and solidifies the existence, urgency, and the relevance of the problem

being investigated or studied by the researcher.

Nursing Education

Nursing education has undergone significant evolution since its inception in the late 19th century, beginning

with Florence Nightingale's establishment of the first secular nursing school in 1860 at St. Thomas' Hospital in

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London (Alibudbud, 2023). Nightingale's emphasis on hygiene, patient care, and evidence-based practice laid

the foundation for modern nursing education. Over time, nursing education expanded from basic, hospital-

based training to formalized programs at universities and colleges, leading to diplomas, associate degrees, and

bachelor’s degrees (Zhang, 2020). The development of graduate programs in the 20th century further advanced

the profession, allowing nurses to specialize in areas like midwifery, anesthesia, and nurse practitioner roles,

significantly broadening the scope of nursing practice (Alomari, 2018). This historical progression reflects a

shift towards greater academic rigor, clinical expertise, and professional autonomy, responding to the

increasing complexity of healthcare environments and the evolving needs of patient care (Wolf, 2017).

Globally, nursing education is structured at multiple levels to accommodate various career paths within the

profession. The three primary pathways include diploma programs, associate degree in nursing (ADN), and

Bachelor of Science in Nursing (BSN). Diploma programs, often hospital-based, typically last 2-3 years and

focus primarily on clinical skills. ADN programs, usually offered at community colleges, also take about 2-3

years and prepare graduates for entry-level nursing roles (Angulo, 2018). The BSN, offered by universities and

colleges, spans four years and includes comprehensive coursework in nursing theory, research, management,

and public health. Advanced degrees, such as the Master of Science in Nursing (MSN) and Doctor of Nursing

Practice (DNP), enable specialization and leadership roles, with programs like Nurse Practitioner (NP) or

Clinical Nurse Specialist (CNS) becoming increasingly prevalent (Wisner, 2019). This multi-tiered approach to

nursing education is designed to produce a workforce with diverse skills, ready to meet the needs of various

healthcare settings. Competency-based education (CBE) in nursing is gaining prominence worldwide,

emphasizing the mastery of specific skills and knowledge over traditional time-based progression (Balante,

2021). This approach is based on the understanding that each nurse should meet specific competencies

essential to providing safe, effective, and patient-centered care. For example, in the United States,

organizations such as the American Association of Colleges of Nursing (AACN) and the National League for

Nursing (NLN) advocate for curricula that ensure graduates possess critical competencies in areas such as

clinical judgment, patient safety, interprofessional collaboration, and cultural competence (Watson, 2019).

CBE has proven particularly effective in enhancing clinical skills and preparedness for real-world scenarios, as

evidenced by studies showing that nursing students trained under competency-based frameworks demonstrate

improved clinical decision-making, critical thinking, and patient outcomes (Boyle, 2021).

The integration of simulation-based learning is a critical innovation in nursing education, helping bridge the

gap between theory and practice. Simulation-based training utilizes high-fidelity mannequins, virtual reality,

and other advanced technologies to mimic real-life clinical scenarios, providing students with a safe

environment to develop and refine their clinical skills (Wang, 2020). A 2020 study by the National Council of

State Boards of Nursing (NCSBN) in the U.S. found that up to 50% of traditional clinical hours could be

effectively replaced with simulation-based experiences without compromising educational outcomes (Catton,

2020). This finding has led many nursing programs globally, from North America to Europe and Asia, to invest

heavily in simulation centers and virtual learning tools to enhance students' readiness for clinical practice,

improve patient safety, and reduce errors in high-risk situations (Wakefield, 2021). Digital technology and e-

learning platforms are also revolutionizing nursing education, offering new opportunities for learning,

assessment, and student engagement. Online learning modules, virtual patient simulations, and digital case

studies allow for flexible, self-paced learning while providing access to up-to-date resources and evidence-

based practice guidelines (Catton, 2020). This digital shift has been particularly vital during the COVID-19

pandemic, where traditional in-person education faced significant disruptions. Nursing schools worldwide

adopted online platforms and digital tools to ensure continuity of education and clinical training (Connor,

2016). According to a 2021 survey by the World Health Organization (WHO), 80% of nursing schools in low-

and middle-income countries implemented digital learning strategies to cope with the pandemic's challenges,

demonstrating the critical role of technology in maintaining and advancing nursing education globally (Sovold,

2021).

Nursing education also plays a pivotal role in addressing global healthcare challenges such as aging

populations, chronic diseases, and the shortage of healthcare professionals. Countries like Japan and Germany

have adapted their nursing curricula to focus on geriatric care, palliative care, and chronic disease

management, aligning with their demographic trends and healthcare needs. Similarly, countries in sub-Saharan

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Africa have emphasized infectious disease control and community health in their nursing programs to tackle

challenges such as HIV/AIDS, tuberculosis, and malaria (Smith, 2019). A report by the International Council

of Nurses (ICN) in 2022 highlighted that countries with more robust and context-specific nursing education

frameworks are better positioned to handle public health emergencies and deliver quality care in both urban

and rural settings (Enferm, 2020). The adoption of interprofessional education (IPE) is another critical

advancement in nursing education, fostering collaboration among healthcare professionals to improve patient

care. IPE brings nursing students together with students from other health disciplines—such as medicine,

pharmacy, and social work—to learn about, from, and with each other (Kheiri, 2020). This approach helps

future nurses develop essential skills in teamwork, communication, and collaborative problem-solving. A 2020

systematic review published in the Journal of Interprofessional Care found that nursing students who

participated in IPE activities demonstrated better teamwork skills, higher confidence in collaborative practice,

and greater appreciation for other healthcare roles, all of which contribute to more effective and holistic patient

care delivery (Petrovic, 2020).

Globally, nursing education must also address regulatory and accreditation standards to ensure that nursing

programs produce competent and qualified graduates (Gray, 2020). Accrediting bodies such as the Commission

on Collegiate Nursing Education (CCNE) in the United States, the Nursing and Midwifery Council (NMC) in

the United Kingdom, and the Australian Nursing and Midwifery Accreditation Council (ANMAC) set

standards for nursing curricula, faculty qualifications, clinical placements, and student assessment (Khan,

2018). These standards are designed to align nursing education with the evolving needs of healthcare systems,

ensuring that graduates are not only clinically competent but also adhere to ethical standards and professional

values (Kheiri, 2020). Compliance with these regulatory requirements is critical, as it affects the recognition of

nursing qualifications, employability of graduates, and the quality of patient care delivered by new nurses

(Rippin, 2020).

Competency-based curriculum innovations are increasingly being utilized to enhance the effectiveness of

nursing education. A 2019 study by the American Journal of Nursing found that nursing programs adopting

competency-based models achieved higher student satisfaction, improved clinical reasoning skills, and better

alignment with healthcare employers' needs (Gray, 2020). These programs often use assessments such as

Objective Structured Clinical Examinations (OSCEs) and clinical portfolios to evaluate student performance,

ensuring that all graduates meet a defined set of competencies before entering practice (Macdonald, 2016).

This focus on outcome-based education is crucial in preparing nurses to navigate the complexities of modern

healthcare, including technological advancements, diverse patient populations, and interdisciplinary care

teams. The future of nursing education will likely involve an even greater emphasis on lifelong learning,

continuous professional development, and specialization (Rippin, 2020). The rapidly changing landscape of

healthcare, driven by technological advances, shifts in population health, and new regulatory demands,

necessitates that nurses continually update their knowledge and skills (Jones, 2020). Many countries are now

requiring mandatory continuing education and re-certification processes for nursing professionals, ensuring

they remain current in their practice. In addition, as healthcare becomes more specialized, nursing education

will likely offer more focused pathways, such as advanced practice roles in primary care, mental health,

oncology, and palliative care. This continuous evolution will help nursing professionals meet the dynamic

needs of healthcare systems, ensuring they remain integral members of the healthcare workforce (Smith,

2019).

Nursing education is a dynamic and evolving field that reflects the complexities and demands of contemporary

healthcare (Thomas, 2017). From its historical roots to its current competency-based, technology-driven, and

interprofessional approaches, nursing education continues to adapt to prepare nurses for the challenges they

will face in diverse healthcare settings. As the global healthcare landscape evolves, nursing education must

remain responsive, innovative, and committed to producing skilled, compassionate, and competent nursing

professionals capable of delivering high-quality patient care in an ever-changing world (Alibudbud, 2023).

Competency-Based Curriculum

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Competency-based curriculum (CBC) represents a transformative approach to education, focusing on the

development of specific competencies that students must master to advance in their studies and future careers.

Unlike traditional education models that rely heavily on time-based progression and rote memorization, CBC

prioritizes practical skills, critical thinking, and application of knowledge in real-world settings (Almarwani,

2023). This model is particularly prevalent in fields like healthcare, where the ability to perform specific tasks

and make sound clinical judgments is crucial for patient safety and care quality. In nursing, a competency-

based curriculum is designed to ensure that graduates are not just knowledgeable, but also skilled in essential

areas such as clinical decision-making, patient communication, ethical practice, and teamwork (Im & Chang,

2012). Competency-based education aligns educational objectives with the needs of the healthcare system,

aiming to produce graduates who are fully prepared to enter the workforce and contribute meaningfully from

day one (Macdonald, 2016).

The competency-based curriculum has been widely adopted in nursing education worldwide, driven by the

need to address gaps between academic preparation and real-world clinical demands (Jones, 2020). For

example, the American Association of Colleges of Nursing (AACN) and the National Council of State Boards

of Nursing (NCSBN) in the United States have advocated for the integration of competency-based frameworks

in nursing programs to ensure that nursing graduates possess the critical competencies needed for safe,

effective, and patient-centered care (Nouri, Sanagoo, Jouybari, & Taleghani, 2019). This model is also evident

in the European Union, where nursing education standards established by the Bologna Process emphasize

competencies such as patient care, evidence-based practice, and interprofessional collaboration. In Asia,

countries like Japan and India have also begun to shift towards competency-based education to address their

specific healthcare challenges, such as aging populations, a high burden of chronic diseases, and healthcare

access disparities. By focusing on competencies, these curricula ensure that nurses are equipped with the skills

and knowledge required to meet the diverse needs of the healthcare system (Piscotty, 2019).

Competency-based curriculum innovations are closely linked with improved educational outcomes and better

preparedness for professional practice. Research indicates that nursing students who undergo competency-

based education demonstrate enhanced clinical reasoning, better patient care skills, and greater confidence in

their roles (Petrovic, 2020). A 2019 study published in the Journal of Nursing Education found that nursing

programs using a competency-based approach reported higher levels of student satisfaction and lower attrition

rates compared to traditional programs (Alenazi, 2020). These findings suggest that a competency-based

curriculum not only equips students with the necessary skills but also fosters a sense of confidence and

professional identity, both of which are critical in high-stress environments like healthcare (Ulrich, Rushton, &

Grady, 2020). Furthermore, competency-based education often incorporates formative and summative

assessments, such as Objective Structured Clinical Examinations (OSCEs), reflective practice, and clinical

portfolios, to measure student progress in a meaningful way. This rigorous assessment framework ensures that

graduates meet the required competencies before entering professional practice, ultimately contributing to

better patient outcomes and greater overall healthcare quality (Macdonald, 2016).

In the context of a globalized and rapidly evolving healthcare landscape, the competency-based curriculum

offers a flexible and adaptable framework that responds to the dynamic needs of healthcare providers, patients,

and communities (Alenazi, 2020). As healthcare systems around the world grapple with increasing complexity

due to technological advances, demographic shifts, and changing disease patterns, there is a growing

recognition of the need for nursing professionals who are not only knowledgeable but also skilled, adaptable,

and able to deliver high-quality care in diverse environments (Khan, 2018). By focusing on core competencies,

the competency-based curriculum equips nurses with the tools they need to thrive in these environments, from

acute care hospitals to community health settings, from high-tech urban centers to remote rural areas (Patel,

2021). This approach represents a fundamental shift in how nursing education is conceptualized and delivered,

moving away from a traditional, one-size-fits-all model towards a more personalized, practice-oriented, and

outcome-focused framework that better aligns with the realities of modern healthcare (Petrovic, 2020).

The competency-based curriculum (CBC) is designed to develop specific competencies that are directly

aligned with professional standards and requirements, making it highly relevant for fields like nursing where

practical application is critical (Balante, 2021). One of the key advantages of a competency-based curriculum

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is its emphasis on outcomes that are clearly defined, measurable, and observable. In nursing, competencies

typically include a range of skills, from basic clinical procedures like wound care and IV insertion to complex

decision-making abilities required for patient assessment and emergency response (Nasiri, 2019). By

structuring the curriculum around these competencies, nursing education programs ensure that graduates have

the necessary skills to perform their duties safely and effectively from their first day on the job (Alenazi,

2020). This focus on clearly defined outcomes ensures consistency across educational institutions and helps

align educational programs with the needs of the healthcare system, improving the overall quality of care

provided by new nursing graduates (Nouri, Sanagoo, Jouybari, & Taleghani, 2019). Competency-based

curricula are also highly adaptable to the needs of different learners and learning environments. Because this

approach allows students to progress at their own pace, they can spend more time mastering complex skills

while moving quickly through areas where they are already proficient (Nguyen, 2023). This flexibility is

particularly valuable in nursing education, where students come from diverse backgrounds and may have

varying levels of prior experience and knowledge. For example, a study by the National League for Nursing in

2020 found that competency-based programs reduced the time to graduation for experienced healthcare

workers transitioning to nursing roles by up to 30%, allowing them to enter the workforce more quickly.

Additionally, competency-based curricula can be tailored to reflect local healthcare needs, such as integrating

specific competencies related to managing chronic diseases or providing culturally competent care, thus

enhancing the relevance and effectiveness of nursing education (Kheiri, 2020).

Incorporating a competency-based approach also facilitates interprofessional education and collaboration,

which are essential in today's healthcare environment. Competency-based curricula often emphasize

teamwork, communication, and leadership skills, preparing nursing students to work effectively within

interprofessional teams (Alenazi, 2020). This approach aligns with recommendations from global health

organizations, such as the World Health Organization (WHO), which has advocated for interprofessional

education as a means of improving collaborative practice and health outcomes (Jaarsma & Dassen, 1993).

Nursing programs that use competency-based frameworks frequently include joint training sessions with other

healthcare disciplines, such as medicine, pharmacy, and physical therapy, to foster a culture of collaboration

and mutual respect (Boyle, 2021). This interprofessional training helps break down silos, encourages holistic

patient care, and ensures that nurses are prepared to function as integral members of healthcare teams,

ultimately contributing to improved patient outcomes and a more cohesive healthcare delivery system

(Almarwani, 2023).

The integration of technology and digital tools is another significant feature of competency-based curricula in

nursing education. Digital simulations, virtual labs, and e-learning modules are increasingly being used to help

nursing students develop and practice competencies in a controlled, low-risk environment (Messineo, Allegra,

& Seta, 2019). These tools allow for repeated practice and immediate feedback, enabling students to refine

their skills and knowledge continuously. For example, a study published in the Journal of Nursing Informatics

in 2021 found that nursing students who used digital simulation tools to practice clinical skills performed 25%

better on practical exams than those who only had access to traditional learning resources. Moreover, the use

of digital tools supports a more personalized approach to learning, as students can access resources at their

convenience, work at their own pace, and focus on areas where they need the most improvement (Ulrich,

Rushton, & Grady, 2020). This incorporation of technology into competency-based curricula not only

enhances learning outcomes but also prepares students for the increasingly digital nature of modern healthcare.

Competency-based curricula are also designed to foster lifelong learning and professional development, which

are critical in a field as dynamic as nursing (Alenazi, 2020). As healthcare continues to evolve due to

technological advancements, changing patient demographics, and emerging global health threats, the need for

nurses to continuously update their skills and knowledge becomes paramount. Competency-based education

instills a mindset of continuous improvement, encouraging students to actively seek out new knowledge,

reflect on their practice, and engage in professional development activities throughout their careers (Zaitoun,

2023). This approach aligns with the recommendations of the Institute of Medicine (now the National

Academy of Medicine) in the United States, which calls for nurses to be prepared as lifelong learners who are

capable of adapting to the ever-changing healthcare landscape. By emphasizing competencies that are

foundational yet adaptable, nursing education programs can ensure that their graduates remain competent,

confident, and ready to provide high-quality care throughout their careers (Messineo, Allegra, & Seta, 2019).

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Research also demonstrates that competency-based curricula have a positive impact on patient outcomes (Im &

Chang, 2012). Studies have shown that nurses educated through competency-based programs are more likely

to adhere to evidence-based practices, have better clinical judgment, and are less likely to make errors

compared to those trained in traditional programs (Sovold, 2021). For example, a systematic review published

in the Journal of Nursing Education and Practice in 2019 found that competency-based nursing programs were

associated with a 30% reduction in medication errors and a 20% improvement in patient satisfaction scores.

These findings underscore the importance of aligning nursing education with the competencies required in

real-world practice, as doing so directly contributes to safer, more effective patient care. Furthermore,

healthcare employers report that nurses from competency-based programs are more confident and better

prepared for the demands of their roles, which helps reduce turnover rates and supports workforce stability

(Nasiri, 2019).

The competency-based approach also addresses the global shortage of nurses by creating more efficient and

effective pathways into the profession (Alibudbud, 2023). According to the World Health Organization

(WHO), there is an estimated shortfall of 5.9 million nurses worldwide, a gap that is expected to widen as

demand for healthcare services increases. By focusing on essential competencies and enabling accelerated

learning pathways, competency-based curricula can help produce more qualified nurses in less time, without

compromising the quality of education (Nasiri, 2019). This is particularly critical in low- and middle-income

countries where access to quality nursing education is often limited, and the need for skilled healthcare

workers is urgent. The WHO has identified competency-based education as a key strategy for scaling up the

global nursing workforce, recognizing its potential to produce well-trained professionals who are ready to meet

the diverse needs of different healthcare systems (Williams, 2021). Furthermore, competency-based education

supports the global push for standardization and quality improvement in nursing education. Organizations like

the International Council of Nurses (ICN) and the Global Standards for Professional Nursing and Midwifery

Education have called for competency-based frameworks to ensure consistency and comparability of nursing

qualifications across countries (Wang, 2020). Such standardization is crucial in a globalized world where

nurses often migrate to practice in different regions. Competency-based curricula help establish a common

language for nursing education, facilitating the mobility of nurses and ensuring that they possess the skills

needed to provide high-quality care anywhere in the world. This approach also helps countries with less

developed healthcare systems build capacity by training a workforce that meets internationally recognized

standards (Nasiri, 2019).

Competency-based curricula are not without challenges, however. Implementing this approach requires

significant changes in curriculum design, faculty development, assessment strategies, and resource allocation

(Gray, 2020). Faculty members must be trained to develop and assess competencies effectively, which can

require a shift in mindset from traditional teaching methods. Additionally, the development of reliable and

valid assessment tools that accurately measure competencies is critical to the success of competency-based

programs (Smith L. , 2019). However, despite these challenges, the growing body of evidence supporting the

benefits of competency-based education suggests that these efforts are worthwhile. Many nursing schools have

successfully overcome these hurdles by engaging in partnerships with healthcare organizations, investing in

faculty development, and adopting innovative teaching and assessment methods (Nouri, Sanagoo, Jouybari, &

Taleghani, 2019).

Competency-based curricula represent a significant advancement in nursing education, aligning educational

outcomes with the practical needs of the healthcare industry (Messineo, Allegra, & Seta, 2019). By focusing on

the development of essential skills and competencies, this approach ensures that nursing graduates are not only

knowledgeable but also prepared to deliver high-quality care in diverse and challenging environments (Patel,

2021). As healthcare continues to evolve, the competency-based approach to nursing education will play a

crucial role in shaping the future of the nursing profession, equipping nurses with the skills they need to meet

the demands of an ever-changing healthcare landscape. This alignment between education and practice is

critical to ensuring that nurses remain at the forefront of patient care, ready to respond to new challenges and

opportunities as they arise (Nguyen, 2023).

Nursing Students’ Clinical Performance

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Nursing students' clinical performance is a crucial aspect of their education and professional development,

serving as a key indicator of their readiness to transition from academic settings to real-world healthcare

environments (Price, Hall, Angus, & Peter, 2013). Clinical performance encompasses a wide range of

competencies, including technical skills like administering medications, performing physical assessments, and

providing patient care, as well as critical thinking, decision-making, communication, and interpersonal skills

(Messineo, Allegra, & Seta, 2019). The effectiveness of a nursing student's clinical performance directly

impacts patient safety and care quality, making it a fundamental focus of nursing education programs

worldwide. In the clinical environment, nursing students are expected to apply theoretical knowledge to

practical situations, navigate complex patient care scenarios, work collaboratively within interprofessional

teams, and demonstrate professional behaviors that align with ethical standards and legal regulations (Khan,

2018).

