Download PDF
CC BY-NC-ND 4.0 · Journal of Health and Allied Sciences NU 2023; 13(01): 114-125
DOI: 10.1055/s-0042-1744554
Original Research

Self-Reported Clinical Practice Skill Readiness of Final Year Nursing Students Studying in Bengaluru, Karnataka: An Institutional-Based Cross-Sectional Study

Shivaleela P. Upashe
1   Department of Child Health Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
,
Rahul Shil
2   Department of Medical & Surgical Nursing (Neuroscience), College of Nursing & Health Sciences, Dayananda Sagar University (Deemed to be University), Bengaluru, Karnataka, India
,
Shraddha Shetty 
3   Department of Biostatistics, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
› Author Affiliations
Funding None.
› Further Information
 
 PDF Download Permissions and Reprints

Abstract

Introduction In recent few years, the production of nurses in both the public and private sectors has been growing rapidly to fill up the gap of health care staff. As there is a lack of data available on clinical practice readiness among final year nursing students in India, the question remains of how nursing students see themselves and what qualities and areas interest them are of great importance.

Objectives This study was conducted to determine the clinical practice skill readiness among final year nursing students and also to explore the factors that show the significant difference with clinical practice skill readiness level.

Methodology A nonexperimental institutional-based cross-sectional online survey was conducted from October 15 to November 15, 2020 using a simple random sampling technique. A total of 200 final year nursing students have participated in the study through the self-structured and prevalidated comprehensive nursing competencies questionnaire (CNCQ). Data was collected through Google Form and exported to SPSS version 20.0 for further analysis. To compare the nursing competencies score with selected demographic characteristics, a one-way analysis of variance and an unpaired t-test were applied at a 95% confidence interval (CI). The post hoc test was used to check for multiple comparisons.

Results Results of the study revealed that the overall CNCQ mean score of basic nursing skills were reasonably high (39.08 ± 13.27) compared with advanced nursing care skills (13.03 ± 5.28). A significant difference (p < 0.05) was observed in overall clinical posting duration in both basic (p < 0.004) and advanced (p < 0.001) nursing skills with selected demographic variables. There is also a significant difference found in the overall level of qualification (p < 0.004) in basic nursing skills. It was observed that in basic nursing care skills half of the year clinical posting (minimum 6 months) duration had a significant difference with the improved performance skills (p < 0.005) (0.57; 95% CI 0.14–1.00). Whereas the results also show that, the advanced nursing skills will be greatly improved if the nursing students get an opportunity to practice in different specialty areas for at least 2 months (p < 0.013) (0.62; 95% CI 0.11–1.14) or half of the year (p < 0.001) (0.95; 95% CI 0.34–1.56). This result shows a clear indication of how important clinical posting for nursing students is.

Conclusion Our data suggested that the final year nursing students are losing ground in clinical practice readiness and competency. The result also shows that the clinical competency score will greatly improve in both basic and advanced nursing skills if the students are exposed to the clinical areas at least for a few months. Our findings will support the stakeholders, authorities of nursing colleges, and policymakers to make a significant decision to enhance the clinical practice among final year nursing students.


#

Keywords

self-reported clinical practice - graduating nursing students - clinical performance

Introduction

In essence, the nursing profession has considerably been around ancient times. Since then it has drastically evolved throughout history. Today, nursing is among the most pivotal profession within the health care industry and are learned in a wide selection of occupational duties that are utilized within a variety of settings throughout the world.[1] As among the strong multidisciplinary health care teams, nurses and midwives make a consequential contribution to delivering on the commitments made within the 2018 Astana Declaration on Primary Health Care, ensuring patient-centered care to the community. Currently, nurses and midwives account for nearly 50% of the worldwide health workforce for all countries to succeed in Sustainable Development Goals on health and well-being. World Health Organization estimates that the globe will need further 9 million nurses and midwives by the year 2030.[2]

Despite the great need for nursing graduates, there are concerns for their overall clinical performance before and after joining the clinical areas. Various reports and studies have concluded that the current system fails to prepare nursing students for real practical performance in the field, and after graduation also they cannot perform the procedure in clinical environments as expected.[3] Presently, nursing profession has changed drastically and the focus of health care is leading into a complex direction that requires a generation of dedicated nursing professionals.[4]

Today, nursing educational institutions are expected to fabricate nurses which are clinically practiced ready despite of being a novice to satisfy the growing health care demands of an aging population and a projected looming nursing shortage.[5] Developed countries like the United States are currently experiencing a serious shortage of nurses due to the aging nursing workforce and decreased nursing program enrollments because of the nursing faculty crunch.[6] And presently India alone is facing a shortage of around 2 million nurses.[7] On the other hand, India is one of the top supplies of nurses to the Gulf and the Organization for Economic Co-operation and Development countries, especially the United States, Canada, United Kingdom, Ireland, Australia, and New Zealand.[8] [9]

