The Impact of Clinical Teaching Behavior on Learning Experience of Nursing Students

Abstract

Background

Clinical education is the cornerstone of nursing education and an important aspect of the nursing curriculum. The perspective of nursing students and clinical teachers can have a significant impact on the curriculum and knowledge delivery. This research aimed to investigate the influence and effect of the teaching methods utilized by clinical teachers on the training of Saudi nursing students.

Participants and Methods

A descriptive cross-sectional quantitative study was conducted among n = 135 nursing students at different levels of education. Nursing Clinical Teacher Effectiveness Inventory was administered and analyzed to address the aim.

Results

Respondents rated Teaching Ability as the most effective clinical teaching behavior (mean [M] = 3.98, standard deviation [SD] = 0.84), followed by Nursing Competence (M = 3.92, SD = 0.81). Both Interpersonal Relations and Personality were equally rated at M = 3.88, while Evaluation received the lowest overall mean (M = 3.75, SD = 0.98). Multivariate analysis of variance results indicated significant differences in students' perceptions across academic levels (Pillai test = 0.51, F = 3.79, p < 0.001).

Conclusion

These findings highlight the importance of tailoring clinical teaching strategies based on program level. The Bachelor of Science in Nursing (BSN4) cohort consistently rated all teaching dimensions more favorably, suggesting higher satisfaction or more developed expectations among students in the later stages of their program. Conversely, lower ratings from Bridging 2 (BRID) students indicate a potential gap in their clinical learning experience. These disparities emphasize the need for a program-level-responsive approach to clinical teaching—strengthening underperforming categories like Evaluation, while reinforcing effective practices in cohorts with positive perceptions.

 

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Keywords

nursing education - clinical teacher - students - perspectives - behavior

Introduction

Clinical education is the cornerstone of nursing education and an important aspect of the nursing curriculum. The perspective of nursing students and clinical educators can have a significant impact on the curriculum and knowledge delivery.[1] [2] [3] Nursing education requires a close connection between the theoretical field and the clinical field, while clinical training is described as a discipline that prepares students to apply previously acquired knowledge to new skills and competencies. Personal and professional skills, attitudes, and behaviors are learned and practiced in patient care as students put theory into practice.[4] [5] [6]

Some authors suggest that clinical nursing education takes place in a clinical setting and includes real-life situations to enable students to apply their knowledge, while others argue that traditional methods are overly focused on the theoretical aspects of knowledge transfer rather than allowing students to practice while learning.[7] [8] [9] Other arguments suggest that traditional methods reduce the effectiveness of the training program because nurses cannot put their knowledge into practice, and students often encounter problems during clinical practice.[7] [8] [9] [10] Since the importance of clinical nursing education is unquestionable for personal and professional skills, recognition of nursing students' perspectives on clinical education can be the first step to positive changes.[7] [10] [11] At the same time, the role of clinical teachers should not be underestimated due to their significant impact on the clinical knowledge and experience of students.[10] [11] [12]

In 1948, nursing education was officially included in the Saudi medical education curriculum.[13] [14] Nowadays, nurses make an essential contribution to the health care sector, which has made them one of the most sought-after professions. According to the latest statistics from the Ministry of Health (MoH, 2017) of Saudi Arabia, nurses make up 41% (83,596) of the MoH workforce, of which 63% are Saudis. As a result, nursing education has evolved from 2-year vocational colleges to 4-year course at universities with over 39 nursing programs across the Kingdom.[15]

The wave in nursing education programs has created a dire need for educators.[13] [16] [17] As a result, many registered nurses have applied for teaching positions with no previous experience as staff nurses, clinical nurse educators, or clinical trainers in the field, thereby creating a double burden for both students and institutions in providing and acquiring knowledge.[13] [14] [18] Despite high demand for the profession and the training opportunities offered, data from published articles indicate a lack of sufficient education and practical readiness of Saudi nurses to work in medical institutions. As a result, Saudi nursing students face various challenges during course work and practical training. The most significant are inadequate professional skills and abilities, and gaps between theory and practice. Students explained that inadequate knowledge and skills in clinical training were caused by a lack of qualified nursing instructors who did not have sufficient teaching skills, poor communication skills, failure to influence students' perceptions positively, and inadequate training in clinical education.[13] [18] [19] [20]