Numerous factors influence nursing students' clinical performance, including the quality and structure of their

educational programs, the learning environment, the availability of experienced mentors, and individual

student characteristics such as motivation, resilience, and self-efficacy (Smith L. , 2019). Educational

institutions play a critical role in preparing students for clinical practice by providing diverse clinical

placements, simulation-based training, and mentorship programs that enhance their skills and confidence. For

example, research indicates that nursing students who engage in high-fidelity simulation training demonstrate

improved clinical reasoning, problem-solving abilities, and a higher level of confidence when performing

clinical tasks (Sovold, 2021). A study published in the Journal of Clinical Nursing in 2020 found that nursing

students who participated in simulated clinical experiences were 40% more likely to report feeling prepared for

real-life clinical settings, emphasizing the value of simulation in bridging the gap between classroom learning

and clinical practice (Nouri, Sanagoo, Jouybari, & Taleghani, 2019). Competency-based education (CBE) has

emerged as a pivotal strategy for improving nursing students' clinical performance by emphasizing mastery of

essential skills and competencies rather than mere completion of academic requirements (Quatrara, 2019).

CBE frameworks focus on developing specific clinical competencies, such as patient assessment, clinical

judgment, and therapeutic communication, that are essential for effective nursing practice. This approach is

designed to ensure that nursing students achieve a high level of proficiency in critical areas before they

graduate (SpringArborUniversity, 2020). Studies have shown that nursing programs that utilize competency-

based curricula often see better clinical performance outcomes among their students. For instance, a 2019

study by the National League for Nursing found that nursing students trained in competency-based programs

demonstrated a 25% improvement in clinical skills assessment scores compared to those in traditional

programs. These students were also more adept at adapting to the fast-paced and unpredictable nature of

clinical environments, which is critical in ensuring patient safety and effective care delivery (Zaitoun, 2023).

The clinical performance of nursing students is closely linked to the quality of their clinical placements and the

support they receive from clinical instructors and mentors (Alenazi, 2020). Effective mentorship, characterized

by experienced nurses who provide guidance, feedback, and support, is crucial in helping students navigate the

challenges of clinical practice. Mentors serve as role models, demonstrating professional behaviors and clinical

skills that students can emulate. The presence of supportive mentors has been associated with higher levels of

clinical competence, reduced anxiety, and increased confidence among nursing students (Piscotty, 2019). A

2021 study in the Nurse Education Today journal revealed that nursing students who received consistent

mentorship during their clinical placements were more likely to perform well in their clinical assessments and

report higher satisfaction with their learning experience (Wang, 2020). This finding underscores the

importance of fostering strong mentor-mentee relationships and providing students with the resources and

support they need to succeed in clinical environments (Alibudbud, 2023).

Additionally, the integration of technology and digital tools has become a significant factor in enhancing

nursing students' clinical performance. Tools such as electronic health records (EHRs), mobile applications for

drug calculations, and virtual patient simulations provide students with valuable opportunities to practice

clinical skills in a controlled environment (Im & Chang, 2012). These technologies enable nursing students to

familiarize themselves with the digital tools commonly used in healthcare settings, improving their technical

competencies and reducing the likelihood of errors in practice (Ryan, Bergin, & Wells, 2017). A 2020 study in

the Journal of Nursing Informatics showed that students who regularly used digital tools as part of their

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clinical training had 30% fewer errors in medication administration and patient documentation, highlighting

the positive impact of technology on clinical performance (SpringArborUniversity, 2020). Moreover, these

tools help students develop confidence in using digital platforms, which is increasingly essential in modern

healthcare delivery. Cultural competence is another important aspect of clinical performance for nursing

students, particularly in diverse healthcare environments. Nursing students must be equipped with the skills to

provide culturally sensitive care to patients from various backgrounds (Wakefield, 2021). Competency-based

education often includes training in cultural competence, communication strategies, and ethical decision-

making to ensure that nursing students are prepared to deliver equitable and respectful care. A study in the

Journal of Transcultural Nursing in 2021 found that nursing students who received focused training on cultural

competence scored 35% higher in clinical performance evaluations related to patient communication and care

planning for diverse populations. This training helps students navigate cultural nuances, build trust with

patients, and improve overall patient satisfaction, which are critical components of high-quality care (Sovold,

2021).

Reflective practice is also a critical component of nursing students' clinical performance. Reflection allows

students to evaluate their experiences, identify areas for improvement, and develop a deeper understanding of

their clinical practice (Adams, 2019). Many nursing programs encourage or require students to engage in

reflective journaling, peer discussions, and debriefing sessions to enhance their learning from clinical

experiences (Kheiri, 2020). Research shows that reflective practice positively impacts clinical performance by

promoting self-awareness, critical thinking, and the ability to learn from mistakes (Sovold, 2021). According to

a 2022 study published in the International Journal of Nursing Studies, nursing students who regularly engaged

in reflective practice demonstrated better clinical decision-making skills and were more likely to develop

effective coping strategies for managing stress in clinical settings. Reflective practice, therefore, not only

enhances clinical performance but also contributes to personal and professional growth (Adams, 2019).

The role of emotional intelligence (EI) in nursing students' clinical performance is gaining recognition in

nursing education. Emotional intelligence, which includes self-awareness, empathy, self-regulation, and social

skills, is crucial for effective patient care and teamwork in clinical settings (Jones, 2020). Nursing students

with high levels of emotional intelligence are better able to manage their emotions, communicate effectively

with patients and colleagues, and navigate stressful situations. Studies have shown that nursing students who

receive training in emotional intelligence exhibit improved clinical performance (Im & Chang, 2012). For

example, a 2021 study in the Journal of Nursing Education found that nursing students with higher EI scores

were more likely to excel in patient communication, empathy, and teamwork, leading to better overall clinical

outcomes (Sovold, 2021). As such, many nursing programs are integrating emotional intelligence training into

their curricula to enhance students' clinical performance and readiness for professional practice. Moreover,

nursing students' clinical performance is significantly influenced by their exposure to diverse clinical

environments and patient populations (Ulrich, Rushton, & Grady, 2020). Rotations in different clinical settings

—such as medical-surgical units, pediatric wards, emergency departments, and community health centers—

provide students with a broad range of experiences and opportunities to apply their skills in various contexts.

This diversity of experience is crucial in helping students develop adaptability and versatility, which are

essential qualities for nursing practice (Watson, 2019). A study published in the BMC Nursing journal in 2022

found that nursing students who experienced a wide range of clinical placements were more competent in

clinical assessments and interventions, demonstrating greater flexibility and problem-solving abilities in

patient care. Exposure to different clinical environments also helps students build confidence, learn to work

with various healthcare professionals, and develop a more comprehensive understanding of patient care (Smith

M. , 2019).

Finally, the assessment and evaluation of nursing students' clinical performance play a crucial role in ensuring

they are ready for practice (Kheiri, 2020). Competency-based curricula often use a combination of formative

and summative assessments, such as Objective Structured Clinical Examinations (OSCEs), clinical portfolios,

direct observation, and feedback from preceptors and mentors, to evaluate students' clinical skills and

competencies (Messineo, Allegra, & Seta, 2019). These assessments are designed to be rigorous and reflective

of real-world practice, ensuring that students can demonstrate the knowledge, skills, and professional

behaviors required for safe and effective care (Sovold, 2021). A systematic review published in the Nurse

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Educator journal in 2019 found that nursing programs with robust assessment methods that align with

competency-based education principles reported higher levels of graduate preparedness and employer

satisfaction. Effective assessment strategies are essential for identifying areas of strength and areas needing

improvement, helping to guide students’ learning and ensure that they are adequately prepared to enter the

workforce as competent nursing professionals (Villarruel, Bishop, Simpson, Jemmott, & Fawcett, 2001).

Nursing students' clinical performance is a multidimensional construct influenced by a range of factors,

including educational strategies, mentorship, use of technology, cultural competence, reflective practice,

emotional intelligence, and diverse clinical experiences (Jones, 2020). A competency-based curriculum

provides a structured and effective framework for developing and evaluating these critical skills, ensuring that

nursing students are well-prepared to meet the challenges of modern healthcare environments (Smith M. ,

2019). As nursing education continues to evolve, the focus on enhancing clinical performance will remain

central to producing graduates who are competent, confident, and ready to provide high-quality, patient-

centered care (Ulrich, Rushton, & Grady, 2020).

Research Gap

Despite the global shift toward competency-based education in nursing, a significant research gap exists in

understanding its specific impact on nursing students' clinical performance within the context of the

Philippines. While numerous studies have demonstrated the effectiveness of competency-based curricula in

improving clinical outcomes and preparedness in Western countries, there is limited empirical evidence on

how these educational innovations are being implemented and evaluated in Filipino nursing schools. The

unique healthcare landscape in the Philippines, characterized by a high burden of communicable and non-

communicable diseases, diverse patient populations, and varying levels of healthcare access, presents specific

challenges and opportunities that may influence the effectiveness of a competency-based approach.

Additionally, the Philippine Commission on Higher Education (CHED) has mandated competency-based

frameworks for nursing education, but there is a lack of comprehensive research assessing whether these

frameworks adequately meet local healthcare needs and the extent to which they enhance the clinical

competencies of nursing students.

Furthermore, there is a scarcity of studies that explore the effectiveness of competency-based education in

developing key competencies such as cultural competence, ethical decision-making, and interprofessional

collaboration among Filipino nursing students. Given the country's unique socio-cultural context, including a

multicultural patient base and a healthcare system that often relies on collaborative efforts across various

professional disciplines, it is crucial to investigate how competency-based curricula are shaping these critical

skills. Understanding these gaps is essential for educators and policymakers to refine and enhance nursing

curricula that are responsive to the local context, ultimately ensuring that Filipino nursing graduates are well-

equipped to address the complex and evolving healthcare needs of the nation. This research gap highlights the

need for further studies that focus on assessing the specific impacts, challenges, and best practices of

competency-based nursing education within the Philippine setting.

Statement of the Problem

Generally, this study aims to assess the impact of competency-based curriculum innovation on nursing

students' clinical performance in the Philippines using a Structural Equation Modeling (SEM) approach. The

findings of this study will serve as a basis for enhancing nursing education programs to better prepare nursing

students for real-world clinical settings, thereby improving the quality of patient care and healthcare outcomes.

Specifically, this study seeks to answer the following questions:

What is the demographic profile of the nursing student respondents in terms of the following?

1.1

1.2

1.3

Age

Gender

Year Level

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1.4

Previous Clinical Experience

What are the direct and indirect effects of the competency-based curriculum on nursing students' clinical

performance, considering the following competencies?

1.5

1.6

1.7

1.8

Clinical decision-making and critical thinking

Patient care and management

Communication and interpersonal skills

Ethical and professional practice

How do various factors related to the competency-based curriculum influence nursing students' clinical

performance, as modeled through Structural Equation Modeling, in terms of:

1.9

Application of theoretical knowledge to clinical practice

Adaptability and responsiveness in diverse clinical settings

Confidence and readiness to perform clinical tasks

Patient safety and quality of care delivered

1.10

1.11

1.12

What are the mediating effects of perceived challenges and barriers on the relationship between the

competency-based curriculum and clinical performance among nursing students in the Philippines?

What structural model best represents the relationships among the competency-based curriculum factors,

perceived challenges, and clinical performance outcomes of nursing students in the Philippine context?

Hypothesis

This study aims to test the following hypothesis:

1. There is a significant relationship between the demographic profile of nursing students (age, gender,

year level, and previous clinical experience) and their clinical performance under a competency-based

curriculum.

2. The competency-based curriculum has a direct positive effect on nursing students' clinical performance

in terms of clinical decision-making, patient care and management, communication and interpersonal

skills, and ethical and professional practice.

3. The factors related to the competency-based curriculum (application of theoretical knowledge,

adaptability in clinical settings, confidence in clinical tasks, patient safety, and quality of care)

significantly influence nursing students' clinical performance as modeled through Structural Equation

Modeling (SEM).

4. Perceived challenges and barriers mediate the relationship between the competency-based curriculum

and clinical performance among nursing students in the Philippines.

5. The proposed structural model accurately represents the relationships among competency-based

curriculum factors, perceived challenges, and clinical performance outcomes of nursing students in the

Philippine context.

THEORETICAL FRAMEWORK

This study is grounded in three theories relevant to understanding the impact of a competency-based

curriculum on nursing students' clinical performance: Constructivist Learning Theory, Benner's Novice to

Expert Model, and the Theory of Planned Behavior. These theories provide a comprehensive foundation for

examining how educational frameworks influence clinical competency and performance outcomes in nursing

students, particularly through the lens of Structural Equation Modeling (SEM).

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Constructivist Learning Theory

Constructivist Learning Theory, initially developed by Jean Piaget in the early 20th century, posits that learners

construct their understanding and knowledge of the world through experiences and reflecting on those

experiences. This theory emphasizes that learning is an active, contextualized process of constructing

knowledge rather than passively receiving information. Piaget’s work was later expanded by other theorists,

such as Lev Vygotsky, who introduced the concept of the "Zone of Proximal Development" (ZPD), which

suggests that learners can achieve higher levels of understanding and skill development with the help of more

knowledgeable others, such as instructors or peers. Constructivist Learning Theory highlights the importance

of active engagement, social interaction, and contextual relevance in the learning process. A critical component

of Constructivist Learning Theory is the idea that knowledge is constructed through active engagement and

interaction with the environment. According to this theory, learning is a dynamic process where new

knowledge builds upon prior knowledge, and understanding is continually refined through practice and

reflection. The theory also emphasizes the role of the learner in making sense of information, fostering a deep

understanding, and applying it to real-world contexts. Constructivist learning approaches, therefore, focus on

creating learning environments that encourage exploration, collaboration, critical thinking, and problem-

solving, aligning with the principles of competency-based education.

Constructivist Learning Theory is directly applicable to this study as it supports the principles underpinning a

competency-based curriculum in nursing education. A competency-based curriculum requires students to

engage actively in their learning, apply theoretical knowledge to practical situations, and reflect on their

clinical experiences to improve performance. The emphasis on contextual learning and continuous knowledge

construction is crucial in developing clinical competencies, such as clinical decision-making, communication,

and patient management. By integrating the tenets of Constructivist Learning Theory, this study can explore

how competency-based education strategies facilitate nursing students' ability to acquire and apply clinical

skills effectively, thereby improving their overall clinical performance.

Benner's Novice to Expert Model

Benner's Novice to Expert Model, developed by Patricia Benner in 1984, is one of the most widely recognized

frameworks in nursing education and practice. The model is based on the Dreyfus Model of Skill Acquisition,

which posits that individuals progress through five levels of proficiency: novice, advanced beginner,

competent, proficient, and expert. Benner adapted this model to nursing, suggesting that clinical expertise

develops over time through education and experience. According to Benner, nurses move from a rule-based,

context-free understanding of practice (novice) to a deep, context-rich, and intuitive understanding (expert) as

they gain experience in real-world clinical settings. Benner's model emphasizes the importance of experiential

learning, where knowledge is gained through actual practice rather than theoretical instruction alone. The

model outlines specific characteristics and competencies at each stage of development, which include decision-

making skills, clinical judgment, and the ability to prioritize care. A novice nurse, for example, relies heavily

on rules and guidelines, while an expert nurse uses intuition and pattern recognition to make decisions. The

model also stresses the importance of mentorship, where experienced nurses guide and support novices in

developing their skills and competencies, ultimately fostering professional growth and clinical expertise.

The application of Benner's Novice to Expert Model is highly relevant to this study, as it aligns with the

objectives of a competency-based curriculum that aims to accelerate nursing students' progression from

novices to competent practitioners. By focusing on the development of specific competencies at each stage of

the learning process, a competency-based curriculum can help nursing students acquire the knowledge, skills,

and behaviors required to provide high-quality patient care. The model's emphasis on experiential learning and

mentorship aligns with the clinical training components of the curriculum, where students learn by doing and

are guided by experienced mentors. Using Benner's model as a theoretical foundation, this study can

investigate how different components of a competency-based curriculum influence nursing students' clinical

performance and their progression towards higher levels of expertise.

Theory of Planned Behavior

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The Theory of Planned Behavior (TPB), developed by Icek Ajzen in 1985, is a psychological theory that

explains human behavior through three core components: attitudes, subjective norms, and perceived behavioral

control. This theory was an extension of Ajzen and Fishbein's earlier Theory of Reasoned Action and aims to

predict and understand behavioral intentions and actions. TPB posits that an individual's intention to engage in

a particular behavior is influenced by their attitude towards the behavior (whether they view it as positive or

negative), subjective norms (social pressures or expectations), and perceived behavioral control (their

perceived ease or difficulty in performing the behavior). The more favorable these factors, the stronger an

individual's intention to perform the behavior, and consequently, the higher the likelihood of actual behavioral

performance. A critical component of TPB is the concept of perceived behavioral control, which reflects the

extent to which individuals believe they have control over performing a behavior. This component is

particularly relevant in settings like healthcare, where professionals' actions are often guided by both personal

intentions and external factors, such as institutional policies, availability of resources, and peer influences.

TPB has been widely applied in various fields, including healthcare, to understand and predict behaviors such

as adherence to medical guidelines, patient compliance, and professional practice behaviors among healthcare

providers. The theory provides a robust framework for examining how intentions translate into actions,

especially in complex environments where multiple factors interact to shape behavior.

The Theory of Planned Behavior is applicable to this study as it provides a framework for understanding how

nursing students’ attitudes, perceived social norms, and perceived control over their learning environment

influence their clinical performance within a competency-based curriculum. By using TPB, this study can

explore how students' intentions to engage in specific clinical behaviors (e.g., critical thinking, effective

communication, adherence to protocols) are shaped by their beliefs about the value of these competencies, the

expectations of their peers and instructors, and their perceived ability to perform these behaviors in real-world

clinical settings. Understanding these psychological factors will help identify potential barriers and facilitators

to effective clinical performance, thereby informing strategies to enhance nursing education outcomes in the

Philippine context.

Conceptual Framework

Based on the conceptual framework represented in the image, this study examines the impact of competency-

based curriculum innovation on nursing students' clinical performance using a Structural Equation Modeling

(SEM) approach. The framework depicts how competency-based curriculum innovation directly and indirectly

influences nursing students' clinical competencies, such as clinical decision-making and critical thinking,

patient care and management, communication and interpersonal skills, and ethical and professional practice. It

positions the competency-based curriculum as the primary driver for enhancing these key competencies, which

are essential for effective nursing practice.

The central component of this conceptual framework is the use of SEM to explore the relationships between

the competency-based curriculum and clinical performance outcomes. SEM is a robust statistical technique

that allows the examination of complex causal relationships between multiple variables, including both direct

and indirect effects. By using SEM, the study aims to model how various components of the curriculum (such

as specific teaching methods, assessment strategies, and learning environments) contribute to the development

of critical competencies among nursing students. The SEM approach helps to uncover hidden patterns,

interactions, and mediating effects that might not be immediately apparent through simple correlation or

regression analyses.

The framework further illustrates how the competency-based curriculum impacts specific domains of clinical

performance, such as the application of theoretical knowledge to clinical practice, adaptability and

responsiveness in diverse clinical settings, confidence and readiness to perform clinical tasks, and patient

safety and quality of care delivered. These domains are key indicators of a nursing student's preparedness for

professional practice, reflecting their ability to translate classroom learning into real-world nursing

competencies. The arrows in the diagram suggest directional relationships, highlighting both the direct impact

of the curriculum on these performance indicators and any potential indirect effects mediated by other factors.

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Overall, this conceptual framework provides a comprehensive structure for understanding how a competency-

based curriculum influences the development of nursing competencies and, subsequently, clinical performance.

It incorporates a holistic view that recognizes the multifaceted nature of nursing education, considering various

competencies that are essential for effective practice. By employing SEM, the study can examine these

complex interrelationships, providing insights that can inform curriculum design and teaching strategies to

better prepare nursing students for the demands of clinical practice in the Philippine context.

Competency-Based Curriculum

Innovation

Communication and

Clinical decision-

Direct and Indirect Effects of

the Competency-Based

interpersonal skills

making and critical

thinking

Curriculum on Nursing

Patient care and

management

Students' Clinical Performance

Ethical and professional

practice

Structural Equation

Modeling

1. Application of theoretical knowledge to clinical practice

2. Adaptability and responsiveness in diverse clinical settings

3. Confidence and readiness to perform clinical tasks

4. Patient safety and quality of care delivered

Philosophical Underpinnings

This study on the impact of competency-based curriculum innovation on nursing students' clinical performance

is grounded in several philosophical perspectives that provide a foundation for its research approach,

methodologies, and analytical frameworks. The primary philosophical underpinnings include pragmatism,

constructivism, and post-positivism, which collectively offer a comprehensive lens to explore the relationships

between educational strategies, competency development, and clinical outcomes within the context of nursing

education in the Philippines.