Consequently, nursing graduates have significantly increased in India as nursing colleges boomed from just 165 nursing colleges in 2004[10] to 1,667 in 2017.[11] These data indicate that there is a very rapid climb in the number of nurses produced in India to meet the national and international needs of nurses. However, in that spot, there is always a challenge to sustain quality with rapid production of quantity. Further, an acute shortage of nurses necessitates the readiness of nurses to right away take up the full-fledged role as registered nurses to set the seal on patient safety and quality of care.[12] Some recent studies conducted in Iran,[13] Australia,[14] and United Arab Emirates[15] showed that nurses are having clinical knowledge shortages and only a few of them are possessing entry-level competencies and practice-level readiness. And surprisingly, only a few research studies were done on clinical practice readiness, and in India, there is less statistical data to understand the nursing student's competencies which are produced by mass growing nursing institutes in Bengaluru, Karnataka, India. Therefore, this study was planned to assess the self-reported clinical practice of final year nursing students at Bengaluru. The findings of this study will help the nurse educator to see the lacunae or the gap between the theory and clinical practice culture among nurses and this study will also help the national and international recruiters about the clinical practice readiness among final year nursing students from Bengaluru.


#

Objectives of the Study

  1. To determine the clinical practice skill readiness among final year nursing students.

  2. To explore the factors that show the significant difference with clinical practice skill readiness level.


#

Methods

Study Design and Study Population

An institutional-based cross-sectional online survey was undertaken on final year nursing students studying in B.Sc. Nursing, General Nursing and Midwifery (GNM), and Post Basic (PB) B.Sc. Nursing at selected private nursing colleges across Bangalore in the academic year 2019 to 2020. A total of 200 final year nursing students have participated in the study.


#

Study Setting

Bangalore (also known as Bengaluru) is the capital of Karnataka state, India. There are a total number of 124 nursing colleges in Bangalore, of both government and nongovernment colleges. This survey was undertaken in the academic year 2019/2020 on final year nursing students at eight nursing institutes which are situated in the northern part of Bengaluru. As we obtained information from the institute's head, there was a total of 208 nursing students completing their graduation in the 2019/2020 academic year in the eight nursing institutes, including B.Sc. Nursing, PB B.Sc. Nursing, and GNM Nursing.


#

Sample Size and Sampling Procedures

A total of 200 samples were collected conveniently from eight selected private nursing colleges in Bangalore. The sample size was estimated using the formula (Z1-∝/2)[2] (p) (q)/d[2] [16] the expected proportion of a good level of nursing competency is 0.23 (23%),[17] the expected precision of 6%, and at 95% level of confidence, the estimated sample size was 189 participants, whereas considering 10% nonresponsive rate, total 208 sample size was considered for the present study. A sampling frame of students studying in the final year nursing was obtained from selected colleges and the desired sample was obtained conveniently. However, 8 students did not complete the questionnaire (96.2% response rate); thus finally, data collected from 200 participants were considered for analysis. It was an online survey, and all final year students (B.Sc. Nursing, PB B.Sc. Nursing, and GNM Nursing) who were willing to give informed consent were included in the study. Participants who did not have access to the Internet and did not given informed consent were excluded from the study.


#

Tool for Data Collection and Data Collection Instrument

A self-structured prevalidated and reliable (r = 0.93) instrument, that is, “comprehensive nursing competencies questionnaire (CNCQ),” was used to assess the clinical practice readiness of final year nursing students.[17] Permission was obtained from Prof. Dr. Suresh K. Sharma, Principal, College of Nursing (All India Institute of Medical Sciences [AIIMS], Jodhpur, Rajasthan, India) to use the prevalidated CNCQ tool. The tool consisted of a total of 100 essential nursing skills items based on the prescribed curriculum for the baccalaureate nursing program in India, which was divided into two sections, that is, (1) basic nursing skills (52 items) and (2) advanced nursing skills (48 items). Each listed nursing skill practiced during the nursing program was measured on the six-point rating scale, that is, perform independently (5), under supervision (4), only assisted (3), only observed (2), only read (1), and do not know anything (0). The basic nursing skill section included a total of 52 items (with score range: 0–260) under different categories, that is, admission and discharge, personal hygiene, medication administration, invasive procedures, wound care and bandaging, respiratory nursing interventions, elimination, perioperative nursing, infection control, handling of basic medical equipment, and documentation. Similarly, the advanced nursing skills section included 48 items (with a score range: 0–240) under different categories, that is, medical and surgical nursing, child health nursing, obstetrical and gynecological nursing, and mental health nursing.


#

Pilot Study

Pilot study was conducted on 10% of the sample size of the main study in one of the nursing colleges which was not included in the main study to check for the clarity of language, acceptability, validity, and completeness of the questionnaire.


#

Data Collection Technique

Official permission was obtained from principals of all the eight nursing colleges, and the data were collected using a Google Form. Then, students were requested to respond to the questionnaire through online Google Forms, with a consent form appended to it. The link was sent through e-mails and WhatsApp. The instructions were given to the students in the Google Form not to use reference material and not to discuss with their friends to find the correct answer. A standardized and pretested questionnaire was adapted and we have conveniently selected 8 nursing colleges and conducted a cross-sectional survey from October 15 to November 15, 2020. The tool was included with five sociodemographic variables. Under the basic nursing care skills, 11 areas and a total of 52 questions were asked. Under advanced nursing care skills, four areas, including medical-surgical, child health, obstetrical and gynecological, and mental health nursing, a total of 48 questions were asked. Then, students were requested to respond to the questionnaire through Google Form.