Essentially, the perceptual patterns described above are consistent with current clinical education worldwide, not just in Saudi Arabia.[2] [7] [18] Through their direct involvement in the process, students are the best and most reliable sources of information on educational and practical issues, based on which the improvement of student learning conditions and clinical experience can increase their clinical competence.[2] [7] [18]

This study aimed to investigate and evaluate the impact and effect of teaching methods and techniques used by clinical teachers on the education of Saudi nursing students at a medical institution in the Eastern Province. This approach will allow a better understanding of the relationship between clinical learning behavior and the educational experience of nursing students, as well as identify areas for improvement to improve the quality of college nursing education. Furthermore, any obstacles or constraints that impact the efficacy of teaching and learning in a clinical setting will be recorded. By identifying these factors, the study will provide insights and recommendations for enhancing the effectiveness of clinical teaching and learning, thereby improving the overall educational experience of nursing students.

 

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Participants and Methods

Research Design and Participants

The study employed a descriptive cross-sectional quantitative design targeting Saudi nursing students in the Eastern Province. A purposive sampling technique was used to intentionally select participants who had relevant clinical exposure and were capable of providing informed responses related to the study objectives.[21] [22] While this nonrandom method introduces potential selection bias, the researchers mitigated it by establishing clear inclusion criteria—specifically selecting students (n = 135) enrolled in the second semester of a clinical course with at least one real-world clinical training experience. This ensured the sample's alignment with the research focus.

 

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Instrumentation

The study used the Nursing Clinical Teacher Effectiveness Inventory (NCTEI) developed by Knox and Morgan (1985), a 47-item checklist using a 5-point Likert scale, where strongly agree = 5, agree = 4, neutral = 3, disagree = 2, and strongly disagree = 1. Teacher characteristics were grouped into five subscales: teaching ability (17 items), nursing competence (9 items), personality traits (7 items), interpersonal relationship (6 items), and evaluation (8 items). Participants rate how the descriptive describes the teacher. The inventory has content and external validity according to peer review. The α range is 0.79 to 0.92; the test–retest correlation at 4-week intervals is 0.76 to 0.92.[23]

The questionnaire included two parts: (1) the first part of the tool consists of participants' demographic information, which includes age and group; and (2) the second section has 47 items describing clinical teacher behavior within five categories: teaching ability, nursing competence, evaluation of students, interpersonal relationship, and personality of the clinical teachers, the extent to which nursing instructors used teaching behaviors and the effectiveness of these behaviors on students' learning. Scoring of less than 60% is considered low priority learning behaviors, 60 to 75% moderate, and more than 75% high priority learning behaviors.

 

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Procedures

Ethical approval from the institutional review board (IRB) committee clearance was obtained with the IRB clearance number IRB-2022-NUR-016. Written informed consent was obtained from the respondents. Participation was voluntary. The researchers explained the purpose of the study and distributed the questionnaires. The time required for each respondent to complete the questionnaires was between 15 and 30 minutes.

 

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Data Analysis

Statistical Package for the Social Sciences (SPSS version 23, IBM Corp, Armonk, New York, United States) was used to compile and analyze the acquired data. The demographic data and participant responses were compiled and presented using descriptive statistics. Means (M) and standard deviations (SDs) were calculated to identify the successful actions of clinical teachers, as well as to describe the highest and lowest frequencies of behavior affecting student learning. The substantial differences in nursing students' views of clinical teacher actions were assessed using a multivariate analysis of variance (MANOVA): Pillai test. A p-value of less than 0.05 was considered statistically significant for this study.

 

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Results

An analysis of demographic data showed that the majority of participants were between the ages of 21 and 24 (50.37%). The group distribution showed that 23.7% of the respondents were Bachelor of Science in Nursing (BSN) students, followed by bridging students (BRID2) and BSN6, 22.2% in each group ([Table 1]).

Table 1 Demographic characteristics of n = 135 participants

Variable	Frequency	Percentage
Age
19–20	19	14.07
21–24	68	50.37
25–26	9	6.67
27 ≥	39	28.89
Group (level)[a]
brid2	30	22.22
brid3	17	12.59
bsn4	32	23.7
bsn6	30	22.22
bsn8	26	19.26

Abbreviation: BSN, Bachelor of Science in Nursing.

^a Brid – bridging students.