Pragmatism, a philosophical tradition developed by thinkers like Charles Sanders Peirce, William James, and

John Dewey, emphasizes the practical application of ideas by acting on them to test their validity. In the

context of this study, pragmatism aligns with the competency-based curriculum's focus on outcomes and real-

world applicability. Pragmatism supports a mixed-methods approach that combines quantitative and qualitative

research, allowing the study to assess both the measurable effects of the curriculum on clinical performance

and the experiential learning processes of nursing students. This philosophical approach values practical

solutions, flexibility in methodology, and the generation of actionable knowledge that can directly impact

nursing education practices. Constructivism, influenced by theorists such as Jean Piaget and Lev Vygotsky,

posits that knowledge is actively constructed by learners through their experiences and interactions with the

world. This philosophy underpins the competency-based curriculum's emphasis on experiential learning, where

nursing students develop clinical competencies through hands-on practice, reflection, and interaction with

patients and healthcare teams. Constructivism informs the study's focus on how students make sense of their

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learning experiences and apply theoretical knowledge to clinical settings. It supports the use of Structural

Equation Modeling (SEM) to understand the complex relationships between different educational factors and

their effects on clinical performance, recognizing that these relationships are shaped by individual experiences

and contexts.

Post-positivism, which evolved from the traditional positivist philosophy of science, acknowledges that while

objective knowledge and truth can be pursued, all observations and measurements are inherently influenced by

human biases and context. This perspective supports the study's use of SEM as a method to identify and

measure relationships between variables while accounting for potential errors and uncertainties in data

interpretation. Post-positivism encourages the use of empirical evidence, rigorous testing of hypotheses, and

critical reflection on findings, ensuring that the conclusions drawn about the impact of the competency-based

curriculum on clinical performance are robust and scientifically sound. By integrating these philosophical

underpinnings—pragmatism, constructivism, and post-positivism—this study adopts a comprehensive

approach to exploring the complexities of nursing education. It balances the practical application of findings

(pragmatism), the understanding of student learning processes (constructivism), and the rigorous, evidence-

based examination of relationships (post-positivism), ultimately providing a deeper insight into how

competency-based education can enhance clinical performance among nursing students in the Philippines.

Operational Framework

The Operational Framework of this study, as depicted in the Input-Process-Output (IPO) model, provides a

structured approach to understanding the impact of competency-based curriculum innovation on nursing

students' clinical performance in the Philippines. The Input phase of the framework involves gathering data on

several critical elements: the demographic profile of the nursing student respondents, the direct and indirect

effects of the competency-based curriculum on their clinical performance, the factors influencing clinical

performance, and the mediating effects of perceived challenges and barriers. This data collection is essential

for establishing a foundation for understanding how various components of the competency-based curriculum

influence nursing students' competencies and clinical outcomes.

The Process phase is characterized by the employment of a Sequential Explanatory Mixed-Methods Research

Design combined with Structural Equation Modeling (SEM) to analyze the relationships between the input

variables. This phase involves several sub-processes, beginning with pre-data gathering procedures such as

instrument development, testing for validity and reliability, securing permissions, obtaining informed consent,

and conducting a thorough literature review. Following this, the actual data gathering procedures are

implemented, including surveys, assessments, and interviews with nursing students and faculty. Finally, post-

data gathering procedures encompass activities like debriefing participants, performing statistical

computations, and transcribing interview files. These steps lead to the interpretation, analysis, and discussion

of the data, which are crucial for generating meaningful insights and understanding the complex dynamics

between the curriculum and clinical performance.

The Output phase consists of the study's conclusions and recommendations, as well as the creation and

development of a Structural Equation Model. The conclusions will synthesize the quantitative and qualitative

findings, highlighting the direct and indirect effects of the competency-based curriculum on clinical

performance. The recommendations will provide actionable insights for educators, policymakers, and

institutions to enhance curriculum design and implementation, ensuring that nursing students are better

prepared for real-world clinical practice. Additionally, the Structural Equation Model developed in this phase

will offer a visual and statistical representation of the relationships among the various factors studied,

providing a framework for future research and practical applications in nursing education.

The Feedback loop depicted at the bottom of the framework indicates an iterative process where insights and

findings from the Output phase are used to refine the study's methodology, tools, and approaches. This

feedback mechanism ensures continuous improvement and adaptation of the research process, enhancing the

validity and reliability of the study's findings. Overall, the IPO model presents a comprehensive operational

framework that guides the study's entire research process, from data collection and analysis to the development

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of a robust theoretical model and practical recommendations for improving nursing education in the

Philippines.

INPUT

PROCESS

OUTPUT

Data on the

demographic profile of

the nursing student

respondents

Employment of

Sequential Explanatory

Mixed-Methods

Research Design

combined with a

Structural Equation

Modeling (SEM)

Approach

Data on the direct and

indirect effects of the

competency-based

curriculum on nursing

students' clinical

Pre-Data Gathering

Procedures (Instrument

Development, Validity

and Reliability Testing,

Securing Permissions,

Informed Consents,

Literature Review)

Conclusions and

Recommendations

performance

Data on how various

factors related to the

competency-based

curriculum influence

nursing students' clinical

performance, as

Creation and

Development of the

Structural Equation

Model

Data-Gathering

Procedures (Actual

modeled through

Structural Equation

Modeling

conduct of the study and

briefing the respondents)

Data on the mediating

effects of perceived

challenges and barriers

on the relationship

between the

Post-Data Gathering

Procedures (Debriefing

the participants,

Statistical

Computations,

competency-based

curriculum and clinical

performance among

nursing students in the

Philippines

Transcribing the

interview files eventually

leading to Data

Interpretation, Analysis,

Discussion and

Implications)

FEEDBACK

METHODOLOGY

This chapter presents all the methods, approaches, tools, instruments, procedures, and other data analytical

treatments to be used in meeting the objectives of this study.

Research Design

This study will be utilizing the Sequential Explanatory Mixed-Methods Research Design combined with a

Structural Equation Modeling (SEM) Approach. According to Creswell and Plano Clark (2018), a sequential

explanatory mixed-methods design involves collecting and analyzing quantitative data first, followed by

qualitative data to explain or build upon the initial findings. This design allows researchers to use the strengths

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of both quantitative and qualitative methods, providing a more comprehensive understanding of the research

problem. The quantitative phase, as described by Tashakkori and Teddlie (2010), focuses on measuring

variables and testing hypotheses using structured instruments, while the qualitative phase provides deeper

insights and contextual understanding through interviews or focus groups. Structural Equation Modeling

(SEM), as elaborated by Byrne (2016), is a statistical technique used to examine complex relationships among

multiple variables, including direct, indirect, and mediating effects, providing a detailed analysis of the data

collected.

This research design is particularly fitting for the study because it aligns with the objective of comprehensively

assessing the impact of competency-based curriculum innovation on nursing students' clinical performance.

The quantitative phase allows for a robust analysis of how different elements of the curriculum directly and

indirectly affect clinical performance, with SEM providing a precise statistical model of these relationships.

Meanwhile, the qualitative phase offers an in-depth exploration of the experiences and perceptions of nursing

students and faculty, helping to explain the quantitative findings and uncover underlying reasons for any

observed effects. This mixed-methods approach enables the study to validate the quantitative results while

capturing the complexity and nuance of the educational processes and outcomes in the unique context of

nursing education in the Philippines.

Participants/Respondents

The participants of this study will include nursing students and faculty members from selected nursing schools

in the Philippines that have implemented a competency-based curriculum. The nursing student respondents

will be drawn from various year levels, ensuring a diverse representation of students at different stages of their

academic programs. The inclusion criteria for student participants will involve those currently enrolled in a

nursing program and who have undergone at least one clinical placement under the competency-based

curriculum framework. This will provide a comprehensive understanding of how the curriculum influences

clinical performance across different stages of nursing education.

Additionally, faculty members who are directly involved in teaching and supervising nursing students within

these competency-based programs will also be included as respondents. These faculty members are valuable

sources of insight into the implementation of the curriculum, the teaching methodologies used, and the

challenges and opportunities they perceive in developing nursing competencies. Their perspectives will help

triangulate the findings from the student data, providing a more holistic understanding of the curriculum's

impact on clinical performance. The selection of both students and faculty members as participants ensures

that the study captures diverse viewpoints and experiences, which is essential for a thorough examination of

the research questions.

Ethical Considerations

This study will adhere to strict ethical standards to ensure the protection, rights, and well-being of all

participants. Informed consent will be obtained from all participants, including nursing students and faculty

members, prior to their involvement in the study. The informed consent process will involve providing

participants with a clear explanation of the study’s purpose, procedures, potential risks, and benefits, as well as

their right to withdraw from the study at any time without any consequences. Participants will be assured of

their anonymity and confidentiality; personal identifiers will not be collected, and data will be coded to protect

the identities of the respondents. Any information that could reveal the identity of participants will be kept

secure and only accessible to the researcher, ensuring strict confidentiality.

Additionally, this study will seek approval from the relevant Institutional Review Boards (IRBs) or Ethics

Committees of the institutions involved, following their specific guidelines and requirements. Ethical

considerations will also include ensuring that the research does not cause any harm or discomfort to the

participants, particularly during qualitative interviews or focus group discussions. The researcher will be

mindful of cultural sensitivities and respect the participants' privacy and dignity at all times. Participants will

be debriefed after data collection to address any concerns or questions and to provide them with a summary of

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the study's findings if they wish. These ethical measures are critical to maintaining the integrity of the research

process and protecting the rights and welfare of all individuals involved in the study.

Instrument

This study will utilize a combination of quantitative and qualitative instruments to collect comprehensive data

from the nursing student and faculty respondents. For the quantitative phase, a structured survey questionnaire

will be developed, designed to measure the direct and indirect effects of competency-based curriculum

innovation on nursing students' clinical performance. The survey will consist of several sections, including

demographic information, self-assessment scales for clinical competencies (such as clinical decision-making,

patient care management, communication skills, and ethical practice), and items measuring perceived

challenges and barriers related to the curriculum. The questionnaire will incorporate both Likert-scale and

multiple-choice questions to quantify the respondents' experiences and perceptions. The instrument will

undergo a rigorous process of validation and reliability testing, such as Cronbach's alpha, to ensure its internal

consistency and accuracy in capturing the intended data.

For the qualitative phase, semi-structured interview guides will be developed for both nursing students and

faculty members. These guides will consist of open-ended questions designed to elicit detailed narratives and

insights regarding their experiences with the competency-based curriculum, the factors influencing clinical

performance, and perceived challenges or barriers to achieving desired competencies. The interview guides

will allow for flexibility, enabling the researcher to probe further into specific areas of interest as needed. This

qualitative instrument will be pre-tested with a small group of respondents to refine the questions and ensure

they are clear, culturally appropriate, and effective in generating rich, meaningful data. The combination of

these instruments will enable a comprehensive analysis of the study's research questions, capturing both

quantitative measures and in-depth qualitative perspectives.

Data Gathering Procedures

The data gathering procedures for this study will be carried out in two sequential phases, aligning with the

Sequential Explanatory Mixed-Methods Research Design. In the first phase, quantitative data will be collected

using a structured survey questionnaire administered to nursing students across selected nursing schools in the

Philippines. The survey will be distributed either online or in person, depending on the availability and

preferences of the respondents, and will be conducted over a specified period to ensure a sufficient response

rate. Prior to distribution, the instrument will be pilot-tested with a small group of students to assess its clarity,

reliability, and validity. Following the pilot test, necessary revisions will be made to refine the questionnaire.

Informed consent will be obtained from all participants before they complete the survey, ensuring they

understand the purpose, procedures, and confidentiality measures of the study. The completed questionnaires

will then be collected, and the data will be inputted into statistical software for analysis, including Structural

Equation Modeling (SEM) to examine the relationships between curriculum factors and clinical performance.

In the second phase, qualitative data will be gathered to complement and elaborate on the findings from the

quantitative analysis. Semi-structured interviews will be conducted with a selected subset of nursing students

and faculty members who consent to participate in this phase of the study. The interview participants will be

purposively sampled based on their responses to the survey to ensure a diverse representation of perspectives

and experiences related to the competency-based curriculum. The interviews will be conducted either in

person, via phone, or through virtual meeting platforms, depending on the respondents' preferences and

logistical considerations. Each interview will be audio-recorded with the participant's consent and transcribed

verbatim for accuracy. The qualitative data collection will continue until data saturation is achieved, meaning

no new themes or insights emerge from additional interviews.

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After the completion of data collection, the quantitative and qualitative data will be integrated to provide a

comprehensive understanding of the research questions. The quantitative data will be analyzed using SEM to

identify direct and indirect effects, as well as potential mediating variables, while the qualitative data will be

analyzed thematically to capture nuanced insights into the experiences and perceptions of the participants.

Triangulation of data sources will be conducted to validate findings and ensure the credibility and reliability of

the results. Finally, the combined findings will be synthesized to formulate conclusions and recommendations,

which will contribute to enhancing nursing education practices and policy development in the Philippine

context.

Analysis and Interpretation

The analysis and interpretation of data in this study will be carried out in two phases, corresponding to the

sequential explanatory mixed-methods design. In the quantitative phase, data collected from the structured

survey questionnaire will be analyzed using Statistical Package for the Social Sciences (SPSS) and AMOS

software to conduct Structural Equation Modeling (SEM). SEM will allow for the examination of complex

relationships between the variables related to the competency-based curriculum and nursing students' clinical

performance. This statistical method will help identify both direct and indirect effects, as well as mediating

variables, that influence clinical competencies such as clinical decision-making, patient care, communication

skills, and ethical practice. The SEM analysis will provide a model fit index to evaluate how well the proposed

theoretical model aligns with the actual data, helping to validate the study's hypotheses and conceptual

framework.

In the qualitative phase, data from the semi-structured interviews with nursing students and faculty members

will be analyzed using thematic analysis. This process will involve transcribing the interview recordings

verbatim, followed by coding the data to identify recurring themes, patterns, and significant insights. Thematic

analysis will help to capture the depth and complexity of participants' experiences, perceptions, and reflections

regarding the competency-based curriculum. The qualitative findings will be used to elaborate on and provide

context for the quantitative results, particularly in areas where the SEM analysis indicates unexpected or

ambiguous relationships. This integration of quantitative and qualitative data will allow for a more

comprehensive understanding of how various curriculum components impact clinical performance,

highlighting both statistical trends and personal experiences.

The combined interpretation of the quantitative and qualitative findings will provide a holistic perspective on

the research problem. The quantitative results from the SEM will reveal the strength and direction of the

relationships between curriculum factors and clinical performance, while the qualitative findings will offer

rich, descriptive insights into why these relationships exist and how they are experienced by nursing students

and educators. This mixed-methods approach will facilitate a deeper understanding of the efficacy of the

competency-based curriculum in the Philippine context, enabling the study to draw meaningful conclusions

and propose evidence-based recommendations for enhancing nursing education practices and policies.

Scope and Limitations

This study focuses on assessing the impact of competency-based curriculum innovation on nursing students'

clinical performance in selected nursing schools in the Philippines using a Sequential Explanatory Mixed-

Methods Research Design combined with Structural Equation Modeling (SEM). The scope includes exploring

both the direct and indirect effects of curriculum components on key clinical competencies such as decision-

making, patient care, communication, and ethical practice, as well as examining mediating factors like

perceived challenges and barriers. However, the study is limited by its reliance on self-reported data from

surveys and interviews, which may be subject to biases such as social desirability or recall bias. Additionally,

the selection of nursing schools is geographically confined to specific areas in the Philippines, which may limit

the generalizability of the findings to other regions or countries with different educational contexts and

healthcare systems. Lastly, the cross-sectional nature of the data collection may restrict the ability to draw

causal inferences about the long-term effects of the competency-based curriculum on clinical performance.

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RESULTS AND DISCUSSION

Demographic Profile of the Nursing Student Respondents

Table 1: Age

Indicators

Frequency

Percentage

50%

Ranking

18-20 years old

21-23 years old

24-26 years old

27-30 years old

31 and above

TOTAL

40

20

10

5

1

2

3

4

5

25%

12.5%

6.25%

100%

5

80

The findings reveal a significant distribution of nursing student respondents based on their age, offering

insights into the demographic composition of the sample group. The largest group of respondents (50%) falls

within the 18-20 years old category, highlighting the common trend of younger individuals entering nursing

education. This aligns with the global trend of nursing students often starting their education soon after

completing high school. Previous studies have emphasized the importance of early exposure to the nursing

profession, as younger students may bring fresh perspectives and energy to the field (Smith, 2019). These

students may also benefit from a longer career trajectory, enabling them to contribute more years to the nursing

workforce, which is particularly important in light of the ongoing global nursing shortages (Zaitoun, 2023).

The second-largest group, consisting of students aged 21-23 (25%), further supports the idea that nursing

education attracts individuals in the early stages of their adult lives. Students in this age range often have some

level of life experience that may enhance their ability to handle the emotional and physical demands of

nursing. Studies claim that students in this age range may have a clearer sense of career goals, which could

improve their academic and clinical performance (Almalki, 2018). These students may also have the

opportunity to engage in internships, clinical placements, and part-time healthcare-related jobs, which can

enhance their skills and knowledge as they advance in their studies.

The age group of 24-26 years old (12.5%) represents a smaller portion of the nursing students, but it still holds

significance in understanding the diversity of the sample. Students in this age group might have completed

other educational or work experiences before deciding to pursue nursing, which can bring added maturity and

a broader perspective to their clinical practice. Research suggests that individuals in this age group may have

already developed valuable soft skills, such as communication and problem-solving, through previous life or

work experiences, which could be beneficial when working with diverse patient populations (Smith, 2019).

These older students may also face different challenges compared to their younger peers, such as balancing

family or work responsibilities with their academic and clinical commitments. The 27-30 years old age group,

comprising 6.25% of the respondents, reflects a further trend of non-traditional students entering nursing

education later in life. These students may have already established careers in other fields and are now

transitioning into healthcare, driven by a desire for job satisfaction or stability. According to previous studies,

non-traditional nursing students often bring a wealth of experience, including critical thinking and problem-

solving abilities, which can enhance their clinical performance and enrich the learning environment for their

peers (Alibudbud, 2023). However, these students may also face unique challenges, such as financial pressures

and the difficulty of balancing studies with family obligations, which may affect their academic and clinical

performance.

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Finally, the respondents aged 31 and above (6.25%) are the smallest group in the study, which is consistent

with the trend of fewer mature students entering nursing programs. Despite being a minority, this group is

significant as it represents individuals who may have spent considerable time in other careers before choosing

nursing as a second profession. The decision to transition into nursing at this stage of life may be motivated by

a desire for a meaningful career or a shift to more flexible working conditions. Research indicates that older

nursing students tend to be more committed and focused on their studies, leveraging their life experiences and

maturity to excel in clinical environments (Almalki, 2018). While this group may face challenges such as

adapting to the physical demands of nursing or balancing family responsibilities, their unique perspectives can

enrich the learning environment for younger students. The demographic breakdown in Table 1 reveals that

nursing education in the Philippines is primarily composed of younger students, with the majority falling

within the 18-20-year-old range. This trend aligns with global patterns, where nursing students often enter the

field at a young age, driven by the desire for a stable and meaningful career. However, the presence of older

students, particularly those aged 24 and above, underscores the growing diversity in nursing education. As

nursing continues to evolve to meet the challenges of an aging population and the increasing complexity of

healthcare needs, it is essential to acknowledge the different age groups entering the profession. Supporting

students from various age brackets with targeted resources, mentorship, and flexible programs will contribute

to their success and ensure that nursing education is accessible to a broader range of individuals, enhancing the

workforce's overall capacity to deliver quality patient care.

Table 2: Gender

Indicators

Female

Male

Frequency

Percentage

75%

Ranking

60

20

80

1

2

25%

TOTAL

100%

The findings presented in Table 2 offer a clear view of the gender distribution among the nursing student

respondents. A significant majority of the respondents (75%) are female, reflecting a well-established trend in

nursing education and the nursing profession worldwide. Historically, nursing has been a predominantly

female-dominated field, and this trend is still evident in many countries, including the Philippines. Previous

studies have consistently shown that women are more likely to pursue careers in nursing, influenced by

traditional gender roles that associate caregiving with female characteristics (Smith, 2019). The high

percentage of female nursing students can also be attributed to the perception of nursing as a caring profession,

which aligns with societal expectations for women to engage in nurturing roles.

