CHAPTER ONE

INTRODUCTION
1.1 Background of the study
Attitude plays a major role in leading human toward achieving the desired goals,
awareness of its consequences, and effective processing of complex information.
Students’ attitude towards clinical practice could be affected by a clinical
environment, student staff interaction, clinical preceptors, and the availability of
necessary equipment in a hospital setting
Lack of interest in what people do could decrease the quality of work. More than half
of all healthcare providers are Midwives and Nurse in the healthcare setting. Hence, if
the attitude of Nursing and Midwifery professionals is not favorable, the quality of
health care could be compromised in a significant manner. In Nigeria, students join
Nursing and Midwifery degree programs directly after completing secondary
education which demands intensive clinical training to acquire Nursing and
Midwifery competencies.
A thorough nursing education that is based on theoretical knowledge accumulated
over time is necessary for anyone pursuing a career in nursing (Gemuhay et al., 2019).
The current population explosion, new diseases, rising hospital stays, and rising health
care use need for improvements in nursing education and the way that information is
taught. More specifically, the clinical learning environment has been a focus area in
nursing education for more than 20 years (Gamtessa, 2021), with the goal of
producing nurses who are competent, quick clinical judgement makers and prudent
decision makers because real-life experiences are harnessed in this area to meet the
rising demand for healthcare. Nonetheless, it is a well-researched fact that nursing
students encounter difficulties in acquiring the clinical skills needed to become
certified, competent nurses (Amoo & Enyan, 2022).
Research on nursing students' attitudes towards clinical work has been noted to be of
interest because, depending on the attitude students exhibit (positive or negative)
which can either improve clinical learning that is effective or hinder the development
of critical clinical skills (Kaliyangile, 2020). In order to fill in any gaps in their
education, it is crucial that nursing students receive a thorough education in all areas
required for them to be competent nurses in society (Gamtessa, 2021). It is also
critical to comprehend how nursing students view and feel about clinical placements,
as well as the effect this clinical posting has on their academic performance.

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Therefore, the purpose of this study project is to ascertain how clinical experience
affects nursing students' academic performance at Lagos state college of nursing.
In nursing programmes, students are exposed to both theoretical and practical
components. The combination of theory and practice in the clinical setting is seen by
Mabuda, Potgieter, and Alberts (2008) as the “art and science of nursing” (p. 19).
Clinical learning is a vital component of nursing education. In addition to providing
opportunities to develop competence in nursing skills, the clinical environment
engenders in nursing students a sense of identity as professionals in the real world.
This is because to complete the practical component of their training; the nursing
students are assigned to a hospital or clinic under the supervision of experienced nurse
practitioners and/or educators. Clinical supervision is defined as “a process of
professional support and learning in which nurses are assisted in developing their
practice through regular discussion time with experienced and knowledgeable
colleagues” (Fowler, 1996, as cited in Brunero & Stein-Parbury, 2008, p. 87). Brunero
and Stein-Parbury (2008) stated that clinical supervision “provides nurses with the
opportunity to improve patient care in particular for a given patient and in general in
relation to maintaining standards of care” (p. 87). For clinical learning and
supervision to occur successfully, Mabuda, Potgieter, and Alberts (2008) appointed to
the need for the clinical environment to be conducive to learning as well as to be
supportive. This is because such an environment would have an effect on nursing
students’ achievement and satisfaction (Mabuda, Potgieter, & Alberts, 2008).
Numerous studies have shown that nursing students' attitudes towards clinical work or
placement are problematic, notwithstanding the significance of clinical experience,
posting, or placement in the acquisition of nursing skills (Kaliyangile, 2020). Nursing
students' negative views regarding clinical practice and postings were still noted by
Avbuluimen & Chiejina (2021). Only 42.9% of nursing students showed a good
attitude towards clinical work, compared to 57.1% who had negative attitudes towards
clinical practice, according to Aragaw et al. (2019). The spectrum of attitudes
demonstrated includes being on time for work, being willing to resume nursing
operations, having a good connection with interprofessional students, and showing
respect for senior coworkers and nurse clinicians. It is expected of nursing students to
work as scheduled, with the exception of their designated days off.

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They have the chance to get guidance, instruction, and correction from nurse
clinicians, preceptors, and clinical instructors when they show up for work on a
regular basis. Because they practise on actual patients rather than the models utilized
in nursing laboratories, it lessens the fear associated with doing treatments on humans.
Nonetheless, maintaining consistent attendance at work has proven difficult, even
with the majority of training institutions setting an expected percentage of attendance
(Amoo & Enyan, 2022). Saleh (2019) concluded that these factors lower motivation
to learn as students considered their presence in the clinical environment as not
necessary, which had a negative influence on the students' academic performance.
They also attributed tardiness and absenteeism to a lack of educational opportunities,
such as the lack of novel cases in the inpatient wards and outpatient clinics, and the
inability to put acquired knowledge and skills into practice. Thus, the need for this
study to evaluate the effect of clinical experience on nursing students' academic
performance at Lagos state college of nursing.