The highest clinical teacher behaviors perceived by students concerning teaching ability category were “Demonstrates clinical procedures and techniques” (M = 4.21, SD = 0.92) and “Guides students' development of clinical skills” (M = 4.19, SD = 0.90), “Remains accessible to students” (M = 4.10, SD = 0.92), and “Explains clearly” (M = 4.09, SD = 0.93). In terms of the nursing competence category, the highest clinical teacher behaviors perceived to be “Demonstrates a breadth of knowledge in nursing” (M = 4.09, SD = 0.89) ([Table 2]).

Table 2 Top 10 highest behaviors as perceived by students (n = 135)

Behavior description	Category	Mean	Standard deviation
Demonstrates clinical procedures and techniques	Teaching Ability	4.21	0.92
Guides students' development of clinical skills	Teaching Ability	4.19	0.9
Remains accessible to students	Teaching Ability	4.1	0.92
Explains clearly	Teaching Ability	4.09	0.93
Demonstrates a breadth of knowledge in nursing	Nursing Competence	4.09	0.89
Emphasizes what is important	Teaching Ability	4.05	1.03
Encourages a climate of mutual respect	Interpersonal Relations	4.04	0.9
Demonstrates communication skills	Nursing Competence	4.03	1.04
Demonstrates clinical skill and judgment	Nursing Competence	4	0.93
Offers special help when difficulties arise	Teaching Ability	3.99	1.08

The lowest behaviors perceived by students concerning the teaching ability category was “Is well prepared for teaching” (M = 3.99, SD = 1.06) and “Takes responsibility of own actions” (M = 3.99, SD = 0.95) in the nursing competence category. In evaluation and personality categories, the lowest perceived behaviors were “Observes students' performance frequently” (M = 3.97, SD = 1.11) and “Self-confidence” (M = 3.97, SD = 1.01), accordingly ([Table 3]).

Table 3 Lowest rated behaviors as perceived by students (n = 135)

Behavior description	Category	Mean	Standard deviation
Is well prepared for teaching	Teaching Ability	3.98	1.06
Takes responsibility of own actions	Nursing Competence	3.98	0.95
Observes students' performance frequently	Evaluation	3.97	1.11
Self-confidence	Personality	3.97	1.01
Is self-critical	Personality	3.97	1.06
Answers carefully and precisely questions raised by students	Teaching Ability	3.96	1.12
Questions students to elicit underlying reasoning	Teaching Ability	3.96	0.96
Provides specific practice opportunity	Teaching Ability	3.94	1.02
Listens attentively	Interpersonal Relations	3.94	1.04
Helps students organize their thoughts about patient problems	Teaching Ability	3.93	1.09
Encourages active participation in discussion	Teaching Ability	3.93	1.2
Quickly grasps what students are asking or telling	Teaching Ability	3.93	1.16
Makes specific suggestions for improvement	Evaluation	3.92	1.02
Is a dynamic and energetic person	Personality	3.92	0.99
Is a good role model	Nursing Competence	3.91	0.99
Is approachable	Interpersonal Relations	3.91	1.05
Promotes student independence	Teaching Ability	3.9	1.21
Gears instruction to students' level of readiness	Teaching Ability	3.85	1.02
Directs students to useful literature in nursing	Nursing Competence	3.85	1.16
Recognizes own limitations	Nursing Competence	3.83	0.93
Stimulates student interest in the subject	Teaching Ability	3.82	1.18
Provides frequent feedback on students' performance	Evaluation	3.82	1.22
Enjoys teaching	Teaching Ability	3.81	1.16
Communicates expectations of students	Evaluation	3.81	1.04
Demonstrates empathy	Interpersonal Relations	3.81	1.08
Demonstrates enthusiasm	Personality	3.8	1.03
Discusses current development in his/her field	Nursing Competence	3.79	1.09
Provides support and encouragement to students	Interpersonal Relations	3.79	1.07
Shows a personal interest in students	Interpersonal Relations	3.79	1.09
Reveals broad reading in his/her area of interest	Nursing Competence	3.79	1.03
Is open-minded and nonjudgmental	Personality	3.76	1.24
Gives students positive reinforcement for good contributions, observations, or performance	Evaluation	3.74	1.26
Identifies students' strengths and limitations objectively	Evaluation	3.7	1.16
Has a good sense of humor	Personality	3.68	1.2
Does not criticize students in front of others	Evaluation	3.59	1.33
Corrects students' mistakes without belittling them	Evaluation	3.45	1.38

The frequencies of teaching categories, as perceived by students, are presented in [Table 4]. Respondents ranked the “Teaching Ability” of the clinical teachers as the highest teaching category (M = 3.98, SD = 0.84), followed by “Nursing Competence” (M = 3.92, SD = 0.81) and “Evaluation” (M = 3.75, SD = 0.98). The lowest scored categories were “Interpersonal Relations” (M = 3.88, SD = 0.90) and “Personality” (M = 3.88, SD = 0.91).