#

Operational Definitions

The two terms frequently used in the present study are operationally defined:

  • Clinical practice readiness: Graduating nurses' level of clinical competency for each selected basic and advanced nursing skill, based on the scale of performed independently 5, under supervision 4, only assisted 3; only observed 2, only read theoretically 1, to do not know anything 0.

  • Final year nursing students: Final year B.Sc. Nursing, GNM, and PB B.Sc. Nursing students, who are about to complete their nursing program and do their internship.


#

Data Quality Control

Quality of data was assured by proper designing and pretesting of the questionnaires in one of the nursing colleges located other than Bangalore on 10% of the total participants, to ensure that the questions are clear and can be understood by the respondents, and further questionnaires were refined based on the results of the pilot study.


#

Study Variables

  • Dependent/Outcome variable: Self-reported clinical practice readiness.

  • Research variables: Demographic characteristics of study subjects such as age, gender, level of educational qualification, percentage in a previous university exam, clinical posting duration, etc.


#

Data Processing and Analysis

After the data collection, the data were exported from Google Form to Statistical Package for Social Science (SPSS) version 20.0 for analysis and interpretation. The descriptive statistics were presented with mean ± standard deviation, frequency, and percentage. The data were analyzed using an unpaired t-test and a one-way analysis of variance (ANOVA). To compare the demographic variables with the basic and advanced nursing skills, post hoc multiple comparisons were performed for significant variables.


#
#

Results

A total of 200 nursing students have participated in this study. Out of the study participants, 167 (83.5%) of them were female and 105 (52.5%) students were in the age group of 18 to 19 years. One hundred and forty (70%) students were studying Bachelor of Nursing. Ninety-four (47%) students got 60 to 69% marks in university exams but 108 (54%) of them had clinical experience only for 2 months or less ([Table 1]).

Table 1

Sociodemographic characteristics of final year nursing students from nursing institutions in Bangalore (n = 200)

Demographic variables

Frequency (f)

Percentage (%)

Age (in years)

≤ 21

105

52.5

22

77

38.5

≥ 23

18

9.0

Gender

Male

33

16.5

Female

167

83.5

Educational qualification

B.Sc. Nursing

140

70.0

PB B.Sc. Nursing

49

24.5

GNM Nursing

11

5.5

Percentage (%) of marks obtained in previous university exam

50–59

29

14.5

60–69

94

47

70–79

67

33.5

> 80

10

5

Duration of clinical posting

Throughout the year

35

17.5

Half of the year

57

28.5

Only for 2 months or less

108

54.0

Abbreviations: GNM, General Nursing and Midwifery; PB, Post Basic.


[Table 2] depicts the mean competencies score for nursing skills which were divided into two parts, basic nursing skills and advanced nursing skills. The maximum score for basic nursing skills is 355 and for advanced nursing skills 145. The findings suggest that the overall CNCQ mean score of basic nursing skills was reasonably high (39.08 ± 13.27) compared with advanced nursing care skills (13.03 ± 5.28). Regarding basic nursing skills, it was found that the mean score of personal hygiene (4.46 ± 1.06) and infection control and biomedical waste (BMW) management (4.03 ± 1.27) is higher than other basic nursing skills where the mean competencies score is relatively the same. Further, under advanced nursing skills, the mean score is relatively the same.

Table 2

Mean competencies score of basic and advanced nursing care skills of the final year nursing students form nursing institutions in Bangalore (n = 200)

Domains of nursing care skills

Nursing care skills score

Maximum score

Mean ± SD

Rank order

Basic nursing care skills

355

39.08 ± 13.27

−

 Personal hygiene

74

4.46 ± 1.06

I

 Medication administration

29

3.87 ± 1.06

II

 Admission/discharge

34

3.02 ± 1.23

III

 Respiratory nursing interventions

38

3.21 ± 1.20

IV

 Documentation

23

3.42 ± 1.33

V

 Invasive procedures

11

3.10 ± 1.25

VI

 Wound care and bandaging

36

3.91 ± 1.08

VII

 Infection control and BMW

50

4.03 ± 1.27

VIII

 Elimination

22

3.31 ± 1.33

IX

 Perioperative nursing

12

3.12 ± 1.25

X

 Handling basic medical equipment

26

3.63 ± 1.21

XI

Advanced nursing care skills

145

13.03 ± 5.28

−

 Mental health nursing

39

2.99 ± 1.40

1

 Child health nursing

46

3.33 ± 1.32

2

 Midwifery

35

3.03 ± 1.45

3

 Medical surgical nursing

25

3.68 ± 1.11

4

 Overall nursing care skills

500

52.11 ± 18.55

−

Abbreviations: BMW, biomedical waste; SD, standard deviation.