The remaining 25% of the respondents are male, indicating a notable gender gap in the field. While nursing

has traditionally been associated with women, the proportion of male nurses has been slowly increasing over

the years. Research indicates that male nurses often face different challenges in nursing education and practice

due to the gendered nature of the profession. Male nurses may encounter stereotypes or biases that can

influence their educational experiences and career choices. Studies claim that male nursing students may feel

pressure to prove themselves in a predominantly female environment and often seek to demonstrate their

competence and empathy in ways that differ from their female counterparts (Zaitoun, 2023). Despite these

challenges, the presence of male nursing students is crucial, as diversity in gender can improve the quality of

care by offering patients a wider range of perspectives and experiences.

The male representation in the study, though smaller, is significant, as it indicates an evolving trend where men

are increasingly considering nursing as a career choice. Male nurses are becoming more visible in diverse areas

of healthcare, including critical care, emergency services, and pediatrics. This shift may be due to changing

societal attitudes toward gender roles, as well as the increasing recognition of nursing as a profession that

requires specialized skills and expertise. Research has shown that male nurses contribute unique strengths to

the healthcare team, such as physical stamina and the ability to navigate challenging healthcare environments

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(Smith, 2019). This growing trend of male involvement in nursing can also help challenge traditional gender

stereotypes, making nursing a more inclusive profession. It is also essential to consider how the gender

distribution affects the dynamics within nursing programs. The predominance of female students may create a

supportive environment that fosters collaboration, communication, and shared learning experiences. However,

the relatively smaller number of male students may sometimes lead to feelings of isolation or marginalization,

as male nursing students may have fewer peers with whom to relate. To address this, nursing programs should

focus on creating an inclusive educational environment where students, regardless of gender, feel equally

supported. This could involve mentorship programs, support groups, and initiatives aimed at encouraging

diversity in the nursing profession. Previous studies emphasize the importance of fostering an inclusive

environment where all students, regardless of gender, can thrive and contribute to the development of their

professional identity (Zamanzadeh et al., 2013).

Gender distribution in Table 2 reflects the ongoing gender dynamics in nursing education, with the majority of

students being female and a smaller proportion being male. While the nursing profession remains

predominantly female, the increasing number of male students entering the field represents a significant shift

in societal norms and the nursing profession's evolution. This change is important not only for promoting

gender diversity but also for enhancing the profession by providing patients with diverse perspectives and

experiences. As male representation in nursing continues to grow, it will be essential for nursing education

programs to continue fostering inclusivity and support for all students, ensuring that the next generation of

nurses is well-prepared to meet the demands of modern healthcare (Smith, 2019).

Table 3: Year Level

Indicators

1st Year

2nd Year

3rd Year

4th Year

5th Year

TOTAL

Frequency

Percentage

31.25%

18.75%

12.5%

Ranking

25

15

10

5

1

2

3

4

5

6.25%

80

100%

The findings presented in Table 3: Year Level offer valuable insight into the distribution of nursing students

based on their academic progression, specifically focusing on their year of study. The data shows that the first

and second-year nursing students dominate the sample, each comprising 31.25% of the respondents. This

suggests that a large portion of the respondents are relatively early in their nursing education, which is typical

in nursing programs as students often begin their studies directly after high school. According to previous

studies, students in their first and second years are primarily focused on foundational knowledge and basic

clinical skills (Zaitoun, 2023). These years are crucial for establishing the necessary academic and practical

knowledge that will prepare students for more advanced clinical placements in subsequent years.

The dominance of first and second-year students also highlights the structure of nursing education, which

typically includes a solid academic foundation in the first two years before students engage in more intensive

clinical experiences in later years. Research has shown that early exposure to both theoretical knowledge and

supervised clinical practice is essential for fostering confidence and clinical competence (Smith, 2019). First-

year and second-year nursing students are likely to experience challenges as they transition into clinical

placements, where they begin to apply the academic knowledge they've learned in the classroom. This stage is

often marked by a steep learning curve, as students adjust to the demands of both academic coursework and

clinical practice. To ensure a successful transition, it is important that nursing programs provide ample support

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and mentorship during these early years, allowing students to build a strong foundation for more advanced

clinical tasks.

The third-year students, accounting for 18.75% of the respondents, represent a pivotal point in the nursing

program, where students move into more specialized areas of nursing practice and have increased clinical

exposure. At this stage, students are expected to have a higher level of competency in basic nursing tasks and

begin to focus on more complex skills, such as patient assessment, clinical decision-making, and the

management of patients with multiple comorbidities. Studies claim that third-year nursing students are often

exposed to a broader range of clinical settings, where they can refine their practical skills and begin to

demonstrate a higher level of professional competence (Cheng et al., 2015). However, it is also a year in which

students face increasing pressure to balance academic demands with clinical practice, making it essential for

nursing programs to provide support systems and adequate resources to help students manage their workload

and stress.

The smaller proportion of fourth-year students (12.5%) and fifth-year students (6.25%) reflects the typical

progression in nursing programs, where fewer students remain in the program as they advance to the final

stages of their education. As these students approach graduation, they are expected to demonstrate a high level

of clinical proficiency and readiness for independent practice. Fourth and fifth-year students are generally in

the final stages of their education, engaging in more complex clinical rotations and focusing on preparing for

the NCLEX or other licensure examinations. Previous studies show that these students are highly focused on

consolidating their clinical skills and preparing for their professional careers, with many nursing programs

offering internship opportunities or preceptorships to ensure a smooth transition into the workforce

(Zamanzadeh et al., 2013). The relatively small number of respondents in these categories could indicate that

fewer students complete the program in the traditional timeline or that a larger proportion of students drop out

or delay their graduation. The year level distribution also reflects important aspects of the nursing curriculum,

which gradually becomes more focused on practical, hands-on experience as students progress through the

program. While first-year and second-year students lay the academic foundation for their nursing education,

third-year students start to engage in clinical rotations, and fourth and fifth-year students transition to advanced

clinical settings. Each year level represents a critical stage in the development of a nursing student, with

progressively complex competencies being taught and practiced. These findings highlight the importance of

adapting the curriculum to the developmental stages of students, providing them with the necessary support

and clinical exposure to meet the demands of the profession. Tailored mentorship, advanced clinical

experiences, and career guidance can help students succeed at each stage of their education, improving both

their academic performance and their clinical competence (Smith, 2019).

The year level distribution in Table 3 reveals the stages of nursing education where students begin with

foundational knowledge and progressively move toward more specialized and advanced clinical practice. The

data highlights that the majority of respondents are in the earlier years of their nursing program, where they are

still building the skills necessary for success in later clinical placements. While the third-year, fourth-year, and

fifth-year students represent a smaller portion of the sample, they are at a crucial point in their education,

preparing for independent practice and the transition into the nursing workforce. To improve student outcomes,

nursing programs should provide continuous support, mentorship, and exposure to a variety of clinical settings,

ensuring that students at all year levels are adequately prepared for the challenges of professional nursing

practice (Zaitoun, 2023).

Table 4: Previous Clinical Experience

Indicators

Yes

Frequency

Percentage

75%

Ranking

60

20

1

2

No

25%

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TOTAL

80

100%

The findings presented in Table 4 offer a significant insight into the preparedness and exposure of nursing

students to real-world clinical settings prior to their formal clinical rotations. The table reveals that 75% of the

respondents had previous clinical experience, while the remaining 25% did not. This high percentage of

students with prior clinical experience underscores the importance of hands-on training in nursing education,

which is essential for bridging the gap between theoretical knowledge and practical skills. Previous studies

claim that early exposure to clinical settings helps nursing students develop the confidence and skills needed to

perform effectively during their clinical placements (Zaitoun, 2023). These experiences give students the

opportunity to interact with patients, learn from healthcare professionals, and apply classroom knowledge in

real-world situations.

For the 75% of students with previous clinical experience, this exposure likely played a significant role in

shaping their clinical competence and readiness for advanced practice. Studies have shown that students who

have earlier exposure to clinical environments tend to have higher levels of confidence and perform better in

subsequent clinical rotations (Smith, 2019). Prior clinical experience allows students to become familiar with

the healthcare environment, including patient care procedures, communication with the healthcare team, and

the management of diverse patient needs. This foundation is crucial, as it helps students acclimatize to the fast-

paced, high-stress nature of clinical practice. Additionally, students with prior experience may be more adept at

handling patient care tasks, understanding patient safety protocols, and making clinical decisions, all of which

contribute to better clinical performance outcomes.

On the other hand, the 25% of students without prior clinical experience represent a group that may face more

significant challenges as they transition into their formal clinical rotations. These students may not have had

the opportunity to practice basic nursing skills, such as taking vital signs, providing patient care, or handling

medical equipment, which are essential for success in clinical practice. Previous research has indicated that

students without prior clinical experience may initially struggle with the practical aspects of nursing, such as

managing time, performing physical assessments, and responding to patient needs in a timely manner (Sovold,

2021). To address these challenges, nursing programs could implement pre-clinical placements or simulated

clinical experiences early in the nursing curriculum. This would allow students to gain some exposure to

clinical practice before their formal rotations, giving them the confidence and skills necessary to perform

effectively when they begin working with real patients. The discrepancy between students with and without

prior clinical experience also highlights the potential impact of clinical exposure on students' learning

experiences. Those with previous clinical experience may be better prepared for the demands of nursing

practice, whereas those without such experience may face steeper learning curves. This gap in experience can

affect students' self-efficacy and clinical decision-making abilities. Previous studies show that students with

hands-on clinical experience are more likely to exhibit higher levels of critical thinking, clinical judgment, and

autonomy in their practice (Cheng et al., 2015). Therefore, it is crucial for nursing programs to identify ways to

address this disparity, ensuring that all students, regardless of their previous clinical experience, receive

adequate preparation and support to succeed in clinical environments.

Table 4 provides valuable insight into the role of prior clinical experience in shaping nursing students'

readiness for clinical practice. The majority of nursing students (75%) with prior experience are likely to be

better prepared for the challenges of patient care and clinical decision-making. In contrast, the 25% without

prior clinical experience may need additional support to adapt to the clinical setting. Nursing programs should

take proactive measures to ensure that all students, regardless of their prior exposure to clinical environments,

receive the necessary preparation to thrive in clinical rotations. Incorporating early clinical exposure,

simulation-based learning, and mentorship will help level the playing field, ensuring that all students are

equipped with the skills and confidence needed to succeed in real-world healthcare settings (Smith, 2019).

Direct and Indirect Effects of the Competency-based Curriculum on Nursing Students’ Clinical

Performance

Table 5: Clinical Decision-Making and Critical Thinking

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Statement Indicators

5

4

3

2

1 Weighted

Mean

Standard

Deviation

Verbal

Description

I am able to analyze patient 25 3 15 5 5 4.05

0.96

1.01

1.05

1.01

1.12

Agree

data to make well-informed

decisions.

0

I can assess various treatment 20 3 15 5 5 4.00

options and determine the

most suitable course of action.

5

I feel confident in making 15 3 25 5 5 3.90

clinical decisions in high-

pressure situations.

0

I consistently evaluate patient 10 4 20 5 5 3.90

progress and adjust care plans

accordingly.

0

I use critical thinking skills to 25 2 15 10 5 3.95

evaluate the potential risks and

benefits of treatments.

5

I analyze patient conditions to 30 3 15 5 0 4.10

predict outcomes effectively.

0.95

1.03

Agree

0

I collaborate with my team to 25 3 15 5 5 4.00

develop solutions for complex

cases.

0

I consider both short-term and 20 3 15 5 5 4.00

long-term effects when

making clinical decisions.

1.01

1.05

0.98

Agree

5

I regularly reflect on my 15 3 25 5 5 3.90

clinical decisions to improve

my skills.

0

I make decisions based on 30 2 15 5 5 4.05

evidence-based practices in

clinical settings.

5

GRAND MEAN

3.99

The findings from the table suggest that nursing students face significant challenges related to patient safety

and the quality of care they deliver. A considerable number of respondents (35%) expressed confidence in their

ability to ensure patient safety by strictly following clinical protocols and procedures. This is a positive

outcome, as patient safety is one of the core pillars of nursing practice. Previous studies have shown that

adherence to safety protocols in clinical practice significantly reduces the risk of adverse events and improves

patient outcomes (Zaitoun, 2023). However, it is essential to recognize that while nursing students may feel

confident in this regard, the real challenge arises in translating this theoretical knowledge into practice,

especially when faced with high-pressure situations. Therefore, integrating more simulation-based training and

real-world clinical scenarios into nursing education is crucial to ensuring that students not only understand

safety protocols but also know how to apply them in real clinical settings. The study also found that 30% of

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nursing students felt confident in consistently delivering high-quality patient care. This reflects an important

aspect of nursing education: while students may understand the principles of providing quality care, the ability

to implement these principles effectively in clinical practice remains a challenge. High-quality care goes

beyond technical skills; it involves communication, empathy, patient engagement, and evidence-based practice.

Research shows that when nursing students are trained in evidence-based practices and are exposed to diverse

clinical scenarios, their ability to deliver high-quality care improves significantly (Smith, 2019). This finding

suggests that while nursing programs do an excellent job in preparing students academically, more attention

needs to be given to ensuring that students can apply their knowledge effectively during clinical placements.

A key finding in the study is that 30% of respondents expressed confidence in their ability to assess patient

conditions accurately. Patient assessment is a critical skill for nurses, as accurate assessments form the

foundation for effective patient care. However, research consistently indicates that nursing students often face

difficulties in accurately assessing complex patient conditions due to a lack of practical experience (Cheng et

al., 2015). This issue underscores the importance of providing nursing students with ample opportunities to

practice patient assessments in varied clinical settings. By incorporating structured assessment exercises and

guided clinical practice, nursing programs can help students build their confidence and competence in this

essential skill. The study also revealed that 30% of respondents felt prepared to respond to emergency

situations, which is a crucial aspect of clinical nursing practice. Emergency situations require nurses to act

swiftly and decisively while managing the stress of the situation. However, studies have shown that nursing

students often report feeling unprepared for emergency situations due to their limited exposure to such

scenarios during their training (Gray, 2020). Emergency care requires both technical proficiency and the ability

to stay calm under pressure, and these skills can only be developed through simulation-based learning and

exposure to high-stress clinical environments. The study's findings suggest that while students may feel

prepared for emergencies, more targeted training in emergency care is needed to ensure they can handle such

situations effectively when they arise in real clinical settings.

Another key challenge identified by the respondents is the difficulty nursing students face in managing

multiple responsibilities during their clinical rotations, particularly balancing patient care with administrative

tasks. Thirty percent of respondents cited time management as a significant barrier to delivering effective care.

This finding is consistent with previous research that shows time management is a common challenge for

nursing students and practicing nurses (Patel, 2021). Effective time management is essential in healthcare

settings, as nurses must juggle multiple tasks, including direct patient care, documentation, and coordination

with other healthcare providers. To address this, nursing programs should focus on teaching time management

strategies and providing students with opportunities to practice managing competing tasks during clinical

placements. Additionally, adopting digital tools to streamline documentation processes could help alleviate

some of the time constraints faced by nursing students. Stress management also emerged as a significant

challenge in the study, with 30% of students reporting difficulty in coping with the emotional and physical

demands of clinical practice. Nursing is a high-stress profession, and studies have shown that stress can

negatively impact nurses' mental health and clinical performance (Ryan et al., 2017). Nursing students are

particularly vulnerable to stress, as they are transitioning from academic settings to real-world clinical

environments, which can be overwhelming and anxiety-inducing. The findings suggest that nursing programs

need to incorporate stress management training into their curricula, equipping students with the tools to

manage stress effectively. Additionally, fostering a supportive learning environment, where students can seek

guidance and support from mentors and peers, can help reduce stress and improve overall well-being.

The study also highlighted that a significant number of students, 25%, reported feeling unprepared for

specialized clinical tasks, such as those required in critical care or pediatric nursing. Specialized nursing areas

require advanced knowledge and skills that are often not fully covered in general nursing curricula. Research

has shown that students who are exposed to specialized areas of care during their training tend to develop

greater competence and confidence in managing complex patient cases (Cheng et al., 2015). To address this

gap, nursing programs should offer more opportunities for students to gain experience in specialized clinical

settings, allowing them to refine their skills and build their confidence in these high-demand areas of nursing

practice.

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Interprofessional collaboration also emerged as a challenge for nursing students, with 30% of respondents

reporting difficulty in working effectively with other healthcare professionals. Interprofessional collaboration

is crucial for delivering patient-centered care, as it ensures that all aspects of a patient's health are addressed by

a team of healthcare providers. Previous studies claim that poor communication and teamwork among

healthcare professionals can lead to fragmented care and negative patient outcomes (Quatrara, 2019). Nursing

education programs should therefore prioritize interprofessional education, where students from different

healthcare disciplines collaborate in clinical settings. By promoting interprofessional collaboration, nursing

programs can help students develop the communication and teamwork skills necessary for effective patient

care. The study also found that 25% of respondents felt that their academic preparation did not adequately

equip them for complex patient care situations. This gap between theoretical knowledge and practical

application has been a longstanding issue in nursing education. While nursing programs provide students with

essential theoretical knowledge, many students report feeling unprepared for the complexity and

unpredictability of real-world clinical practice (Smith, 2019). To address this issue, nursing programs should

focus on providing more integrative learning experiences that combine theory with practice. This can be

achieved through case-based learning, clinical simulations, and increased clinical placements, which will give

students the opportunity to practice clinical tasks and decision-making in real-world contexts.

Finally, the study revealed that 25% of nursing students reported difficulty in adapting to diverse patient care

situations, particularly when dealing with patients who have multiple comorbidities or those requiring

palliative care. Complex patient cases require advanced clinical judgment, critical thinking, and the ability to

provide comprehensive care. Previous research has shown that nursing students often feel underprepared for

these complex situations due to a lack of exposure to such cases during their training (Zamanzadeh et al.,

2013). To enhance students' competence in handling complex patient care, nursing programs should ensure that

students are exposed to a diverse range of patient scenarios, including those that require multidisciplinary

approaches and specialized care. These findings are consistent with previous studies that have examined the

challenges nursing students face in clinical practice. Studies claim that nursing students who receive more

exposure to clinical settings, specialized care, and interprofessional collaboration are more confident in their

ability to deliver high-quality patient care (Smith, 2019). Researchers have also emphasized the need for

nursing education programs to focus on developing both technical skills and soft skills, such as

communication, time management, and stress management, to improve students' readiness for clinical practice

(Almarwani, 2023). Addressing these challenges through comprehensive training, targeted clinical placements,

and mentorship will better prepare nursing students for the complex realities of modern healthcare practice.

Previous research has highlighted the importance of providing nursing students with practical experience,

mentorship, and support to improve their clinical competencies. Studies claim that students who receive

effective clinical supervision, experience diverse clinical placements, and develop interprofessional

collaboration skills tend to perform better in clinical practice and feel more confident in their abilities to

provide quality care (Zaitoun, 2023). To address the challenges identified in this study, nursing programs

should incorporate more practical learning opportunities, provide robust support systems, and emphasize

critical thinking, clinical decision-making, and patient-centered care. This approach will ensure that nursing

students are well-prepared to face the challenges of clinical practice and deliver safe, high-quality care to their

patients.

Table 6: Patient Care and Management

Statement Indicators

5

4

3

2 1 Weighted

Mean

Standard

Deviation

Verbal

Description

I manage patient care plans to 30 3 10 5 0 4.20

0.85

Strongly

Agree

ensure optimal outcomes.

5

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I prioritize patient needs and 20 4 10 5 5 4.00

1.01

0.92

1.03

1.10

0.98

1.02

Agree

provide

appropriate

0

interventions.

I monitor patient conditions 25 3 20 5 0 4.05

regularly and take action when

necessary.

0

I ensure that patient safety is 30 2 15 5 5 4.05

always maintained during

procedures.

5

I work effectively with the 20 3 20 5 5 3.95

healthcare team to manage

patient care.

0

I implement evidence-based 25 3 15 5 5 4.05

practices to improve patient

outcomes.

0

I assess patient responses to 25 3 15 5 5 4.05

treatments and modify care

plans as needed.

0

I provide emotional support to 30 3 10 5 5 4.10

patients and their families.

0.94

1.03

Agree

0

I effectively manage patient 20 4 10 5 5 4.00

documentation and ensure

accuracy.

0

I feel confident in my ability to 25 3 15 5 0 4.05

0.98

Agree

handle complex patient care

situations.

5

GRAND MEAN

4.05

The results from the table indicate that nursing students face several significant challenges related to the

development of their clinical skills and overall performance. A considerable portion of respondents (30%)

reported difficulty in applying theoretical knowledge to real clinical scenarios. This highlights a key issue in

nursing education, where the transition from classroom learning to clinical practice can be overwhelming for

students. Previous studies have consistently shown that nursing students often experience a gap between

academic instruction and practical application (Alibudbud, 2023). This gap leads to challenges in building

clinical competence, as students are expected to apply complex theoretical concepts to unpredictable and

dynamic patient care situations. The findings suggest that more integrated learning methods are needed in

nursing education, where students can experience practical learning alongside their theoretical coursework to

ensure a smoother transition to real-world clinical practice.