Table 4 The rank of teaching categories among n = 135 participants

Teaching categories	Mean	Standard deviation
Teaching Ability	3.98	0.84
Nursing Competence	3.92	0.81
Evaluation	3.75	0.98
Interpersonal Relations	3.88	0.9
Personality	3.88	0.91

Differences in perception between different groups (levels) of students were identified using the MANOVA: Pillai test. There is enough evidence to support significant differences in perception between different groups (p < 0.001). The group levels significantly impact the mean perceived scores in the five teaching categories ([Table 5]).

Table 5 The difference in perception between different groups (levels) of the students, MANOVA: Pillai test. (n = 135)

Cases	df	Approx. F	TracePillai	Num df	Den df	p-Value
Group	4	3.79	0.51	20	516	< 0.001
Residuals	130

Abbreviations: df, degrees of freedom; MANOVA, multivariate analysis of variance.

Further investigation on the means of the teaching categories across the different levels revealed that the BSN4 group had the highest mean ratings across the five categories ([Table 6]).

Table 6 Mean teaching categories across the different groups (levels) of n = 135 participants

Categories	Groups	Mean	Standard deviation
Mean Teaching Ability	brid2	3.384	0.841
	brid3	4.201	0.668
	bsn4	4.586	0.569
	bsn6	3.8	0.892
	bsn8	3.98	0.594
Mean Nursing Competence	brid2	3.522	0.75
	brid3	4.255	0.547
	bsn4	4.417	0.69
	bsn6	3.667	0.853
	bsn8	3.833	0.733
Mean Evaluation	brid2	3.229	1.017
	brid3	4.265	0.615
	bsn4	4.414	0.771
	bsn6	3.388	0.937
	bsn8	3.611	0.862
Mean Interpersonal Relations	brid2	3.439	0.806
	brid3	4.284	0.571
	bsn4	4.474	0.694
	bsn6	3.478	0.975
	bsn8	3.859	0.806
Mean Personality	brid2	3.333	0.941
	brid3	4.345	0.565
	bsn4	4.58	0.57
	bsn6	3.467	0.818
	bsn8	3.841	0.83

Abbreviations: Brid, bridging students; bsn, Bachelor of Science in Nursing.

 

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Discussion

Clinical education is the core of nursing education, provided to students by experienced clinical teachers in educational and medical institutions.[24] [25] [26] Clinical teachers should demonstrate commitment, internal motivation, flexibility and creativity, time management, morality, and up-to-date knowledge and skills. Additional evidence suggests that proficiency, behavior and character, and the ability to transfer theoretical knowledge of nursing students in clinical practice, thereby ensuring the integration of theory and practice, affect student learning attitudes.[27] [28] [29] Likewise, findings of the current study showed that Saudi nursing students have precise expectations of the behaviors of clinical teachers in facilitating students' clinical experiences.

Respondents rated teaching ability as the most effective clinical teaching behavior, followed by nursing competence. Both interpersonal relations and personality were equally rated, while evaluation received the lowest overall mean. The patterns identified in this research were consistent with international data, suggesting that clinical teachers are expected to maintain their credibility and be relevant, devoting time to studying and exchanging new knowledge, guiding, and supporting students in their training.[26] [30] [31] [32] [33]

Clinical competence was proposed as a fundamental element in improving the quality of patient care, increasing patient satisfaction, and improving nursing education and clinical nursing.[26] [34] [35] This research showed that, along with teaching ability, students considered nursing competence as some of the highest category for an effective clinical teacher. These perceptions corresponded to earlier study by Ludin and Fathullah, who reported that the competence of teachers was the most significant influential factor for students.[34] In addition, a comprehensive review of 29 studies by Labrague et al reported that medical students value nursing competence, suggesting that educators should strive to improve their professional competence and interpersonal skills to provide better nursing education.[35]

According to the World Health Organization (2016), all member countries should implement their plans to improve the professional competence of nurses.[36] While there is no universal consensus on the characteristics of clinically competent instructors, characteristics such as codes of ethics, updated theoretical and clinical knowledge, effective communication with students, and leading ability have been suggested as important factors. To get the necessary competencies, clinical teachers should receive adequate training and support through continued medical education and professional development.[27] [37] [38] Professional competence can positively affect not only knowledge of students and their perception but also increase the effectiveness of a clinical teacher, their quality of nursing, and organization performance.