The variables such as age, percentage in previous university exam, clinical posting duration, and educational qualification were tested using ANOVA test and the variable gender is tested using unpaired t-test to check the nursing competency score. The results show that there is a higher CNCQ score and statistically significant (p < 0.05) in overall clinical posting duration in both basic (p < 0.004) and advance (p < 0.001) nursing skills with selected demographic variables. There is also a significant difference found in the overall level of qualification (p < 0.004) in basic nursing skills. Further, our study did not find any other significant difference with other demographic variables such as age, gender, and percentage in previous university exams. The overall significance score found in clinical posting duration and the level of qualification is important because there is a consistent amount of clinical posting in a year in different nursing specialty subjects and the advanced level of qualification among nurses then there is a higher chance for the students to get improved in different types of clinical skills which ultimately makes them be a specialized nurse in the coming future ([Table 3]).

Table 3

Comparison of nursing competencies score with selected demographic characteristics of final year nursing students from nursing institutions in Bangalore (n = 200)

Demographic variables

N

Basic nursing skill score

Advanced nursing skills score

Mean ± SD

F -value

p -Value

Mean ± SD

F -value

p -Value

Age

 ≤ 21 y

105

3.48 ± 0.86

5.68

0.40

3.30 ± 1.43

6.67

0.75

 22 y

77

3.64 ± 1.04

3.42 ± 1.29

 ≥ 23 y

18

3.72 ± 1.07

3.17 ± 1.46

Gender

 Male

33

3.67 ± 0.99

0.70

0.48

3.48 ± 1.39

0.68

0.49

 Female

167

3.54 ± 0.94

3.31 ± 1.37

Percentage in previous university exam

 50–59

29

3.59 ± 0.86

4.84

0.42

3.66 ± 1.37

5.81

0.43

 60–69

94

3.45 ± 0.99

3.21 ± 1.48

 70–79

67

3.70 ± 0.96

3.40 ± 1.18

 > 80

10

3.60 ± 0.69

3.10 ± 1.59

Clinical posting duration

 Throughout the year

35

3.94 ± 0.83

1.89

0.004[a]

3.94 ± 1.13

1.09

< 0.001[a]

 Half of the year

57

3.68 ± 1.00

3.61 ± 1.14

 Only for 2 months

108

3.37 ± 0.92

2.99 ± 1.46

Educational qualification

 B.Sc. Nursing

140

3.61 ± 0.88

1.53

0.003[a]

3.32 ± 1.29

2.13

0.153

 PB B.Sc. Nursing

11

4.27 ± 0.79

4.09 ± 1.04

 GNM Nursing

49

3.27 ± 1.09

3.20 ± 1.62

Demographic variables

N

Basic nursing skill score

Advanced nursing skills score

Mean ± SD

t -Value

p -Value

Mean ± SD

t -Value

p -Value

Gender

 Male

33

3.67 ± 0.99

0.70

0.48

3.48 ± 1.39

0.68

0.49

 Female

167

3.54 ± 0 0.94

3.31 ± 1.37

Abbreviations: GNM, General Nursing and Midwifery; PB, Post Basic; SD, standard deviation.


a p < 0.001 and 0.004 are statistically significant.


One-way ANOVA was performed to determine the significant difference in the average basic nursing skills and advance nursing skills across different timings of clinical posting duration. As the ANOVA test was found statistically significant in overall clinical posting duration with selected demographic variables, the post hoc test was done to check the multiple comparisons between basic and advanced nursing care skills with clinical posting duration. It was observed that in basic nursing care skills, half of the year clinical posting duration had a significant difference with improved performance skills (p < 0.005) compared with throughout the year (0.40) and only for 2 months (0.10). It was also observed that the advanced nursing skills will be greatly improved if the nursing students get an opportunity to practice in different specialty areas for at least 2 months (p < 0.013) or half of the year (p < 0.001) ([Table 4]).

Table 4

Pairwise comparison of basic nursing care skills and advanced nursing care skills with clinical posting duration of final year nursing student from nursing institutions in Bangalore

Basic nursing care skills

Pairwise comparison

MD (95% CI of difference)

p -Value

Throughout the year

0.26 (−0.21, 0.73)

0.40

Half of the year

0.57 (0.14, 1.00)

0.005[a]

Only for 2 months

0.31 (−0.05, 0.67)

0.10

Advance nursing care skills

Pairwise comparison

MD (95% CI of difference)

p -Value

Throughout the year

0.33 (−0.35, 1.00)

0.48

Half of the year

0.95 (0.34, 1.56)

0.001[a]

Only for 2 months

0.62 (0.11, 1.14)

0.013[a]

Abbreviations: CI, confidence interval; MD, mean difference.


a Significant.


[Table 5] depicts the pairwise comparison of basic nursing care skills with the level of educational qualification of final year graduating nurses. The result shows that there is a significant difference between advanced nursing qualification (PB B.Sc.) and improved basic nursing skills (p < 0.004) compared with B.Sc. Nursing graduating students as they are freshly graduating. This could be due to the fact that PB B.Sc. Nursing is an advanced nursing course compared with B.Sc. Nursing where students will learn advanced clinical skills in the health care sector after completion of their GNM degree. So it is important to have continuing education with higher nursing degree to improve the basic and specialized nursing skills in different areas.

