A total of 403 students have participated in the study, giving a response rate of 100%. The total, 213 (52.9%) of the respondents were females and the minimum and maximum age of the participants were 18 and 29 respectively. The largest numbers of students belonging to the age category of 20-24, 348 (86.4%) Half of the study participants 270 (67%) were Orthodox followers and 304 (75.4%) of them were Amhara by ethnicity (Table 1).
Table 1: Socio-demographic characteristics of Midwifery and Nursing students at Bahir Dar Health Sciences Colleges, Northwest Ethiopia 2022, (n=403).
Characteristics
|
Frequency
|
Percentage %
|
University/College
|
Bahir Dar University
|
69
|
17.1
|
Rift valley University
|
77
|
19.1
|
Alkan University College
|
69
|
17.1
|
GAMBY College of Medical Sciences
|
118
|
29.3
|
Kea-Med Medical College
|
70
|
17.4
|
Religion
|
Orthodox
|
270
|
67.0
|
Muslim
|
41
|
10.2
|
Protestant
|
81
|
20.1
|
Others
|
11
|
2.7
|
Marital status
|
Single
|
392
|
97.3
|
Married
|
11
|
2.7
|
Ethnicity
|
Amhara
|
304
|
75.4
|
Gurage
|
29
|
7.2
|
Somalie
|
16
|
4.0
|
Tigray
|
4
|
1.0
|
SNNPR
|
26
|
6.5
|
Oromo
|
24
|
5.9
|
Residence
|
Urban
|
326
|
80.9
|
Rural
|
77
|
19.1
|
Departments
|
Midwifery
|
173
|
42.9
|
Nursing
|
230
|
57.1
|
Year of study
|
3rd year
|
199
|
49.4
|
4th year
|
204
|
50.6
|
Father educational status
|
Unable to write and read
|
36
|
8.9
|
Able to write and read
|
149
|
37.0
|
Primary (1-8)
|
24
|
6.0
|
Secondary (9-12)
|
47
|
11.7
|
Diploma and above
|
147
|
36.5
|
Mother educational status
|
Unable to write and read
|
72
|
17.9
|
Able to write and read
|
159
|
39.5
|
Primary (1-8)
|
35
|
8.7
|
Secondary (9-12)
|
53
|
13.2
|
Degree and above
|
84
|
20.8
|
Prevalence of clinical practice competence
This study revealed that the overall clinical practice competence of the study participant was 147(36.5%) with 95% CI 32 - 41% (Figure 4).
Clinical practice competencies by year of study and departments
There was a difference in clinical practice competence of the study participants in terms of year of study and departments. Regarding the department of study participants, 64 (43.5%) of Midwifery students and 83 (56.5%) of nursing students were clinically competent. Concerning year of study when increase in yea the clinically competent level should be also, increase (Figure 2).
Clinical instructor factors
Among the participant, more than half of them 348 (86.4%) were agreed on clinical instructor use different learning methods, and 128(31.8%) of them were disagreed regarding clinical instructor Orient the objective of clinical practice during clinical practice. Regarding the clinical instructor, 327(81.1%) of the participants were agreed on Spent enough time on clinical site and 117(29.0 %) of the participant were disagreed on clinical instructor provides constructive feedback (Table 2).
Table 2: Clinical instructor characteristics response of Midwifery and Nursing students at Bahir Dar Health Sciences Colleges, Northwest Ethiopia 2022, (n=403).
Clinical instructor factor
|
Yes
|
No
|
Frequency
|
%
|
Frequency
|
%
|
1
|
Provide logbook
|
285
|
70.7
|
118
|
29.3
|
2
|
Orient the objective of clinical practice
|
275
|
68.2
|
128
|
31.8
|
3
|
Spent enough time on clinical site
|
327
|
81.1
|
76
|
18.9
|
4
|
Use different learning methods
|
348
|
86.4
|
55
|
13.6
|
5
|
Show clinical procedure
|
323
|
80.1
|
80
|
19.9
|
6
|
Provides constructive feedback
|
286
|
71.0
|
117
|
29.0
|
Clinical practice environment factors
Regarding the clinical practice environment is conducive, 306 (75.9%) of the study participant were agreed and 251(62.3%) of them were disagreed on clinical placement has a room for joint meetings during clinical practice. Concerning staff encourages students during clinical practice, 251(62.3%) of the study participant were agreed and 168 (41.7%) of them were disagreed on Clinical practice environment has sufficient cases (Table 3).