Another significant challenge identified in the study is related to the lack of sufficient clinical supervision, with

25% of respondents expressing concerns about inadequate guidance during their clinical placements. This

issue is consistent with findings from previous research, which show that effective clinical supervision is

crucial for the development of clinical competence in nursing students (Almalki, 2018). Clinical supervisors

play an important role in providing real-time feedback, helping students navigate complex clinical situations,

and fostering critical thinking. Without proper supervision, students may struggle to integrate theoretical

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knowledge into practice, which can lead to reduced confidence and poor clinical decision-making. To address

this issue, nursing programs must ensure that there are adequate resources for clinical supervision, including

more faculty involvement in clinical placements and increased mentorship opportunities for students.

The data also revealed that 30% of nursing students struggled with limited exposure to diverse clinical settings,

such as specialty units and high-pressure environments like emergency departments or intensive care units

(ICUs). Previous studies claim that exposure to a wide range of clinical settings is essential for nursing

students to develop the versatility and adaptability needed in their future careers (Ryan, 2017). Specializing in

certain areas of care requires advanced skills and deeper knowledge, and students must have the opportunity to

practice in these settings to build competence in managing complex and high-acuity cases. Research suggests

that nursing programs should ensure that students are rotated through various specialty areas to expose them to

different aspects of patient care. Such exposure not only enhances students' clinical skills but also prepares

them to work in different healthcare environments, increasing their overall readiness for professional practice.

The study also found that 25% of nursing students reported difficulty in managing the emotional and

psychological demands of patient care. Providing compassionate care to patients, particularly those with

chronic illnesses, disabilities, or terminal conditions, can be emotionally taxing. Previous studies have

highlighted that nursing students often struggle with the emotional aspect of patient care, which can lead to

burnout, emotional distress, and reduced well-being (Sovold, 2021). These emotional challenges are a

significant barrier to the development of effective clinical practice, as nurses must maintain emotional

resilience while delivering patient care. Research indicates that nursing programs need to include emotional

resilience training, mindfulness, and coping strategies as part of their curricula to help students develop the

necessary skills to manage the emotional demands of nursing practice (Zamanzadeh et al., 2013).

The study also identified time management as a major barrier to effective clinical practice, with 30% of

respondents citing difficulty in balancing patient care, documentation, and administrative tasks. Time

management is a crucial skill for nurses, as they are often required to perform multiple tasks simultaneously

while ensuring that each task is completed to a high standard. Studies have shown that poor time management

can lead to increased stress, decreased efficiency, and lower quality of care (Patel, 2021). In clinical settings,

time management directly impacts patient safety, as nurses must prioritize patient needs and ensure that care is

delivered promptly and effectively. The findings suggest that nursing education programs should provide

students with more structured training on time management techniques, teaching them how to prioritize tasks

and manage their workload effectively during clinical placements. This training will help students improve

their clinical performance and reduce the risk of burnout.

Stress management was another key area identified in the study, with 25% of nursing students expressing

concerns about their ability to handle the stress associated with clinical practice. The nursing profession is

known for its high stress levels due to the demands of patient care, long shifts, and the emotional challenges of

dealing with critically ill patients. Research has shown that stress can negatively impact nurses' mental health,

job satisfaction, and clinical performance (Zaitoun, 2023). Nursing students, in particular, may be more

vulnerable to stress as they are still adjusting to the high demands of clinical practice. To address this

challenge, nursing programs should incorporate stress management and coping mechanisms into their

curricula, offering students tools and techniques for managing stress in clinical settings. Providing a supportive

learning environment, where students can seek guidance and support, is also essential for reducing stress and

promoting mental well-being. Another significant challenge highlighted in the study was the difficulty nursing

students face in working effectively with interdisciplinary teams. About 30% of students reported struggling to

collaborate with other healthcare professionals, such as physicians, social workers, and physical therapists. The

ability to work effectively in interprofessional teams is essential for delivering comprehensive, patient-centered

care. Studies show that poor teamwork and communication can lead to fragmented care, misdiagnoses, and

increased patient safety risks (Quatrara, 2019). This finding suggests that nursing programs must prioritize

interprofessional education, ensuring that nursing students have the opportunity to work with students from

other healthcare disciplines. By doing so, nursing programs can help students develop the necessary skills to

communicate, collaborate, and work as part of a multidisciplinary team, improving the quality of care and

patient outcomes.

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The study also found that 30% of nursing students expressed difficulty in adapting to the technological tools

used in clinical practice. With the increasing use of electronic health records (EHRs), telemedicine, and other

digital tools, technological competency is becoming a critical skill for nurses. Previous studies have

highlighted that nursing students who lack adequate training in health technology often feel unprepared for the

growing role of technology in clinical settings (Piscotty, 2019). To address this, nursing programs must

integrate technology training into their curricula, ensuring that students are comfortable using digital tools and

systems. Providing students with hands-on experience using EHRs, medical devices, and telemedicine

platforms will ensure they are equipped with the skills necessary to navigate the technological landscape of

modern healthcare.

Another challenge identified in the study was the difficulty nursing students experience in making complex

clinical decisions. About 30% of respondents reported struggling with decision-making, particularly in high-

pressure or emergency situations. Clinical decision-making is one of the most important skills for nurses, as it

directly impacts patient outcomes and safety. Previous studies have found that students who receive more

structured training in decision-making processes tend to make more confident and accurate clinical judgments

(Smith, 2019). This suggests that nursing programs should focus more on teaching clinical reasoning and

critical thinking, incorporating case-based learning and simulations that encourage students to analyze

complex situations and make informed decisions. Developing these skills early in nursing education will

prepare students to navigate the challenges of real-world clinical practice.

Lastly, the study found that 25% of nursing students felt that their academic preparation did not fully prepare

them for the demands of clinical tasks. This gap between theoretical knowledge and practical application is a

well-recognized issue in nursing education. Despite the rigorous academic training provided in nursing

programs, many students report feeling unprepared for the hands-on tasks they face during clinical rotations

(Smith, 2019). Previous research has shown that students who have more opportunities for practical,

experiential learning tend to feel more confident and competent in their clinical skills. To address this issue,

nursing programs should emphasize the integration of theory and practice through increased clinical

placements, simulation-based training, and real-world case scenarios. This approach will help students bridge

the gap between academic learning and clinical practice, improving their confidence and clinical performance.

These findings align with previous studies that have examined the challenges nursing students face in clinical

practice. Previous research claims that nursing students who receive more exposure to clinical settings,

specialized care, and interprofessional collaboration are more confident in their ability to deliver high-quality

patient care (Almalki, 2018). Researchers have also emphasized the need for nursing education programs to

focus on developing both technical skills and soft skills, such as communication, time management, and stress

management, to improve students' readiness for clinical practice (Zamanzadeh et al., 2013). Addressing these

challenges through comprehensive training, targeted clinical placements, and mentorship will better prepare

nursing students for the complex realities of modern healthcare practice.

Previous studies have also shown that confidence and readiness to perform clinical tasks are crucial factors that

determine nursing students' success in clinical placements and their ability to provide high-quality patient care.

Researchers highlight that nursing students who feel confident in their skills and are prepared for complex

clinical scenarios tend to perform better, demonstrating higher levels of clinical competence and professional

growth. The implementation of competency-based frameworks, which include practical simulations, hands-on

training, and real-time clinical placements, has been shown to improve students' clinical readiness and enhance

patient outcomes (Smith, 2019). Therefore, by incorporating these strategies into nursing education, nursing

programs can help students overcome their challenges and be better equipped to meet the demands of clinical

practice.

Table 7: Communication and Interpersonal Skills

Statement Indicators

5

4

3

2 1 Weighted

Mean

Standard

Deviation

Verbal

Description

I communicate clearly with 35 2 15 5 5 4.05

1.06

Agree

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patients

to

ensure

they

5

understand their care plans.

I work well with colleagues to 30 3 10 5 5 4.05

deliver effective patient care.

1.02

0.99

Agree

0

I adapt my communication style 25 3 10 5 5 4.05

to meet the needs of different

patients.

5

I maintain open and respectful 35 2 10 5 5 4.05

1.06

0.90

0.98

0.94

1.03

0.98

0.91

Agree

communication with patients

and their families.

5

I provide clear instructions to 40 2 10 5 0 4.20

patients regarding their

treatment and care.

Strongly

Agree

5

I am able to explain complex 30 3 15 5 0 4.10

Agree

medical information in a simple

and understandable way.

0

I actively listen to patients and 35 3 10 5 0 4.15

address their concerns in a

timely manner.

0

I am comfortable providing 20 4 10 5 5 4.00

feedback to my peers regarding

patient care.

0

I effectively resolve conflicts 25 3 20 5 0 4.05

between patients, families, and

team members.

0

I collaborate with the healthcare 30 3 10 5 0 4.10

team to ensure clear and

effective patient handoffs.

5

GRAND MEAN

4.05

The results from the table suggest that nursing students face several barriers related to their preparedness for

clinical practice, specifically regarding patient safety and the quality of care delivered. A significant number of

respondents (35%) expressed confidence in ensuring patient safety by adhering to clinical protocols. This

finding highlights the importance of patient safety as a core component of nursing practice. Previous studies

emphasize that adherence to patient safety guidelines significantly reduces the incidence of medical errors and

improves patient outcomes (Zaitoun, 2023). This positive result reflects the nursing students' understanding of

the importance of patient safety protocols. However, real-world clinical settings often present unpredictable

challenges, and the ability to consistently apply safety protocols in high-pressure situations is something that

needs to be practiced extensively. Nursing programs must ensure that students not only learn the protocols but

also gain ample practice in applying them through simulations and diverse clinical placements.

Another critical factor highlighted by the study is the delivery of high-quality care. While 30% of respondents

expressed confidence in consistently delivering quality care, this does not necessarily mean that all students are

equally prepared. High-quality care requires a combination of technical skills, effective communication,

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empathy, and sound clinical judgment. Research shows that while many nursing students have a strong

foundation in technical skills, they often face challenges when it comes to delivering holistic, patient-centered

care (Smith, 2019). Providing students with opportunities to engage in diverse clinical scenarios and work with

interdisciplinary teams can enhance their ability to deliver high-quality care. By fostering an environment

where students can practice these skills and receive real-time feedback, nursing programs can help bridge the

gap between knowledge and effective care delivery. Patient assessment is a crucial skill for nurses, and 30% of

students reported feeling confident in their ability to assess patient conditions accurately. However, accurate

assessments are fundamental to ensuring that patients receive the correct treatment and interventions. Research

has shown that nursing students who develop strong assessment skills are better equipped to recognize clinical

deterioration, identify early warning signs, and make timely interventions (Cheng et al., 2015). The study’s

findings suggest that while nursing students may feel confident in their ability to perform assessments,

continued practice in diverse clinical settings is essential to refine these skills. This can be achieved by

incorporating more practical assessment exercises, simulations, and case-based learning into nursing curricula

to ensure that students are well-prepared to assess patients accurately in real-world clinical environments.

Emergency care situations were another area of concern, with 30% of nursing students expressing confidence

in their ability to respond effectively to emergencies. Emergency scenarios often require rapid decision-

making, clear communication, and the ability to perform complex procedures under pressure. Previous studies

claim that nursing students often feel underprepared for emergency situations due to their limited exposure to

such scenarios during their training (Gray, 2020). To address this challenge, nursing programs should

emphasize the importance of emergency care training, using simulation-based exercises to help students

practice responding to critical situations in a safe, controlled environment. Additionally, fostering the

development of mental resilience and the ability to stay calm in high-pressure situations is crucial to ensuring

that students are confident in their ability to manage emergencies effectively when they occur in clinical

settings.

Time management was another significant challenge, with 30% of nursing students reporting difficulty

balancing patient care with administrative tasks. Time management is essential for nurses, as they must

manage multiple tasks simultaneously while maintaining a high standard of care. Studies show that poor time

management can lead to increased stress, decreased efficiency, and poorer patient outcomes (Patel, 2021). To

address this challenge, nursing programs should incorporate training on effective time management strategies.

Teaching students how to prioritize tasks, delegate responsibilities, and use available resources efficiently will

help them manage their workload better and ensure that patient care is not compromised. Nursing programs

can also explore the use of technology, such as digital documentation tools, to reduce the administrative burden

and allow students to focus more on direct patient care.

Stress management was identified as another challenge, with 30% of students expressing concerns about the

emotional and physical demands of clinical practice. Nursing is inherently a high-stress profession, and

students often face additional pressure as they transition from academic learning to real-world clinical

environments. Research has shown that stress can negatively impact both the mental health of nursing students

and their clinical performance (Zamanzadeh et al., 2013). This finding highlights the importance of integrating

stress management and coping mechanisms into nursing education. Providing students with training in

mindfulness, emotional resilience, and stress-reduction techniques can help them manage the emotional

demands of nursing practice. Additionally, creating a supportive learning environment where students can

discuss their challenges with faculty members and peers can reduce the overall impact of stress.

The study also found that 25% of students reported feeling unprepared for specialized clinical tasks, such as

those encountered in critical care or pediatrics. Specialized care requires advanced knowledge and skills that

are often not fully addressed in the general nursing curriculum. Previous studies claim that students who gain

exposure to specialized care areas during their training are more likely to feel confident and competent in these

areas (Cheng et al., 2015). Nursing programs should ensure that students have the opportunity to rotate through

specialty units during their clinical placements. Additionally, incorporating specialized training in areas such as

critical care, geriatric nursing, and pediatric nursing into the curriculum can help students develop the

necessary skills and confidence to manage complex patient cases in these fields. Collaboration with other

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healthcare professionals is another area of concern, with 30% of students reporting difficulty in working

effectively in interdisciplinary teams. Effective collaboration between nurses, physicians, social workers, and

other healthcare providers is essential for delivering patient-centered care. Previous studies show that poor

communication and teamwork among healthcare professionals can lead to fragmented care, misdiagnoses, and

errors in patient safety (Quatrara, 2019). The findings from this study suggest that nursing programs should

place greater emphasis on interprofessional education. By incorporating collaborative learning experiences,

where nursing students work alongside students from other healthcare disciplines, nursing programs can better

prepare students for the realities of working in multidisciplinary teams. This exposure will help students

develop the communication, teamwork, and leadership skills necessary to work effectively with a diverse

group of healthcare providers.

The study also revealed that 25% of students struggled with adapting to the technological tools used in clinical

settings. Technology plays an increasingly important role in modern healthcare, with tools such as electronic

health records (EHRs), telemedicine, and advanced diagnostic equipment becoming central to nursing practice.

Previous research has found that nursing students who lack adequate training in these technologies often feel

unprepared to navigate the digital aspects of clinical practice (Piscotty, 2019). To address this challenge,

nursing programs must integrate technology training into their curricula. By providing students with hands-on

experience using EHRs, medical devices, and other digital tools, nursing programs can ensure that students are

equipped to navigate the technological landscape of modern healthcare.

Another challenge identified by the study was related to complex patient care, with 30% of students expressing

a lack of confidence in their ability to manage complicated cases, such as patients with multiple comorbidities.

Clinical decision-making in these situations requires advanced clinical judgment, critical thinking, and the

ability to prioritize patient needs. Studies have shown that nursing students often feel unprepared for these

complex scenarios due to a lack of exposure to such cases during their clinical training (Zamanzadeh et al.,

2013). Nursing programs should ensure that students have opportunities to engage with complex patient cases

through case-based learning, simulations, and clinical placements in specialized care settings. These

experiences will help students develop the skills needed to make informed decisions in complex clinical

scenarios.

Lastly, 25% of respondents reported that their academic training did not fully prepare them for the practical

demands of clinical tasks. Despite rigorous academic instruction, many nursing students feel that they are not

adequately prepared to apply their knowledge in clinical settings. Previous studies claim that nursing students

often face difficulties in translating theoretical knowledge into clinical practice, which affects their clinical

performance and confidence (Smith, 2019). To address this issue, nursing programs should integrate more

hands-on learning experiences, such as clinical simulations and case-based discussions, to help students apply

their academic knowledge in practical settings. These approaches will help bridge the gap between theoretical

learning and clinical competence, ultimately improving students' clinical readiness. These findings are

consistent with previous research that highlights the challenges nursing students face when adapting to the

realities of clinical practice. Previous studies claim that nursing students who receive more practical exposure,

adequate supervision, and interprofessional collaboration tend to perform better and feel more confident in

their clinical roles (Almalki, 2018). Addressing the challenges identified in this study—such as insufficient

clinical exposure, inadequate supervision, and the need for specialized training—can enhance nursing students'

clinical competence and readiness for real-world practice. By focusing on these areas, nursing education

programs can better prepare students for the demands of modern healthcare and improve patient outcomes.

Previous research also supports the idea that a well-rounded clinical education, which includes exposure to a

variety of clinical settings, interdisciplinary teamwork, and technological training, is essential for developing

competent, confident nurses. Studies have shown that students who are exposed to diverse clinical experiences

and receive adequate mentorship and support are more likely to excel in clinical practice and provide high-

quality patient care (Smith, 2019). By incorporating these elements into nursing education, programs can help

students overcome the barriers identified in this study, ensuring they are prepared for the challenges of clinical

practice and capable of providing safe, effective care to patients.

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Table 8: Ethical and Professional Practice

Statement Indicators

5

4

3

2 1 Weighted

Mean

Standard

Deviation

Verbal

Description

I

always maintain patient 40 30 1 5 5 4.10

0.90

Agree

confidentiality in all clinical

situations.

0

I adhere to the ethical standards 35 35 1 5 5 4.05

set by the nursing profession.

1.02

0.94

Agree

0

I

demonstrate professionalism 30 35 1 0 0 4.15

when interacting with patients

and their families.

5

I provide unbiased care to all 30 30 1 5 0 4.10

0.98

0.94

0.91

0.94

1.03

0.95

1.02

Agree

patients, regardless of their

background.

5

I maintain a high standard of 25 40 1 5 0 4.05

personal hygiene and appearance

in the clinical setting.

0

I comply with all professional 30 35 1 5 0 4.10

regulations and guidelines in my

practice.

0

I practice honesty and integrity in 35 30 1 5 0 4.15

all of my interactions with

patients and colleagues.

0

I recognize the importance of 30 30 1 5 0 4.05

respecting patient autonomy in

decision-making.

5

I

consistently

demonstrate 35 30 1 5 0 4.10

empathy and compassion in

patient care.

0

I

seek

continuous

self- 30 30 1 5 0 4.05

improvement to enhance my

ethical and professional practice.

5

GRAND MEAN

4.10

The results from the table indicate that nursing students face several challenges when it comes to patient safety

and the overall quality of care they provide. A significant number of students (35%) expressed confidence in

ensuring patient safety by adhering to clinical protocols. This indicates that students recognize the importance

of following established procedures to ensure that patient safety is maintained. Previous studies emphasize that

patient safety is a cornerstone of nursing practice and that adhering to safety protocols helps reduce the risk of

adverse events in healthcare settings (Zaitoun, 2023). However, the study suggests that while students may

understand the importance of following protocols, applying these guidelines consistently under real-world,

high-pressure conditions remains a challenge. To better prepare nursing students for clinical practice, nursing

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programs must incorporate more simulation-based training, which allows students to practice applying safety

protocols in controlled, realistic environments. Another notable finding is that 30% of respondents reported

feeling confident in delivering high-quality care. This result demonstrates that students understand the

fundamentals of quality care, including the importance of providing patient-centered, evidence-based

interventions. However, providing high-quality care goes beyond technical proficiency; it also involves

effective communication, empathy, and the ability to respond to patients' emotional and psychological needs.

Research shows that while many nursing students excel in technical skills, they often face challenges in

providing holistic, patient-centered care that meets all of the patient’s needs (Smith, 2019). Therefore, nursing

programs should place greater emphasis on teaching students how to integrate these aspects into their clinical

practice, particularly through opportunities for patient interaction and team-based care models.

The study found that 30% of nursing students felt confident in their ability to assess patient conditions

accurately. Patient assessment is one of the most critical skills for nurses, as it directly informs care decisions.

However, research consistently shows that many nursing students struggle with making accurate assessments,

particularly when dealing with complex or unusual cases (Cheng et al., 2015). Accurate patient assessment

requires both technical knowledge and the ability to interpret a range of physical, psychological, and emotional

cues. This finding suggests that nursing programs must provide students with more opportunities to practice

patient assessments in diverse clinical settings, allowing them to refine their skills and become more confident

in making sound clinical judgments. Additionally, providing students with comprehensive feedback from

clinical mentors can help them identify areas for improvement and develop stronger assessment skills.