Table 5

Pairwise comparison of basic nursing care skills with the level of educational qualification of final year nursing students from nursing institutions in Bangalore

Pair wise comparison

MD (95% CI of difference)

p-Value

B.Sc. Nursing

−0.67 (−1.35, 0.02)

0.06

GNM Nursing

0.34 (−0.02, 0.71)

0.07

PB B.Sc. Nursing

1.01 (0.27, 1.74)

0.004[a]

Abbreviations: CI, confidence interval; GNM, General Nursing and Midwifery; MD, mean difference; PB, Post Basic.


a Significant.


[Table 6] depicts the independently practiced basic nursing skills procedures. The basic nursing skills had been categorized into several subsections like admission and discharge, infection control and BMW management, documentation, hygiene care, elimination, innovative procedure, medication administration, oxygenation/respiratory care, wound care and bandaging, handling basic medical equipment, and preoperative care. The result shows that under the basic nursing skill (admission and discharge skills) procedures, more than half 159 (79.5%) and 133 (66.5%) of the students know about vital signs monitoring and health assessment procedure. The majority 116 (58%) and 87 (43.5%) of the students know about infection control and BMW management procedure skills. Note that 115 (57.5%) and 98 (49%) of the participants know about temperature, pulse, and respiration charting and how to write nurse's notes. Further, majority 175 (87.5%), 122 (61%), and 136 (68%) of the participants were able to perform bed making, oral care, and hair care procedures. In elimination skills, 57 (28.5%) and 51 (25.5%) of the students were able to perform bowel wash and enema. Regarding innovative procedure, 78 (39%) and 47 (23.5%) of the participants were able to perform nasogastric (NG) tube feeding and venous blood sampling procedure. In the skills of medication administration, 124 (62%), 118 (59%), and 115 (57.5%) of the participants were able to perform oral drug administration, intramuscular injection, and eye, ear, and nasal drop instillation. Regarding wound care and bandaging skill procedure, 91 (45.5%) and 54 (27%) of the participants knew how to perform bandaging and surgical wound dressing. It is also observed that more than 50% of the students, 144 (72%) and 114 (57%), knew how to handle basic medical equipment like pulse oximeter and electrocardiogram (ECG) recording followed by 45 (22.5%) of them being able to perform preoperative care for the patients.

Table 6

Percentage of independently practiced basic nursing skills of final year nursing students from nursing institutions in Bangalore (n = 200)

Admission/Discharge

Infection control and BMW

Documentation

Skills

f

%

Skills

F

%

Skills

f

%

Vitals sign monitoring

159

79.5

BMW management

87

43.5

TPR charting

115

57.5

Health assessment

133

66.5

Nurse's notes

98

49.0

Admission of patient

63

31.5

Use of PPE

78

39.0

Informed consent

54

27.0

Discharge/discharge teaching of patient

53

26.5

Disinfection

31

15.5

Fumigation/fogging

116

58.0

Hygiene care

Elimination

Innovative procedure

Skills

f

%

Skills

F

%

Skills

f

%

Bed making

175

87.5

Catheter care

42

21.0

Venipuncture

30

15.0

Oral care

122

61.0

PBG monitoring

37

18.5

Hair care

136

68.0

Suppositories

39

19.5

Venous blood sampling

47

23.5

Back care

121

60.5

Enema

51

25.5

NG tube feeding

78

39.0

Bed bath

105

52.5

Urinary catheterization

19

9.5

NG tube insertion

24

12.0

Bowel wash

57

28.5

Medication administration

Oxygenation/respiratory care

Wound care and bandaging

Skills

f

%

Skills

F

%

Skills

f

%

IV infusion

92

46.0

Nebulization

120

60.0

Bandaging

91

45.5

Intramuscular injection

118

59.0

Steam inhalation

116

58.0

Surgical wound dressing

54

27.0

IV drugs

106

53.0

O2 administration by simple face mask

113

56.5

Bed sore dressing

42

21.0

Oral drug

124

62.0

O2 administration by nasal prongs

61

30.5

Pin-site care dressing

25

12.5

Subcutaneous injection

101

50.5

Assisted patient with incentive spirometer

38

19.0

Removal of structure and staples

47

23.5

Intradermal injection

91

45.5

O2 administration by partial/nonbreather/venture mask

30

15.0

Burns wound dressing

28

14.0

Eye, ear, nasal drops instillation

115

57.5

Handling basic medical equipment

Preoperative care

Skills

f

%

Skills

f

%

Pulse oximeter

144

72.0

Preoperative care

45

22.5

Recoding ECG

114

57.0

Postoperative care

34

17.0

Using defibrillator

21

10.5

Intraoperative care

17

8.5

Abbreviations: BMW, biomedical waste; ECG, electrocardiogram; IV, intravenous; NG, nasogastric; PBG, porphobilinogen; PPE, personal protective equipment; TPR, temperature, pulse, and respiration.