Table 3: Clinical practice environment characteristics response of Midwifery and Nursing students at Bahir Dar Health Sciences Colleges, Northwest Ethiopia 2022, (n=403).
Clinical practice environment factors
|
Yes
|
No
|
Frequency
|
%
|
Frequency
|
%
|
1
|
Clinical practice environment is conducive
|
306
|
75.9
|
97
|
24.1
|
2
|
Clinical practice environment has sufficient cases
|
235
|
58.3
|
168
|
41.7
|
3
|
Clinical practice environment has sufficient material
|
237
|
58.8
|
166
|
41.2
|
4
|
Clinical practice environment has meet objectives of clinical practice
|
251
|
62.3
|
152
|
37.7
|
5
|
Clinical practice environment has sufficient wards
|
246
|
61.0
|
157
|
39.0
|
6
|
Clinical placement has a room for joint meetings
|
162
|
40.2
|
241
|
59.8
|
7
|
Staff allows students to perform tasks during clinical practice
|
249
|
61.8
|
154
|
38.2
|
8
|
Staff encourages students during clinical practice
|
251
|
62.3
|
152
|
37.7
|
Assessment method factors
Regarding assessment methods has a positive influence on clinical practice, 289(71.7%) of participants were agreed and 245(60.8%) of them were disagreed as assessment methods address the three learning domains. About 282 (70.0%) of the participants were agreed on instructor orient about assessment methods during clinical practice and 199(49.4%) of them were disagreed on instructor use checklist to assess the performance during clinical practice (Table 4).
Table 4: Assessment method characteristics of Midwifery and Nursing students at Bahir Dar Health Sciences Colleges, Northwest Ethiopia 2022, (n=403).
Assessment method factors
|
Yes
|
No
|
Frequency
|
%
|
Frequency
|
%
|
1
|
Instructors orient about assessment
|
282
|
70.0
|
121
|
30.0
|
2
|
Assessment method has a positive influence on clinical practice
|
289
|
71.7
|
114
|
28.3
|
3
|
Instructor uses continuous assessment
|
224
|
55.6
|
179
|
44.4
|
4
|
Assessment methods address the three learning domain
|
158
|
39.2
|
245
|
60.8
|
5
|
Instructor use checklist to assess
|
204
|
50.6
|
199
|
49.4
|
Preceptor factors
Majority 391(97.0%) of the respondents agreed that have preceptor in your clinical practice and 122 (31.2%) of the participant have disagreed regarding preceptor provides constructive feedback during clinical practice (Table 5).
Table 5: Preceptor factor characteristics of Midwifery and Nursing students at Bahir Dar Health Sciences Colleges, Northwest Ethiopia 2022, (n=403).
Preceptor factor
|
Yes
|
No
|
Frequency
|
%
|
Frequency
|
%
|
1
|
Do you have preceptor in your clinical practice
|
391
|
97.0
|
12
|
3.0
|
2
|
Preceptor identifies student’s learning needs
|
357
|
91.3
|
34
|
8.6
|
3
|
Preceptor has good clinical skills
|
322
|
82.3
|
69
|
17.6
|
4
|
Preceptor show different procedures
|
309
|
79.0
|
82
|
20.9
|
5
|
Preceptor provides constructive feedback
|
269
|
68.7
|
122
|
31.2
|
6
|
Preceptor has good interpersonal skills
|
270
|
69.0
|
121
|
30.9
|
Student factors
Regarding the absence during clinical practice 321(79.7%) were absent from clinical practice without permission, out of them 281(87.5%) were absent once, 34(10.5%) were twice and 6 (1.8%) were three times and above (Table 6).
Table 6: Student factor characteristics of Midwifery and Nursing students at Bahir Dar Health Sciences Colleges, Northwest Ethiopia 2022, (n=403).