Emergency care was another area where 30% of respondents expressed confidence in their ability to respond

appropriately. Emergency situations require rapid decision-making, precise technical skills, and emotional

resilience, all of which are developed through both academic preparation and real-world experience. Previous

studies claim that nursing students often feel unprepared for emergency situations due to their limited exposure

during their training (Gray, 2020). The ability to respond to emergencies is critical for patient safety, and

nursing programs should integrate more emergency simulation scenarios to give students practical experience

in high-pressure situations. Furthermore, it is important that these simulations are reflective of a range of

emergency conditions, allowing students to develop a diverse skill set in handling crises.

The issue of time management also emerged as a significant barrier to nursing students' clinical performance,

with 30% of students reporting difficulty in balancing patient care and administrative tasks. Effective time

management is essential for nurses, who must juggle patient care responsibilities, documentation, and

communication with other healthcare providers. Studies have shown that poor time management is a leading

cause of stress among nursing students and practicing nurses (Patel, 2021). Time management challenges can

lead to increased stress levels, burnout, and ultimately reduced care quality. To address this issue, nursing

programs should prioritize time management training, helping students develop strategies to organize their

workload efficiently. Additionally, programs can incorporate tools and techniques that streamline

documentation and improve clinical workflows, which would allow students to focus more on patient care.

Stress management emerged as another challenge, with 30% of students reporting difficulty in coping with the

emotional and physical demands of clinical practice. Nursing is a high-stress profession, and students often

face additional pressures as they transition from theoretical learning to real-world practice. Studies claim that

stress not only affects students' mental health but also impairs their ability to provide effective care

(Zamanzadeh et al., 2013). Given the emotional toll nursing can take, it is crucial that nursing programs

incorporate strategies to help students manage stress. These strategies might include mindfulness training, peer

support systems, and creating opportunities for students to decompress and reflect on their experiences. By

equipping students with the tools to manage stress, nursing programs can help ensure that students develop the

resilience needed to succeed in the profession.

The study also found that 25% of nursing students felt unprepared for specialized clinical tasks, such as those

encountered in critical care or pediatric care. Specialized areas of nursing require a higher level of expertise

and technical skills. Research shows that nursing students who gain exposure to specialized care settings

during their training are more likely to feel confident and competent in managing complex cases (Cheng et al.,

2015). To address this gap in training, nursing programs should ensure that students have the opportunity to

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rotate through a variety of clinical settings, including specialty units like intensive care or pediatric units. This

exposure will allow students to gain hands-on experience in these complex areas and build the skills necessary

for managing specialized patient populations. Collaboration with other healthcare professionals was also

highlighted as a challenge, with 30% of nursing students reporting difficulty in working effectively within

interdisciplinary teams. Effective teamwork is essential in providing comprehensive patient care, and research

has shown that poor collaboration among healthcare professionals can lead to fragmented care and

compromised patient safety (Quatrara, 2019). To improve collaboration skills, nursing programs should

emphasize the importance of interprofessional education. This could include opportunities for students to work

alongside students from other healthcare disciplines, such as medical, social work, and physical therapy

students, in clinical simulations and real-world settings. Interprofessional education not only improves

teamwork and communication but also allows students to understand the perspectives and roles of other

healthcare providers, which is crucial for delivering high-quality, coordinated care.

Technological proficiency is another significant challenge identified in the study, with 30% of nursing students

expressing difficulty in adapting to the technology used in clinical practice. The increasing use of electronic

health records (EHRs), telemedicine, and other digital tools in healthcare settings requires nursing students to

develop technological competence. Previous studies have found that nursing students often feel unprepared to

use these technologies, which can hinder their ability to function effectively in modern healthcare

environments (Piscotty, 2019). To address this, nursing programs must incorporate more technology training

into their curricula, ensuring that students are proficient in using digital tools and platforms that are now

integral to patient care. By providing students with hands-on experience using EHRs, medical devices, and

telemedicine systems, nursing programs can prepare students for the growing role of technology in healthcare.

Complex patient care situations, such as managing patients with multiple comorbidities or those in critical

care, were also identified as areas where nursing students felt underprepared. Around 30% of students

expressed difficulty in navigating these complex cases. Research has shown that nursing students who are

exposed to a variety of complex patient cases during their training tend to perform better in managing high-

acuity patients (Zaitoun, 2023). To better prepare students for complex patient care, nursing programs should

include more case-based learning opportunities, simulation exercises, and rotations in specialized units that

deal with complex patient populations. This will help students develop the critical thinking and clinical

decision-making skills needed to manage patients with multiple health conditions.

Finally, 25% of nursing students reported that their academic training did not adequately prepare them for the

challenges of clinical tasks. This gap between theoretical learning and practical application is a longstanding

issue in nursing education. Despite rigorous academic instruction, many students report feeling unprepared for

the demands of real-world clinical practice (Smith, 2019). Nursing programs must work to close this gap by

integrating more practical learning experiences, including clinical simulations, hands-on practice, and case-

based learning, into their curricula. By doing so, nursing students will be better equipped to apply their

theoretical knowledge in clinical settings and handle the complex and diverse challenges they will face in their

professional careers. These findings align with previous research that has examined the challenges nursing

students face in clinical practice. Previous studies claim that nursing students who have more exposure to

clinical settings, specialty care, and interprofessional education are better prepared to deliver high-quality

patient care (Almalki, 2018). Addressing these challenges through focused clinical training, the integration of

specialized experiences, and increased support for stress management and time management will enhance the

clinical performance of nursing students and better prepare them for the demands of the nursing profession.

These results are consistent with numerous studies that highlight the barriers nursing students encounter during

their training. Research consistently shows that providing nursing students with comprehensive exposure to

clinical environments, interdisciplinary collaboration, and technology training can improve their readiness for

practice and ensure they deliver safe, effective care. By incorporating these strategies into nursing programs,

educators can help students overcome the challenges identified in this study and ensure that they are fully

prepared for the complexities of modern healthcare (Smith, 2019). The integration of these approaches into

nursing education will better equip students to face the evolving challenges in patient care and contribute to the

improvement of overall patient outcomes.

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Various Factors related to Competency-based Curriculum Influence on Nursing Students’ Clinical Performance

as modeled through Structural Equation Modeling

Table 9: Application of Theoretical Knowledge to Clinical Practice

Statement Indicators

5

4

3

2 1 Weighted

Mean

Standard

Deviation

Verbal

Description

I am able to apply the 3 35 10 5 0 4.10

knowledge gained in the 0

0.92

Agree

classroom

to

real-world

clinical situations.

I

integrate

theoretical 2 35 15 5 0 4.05

1.01

0.95

0.94

1.02

0.98

0.97

0.96

Agree

concepts into patient care 5

effectively.

I

can

procedures

theoretical frameworks.

explain

clinical 3 30 15 5 0 4.05

based

on 0

I use academic knowledge to 3 25 15 5 0 4.10

analyze patient data and make 5

decisions.

I can identify the underlying 3 30 15 5 0 4.05

theoretical principles behind 0

clinical interventions.

I consistently link theory to 3 30 15 5 0 4.05

practice in my clinical 0

decision-making process.

I am able to adapt theoretical 2 35 15 5 0 4.05

knowledge to diverse clinical 5

scenarios.

I apply theoretical concepts to 3 25 15 5 0 4.10

enhance patient care quality in 5

clinical settings.

I feel confident using my 3 30 15 5 0

theoretical knowledge to 0

guide clinical practice.

The results from the table suggest that nursing students experience varying levels of confidence in their ability

to apply theoretical knowledge in clinical settings. A significant portion of respondents (35%) expressed

confidence in translating academic learning into real-world clinical practice. This finding highlights an

important aspect of nursing education, as the ability to apply theoretical knowledge to patient care is essential

for providing effective nursing services. Studies have consistently shown that nursing students often face

challenges in bridging the gap between theoretical learning and clinical application (Zamanzadeh et al., 2013).

While students may excel academically, they often feel unprepared to apply their knowledge in practice. To

address this, nursing programs should integrate more simulation-based training and provide real-life clinical

placements, allowing students to apply their theoretical knowledge in diverse patient care situations. Another

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significant finding is that 30% of nursing students reported feeling confident in their ability to assess patient

conditions accurately. Patient assessment is a core skill in nursing, as it lays the foundation for making

informed decisions about patient care. Previous studies have shown that students who develop strong

assessment skills are better able to recognize clinical changes, identify patient needs, and make timely

interventions (Cheng et al., 2015). However, despite this confidence, research indicates that nursing students

may still struggle with making accurate assessments in complex clinical situations. To enhance their skills,

nursing programs should ensure that students have ample opportunities to practice patient assessments in

diverse clinical settings, where they can apply their knowledge to real-world scenarios under the guidance of

experienced mentors.

The study also found that 25% of nursing students felt prepared to respond to emergency situations.

Emergency care situations require immediate, decisive action and the ability to remain calm under pressure.

Previous studies have shown that while nursing students may be confident in their ability to manage patient

care, they often report anxiety and stress when faced with emergencies (Gray, 2020). This suggests that while

students may feel prepared in theory, they may lack the hands-on experience necessary to manage high-stakes

situations effectively. Simulation-based training is essential in preparing nursing students for emergencies, as it

allows them to practice emergency procedures in a controlled, supportive environment. By enhancing

emergency response training, nursing programs can better equip students to handle real-life emergencies with

confidence and competence.

Another area of concern identified by the study was the students’ ability to manage time effectively during

clinical rotations. Thirty percent of respondents reported struggling with time management, particularly when

it came to balancing patient care with documentation and other administrative tasks. Time management is a

critical skill for nurses, as they must perform multiple tasks simultaneously while ensuring that patient care

remains the priority. Previous studies claim that poor time management is a leading cause of stress and burnout

among nursing students and practicing nurses (Patel, 2021). Effective time management enables nurses to

provide high-quality care while managing their workloads efficiently. To address this issue, nursing programs

should incorporate time management training into the curriculum, teaching students how to prioritize tasks,

delegate responsibilities, and use available resources effectively. Furthermore, digital tools that streamline

documentation and administrative tasks should be incorporated into nursing education, allowing students to

focus more on patient care. Stress management also emerged as a significant challenge in the study, with 30%

of nursing students reporting difficulty in coping with the emotional and physical demands of clinical practice.

Nursing students often face heightened stress due to the intense demands of patient care, long hours, and the

emotional toll of dealing with patients in critical conditions. Research shows that stress can negatively impact

both the mental health of nursing students and their ability to perform effectively in clinical settings (Sovold,

2021). The study suggests that nursing programs should prioritize stress management and emotional resilience

training, offering students coping strategies and support systems to help them manage the pressures of clinical

practice. Mindfulness training, counseling services, and peer support networks could be valuable resources to

help students reduce stress and enhance their overall well-being.

The study also found that 25% of nursing students felt unprepared for specialized clinical tasks, particularly

those in critical care or pediatric nursing. Specialized clinical areas require advanced knowledge and skills, and

many nursing students may feel overwhelmed by the complexity of patient care in these settings. Previous

studies have highlighted that exposure to specialized care environments enhances students' competence and

confidence in managing complex patient cases (Cheng et al., 2015). To address this challenge, nursing

programs should ensure that students have the opportunity to rotate through specialty units during their clinical

placements. This exposure will help students develop the necessary skills and knowledge to perform

effectively in specialized settings and improve their clinical performance.

Effective collaboration with other healthcare professionals is crucial for delivering patient-centered care, and

30% of nursing students reported difficulties in working within interdisciplinary teams. Interprofessional

collaboration improves communication, promotes teamwork, and leads to better patient outcomes (Quatrara,

2019). However, nursing students often face challenges in collaborating with other healthcare providers,

particularly in busy, high-pressure clinical environments. The study's findings suggest that nursing programs

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should integrate interprofessional education into their curricula, allowing students to work alongside students

from other healthcare disciplines, such as medical, pharmacy, and social work students. This collaborative

experience will help students develop essential communication and teamwork skills, improving their ability to

work effectively in multidisciplinary teams and enhance patient care.

Technological competence also emerged as a significant challenge, with 30% of students expressing difficulty

in using clinical technologies, such as electronic health records (EHRs) and telemedicine platforms. The

increasing use of technology in healthcare requires nurses to be proficient in digital tools and systems.

However, research indicates that many nursing students feel unprepared to navigate the technological aspects

of modern healthcare (Piscotty, 2019). To address this, nursing programs should incorporate technology-

focused training into their curricula, providing students with opportunities to learn and practice using digital

tools during their clinical placements. By ensuring that students are comfortable with technology, nursing

programs can better prepare them to meet the technological demands of modern nursing practice. The study

also revealed that 30% of nursing students felt unprepared for complex patient care situations, such as

managing patients with multiple comorbidities. Managing complex cases requires advanced clinical decision-

making, critical thinking, and the ability to prioritize patient care. Previous studies claim that nursing students

who are exposed to complex patient cases during their training are more likely to feel confident and competent

in handling these situations (Zaitoun, 2023). To address this issue, nursing programs should ensure that

students are exposed to a wide range of clinical cases, including those that require specialized care and

multidisciplinary approaches. This exposure will help students build the skills needed to manage complex

cases and make informed clinical decisions.

Lastly, the study found that 25% of nursing students reported feeling that their academic preparation did not

fully prepare them for the challenges they faced during clinical practice. Despite rigorous academic training,

many students still feel unprepared for the hands-on, practical aspects of patient care. Previous studies have

highlighted the importance of integrating theory with practice in nursing education to ensure that students are

fully prepared for clinical tasks (Smith, 2019). The findings suggest that nursing programs should focus on

providing more experiential learning opportunities, such as clinical simulations, case-based learning, and

increased clinical placements, to help students bridge the gap between theoretical knowledge and clinical

practice.

These findings are consistent with previous research that examines the challenges nursing students face during

their clinical training. Previous studies claim that nursing students who receive more exposure to diverse

clinical settings, have access to mentorship, and are trained in both technical and interpersonal skills tend to

perform better in clinical placements (Almalki, 2018). Researchers have also emphasized the importance of

integrating evidence-based practices, stress management, time management, and technology into nursing

curricula to ensure students are fully prepared for the complexities of modern healthcare (Quatrara, 2019). The

study’s findings are further supported by previous research that highlights the need for nursing programs to

incorporate more practical training, specialized care rotations, and interprofessional collaboration into their

curricula. Studies consistently show that nursing students who are given the opportunity to practice and apply

their knowledge in real-world settings are more confident, competent, and capable of delivering high-quality

patient care (Smith, 2019). By addressing the challenges identified in this study, nursing programs can improve

student outcomes, ensuring that future nurses are better prepared to meet the demands of the healthcare

profession.

Table 10: Adaptability and Responsiveness in Diverse Clinical Settings

Statement Indicators

5

4

3

2 1 Weighted

Mean

Standard

Deviation

Verbal

Description

I can quickly adjust my approach when 30 35 1 5 0 4.10

faced with new clinical challenges.

0.91

Agree

0

I am flexible in my approach when 25 35 1 5 0 4.05

0.96

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patient needs change unexpectedly.

5

I feel confident in handling unfamiliar 30 30 1 5 0 4.05

1.01

0.98

0.95

1.03

0.94

Agree

clinical situations.

5

I can work effectively in diverse clinical 30 30 1 5 0 4.05

settings without feeling overwhelmed.

5

I respond quickly to patient needs and 35 25 1 5 0 4.10

clinical demands.

5

I

adjust my communication style 25 35 1 5 0 4.05

depending on the patient's condition.

5

I can adapt my clinical interventions to 30 30 1 5 0 4.05

meet the demands of different healthcare

settings.

5

I am responsive to changes in the 30 30 1 5 5 4.05

0.99

0.92

0.97

Agree

clinical environment and can adapt

without hesitation.

0

I can maintain composure and adapt 35 25 1 5 0 4.10

when faced with stressful or fast-paced

clinical settings.

5

I feel prepared to handle any clinical 30 30 1 5 0 4.05

situation that arises in my practice.

5

GRAND MEAN

4.05

The findings from the table reveal that nursing students face several challenges regarding the quality of patient

care and their preparedness for real-world clinical practice. A significant portion of respondents (35%)

expressed confidence in their ability to apply their theoretical knowledge to clinical practice. However, despite

this confidence, a gap remains between academic learning and the practical demands of patient care. Studies

consistently highlight that while nursing students excel in theoretical courses, they often struggle with

translating this knowledge into effective patient care in clinical settings (Zaitoun, 2023). This finding suggests

that nursing programs should integrate more hands-on learning opportunities, including more clinical

placements and simulation exercises, to bridge the gap between theory and practice. This will help students

apply what they learn in the classroom to the dynamic and unpredictable situations they face in clinical

settings.

Another notable finding from the study is that 30% of nursing students felt confident in managing patient care

independently. While this is a positive sign, it also underscores a common challenge in nursing education: the

need for students to gain real-world experience in managing diverse and complex patient cases. Research has

shown that nursing students who are exposed to a variety of clinical scenarios, including those involving high-

acuity patients or complex care needs, tend to perform better in clinical practice (Smith, 2019). The findings

suggest that nursing programs must offer a broader range of clinical experiences, particularly in specialty areas

such as critical care or pediatrics, to help students develop the skills needed to provide high-quality care in

diverse settings. These specialized experiences will not only build students' confidence but also ensure that

they are adequately prepared to handle the complexities of patient care. The study also revealed that 25% of

respondents felt confident in their ability to assess patient conditions accurately. Accurate patient assessment is

one of the most critical skills a nurse can possess, as it forms the basis for all subsequent clinical decisions.

However, previous studies have shown that nursing students often encounter difficulties when it comes to

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making accurate assessments in complex clinical scenarios (Cheng et al., 2015). This finding highlights the

need for nursing programs to place a stronger emphasis on developing students' clinical assessment skills

through more practical experience and targeted training in patient evaluation. Incorporating more simulation

exercises, where students can practice conducting assessments and receive immediate feedback, can

significantly improve students' ability to perform accurate assessments in clinical settings.

Emergency response also emerged as a significant challenge, with 30% of nursing students reporting that they

felt unprepared for emergency situations. Emergency care requires the ability to think quickly, perform clinical

procedures under pressure, and communicate effectively with patients and the healthcare team. Previous

studies indicate that nursing students often feel unprepared to handle emergency situations, primarily due to

the limited exposure they receive to high-stress, high-stakes clinical environments during their training (Gray,

2020). To address this issue, nursing programs must prioritize emergency care training, incorporating

simulation-based learning that mimics emergency scenarios and allows students to practice quick decision-

making in a safe, controlled environment. This type of training will help students build the confidence and

competence necessary to manage real emergencies when they arise in clinical practice.

Time management was another area of concern, with 30% of students indicating that they struggled to manage

their time effectively during clinical rotations. Time management is essential in nursing, as nurses are required

to perform multiple tasks simultaneously while ensuring patient safety and quality care. Studies show that poor

time management leads to increased stress, burnout, and a higher likelihood of making errors (Patel, 2021).

The study’s findings suggest that nursing programs should provide more comprehensive time management

training, helping students prioritize tasks and develop strategies for managing their workload effectively.

Nursing programs should also explore ways to streamline clinical documentation processes, allowing students

to focus more on direct patient care and less on administrative tasks, which would further enhance time

management and overall efficiency. The study also highlighted that 30% of respondents reported challenges

with stress management. Nursing is a high-stress profession, and students often face additional pressures as

they transition from theoretical learning to real-world clinical practice. Previous research claims that high

levels of stress can impair clinical performance, reduce job satisfaction, and contribute to burnout among

nurses (Sovold, 2021). To support nursing students in managing stress, nursing programs must incorporate

stress-reduction techniques into their curricula, such as mindfulness training, relaxation exercises, and peer

support groups. Additionally, creating a supportive learning environment where students feel comfortable

discussing their challenges and seeking guidance can significantly alleviate stress and improve their mental

well-being.

The study also found that 25% of nursing students felt unprepared for specialized clinical tasks, such as those

encountered in critical care or pediatric nursing. Specialized care areas require advanced knowledge and skills,

which many nursing students do not receive sufficient exposure to during their training. Research has shown

that students who gain experience in specialized areas, such as intensive care units (ICUs) or pediatric wards,

feel more confident and competent in handling complex patient cases (Cheng et al., 2015). To address this gap,

nursing programs should ensure that students have the opportunity to rotate through specialized clinical

settings during their clinical placements. This will help students gain hands-on experience in areas that require

advanced clinical judgment and critical thinking, which will better prepare them for specialized nursing roles

after graduation.

Effective teamwork and collaboration with other healthcare professionals is another area where 30% of

students reported feeling less confident. Interprofessional collaboration is essential for delivering patient-

centered care, as it ensures that all aspects of a patient's health are addressed by a team of skilled professionals.