[Table 7] depicts the independently practiced advanced nursing skills of final year nursing students. A total of 200 students had participated in the study. Advanced nursing skills have been categorized into four specialty areas. The result shows that in the medical and surgical advanced nursing skill, majority 34 (17%), 29 (14.5%), 33 (16.5%), 23 (11.5%), and 20 (10%) of the participants can independently perform blood transfusion, administration of total parenteral nutrition, gastric lavage, basic life support (BLS), endotracheal/tracheostomy suctioning, and tracheostomy care procedure. Further, in child health nursing majority 100 (50%), 85 (42.5%), 65 (32.5%), 64 (32%), and 49 (24.5%) of the participants were able to perform procedures like nebulization, newborn assessment, intramuscular injection, immunization, care of newborn, and care of newborn in radiant warmer. In the obstetrics and gynecological advance nursing procedure, 80 (40%), 62 (31%), 60 (30%), and 59 (29.5%) of the participants could independently perform procedures like assisting the mother with breastfeeding, antenatal examination, antenatal care, and postnatal examination. Whereas it is observed that 114 (57%), 109 (54.5%), 65 (32.5%), and 63 (31.5%) of the participants were able to perform behavioral therapy, history collection, MMSE, and process recording procedures in the mental health advance nursing skill.

Table 7

Percentage of independently practiced advanced nursing skills of final year nursing students from nursing institutions in Bangalore (n = 200)

Medical and surgical nursing

Child health nursing

Obstetrical and gynecological nursing

Skills

f

%

Skills

f

%

Skills

f

%

Blood transfusion

34

17.0

Nebulization

100

50.0

Perineal care

37

18.5

Endotracheal/tracheostomy suctioning

20

10.0

New born assessment

85

42.5

Assisting the mother with breast feeding

80

40.0

Tracheostomy care

20

10.0

Intramuscular injection

65

32.5

Antenatal care

60

30.0

Care of central venous catheter

18

9.0

Immunization

64

32.0

Postnatal care

58

29.0

Administration of TPN

29

14.5

Care of new born

60

30.0

Antenatal examination

62

31.0

Colostomy care

20

10.0

Care of new born in radiant warmer

49

24.5

Postnatal examination

59

29.5

Arterial blood sampling

18

9.0

IV medication with use of infusion pump

35

17.5

Nonstress test

48

24.0

Care of intercostal chest drainage site

15

7.5

Care of new born under phototherapy

57

28.5

Vaginal examination

27

13.5

Gastrostomy/jejunostomy feeding

14

7.0

Administration of oxygen by oxygen tent

29

14.5

Examination of placenta

31

15.5

Gastric lavage

33

16.5

Administration of oxygen by oxygen hood

24

12.0

Partogram

24

12.0

BLS

23

11.5

Care of new born in incubator

21

10.5

Collection of pap smear

8

4.0

Care of patient on mechanical ventilator

15

7.5

Pediatric vein puncture

12

6.0

Normal vaginal delivery

9

4.5

Care of patient with cardiac catheterization

12

6.0

Neonatal resuscitation

9

4.5

IUCD insertion

7

3.5

Pediatric BLS

15

7.5

Episiotomy and suturing

8

4.0

Mental health nursing

Skills

f

%

History collection

109

54.5

Behavioral therapy

114

57.0

Assisting in AT

13

6.5

MMSE

65

32.5

Care patient for ECT

24

12.0

Process recording

63

31.5

Use of restraints

47

23.5

Abbreviations: BLS, basic life support; ECT, electroconvulsive therapy; IUCD, intrauterine contraceptive device; IV, intravenous; TPN, total parenteral nutrition.



#

Discussion

Nurses are referred to as the backbone of the health care system. They are the key to the detection, treatment, and prevention of disease across the world.[18] Nurses and midwives account for nearly 50% of the global health workforce and the need to fill up these gaps is rising rapidly.[2] Western nations continue to worsen as their population is aging rapidly. So the nurse's migration is at an all-time high in the 21st century. Currently, India is facing a shortage of nurses and the nursing colleges are blooming rapidly to take the chances. And in India, Karnataka has the highest number of nursing colleges, and most of them are in Bangalore. The four southern states of India have two-thirds of the nursing institutions in India. And we can see a clear disproportion.[19] As the number of nursing colleges is increasing day by day in Bengaluru, the quality of nursing care is decreasing simultaneously. Several reports indicated that the compromised quality of nursing in terms of blooming institutions, shortage of nursing faculty, less clinical experience among students, poor infrastructure, less salary, and the institution authority involvement in clinical practice.[19] [20] [21] It is important not to produce the nurses like a mass but to produce qualified experienced nurses who are able to handle any health situation anywhere in the world. The novice nurses who are going to become registered nurses are expected to have basic knowledge in nursing skills and should perform the basic and advanced procedures seamlessly wherever they are.