Student factor during clinical practice
|
Yes
|
No
|
Frequency
|
%
|
Frequency
|
%
|
1
|
Having a good relationship with team members
|
335
|
83.1
|
68
|
16.9
|
2
|
Having good information exchange habit with team members
|
336
|
83.4
|
67
|
16.6
|
3
|
I was motivated and eager to learn
|
403
|
100.0
|
-
|
-
|
4
|
I was confident during conducing procedure
|
356
|
88.3
|
47
|
11.7
|
5
|
Absent from clinical practice without permission
|
321
|
79.7
|
82
|
20.3
|
6
|
I was punctual during my clinical practice
|
365
|
90.6
|
38
|
9.4
|
7
|
My parent economic status affected my clinical practice
|
168
|
41.7
|
235
|
58.3
|
Simulation-based learning factors
Majority 340(84.4%) of the respondents agreed that get necessary help in the use of equipment during skills demonstration and 162 (40.2%) of the participant have disagreed regarding programs of skills demonstration are flexible and adjustable for simulation class (Table 7).
Table 7: Simulation-based factor characteristics of Midwifery and Nursing students at Bahir Dar Health Sciences Colleges, Northwest Ethiopia 2022, (n=403).
Simulation-based learning related factor
|
Yes
|
No
|
Frequency
|
%
|
Frequency
|
%
|
1
|
Teacher provides me accurate information about skills requirements
|
324
|
80.4
|
79
|
19.6
|
2
|
Teacher explains learning objectives for simulation-learning at the beginning of the period
|
286
|
71.0
|
117
|
29.0
|
3
|
Teacher gives me enough time to meet the objective(s)
|
290
|
72.0
|
113
|
28.0
|
4
|
Teacher assists me in developing long-term skills
|
286
|
71.0
|
117
|
29.0
|
5
|
Students’ different backgrounds are taken into account
|
274
|
68.0
|
129
|
32.0
|
6
|
The way my teachers taught the simulation is suitable to the way I learn
|
336
|
83.4
|
67
|
16.6
|
7
|
The teaching methods used in the simulation are helpful and effective
|
306
|
75.9
|
97
|
24.1
|
8
|
There are enough skills practicing programs per semester
|
248
|
61.5
|
155
|
38.5
|
9
|
Programs of skills demonstration are flexible and adjustable for simulation class
|
241
|
59.8
|
162
|
40.2
|
10
|
Number of students per teaching group is small
|
248
|
61.5
|
155
|
38.5
|
11
|
I can get necessary help in the use of equipment
|
340
|
84.4
|
63
|
15.6
|
12
|
I can assess my own skills performance critically
|
312
|
77.4
|
91
|
22.6
|
13
|
My teacher gives me necessary feedback
|
337
|
83.6
|
66
|
16.4
|
Factors associated with clinical practice competence
Hosmer and lemeshow model of fitness show that the model was adequately fit with p-value of 0.429 which is greater than 0.05.
In bivariate logistic regression analysis, provide logbook, show clinical procedure, clinical practice environment has sufficient cases, staff encourages students during clinical practice, assessment method has a positive influence on clinical practice, instructor use checklist to assess the performance, preceptor show different procedures, confident during conducing procedure, way of teachers taught the simulation is suitable to the way of learn, number of students per teaching group is small and get necessary help in the use of equipment were found to be associated factors with clinical practice competence in bivariate with p-value less than 0.2. Thus, transferred to multivariable logistic regression model. In multivariable model provide logbook, clinical practice environment has sufficient cases, assessment method has a positive influence on clinical practice, preceptor show different procedures, confident during conducing procedure and the way of teachers taught the simulation is suitable to the way of learn where maintain their association with clinical practice competence.
Students who were providing logbook were 5 times more likely competent than those who were not logbooks [(AOR=5.40, 95% CI 2.91, 10.02)].
This study also revealed that students with adequate clinical cases in the clinical practice placement were 2 times clinically competent than those students with inadequate clinical cases in the clinical practice placement with [(AOR=2.72, 95% CI 1.60, 4.60)].
Preceptor show different procedures was significantly associated with the clinical practice competence of students. Students who were different procedures showed by preceptors during clinical practice were 2 times more likely competent than those who have not shown different procedures [(AOR=2.50, 95% CI 1.33, 4.71)].