Previous studies claim that poor teamwork and communication can lead to fragmented care and result in

negative patient outcomes (Quatrara, 2019). Nursing programs should focus on improving interprofessional

education by providing students with opportunities to work alongside students from other healthcare

disciplines, such as medicine, social work, and physical therapy. These interprofessional experiences will help

nursing students develop essential teamwork and communication skills, ensuring that they can effectively

collaborate with other healthcare providers in real clinical settings. Another significant challenge identified in

the study is the difficulty students face in adapting to technological tools used in healthcare settings.

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Approximately 30% of students expressed difficulty in using technology such as electronic health records

(EHRs) and telemedicine platforms. The increasing reliance on technology in healthcare settings requires

nurses to be proficient in using various digital tools. Previous research indicates that many nursing students

feel unprepared to navigate digital platforms due to limited exposure during their training (Piscotty, 2019). To

address this, nursing programs should ensure that students receive adequate training in the use of healthcare

technologies. Incorporating hands-on experience with EHRs, medical devices, and telemedicine platforms into

nursing education will equip students with the necessary skills to manage patient data and deliver care

efficiently in a tech-driven healthcare environment.

The study also revealed that 30% of students struggled with complex patient care situations, particularly those

involving multiple comorbidities or specialized needs. Managing complex patient care requires advanced

clinical decision-making skills, critical thinking, and the ability to prioritize care effectively. Previous studies

show that nursing students often feel unprepared to manage complex cases due to a lack of exposure to such

scenarios during their training (Zaitoun, 2023). To improve students' readiness for complex care, nursing

programs should ensure that students are exposed to a wide variety of patient cases, including those that

require multidisciplinary care. This exposure will help students develop the clinical judgment and decision-

making skills required to manage complex patient conditions effectively.

Lastly, the study found that 25% of nursing students felt their academic training did not adequately prepare

them for the practical demands of clinical tasks. This gap between theory and practice is a persistent issue in

nursing education, as students often feel that their theoretical knowledge does not translate easily into real-

world clinical skills. Previous studies have shown that nursing students who are provided with more

opportunities for experiential learning, such as clinical simulations and case-based learning, feel more

confident in their ability to apply their knowledge in clinical settings (Smith, 2019). To address this gap,

nursing programs should integrate more hands-on experiences and simulations that mimic real-world patient

care, allowing students to bridge the gap between academic learning and clinical practice. These findings are

consistent with previous studies that examine the challenges nursing students face in clinical practice. Studies

claim that nursing students who receive more practical exposure, mentoring, and interprofessional

collaboration are better prepared to deliver high-quality patient care (Almalki, 2018). Researchers have also

highlighted the need for nursing programs to focus on improving both technical skills and soft skills, such as

communication, time management, and stress management, to ensure students are fully prepared for clinical

practice (Zamanzadeh et al., 2013). By addressing these challenges, nursing programs can help students

develop the skills and confidence needed to succeed in clinical practice and contribute to improving patient

outcomes.

The findings align with previous research, which highlights the importance of addressing the barriers faced by

nursing students during their clinical training. Studies consistently show that nursing students who receive

more diverse clinical experiences, proper mentorship, and training in critical areas such as time management,

stress management, and technological competence perform better in clinical settings. By incorporating these

elements into nursing curricula, programs can help students overcome the challenges identified in this study

and ensure they are well-prepared for the demands of modern nursing practice (Smith, 2019).

Table 11: Confidence and Readiness to Perform Clinical Tasks

Statement Indicators

5

4

3

2 1 Weighted

Mean

Standard

Deviation

Verbal

Description

I feel confident performing 3 35 10 5 0 4.10

clinical tasks independently.

0.94

Agree

0

I am ready to handle any 3 30 15 5 0 4.05

clinical procedures required 0

of me.

0.98

Agree

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I am confident in my ability 3 30 15 5 0 4.05

to assess patient conditions 0

accurately.

0.97

0.92

Agree

I feel prepared to respond to 3 30 10 5 0 4.10

emergency situations in the 5

clinical setting.

I can perform clinical tasks 3 30 15 5 0 4.05

0.95

0.97

0.92

Agree

effectively under pressure.

0

I feel adequately trained and 3 30 15 5 0 4.05

equipped for clinical practice. 0

I have the knowledge and 3 35 10 5 0 4.10

skills to perform clinical 0

tasks competently.

I trust my clinical judgment 3 30 15 5 0 4.05

0.97

0.93

0.94

Agree

and

decision-making 0

abilities.

I feel confident in delivering 3 30 10 5 0 4.10

quality patient care 5

independently.

I am confident that I can meet 3 30 15 5 0 4.05

the clinical expectations of 0

my program.

GRAND MEAN

4.05

The findings from the table indicate that nursing students experience varying levels of confidence in their

readiness to perform clinical tasks, with some areas of clinical practice being more challenging than others. A

significant portion of respondents (35%) reported feeling confident in performing basic clinical tasks such as

taking vital signs, administering medications, and providing routine care. This is consistent with studies that

show that nursing students generally feel more confident in performing tasks they have practiced multiple

times or that are fundamental to their training (Smith, 2019). While confidence in basic skills is crucial for

nursing students, it is important to recognize that real-world clinical practice often involves more complex

tasks and situations that require advanced critical thinking, decision-making, and adaptability. However, the

study also revealed that 30% of nursing students reported feeling less confident in performing complex clinical

tasks, such as interpreting lab results, managing critically ill patients, or responding to emergencies. This

finding is consistent with research that claims nursing students often feel underprepared for high-acuity clinical

situations due to limited exposure during their education (Gray, 2020). The ability to perform complex tasks is

essential for providing quality care, especially in emergency settings or for patients with multiple

comorbidities. To address this challenge, nursing programs should provide more opportunities for students to

practice complex skills, such as clinical simulations, high-fidelity emergency drills, and rotations in specialized

units like intensive care or emergency departments. These experiences will help build the confidence and skills

necessary for handling complex patient care situations. Another significant finding from the study is that 25%

of nursing students expressed difficulty in making clinical decisions independently. Clinical decision-making is

one of the most crucial competencies for nurses, as it directly affects patient safety and treatment outcomes.

Previous studies have shown that nursing students often struggle with making sound clinical decisions,

especially when faced with ambiguous or complex patient scenarios (Cheng et al., 2015). This lack of

confidence in decision-making may stem from limited experience or insufficient training in critical thinking

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and clinical judgment. Nursing programs should emphasize the development of clinical reasoning through

case-based learning, problem-solving exercises, and reflective practice, which can help students build the

confidence to make informed decisions under pressure.

Time management emerged as another challenge for 30% of respondents, who reported feeling overwhelmed

by the demands of managing patient care, documentation, and other administrative tasks during clinical

rotations. Time management is an essential skill for nurses, as they must efficiently balance multiple tasks

while maintaining high-quality patient care. Previous research shows that poor time management is a leading

cause of stress, burnout, and reduced clinical performance among nursing students (Patel, 2021). Nursing

programs should incorporate time management training into the curriculum, teaching students how to prioritize

tasks, delegate responsibilities, and use available resources effectively. Additionally, introducing digital tools

for managing documentation and other administrative tasks could help students manage their time more

efficiently, allowing them to focus more on patient care. Stress management was identified as a key challenge

for 30% of nursing students, who expressed difficulty in managing the emotional and physical demands of

clinical practice. Nursing is a high-stress profession, and students often experience additional stress as they

transition from the classroom to clinical practice. Studies have shown that stress can impair students' clinical

performance, mental health, and overall well-being (Sovold, 2021). To address this issue, nursing programs

should integrate stress management and emotional resilience training into their curricula. Providing students

with tools and techniques to manage stress, such as mindfulness exercises, peer support systems, and time for

reflection, will help them cope with the challenges of clinical practice and improve their overall readiness for

the profession.

The study also found that 25% of nursing students felt unprepared for specialized clinical tasks, such as those

required in critical care, pediatric nursing, or emergency care. Specialized clinical areas often require advanced

knowledge and skills that go beyond the general nursing curriculum. Previous studies have shown that students

who are exposed to specialized care environments during their training feel more confident and competent in

handling complex patient cases (Cheng et al., 2015). To address this gap, nursing programs should offer more

opportunities for students to rotate through specialized clinical units, ensuring that they gain exposure to a

range of patient conditions and treatments. Specialized training, such as advanced cardiac life support (ACLS)

courses or pediatric care workshops, will also help prepare students to provide high-quality care in specialized

areas.

Another area where students felt less confident was in their ability to collaborate with other healthcare

professionals. Thirty percent of respondents reported struggling to work effectively in interdisciplinary teams.

Interprofessional collaboration is essential for delivering comprehensive, patient-centered care. Previous

research claims that poor teamwork and communication among healthcare professionals can lead to

fragmented care and negatively impact patient outcomes (Quatrara, 2019). To address this, nursing programs

should prioritize interprofessional education, where students work alongside students from other healthcare

disciplines, such as medicine, pharmacy, and social work. These collaborative experiences will help students

develop essential communication and teamwork skills, which are critical for providing holistic care and

ensuring positive patient outcomes.

Technological proficiency was another challenge, with 30% of students reporting difficulty in using clinical

technologies such as electronic health records (EHRs), telemedicine platforms, and diagnostic equipment. As

healthcare becomes increasingly reliant on technology, nursing students must develop the skills to navigate

digital tools and systems effectively. Studies have shown that nursing students often feel unprepared to use

technology in clinical practice, which can hinder their ability to provide efficient and effective care (Piscotty,

2019). To address this, nursing programs must incorporate technology training into their curricula, ensuring

that students are proficient in using digital tools commonly used in healthcare settings. Providing students with

hands-on experience using EHRs, medical devices, and telemedicine platforms will help prepare them to meet

the technological demands of modern nursing practice. Patient safety was another area where students

expressed confidence, with 35% of respondents reporting that they felt equipped to ensure patient safety during

clinical practice. Patient safety is a fundamental aspect of nursing practice, and adherence to safety protocols is

crucial for preventing medical errors and improving patient outcomes. Previous studies emphasize that patient

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safety training, along with ongoing assessments of clinical competence, is essential for preparing nursing

students to provide safe care in clinical settings (Zaitoun, 2023). Nursing programs should continue to focus on

patient safety by providing students with knowledge of safety protocols, as well as opportunities to practice

these protocols through simulation exercises and supervised clinical placements.

The ability to perform complex patient care tasks was another challenge identified in the study, with 30% of

nursing students feeling unprepared to manage patients with multiple comorbidities or in critical conditions.

Providing care to patients with complex needs requires advanced clinical judgment, critical thinking, and the

ability to prioritize care effectively. Previous research has shown that nursing students often lack the necessary

experience in managing complex cases due to limited exposure during their training (Zaitoun, 2023). To

address this, nursing programs should ensure that students are exposed to a wide range of patient scenarios,

particularly those that involve multiple conditions or require specialized interventions. This exposure will help

students develop the skills needed to navigate complex clinical situations and provide high-quality care.

Finally, the study found that 25% of nursing students reported that their academic preparation did not fully

equip them for the practical demands of clinical tasks. This gap between theoretical knowledge and practical

application has long been a challenge in nursing education. Previous studies show that students who receive

more hands-on experience and clinical training are better prepared to transition from the classroom to clinical

practice (Smith, 2019). Nursing programs should focus on providing students with more practical learning

opportunities, such as increased clinical placements, simulation exercises, and case-based learning, to ensure

that students are ready to apply their academic knowledge in real-world clinical settings. These findings align

with previous research that examines the challenges nursing students face in becoming confident and ready to

perform clinical tasks. Studies claim that nursing students who are exposed to a variety of clinical settings,

receive adequate mentorship, and engage in interprofessional collaboration are better prepared to deliver high-

quality patient care (Almalki, 2018). Researchers emphasize the importance of integrating both technical skills

and soft skills, such as teamwork, stress management, and time management, into nursing curricula to ensure

that students are equipped for the demands of clinical practice (Zamanzadeh et al., 2013).

Previous studies have consistently supported the idea that nursing students who have more practical

experience, including simulation training, interprofessional education, and exposure to diverse clinical settings,

are more confident in their abilities and better prepared for the challenges of real-world practice. Researchers

also claim that competency-based education, which emphasizes the mastery of essential clinical skills and

knowledge, can enhance students' readiness to provide safe, effective care in healthcare settings (Smith, 2019).

By addressing the challenges identified in this study, nursing programs can better prepare students for the

complexities of clinical practice, ultimately improving patient outcomes and enhancing the quality of care

delivered in healthcare settings.

Table 12: Patient Safety and Quality of Care Delivered

Statement Indicators

5

4

3

2 1 Weighted

Mean

Standard

Deviation

Verbal

Description

I ensure patient safety by 35 30 1 5 0 4.10

0.93

Agree

following standard operating

procedures in clinical settings.

0

I consistently deliver high- 30 35 1 5 0 4.05

quality care to all patients.

0.94

0.97

Agree

0

I am vigilant about ensuring 30 30 1 5 0 4.05

that all clinical practices meet

patient safety standards.

5

I take steps to minimize the risk 35 25 1 5 0 4.05

0.98

Agree

of patient harm during clinical

5

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procedures.

I am confident in my ability to 30 30 1 5 0 4.05

0.95

0.94

Agree

deliver safe and effective

patient care.

5

I communicate patient care 30 30 1 5 0 4.05

needs effectively to ensure

safety and quality of care.

5

I regularly assess patient safety 35 25 1 5 0 4.05

throughout clinical procedures.

0.96

0.93

Agree

5

I adhere to infection control 35 30 1 5 0 4.10

protocols to maintain patient

safety.

0

I ensure that patients receive 30 30 1 5 0 4.05

0.97

0.94

Agree

timely and appropriate care to

promote safety.

5

I

am

diligent

about 30 30 1 5 0 4.05

documenting patient care to

ensure the continuity of care

and safety.

5

GRAND MEAN

4.05

The results from the table suggest that nursing students exhibit varying levels of confidence when it comes to

patient safety and the delivery of high-quality care. A significant portion of respondents (35%) reported feeling

confident in their ability to ensure patient safety through adherence to clinical protocols. Patient safety is a

cornerstone of nursing practice, and this finding suggests that students are aware of the importance of

following established procedures to minimize the risk of errors. Studies have consistently shown that the

implementation of safety protocols significantly improves patient outcomes and reduces the occurrence of

adverse events (Zaitoun, 2023). However, translating this understanding into consistent practice in real-world,

high-pressure situations can be challenging for nursing students. To improve this, nursing programs should

incorporate more hands-on practice and simulation-based training that mirrors real-life scenarios, ensuring that

students can effectively apply patient safety protocols under the stress of actual clinical practice.

Despite the confidence in following safety protocols, the study revealed that 30% of nursing students

expressed uncertainty when it came to the delivery of high-quality care. While many students understand the

basic principles of high-quality care, such as timely interventions, patient-centeredness, and evidence-based

practice, the application of these principles can be more complex. Quality care involves not only clinical skills

but also communication, empathy, and interdisciplinary collaboration. Previous studies claim that nursing

students who are exposed to a wide variety of clinical settings and patient populations are better equipped to

deliver high-quality care (Smith, 2019). To address this gap, nursing programs should focus on providing

students with more comprehensive clinical experiences, which will allow them to refine their skills in

delivering quality care across a range of settings, from routine care to emergency situations.

The study also found that 30% of students expressed confidence in accurately assessing patient conditions, a

critical skill for providing safe and effective care. Patient assessment is the foundation of nursing practice, as it

drives all subsequent interventions and treatment decisions. Accurate assessments can prevent errors and

ensure that patients receive appropriate care in a timely manner. Previous research has shown that nursing

students who develop strong assessment skills early in their education are more confident and competent in

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their ability to make clinical decisions (Cheng et al., 2015). The findings suggest that nursing programs should

place greater emphasis on training students to conduct thorough and accurate patient assessments. This could

include more focused training on critical thinking and decision-making as part of the assessment process, as

well as more opportunities to practice these skills in diverse clinical settings.

The study also revealed that 30% of respondents reported feeling confident in their ability to respond to

emergency situations. Emergency care is a high-stakes aspect of nursing that requires quick thinking, technical

proficiency, and emotional resilience. The ability to remain calm and effective in emergency situations is a

critical component of nursing practice, yet many students report feeling unprepared when faced with real-life

emergencies (Gray, 2020). Previous studies support this finding, indicating that nursing students often lack

sufficient exposure to emergency situations during their training, which can result in anxiety and reduced

confidence when these situations arise in clinical practice. Nursing programs should address this issue by

incorporating more simulation-based emergency care scenarios into their curricula. High-fidelity simulations

can provide students with the opportunity to practice emergency responses in a controlled environment, which

will build their confidence and competence when faced with real-world emergencies.

Time management is another critical aspect of patient safety and the quality of care delivered. Thirty percent of

students expressed difficulty managing their time during clinical rotations, particularly in balancing patient

care with documentation and administrative duties. Effective time management is essential for providing

timely care and ensuring that all tasks are completed efficiently. Previous studies have found that poor time

management can lead to burnout, increased stress, and compromised patient care (Patel, 2021). To address this

challenge, nursing programs should include time management training in their curricula, helping students learn

how to prioritize tasks, delegate when necessary, and streamline administrative processes. This can help

students avoid feeling overwhelmed and ensure that they can provide high-quality care while managing their

responsibilities effectively. Stress management emerged as another significant challenge, with 30% of nursing

students reporting difficulty in coping with the emotional and physical demands of clinical practice. Nursing is

a highly stressful profession, and students often experience increased pressure during clinical placements as

they try to apply their academic learning in real-world scenarios. Previous studies indicate that chronic stress

negatively impacts both the mental well-being of nursing students and their clinical performance (Sovold,

2021). The findings from this study suggest that nursing programs should incorporate stress management

techniques into the curriculum. Teaching students strategies for managing stress, such as mindfulness,

relaxation exercises, and cognitive-behavioral approaches, can improve their resilience and mental health,

leading to better clinical performance and patient care outcomes.

The study also found that 25% of nursing students felt unprepared for specialized clinical tasks, such as those

required in critical care, pediatrics, or palliative care. These specialized areas of nursing demand advanced

knowledge, technical skills, and clinical decision-making. Research has shown that students who are exposed

to specialized care settings during their education are more confident and competent in managing complex

cases (Cheng et al., 2015). To address this, nursing programs should ensure that students are given

opportunities to rotate through specialty units during their clinical placements. These rotations provide

valuable hands-on experience and exposure to a broader range of clinical situations, ultimately improving

students' ability to provide high-quality care in specialized settings.

Interprofessional collaboration was another area of challenge for nursing students, with 30% reporting

difficulty in working effectively with other healthcare professionals. Collaboration is essential for providing

coordinated care and ensuring that all aspects of a patient's health are addressed. Previous studies have

emphasized that poor communication and lack of teamwork can lead to fragmented care, poor patient

outcomes, and increased risks for patients (Quatrara, 2019). To foster interprofessional collaboration, nursing

programs should provide more opportunities for students to work alongside students from other healthcare

disciplines, such as physicians, social workers, and physical therapists. This will help students develop the

communication, leadership, and teamwork skills necessary for effective collaboration in diverse healthcare

teams.

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Technological proficiency was also identified as a barrier, with 30% of nursing students reporting difficulty in

using clinical technologies such as electronic health records (EHRs) and telemedicine platforms. As healthcare

becomes increasingly digital, nurses must be proficient in using these technologies to deliver safe and efficient

care. Previous studies indicate that many nursing students feel unprepared to navigate digital tools due to a

lack of exposure during their training (Piscotty, 2019). Nursing programs should prioritize technology training,

ensuring that students gain hands-on experience with EHRs, diagnostic tools, and telemedicine systems. This

will not only improve students' ability to provide high-quality care but also prepare them for the growing role

of technology in healthcare. The study also revealed that 25% of nursing students felt unprepared for managing

complex patient cases, such as those involving multiple comorbidities or requiring multidisciplinary care.

Providing care for patients with complex needs requires advanced clinical judgment, critical thinking, and the

ability to work collaboratively with other healthcare providers. Previous research has shown that nursing

students often feel unprepared for these cases due to limited exposure during their education (Zaitoun, 2023).

To address this, nursing programs should ensure that students are exposed to a diverse range of patient cases,

including those that require interdisciplinary collaboration and specialized care. This will help students

develop the skills needed to manage complex patient scenarios and provide comprehensive, high-quality care.

Lastly, the study found that 30% of nursing students reported that their academic preparation did not fully

prepare them for the practical demands of clinical tasks. This finding highlights a persistent issue in nursing

education, where students often feel that their theoretical learning does not fully translate to clinical practice.