The purpose of the present study was to assess the self-reported clinical practice among graduating nurses across Bengaluru. Currently, there were only a few research data available about the clinical practice readiness among final year graduating nurses across India as well as in the world. The findings of the present study suggest that the overall CNCQ mean score of basic nursing skills was reasonably high (39.08 ± 13.27) compared with advanced nursing care skills (13.03 ± 5.28) which were inconsistent when we compared with a similar study done in Uttarakhand, India,[17] where the mean competency score of basic nursing skills is 236.5 ± 25.0 and advanced nursing skills is 148.7 ± 25.6. This discrepancy might be due to the difference in study settings, characteristics of study participants, sampling techniques used in the study, and the techniques of data collection in which the current study covers eight institutions. And also the possible conclusion is that AIIMS Uttarakhand is one of the premier institutions in our country having senior nursing instructors and different specialized multispecialty hospitals leading the students to have more exposure. The difference of results in basic and advanced nursing practice skills among nursing students could also be due to the nursing curriculum, way of teaching in the different nursing institutions, public versus private institutions, the experience of faculty members, and inadequate clinical experience for the students which we should take into account. But similar results were also seen in other several studies conducted in India,[22] Iran,[23] Ethiopia,[24] and Zimbabwe[25] which is a cause of concern.

Our research found a significantly high percentage in basic nursing skills compared with advanced nursing skills. The basic nursing skills result shows that 79.5% was the highest percentage under admission/discharge skills, 58% under infection control and BMW management, 57% under documentation, 87.5% under hygiene care, 28.5% under elimination, 39% under the innovative procedure, 62% under medication administration, 60% under oxygenation/respiratory care, 45% under wound care and bandaging, 72% under handling basic medical equipment, and 22% under preoperative care. Whereas in advanced nursing skills 17% was the highest skill percentage under medical and surgical nursing, 50% under child health nursing, 40% under obstetrics and gynecological nursing, and 57% under mental health nursing. This percentage is moderately low when we compare our study with the study done in Uttarakhand[17] where the result shows that in the basic nursing skills 95.9% was the highest percentage under admission/discharge skills, 94% under infection control and BMW management, 72.8% under documentation, 94.8% under hygiene care, 83.8% under elimination, 79.8% under the innovative procedure, 90.2% under medication administration, 95.4% under oxygenation/respiratory care, 83.2% under wound care and bandaging, 79.2% under handling basic medical equipment, and 38.1% under preoperative care. Similarly in advanced nursing skills, 34.1% were under medical and surgical nursing, 62.4% under child health nursing, 50.3% under obstetrics and gynecological nursing, and 94.2% under mental health nursing.

This study indicated a significant difference in clinical posting duration with the improved performance skills (p < 0.005) whereas it was also observed that the advanced nursing skills will be greatly improved if the nursing students get an opportunity to practice in different specialty areas for at least 2 months (p < 0.013) or half of the year (p < 0.001).

A study conducted at universities in Northern Ethiopia indicates the overall clinical practice competency of graduating nursing students shows that only 29% of the participants were clinically competent and 71% were incompetent.[26] Similarly, another study found that 50% of graduating nurses could not independently practice some of the basic nursing procedures, while only 10% of them could independently practice some of the advanced nursing procedures.[17] This is parallel to our study where we found that only 10.5% of the participants could perform the basic nursing procedures and 20% of them could perform advanced nursing procedures independently. Whereas 52% of the students could perform the basic procedures and 37.5% of them could perform advanced procedures while under supervision. The findings are low when compared with a finding from a study done in Hawassa University, Hawassa, Ethiopia, which revealed that only 25.2% of the students were clinically competent.[26] It is also lower than the study done by Debre Birhan Health Science College, Ethiopia[27] and Annals University of Finland[28] where 78.6 and 66.7% of the participants were clinically competent. This discrepancy might be because of the difference in the study participants in the previous study, where participants were graduated health professionals, whereas in the present study, the study participants were graduating nursing students who were lacking work experience. And possibly one of the other reasons is that most of the private colleges in Bangalore are having less than 2 months of clinical posting and do not have parent hospitals because of the increasing number of nursing institutions.

Our study also found that in basic nursing care skills it was found that the mean score of personal hygiene (4.46 ± 1.06) and infection control and BMW management (4.03 ± 1.27) is a little higher than the other skills like medication administration (3.87 ± 1.06), admission/discharge (3.02 ± 1.23), respiratory nursing intervention (3.21 ± 1.20), documentation (3.42 ± 1.33), invasive procedure (3.10 ± 1.25), wound care and bandaging (3.91 ± 1.08), infection control and BMW (4.03 ± 1.27), elimination (3.31 ± 1.33), perioperative nursing (3.12 ± 1.25), and handling basic medical equipment (3.63 ± 1.21), where most of the mean score is same. Further in advanced nursing care, the result shows that the mean score of medical and surgical nursing care skills (3.68 ± 1.11) is more than other departments like mental health nursing (2.99 ± 1.40), child health nursing (3.33 ± 1.32), and midwifery and obstetrics (3.03 ± 1.45). But the percentage of independently practicing medical and surgical nursing procedures is less and this could be due to less exposure of students in different medical and surgical specialty areas in different hospitals. These results show that the graduating nurses are not getting enough opportunity to practice advanced nursing procedures in hospitals and similar findings are also reported in a study done in Korea.[29]