Among student factors included in the study, student’s confidence during conducting procedure was significantly associated with the clinical practice competency of students. Students who were confident during conducting a procedure were 4 times more likely competent than those who were not confident during conducting a procedure [(AOR=4.16, 95% CI 1.67, 10.35)].
The way of teachers taught the simulation is suitable to the way of learn was significantly associated with the clinical practice competence of students. During skills demonstration, the way of teachers taught the simulation is suitable to the way to learn were 2 times more likely competent than those large number of students per teaching group [(AOR=2.10, 95% CI 1.00, 4.40)].
Table 8: Results of bivariate and multivariate analysis for clinical practice competence and associated factors among Midwifery and Nursing students at Bahir Dar Health Sciences Colleges, Northwest Ethiopia 2022, (n=403).
Variables
|
Clinical practice competence
|
COR (95%CI)
|
AOR (95%CI)
|
Clinically Incompetent
|
Clinically Competent
|
Instructor provide clinical practice logbook
|
Yes
|
166
(41.2%)
|
119
(29.5%)
|
2.30 (1.41, 3.74)
|
5. 40 (2.91, 10.02) ***
|
No
|
90
(22.3%)
|
28
(6.9%)
|
1
|
1
|
Instructor show clinical procedure
|
Yes
|
197
(48.9%)
|
126
(31.3%)
|
1.79 (1.04, 3.10)
|
1.63 (0.71, 3.74)
|
No
|
59
(14.6%)
|
21
(5.2%)
|
1
|
1
|
Clinical placement has sufficient cases
|
Yes
|
157
(39.0%)
|
78
(19.4%)
|
0 .71 (0.47, 1.07)
|
2.72(1.60, 4.60) ***
|
No
|
99
(24.6%)
|
69
(17.1%)
|
1
|
1
|
Staff encourages students during clinical practice
|
Yes
|
170
(42.2%)
|
81
(20.1%)
|
0.62 (0.41, 0.94)
|
1.40 (0.75, 2.61)
|
No
|
86
(21.3%)
|
66
(16.4%)
|
1
|
1
|
Assessment method has a positive influence on clinical practice
|
Yes
|
194
(48.1%)
|
95
(23.6%)
|
0.58 (0.37, 0.90)
|
2.147(1.251, 3.684) ***
|
No
|
62
(15.4%)
|
52
(12.9%)
|
1
|
1
|
Instructors use checklist to assess performance
|
Yes
|
131
(32.5%)
|
73
(18.1%)
|
0.51 (1.00, 2.29)
|
0.71 (0.40, 1.27)
|
No
|
125
(31.0%)
|
74
(18.4%)
|
1
|
1
|
Preceptor show different procedures
|
Yes
|
197
(48.9%)
|
124
(30.8%)
|
1.61 (0.94, 2.74)
|
2.50 (1.33, 4.71)**
|
No
|
59
(14.6%)
|
23
(5.7%)
|
1
|
1
|
Confident during performing procedure
|
Yes
|
220
(54.6%)
|
136
(33.7%)
|
2.02 (0.99, 4.10)
|
4.16 (1.67, 10.35)**
|
No
|
36
(8.9%)
|
11
(2.7%)
|
1
|
1
|
The way of teachers taught the simulation is suitable to the way of learn
|
Yes
|
211
(52.4%)
|
125
(31.0%)
|
1.21 (0.69, 2.11)
|
2.10 (1.00, 4.40)*
|
No
|
45
(11.2%)
|
22
(5.5%)
|
1
|
1
|
Number of students per teaching group is small
|
Yes
|
148
(36.7%)
|
100
(24.8%)
|
0.64 (0.42, 0.98)
|
1.10 (0.64, 1.91)
|
No
|
108
(26.8%)
|
47
(11.7%)
|
1
|
1
|
During skills demonstration, I can get necessary help in the use of equipment
|
Yes
|
216
(53.6%)
|
124
(30.8%)
|
1.00 (0.57, 1.75)
|
0.89 (0.43, 1.84)
|
No
|
40
(9.9%)
|
23
(5.7%)
|
1
|
1
|
P<0.05*, P<0.01**, P<0.001***, COR= Crude Odd Ratio, AOD=Adjusted Odd Ratio, CI=confidence Interval, P-value set <0.2 for bivariate logistic regression and 0.05 for multivariate logistic regression