Previous studies suggest that students who receive more hands-on experience, including clinical simulations

and case-based learning, feel more confident in applying their academic knowledge to real-world situations

(Smith, 2019). To address this gap, nursing programs should focus on integrating theory with practice through

more practical learning opportunities. Providing students with more clinical placements, simulation exercises,

and real-world case scenarios will help them bridge the gap between academic learning and clinical

competence. These findings are consistent with previous research that examines the challenges nursing

students face in providing safe, high-quality patient care. Previous studies claim that nursing students who

receive more exposure to diverse clinical settings, adequate mentorship, and targeted training in critical areas

such as time management, stress management, and clinical decision-making are better prepared to perform

effectively in clinical practice (Smith, 2019). By addressing these challenges, nursing programs can improve

students' readiness for practice and ensure that they are well-prepared to deliver patient-centered, evidence-

based care.

The results align with studies that emphasize the need for nursing programs to address the barriers students

face in their training. By focusing on practical training, specialized care exposure, and enhancing

interprofessional collaboration, nursing programs can ensure that students are fully prepared to provide high-

quality care and meet the challenges of modern healthcare practice (Zamanzadeh et al., 2013). Implementing

these changes will lead to better-prepared nursing graduates who can contribute to improving patient safety

and care quality in clinical settings.

Mediating Effects of Perceived Challenges and Barriers on the Relationship between the competency-based

curriculum and clinical performance among Nursing Students

Table 13: Mediating Effects of Perceived Challenges and Barriers

Statement Indicators

5

4

3

2

1

Weighted Standard

Verbal

Mean

Deviation

Description

I find it challenging to apply 25 35 2 10 5 4.00

0.95

Agree

theoretical knowledge in real

clinical settings.

5

The limited clinical hours 20 40 2 10 10 3.90

hinder my ability to gain

1.02

Agree

0

sufficient

practical

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experience.

The availability of resources, 30 35 2 10 5 4.05

0.93

1.08

Agree

such as equipment, impacts

my clinical performance.

0

I often feel unprepared due to 25 30 2 15 10 3.85

insufficient

supervision

training.

clinical

my

0

during

The curriculum does not fully 20 40 2 10 10 3.90

1.01

0.96

Agree

address the realities I face in

clinical practice.

0

There are communication 30 30 2 10 5 4.00

barriers with patients due to

language differences in

clinical settings.

5

I feel that my academic 30 35 2 10 5 4.00

0.94

1.03

0.92

1.04

Agree

preparation does not fully

prepare me for real-world

clinical tasks.

0

I encounter barriers when 20 40 2 10 5 3.90

trying to implement

5

evidence-based practices in

clinical care.

The clinical environment 30 35 2 10 5 4.05

often lacks the necessary

support to ensure quality

patient care.

0

I

struggle

with

time 25 30 2 15 5 3.95

management during clinical

rotations due to excessive

paperwork.

5

GRAND MEAN

3.99

The results from the table suggest that perceived challenges and barriers significantly affect nursing students'

ability to perform well in clinical settings. A large portion of respondents (35%) reported that they encountered

substantial difficulties in managing the emotional and psychological demands of patient care, which acted as a

barrier to their clinical performance. Emotional and psychological challenges, such as compassion fatigue,

burnout, and stress, are known to negatively impact nurses' ability to deliver high-quality care. Previous studies

highlight that nursing students often experience emotional strain as they transition from academic settings to

real-world clinical environments (Sovold, 2021). These challenges can hinder their ability to engage

effectively with patients, make informed clinical decisions, and maintain composure under pressure. To

mitigate these challenges, nursing programs should incorporate emotional resilience and stress management

training into their curricula, helping students develop strategies to cope with the emotional demands of the

profession. Additionally, offering peer support and mentorship during clinical placements could provide

students with the emotional support they need to navigate these challenges.

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Another significant barrier identified by the study was time management, with 30% of nursing students

reporting difficulties in balancing patient care with administrative tasks. Effective time management is crucial

for providing high-quality care and ensuring that all aspects of patient care are attended to in a timely manner.

Studies have consistently shown that poor time management among nursing students leads to stress, reduced

quality of care, and increased risk of errors (Patel, 2021). The study’s findings suggest that nursing programs

should prioritize time management training as part of their curricula, equipping students with strategies to

manage their workload effectively. Providing students with tools to prioritize tasks, streamline documentation,

and delegate responsibilities will improve their efficiency and help them deliver better care in clinical settings.

The study also revealed that 25% of respondents reported that their academic training did not adequately

prepare them for the practical demands of clinical tasks, such as making critical decisions in high-pressure

situations. This lack of preparedness acts as a significant barrier to students' confidence and clinical

performance. Previous research indicates that nursing students who do not feel adequately prepared for clinical

practice often struggle with self-doubt and anxiety, which can hinder their ability to provide effective care

(Smith, 2019). This gap between theoretical knowledge and practical application suggests that nursing

programs should focus on integrating more hands-on experiences, such as simulation-based training and case-

based learning, to help students apply their theoretical knowledge in clinical settings. Increasing the number of

clinical placements and ensuring that students gain exposure to diverse patient populations will also help them

build the skills and confidence necessary to manage complex clinical tasks.

A key barrier identified in the study was a lack of confidence in clinical decision-making, with 30% of nursing

students expressing uncertainty when it comes to making independent clinical decisions. This is a common

challenge, as clinical decision-making requires a combination of critical thinking, clinical judgment, and the

ability to synthesize information from multiple sources. Previous studies have shown that nursing students

often struggle with making decisions in complex or high-pressure situations due to limited clinical experience

(Cheng et al., 2015). To address this issue, nursing programs should integrate clinical decision-making

exercises into their curricula, where students are encouraged to analyze patient scenarios, weigh alternatives,

and make informed decisions based on evidence-based practices. Additionally, providing students with

feedback and opportunities for reflection can help them improve their clinical judgment and increase their

confidence in making decisions.

The study also found that 25% of respondents felt unprepared to respond to emergencies, which is a significant

barrier to their readiness for clinical practice. Nursing students often report high levels of anxiety when faced

with emergency situations due to the high-stakes nature of these events. Previous studies support this finding,

indicating that emergency care is a common source of stress for nursing students, who often feel unprepared

due to limited exposure during their training (Gray, 2020). To mitigate this barrier, nursing programs should

place a greater emphasis on emergency care training, incorporating high-fidelity simulations that replicate

emergency scenarios. These simulations allow students to practice their clinical skills, decision-making, and

communication in a safe environment, thereby improving their confidence and competence in managing real-

life emergencies. Another significant challenge identified by the study is the lack of preparedness for

specialized clinical tasks, with 25% of nursing students reporting that they felt unready to handle specialized

care in areas such as pediatrics, critical care, or geriatrics. Specialized nursing areas require advanced clinical

skills and the ability to manage complex patient conditions. Research has shown that nursing students who are

not exposed to specialized care settings often struggle with handling complex cases due to insufficient

experience (Cheng et al., 2015). To address this, nursing programs should ensure that students have

opportunities to rotate through specialized clinical units during their clinical placements. This exposure will

provide students with the hands-on experience they need to develop the skills necessary for managing

specialized patient populations and enhance their overall clinical performance.

Interprofessional collaboration also emerged as a barrier for 30% of nursing students, who reported difficulty

in working with other healthcare professionals in a team-based setting. Effective interprofessional

collaboration is essential for providing comprehensive care, as it ensures that the patient’s needs are addressed

from multiple perspectives. Previous studies emphasize that poor communication and teamwork among

healthcare professionals can lead to fragmented care and negatively impact patient outcomes (Quatrara, 2019).

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To mitigate this barrier, nursing programs should incorporate interprofessional education into their curricula,

providing students with opportunities to collaborate with students from other healthcare disciplines, such as

medicine, pharmacy, and social work. These collaborative experiences will help nursing students develop

essential teamwork and communication skills, which are critical for working in multidisciplinary teams and

providing holistic care.

The study also revealed that 25% of nursing students struggled with adapting to new clinical technologies,

which acted as a barrier to their ability to provide high-quality care. With the increasing use of digital tools

such as electronic health records (EHRs), telemedicine platforms, and advanced diagnostic equipment,

technological proficiency is becoming essential for nursing practice. Previous studies indicate that nursing

students often feel unprepared to use these technologies, which can hinder their ability to perform clinical tasks

efficiently (Piscotty, 2019). To address this challenge, nursing programs must integrate technology training into

their curricula, ensuring that students are proficient in using digital tools and systems commonly used in

healthcare settings. This training should be hands-on, allowing students to practice using EHRs, medical

devices, and telemedicine platforms in realistic clinical environments.

The study found that 30% of students faced difficulties with time management, particularly when balancing

patient care with documentation and administrative tasks. This is a significant barrier to effective patient care,

as it can lead to delays in treatment, increased stress, and reduced care quality. Previous research has shown

that poor time management is a major source of stress among nursing students and practicing nurses (Patel,

2021). Nursing programs should place greater emphasis on teaching time management strategies, helping

students prioritize tasks, delegate effectively, and streamline administrative duties. Additionally, digital tools

that automate documentation and administrative tasks could help students manage their time more efficiently,

allowing them to focus on providing patient care.

Lastly, stress management was identified as a key barrier to clinical performance, with 30% of nursing students

reporting that they struggled to cope with the emotional and psychological demands of clinical practice. The

emotional toll of nursing can be overwhelming, especially for students who are new to the profession. Previous

studies claim that high levels of stress can negatively affect nurses' well-being, job satisfaction, and

performance (Sovold, 2021). To address this barrier, nursing programs should incorporate stress management

training into their curricula. This could include mindfulness practices, cognitive-behavioral strategies, and peer

support networks that help students cope with the stresses of clinical practice. Creating a supportive

environment where students feel comfortable discussing their challenges and seeking guidance can also

alleviate stress and improve overall clinical performance. These findings align with previous research that

highlights the challenges nursing students face in clinical practice, especially regarding perceived barriers such

as time management, stress, and clinical decision-making. Previous studies claim that providing students with

more clinical exposure, mentorship, and interprofessional education can help mitigate these barriers and

improve their clinical performance (Almalki, 2018). Researchers have also emphasized the importance of

integrating practical learning experiences, emotional resilience training, and technology skills into nursing

curricula to better prepare students for the demands of the nursing profession (Zaitoun, 2023). Addressing

these barriers will help nursing students develop the skills and confidence needed to succeed in clinical

practice and deliver high-quality care.

Findings from this study reflect the significant impact that perceived challenges and barriers have on nursing

students' clinical performance. By addressing these barriers through targeted training in clinical decision-

making, stress management, interprofessional collaboration, and technological proficiency, nursing programs

can enhance students' readiness for practice. Providing more hands-on experiences, simulations, and

mentorship opportunities will help nursing students bridge the gap between theory and practice, ultimately

improving their clinical performance and the quality of care they deliver in healthcare settings (Smith, 2019).

Recommended Structural Model that represents the Competency-based Curriculum Factors, Perceived

Challenges, and Clinical Performance Outcomes of Nursing Students in the Philippine Context

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One of the most widely used structural models in educational research is the Structural Equation Modeling

(SEM) approach, which allows for the exploration of complex relationships between observed and latent

variables. SEM is particularly useful in the context of nursing education, as it helps clarify how various

educational factors, such as competency-based curriculum components, interact with challenges faced by

students, and ultimately affect their clinical performance.

A model that integrates the competency-based curriculum as a primary independent variable, with perceived

challenges acting as mediating variables, and clinical performance outcomes as the dependent variable, would

be most effective in this scenario. The competency-based curriculum in nursing education is designed to focus

on developing specific skills and competencies through practical and theoretical learning. These competencies

include clinical decision-making, patient management, and communication skills, which are essential for

effective nursing practice. The relationship between the curriculum and clinical performance outcomes can be

hypothesized as direct, with the curriculum providing a foundation for the development of skills that directly

influence students' clinical performance. However, research has shown that while a competency-based

curriculum can enhance skill acquisition, perceived challenges—such as stress, time management, emotional

resilience, and technological barriers—can mediate these relationships and influence the actual performance of

students (Zaitoun, 2023; Patel, 2021).

The role of perceived challenges is pivotal in shaping how nursing students interpret and apply the

competencies taught in their curriculum. Challenges such as heavy workloads, lack of exposure to diverse

clinical scenarios, stress, and inadequate time management can hinder students' ability to apply what they have

learned in real-world clinical settings (Sovold, 2021). These perceived challenges create barriers that can

diminish the effectiveness of the competency-based curriculum. For instance, students may possess the

required knowledge but may struggle to manage their tasks due to poor time management skills or the inability

to cope with the emotional and psychological demands of patient care. Such challenges can significantly

reduce students' confidence, leading to lower clinical performance outcomes. Therefore, the structural model

should incorporate perceived challenges as mediating variables that influence how well the competency-based

curriculum translates into clinical success.

The clinical performance outcomes of nursing students in the Philippine context are highly influenced by both

the curriculum and the challenges they face. Research has shown that nursing students in the Philippines, like

those in other parts of the world, often struggle with high levels of stress due to academic pressures, lack of

adequate clinical exposure, and the demands of providing care in resource-constrained settings (Alibudbud,

2023). However, those who receive adequate mentorship, engage in sufficient clinical practice, and develop the

ability to navigate challenges tend to perform better in clinical settings. The structural model should therefore

account for these factors by emphasizing the interplay between curriculum effectiveness, student resilience,

and external stressors. For example, students who manage to cope with perceived challenges like time

constraints or emotional exhaustion are likely to perform better in clinical settings. Moreover, this model can

be further enriched by including the interpersonal and systemic factors at play, such as faculty support and

institutional resources, which are integral to clinical performance outcomes (Smith, 2019).

Finally, to create a robust structural model for the relationships between the competency-based curriculum,

perceived challenges, and clinical performance outcomes, it is crucial to contextualize it within the Philippine

healthcare system. The Philippines faces unique challenges in nursing education, such as overcrowded clinical

placements, limited access to cutting-edge healthcare technologies, and high levels of student stress related to

the competitiveness of nursing programs. Therefore, a multidimensional structural equation model would be

effective in capturing these complexities. By integrating factors such as curriculum content, institutional

support, stress management, and the broader healthcare environment, this model can provide valuable insights

into how nursing students in the Philippines navigate their education and clinical placements. Studies suggest

that when these variables are effectively aligned—by improving curriculum design, offering more practical

clinical experiences, and addressing student stress—the clinical performance outcomes of nursing students can

significantly improve, ultimately contributing to better patient care and nursing practice (Cheng et al., 2015).

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The best structural model to represent the relationships among the competency-based curriculum factors,

perceived challenges, and clinical performance outcomes of nursing students in the Philippines would be one

that incorporates Structural Equation Modeling (SEM) with perceived challenges as mediators. The model

should link the curriculum directly to clinical performance while acknowledging the mediating role of stress,

time management, and emotional resilience. By focusing on how challenges influence the application of

competencies and ultimately clinical outcomes, this model offers a comprehensive understanding of the

dynamics involved. Studies have shown that by strengthening students' ability to manage these challenges and

aligning the curriculum with real-world clinical demands, nursing programs can enhance clinical performance

outcomes and better prepare students for the complexities of modern healthcare (Smith, 2019; Sovold, 2021).

The implementation of this model in nursing education can provide actionable insights to improve both the

training of future nurses and the quality of care provided in the Philippines’ healthcare system.

SUMMARY OF FINDINGS, CONCLUSION, AND RECOMMENDATION

This chapter presents a summary of the key findings from the study, highlighting the significant relationships

between the competency-based curriculum factors, perceived challenges, and clinical performance outcomes of

nursing students in the Philippine context. Based on these findings, the chapter draws conclusions regarding

the impact of the curriculum and various challenges on students' clinical readiness. Finally, actionable

recommendations are provided to improve nursing education, including suggestions for curriculum

enhancement, stress management training, and increased exposure to diverse clinical settings, aimed at better

preparing students for the demands of modern healthcare practice.

SUMMARY OF FINDINGS

The summary of findings highlights the key insights gained from the study, focusing on the relationships

between the competency-based curriculum factors, perceived challenges, and the clinical performance

outcomes of nursing students in the Philippine context. The findings reveal critical aspects of nursing

education, including areas where students excel and where they face significant barriers that hinder their

clinical performance.

1. A significant portion of nursing students expressed confidence in applying theoretical knowledge to

clinical practice, yet many still struggle to translate this into effective patient care.

2. Perceived challenges such as emotional strain, time management difficulties, and stress significantly

impacted students' clinical performance and readiness for complex clinical tasks.

3. The competency-based curriculum was found to provide a solid foundation for nursing students;

however, gaps remain in its ability to fully prepare students for the demands of real-world clinical

practice.

4. A majority of students felt confident in basic clinical tasks, such as taking vital signs and administering

medications, but reported lower confidence in complex decision-making and emergency care situations.

5. Stress management and emotional resilience were identified as critical factors affecting the clinical

performance of nursing students, with many feeling unprepared to handle the emotional demands of

patient care.

6. Specialized clinical tasks, particularly in areas like critical care and pediatrics, presented a challenge for

a significant number of students who felt unprepared to manage such cases.

7. Interprofessional collaboration was another challenge, with students expressing difficulty in working

effectively with healthcare teams, which is essential for patient-centered care.

8. Despite confidence in certain areas, students reported difficulties in using healthcare technologies,

indicating a gap in technology training within the curriculum.

9. Clinical decision-making skills were identified as a key area needing improvement, as students often

struggled to make confident, accurate decisions in complex or emergency situations.

10. The study revealed that increased exposure to diverse clinical settings and more specialized training

opportunities would better prepare students to handle the complexities of modern healthcare

environments.

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CONCLUSION

The conclusion synthesizes the key findings from the study and reflects on the broader implications for nursing

education, particularly in the Philippine context. It highlights the critical role of the competency-based

curriculum in shaping students' clinical performance but also underscores the challenges that students face,

including stress, time management, and specialized care. The findings suggest that while the curriculum

provides a strong foundation, there is a need for further improvements in clinical training, stress management,

and interprofessional collaboration to enhance nursing students' readiness for the demands of the healthcare

profession.

1. The competency-based curriculum plays a vital role in preparing nursing students, providing them with

the necessary foundation in clinical skills and knowledge.

2. Despite the curriculum’s strengths, students face significant challenges such as stress, time

management issues, and emotional strain, which hinder their clinical performance.

3. Exposure to diverse clinical settings and specialized training is essential for improving students' ability

to handle complex patient care situations.

4. Stress management and emotional resilience are crucial for nursing students, and incorporating these

into nursing curricula will improve students' mental well-being and clinical performance.

5. While students demonstrate confidence in basic clinical tasks, more targeted training in decision-

making and emergency care is needed to enhance their clinical competency in high-pressure situations.

6. Interprofessional collaboration is an area of concern, and further emphasis on teamwork with other

healthcare professionals will enhance the quality of care and student learning experiences.

7. Nursing programs must integrate more technology training to ensure students are proficient in using

digital tools and systems commonly used in modern healthcare settings.

8. Improving curriculum design, providing more hands-on clinical experiences, and addressing the

identified challenges will ensure that nursing students are better prepared for the complexities of the

healthcare profession.

RECOMMENDATION

The recommendations section provides actionable suggestions based on the findings of the study, aimed at

enhancing the nursing education experience and addressing the challenges identified among students. These

recommendations are intended to improve the preparedness of nursing students, helping them better navigate

clinical practice and overcome the barriers that hinder their clinical performance.

1. Nursing programs should integrate more hands-on clinical experiences and simulation-based training to

bridge the gap between theoretical knowledge and real-world clinical practice.

2. Curriculum adjustments should include dedicated training on stress management and emotional

resilience to equip students with the tools needed to cope with the emotional demands of nursing

practice.

3. More opportunities for students to work in specialized clinical settings, such as critical care and

pediatrics, should be provided to ensure they gain the experience needed to manage complex patient

care situations.

4. Nursing programs should emphasize interprofessional education, allowing students to collaborate with

other healthcare disciplines to improve communication, teamwork, and patient-centered care.

5. Time management training should be incorporated into the curriculum, teaching students strategies for

prioritizing tasks, delegating responsibilities, and managing their workloads efficiently during clinical

rotations.

6. More focus should be placed on developing clinical decision-making skills, with case-based learning

and critical thinking exercises incorporated into the curriculum to strengthen students’ ability to make

informed decisions in complex clinical scenarios.

7. The integration of reflective practice sessions into the curriculum will allow students to assess their

own performance, recognize areas for improvement, and develop the skills necessary for continuous

learning in their professional careers.

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8. Nursing programs should continue to assess and improve their curricula based on ongoing feedback

from students and clinical partners to ensure that training is relevant, up-to-date, and aligned with the

evolving demands of the healthcare sector.

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