The findings of the study are an eye opener. This shows that 85% of the students cannot perform basic nursing procedures independently such as informed consent (27%), catheter care (28.5%), bowel wash (9.5%), NG tube insertion (12%), assisted patients with incentive spirometer (19%), pin-site care dressing (12.5%), using defibrillator (10.5%), and intraoperative care (8.5%), but 60% of the students were able to perform most of the basic nursing procedure such as vital sign monitoring (79.5%), health assessment (66.5%), BMW management (58%), bed making (87.5%), hair care (68%), back care (60%), oral drug administration (62%), nebulization (60%), and recording ECG (57%) independently which is a good finding. But the advanced nursing skills among the students is really surprising where only 20% of the participants could perform the procedures independently such as tracheostomy suctioning and care (10%), care of central venous pressure line (9.0%), arterial blood sampling (9.0%), care of intercostal chest drainage (7.5%), gastrostomy tube feeding (7.0%), care of the patient in mechanical ventilator (7.5%), care of the patient in cardiac catheterization (6.0%), pediatrics vein puncture (6.0%), pediatric BLS (7.5%), intrauterine contraceptive device insertion (3.5%), and care of the patient for electroconvulsive therapy (12.0%). Further, majority of the students were able to perform most of the child health nursing, obstetrics and gynecology, and mental health nursing advanced procedure. This shows that the few graduating nursing students from India may possess an adequate amount of basic nursing skills but most of them are lacking while performing advanced procedures.

There is a limited number of similar studies conducted around the world, and in India, the number is very less. Our study was conducted at Bengaluru, in the state of Karnataka with only eight nursing colleges which are private institutions. So it is very difficult to generalize the result with other studies in India and to conclude that nursing students' skills in India is low. As India is a very big country and there are many states in India, the result will differ statewise, institution-wise, geographical areawise, and private and public institution-wise, and there is a higher chance to get improved nursing competency scores in future studies in different states. In our study, the percentage of basic nursing skills is a little better than advanced nursing scores. This could be due to most of the nursing colleges in Bengaluru do not have parent hospitals, proper clinical facilities, lack demonstration laboratory infrastructure, and a lack of experienced faculty. Therefore, it is very important for the nursing teachers to come together to strengthen guiding budding nurses as they are the future generation who will serve humanity in India and around the world.


#

Limitations

The study was conducted at eight nursing institutions which lead to a small sample size and hence the findings of this study cannot be generalized to all nursing college students in Bengaluru. Also, the study was done using online mode thus the practice skills of the graduating students could not be assessed in real-time. In addition, this study is limited to the final year nursing students from private institutions in Bengaluru and did not make any comparison between private versus public nursing institutions.


#

Conclusion and Recommendations

The graduating nurse's overall CNCQ mean score of basic nursing skills was reasonably high compared with advanced nursing care skills. A significant difference was observed in overall clinical posting duration in both basic and advanced nursing skills with selected demographic variables. There is also a significant difference found in the level of qualification with basic nursing skills. It was observed that basic nursing care skills with clinical duration time had a significant difference with the improved performance skills. The authors hope that these findings will support the stakeholders, teachers, authorities of nursing institutions, and state government to make a significant decision and to give due attention to enhance the clinical practice among graduating nurses to improve in both basic and advanced nursing skills if students are exposed in the clinical area for at least few months. Furthermore, regulatory bodies must check that nursing institutes have sufficient facilities and processes for adequate clinical learning experience in basic and advanced nursing skills training.


#
#

Conflict of Interest

None declared.

Acknowledgments

We are thankful to the principals of the nursing institutes of Bengaluru for their permission and also thankful to all of the final year nursing students who participated in this study. A special thanks to Prof. Dr. Suresh K. Sharma, Principal, College of Nursing (All India Institute of Medical Sciences, Jodhpur) for providing us with the prevalidated tool.

Ethical Considerations

Institutional Ethics Committee approval was also taken before the research, and actual data collection, and also permission was obtained from all the nursing colleges. A consent sheet was prepared in English with the descriptions of the impact of the study on the responders and attached the tool on a separate page. Permission was obtained from the Prof. Dr. Suresh K. Sharma, Principal, College of Nursing (All India Institute of Medical Sciences, Jodhpur) to use the prevalidated CNCQ tool.


Authors' Contributions

All authors made a significant contribution to the work reported. R.S. and S.P.U. made study conception and study design, execution, and acquisition of data and S.S. did analysis and interpretation of data. Finally all the authors read, revised, and drafted the manuscript for publication and also gave final approval of the version to be published based on the selected journal to which the article has been submitted.



Address for correspondence

Rahul Shil, PhD Scholar
Department of Medical & Surgical Nursing, College of Nursing & Health Sciences, Dayananda Sagar University
Bengaluru 560078, Karnataka
India   

Publication History

Article published online:
05 May 2022

© 2022. Nitte (Deemed to be University). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India


   Permissions and Reprints