Further findings in this study corresponded to an earlier study in the Philippines, where students evaluated personality and interpersonal relations as the important categories to characterize a good clinical teacher.[39] Thus, although faculty occupy a distinctive position in the education system and can professionally train students, interpersonal communication skills and their positive attitude to knowledge delivery and exchange cannot be underestimated.[40] [41]

The least rated category by the students was evaluation, consistent with the study by Soriano and Aquino, where both faculty and students perceived the evaluation category as the least important characteristic of good clinical educators.[39] Likewise, studies from the Northwest Ethiopia and Egypt showed that the evaluation gained the least average.[26] [42] Nevertheless, the evaluation is an important tool for teachers, managers, and nurses to get information about professional strengths and weaknesses of nurses and, therefore, in educational and developing needs.[36] [43] Moreover, this process helps students get the desired skills and goals and assists teachers in the development of an integrated and acceptable system of providing knowledge.[44] The evaluation convinces that students have acquired the necessary knowledge and skills before graduation and measure their readiness and judgment to ensure effective, safe, and ethical care of patients, certifying that graduates can become competent and safe practitioners. Therefore, although the evaluation is not the ultimate goal of providing knowledge, it should be a motivating force to teach students.[24] [36] [44]

Personality traits reflect the characteristic patterns of thoughts, feelings, and behavior of people and play a critical role in education.[29] [45] [46] The best personal development school is one where students learn about ethics, behavior, and how to gain self-esteem. Evidence from nursing practice and their personality traits shows that nurses' openness is significantly positively related to their competencies, including decision-making, collaboration, and intervention.[45] [47] Moreover, a recent study by Xu et al among Chinese nursing trainees found that the openness of nurse interns was positively associated with clinical decision-making, which is beneficial for clinical nursing in general.[29] Taking into consideration this evidence, it is worth to suggest that Saudi students may lack knowledge about personality traits and what these traits mean within their profession. Therefore, future research needs to assess their knowledge of personality traits and suggest intervention components that can enrich their knowledge.[29] [46] [47]

The clinical experience of nursing students is largely dependent on the behavior of clinical teachers. To educate students about their future professional roles, nursing students want teachers to encourage, engage, develop a trusting relationship with them, and provide insightful feedback and critique.

 

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Conclusion

The study identified significant variation in how students at different academic levels perceive clinical teaching behaviors. Teaching Ability and Nursing Competence were consistently valued across all cohorts, but Evaluation was perceived as the weakest domain, particularly by lower-level and bridging students. The BSN4 group, nearing program completion, rated all aspects of clinical teaching more favorably, possibly reflecting greater appreciation of clinical instruction or more mature academic expectations. These findings highlight the importance of tailoring clinical teaching strategies based on program level. In particular, there is a need to improve evaluation practices and support lower-level students who may perceive less instructional value in their clinical experiences. A holistic and differentiated approach—emphasizing strong teaching behaviors while addressing weaker domains like evaluation—can enhance the learning experience, promote competence, and better prepare nursing students for professional practice.

 

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Conflict of Interest

None declared.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Compliance with Ethical Principles

The study was approved by the Research and Ethics Committee of Prince Sultan Military College of Health Sciences (IRB-2022-NUR-016). After the purpose of the study was explained, participants were asked to complete and sign an informed consent form agreeing to participate.

Authors' Contributions

M.E.M.M., J.B., N.A., A.A.S., A.W. - Conceptualization, Methodology, Formal analysis, Software, Investigation; M.E.M.M., J.B., N.A., A.A.S., J.V.Q., A.W. - Visualization, Writing - Original Draft, Writing - Review & Editing; L.H.A.J., R.A.A., J.V.Q. - Validation, Supervision, Project Administration, Resources, Writing - Review & Editing.

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Publication History

Article published online:
22 August 2025