1.2 Statement of the problem

Since the inception of the nursing programme at the institution used for the study,
nursing students are assigned to hospitals for seven weeks clinical experience. When
asked by their supervisors during and after their posting, these nursing students share
their views of their clinical environment, their encounters with the patients and their
relatives, and their successes and challenges. Despite the nursing students’ informal
responses, as well as their performance at the end of the course, there has not been
any formal quantitative research done on this topic.
A review of the literature shows that a few studies have been done in this area around
the world. For instance, in Africa, Adjei, Sarpong, Attafuah, Amertil, and Akosah
(2018) explored the perceptions of student nurses in a private university in Ghana.
Similarly, Mabuda, Potgieter and Alberts (2008) investigated the experiences of
student nurses during clinical practice at a nursing colleges.
Studies have also been done in the Middle East by Sharif and Masoumi (2005) who
explored nursing students’ experiences of clinical practice in Shiraz University of
Medical Sciences in southern Iran; while Jamshidi, Molazem, Sharif, Torabizadeh,
and Kalyani (2016) examined the challenges of nursing students in clinical learning
Shiraz University of Medical Sciences in Iran. Other studies were done by Tiwaken,

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Caranto, and David (2015) who examined the lived experiences of student nurses
during clinical practice in Bonafide Benguet State University-College of Nursing in
the Philippines in Asia. While in Europe, Mattila, Pitkajarvi, and Eriksson (2010)
studied the clinical practice experiences of international student nurses in the Finnish
health care system. In all these studies done in different parts of the world, the
researchers used mostly the qualitative approach to explore nursing students’
experiences during and/or after clinical practice.
There is a significant incoherence between theory and clinical practice and one of the
cause of this discrepancy could be attitude. A positive attitude towards clinical
practice enhances effective clinical learning. Whereas, a negative attitude hampers the
acquisition of essential clinical skills. Thus, identifying the gap in clinical practice is
noteworthy for improving the quality of Nursing and Midwifery educations

1.3 Objective of the study

The objective of the study are;
1. To ascertain the attitude of midwife towards clinical experience
2. To ascertain the relationship between clinical experience and academic
performance of midwife student
3. To identify issues encountered by the nursing students during their clinical
practice placement.

1.4 Research hypotheses

The following hypotheses were developed for the study:
Hypothesis One
HO: there is no relationship between clinical experience and academic performance of
midwife student.
HI: there is relationship between clinical experience and academic performance of
midwife student
Hypothesis Two
HO: there are no issues encountered by the nursing students during their clinical
practice placement
HI: there are issues encountered by the nursing students during their clinical practice
placement

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1.5 Significance of the study
It is believed that the study will provide results on the clinical placements and
experiences of the nursing students that will be beneficial to different stakeholders
(nursing educators & students). First, the nursing educators at the institution used for
the study may find the results useful since it will reveal the nursing students’
perceptions of their clinical practice experience, and possible ways of improving areas
of weaknesses. Second, by fixing problem areas in the course, it might enhance the
learning experience for the nursing students in the future.

1.6 Scope and limitation of the study

The scope of the study covers evaluating the influence of clinical experience on the
academic performance of student midwives. The researcher encounters some
constrain which limited the scope of the study;
a) AVAILABILITY OF RESEARCH MATERIAL: The research material
available to the researcher is insufficient, thereby limiting the study
b) TIME: The time frame allocated to the study does not enhance wider coverage as
the researcher has to combine other academic activities and examinations with the
study.

1.7 Definition of terms

Clinical experience: Clinical experience means providing direct behavioral health
services on a full-time basis or equivalent hours of part-time work to children and
adolescents who have diagnoses of mental illness and includes supervised internships,
supervised practicums, and supervised field experience for the purpose of Medicaid .
Midwife: A midwife is a health professional who cares for mothers and newborns
around childbirth, a specialization known as midwifery. The education and training
for a midwife is similar to that of a nurse, in contrast to obstetricians and
perinatologists who are physicians
Academic performance: Academic performance or "academic achievement" is the
extent to which a student, teacher or institution has attained their short or long-
term educational goals.

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 CHAPTER TWO
LITERATURE REVIEW
2.1 Concept of Nursing Education
Education in its broadest, general sense is the means through which the aims and
habits of a group of people live on from one generation to the next. Generally, it
occurs through any experience that has a formative effect on the way one thinks, feels
or acts, (Harrison, 2010). In its narrow, technical sense, education is the formal
process by which a profession or society deliberately transmits its accumulated
knowledge, skills, customs and values from one generation to another, e.g.,
instruction in schools (Robert, 2009). Nursing education is a term used to describe the
overall body of knowledge that equips people to practice nursing. Although nursing
education encompasses a variety of knowledge, attitude, skills, concepts and practice,
the universally accepted concept revolves around the unique concepts of nursing,
health, the person and the environment (Melone, 2010). Harrison (2010) affirmed that
nursing education is the process of preparing individuals for caring as nurses.
Through nursing education, future nurses learn the skills which are necessary to
provide patient care, develop and execute treatment, plan and teach clients how to
take care of their medical and other conditions. Nursing education consists of
acquisition of a body of knowledge that is partly delivered in a classroom setting
which forms the theoretical bases of nursing knowledge and an organized and
supervised clinical learning experience. This clinical training starts with practice in

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the demonstration laboratory using dummies representing different areas of nursing
care. Areas where clinical training could be done include different departments in a
hospital clinics, homes, communities, psychiatric hospitals, orthopaedic hospital,
gynaecological section etc. Nursing education takes cognizance of the national policy
on education in developing sound educational principles which are essential to the
preparation of nurses to function as members of interdisciplinary and
interdepartmental health teams (N&MCN, 2001). This programme develops the
students’ affective, cognitive and psychomotor skills in problem solving. Active
participation of nursing students in both the community and hospital based services is
essential for students sound clinical experience.
2.2 The Goal Of Nursing Education
The goal of nursing education over the years according to Searle (2000) has been to
contribute to the health of individuals and the entire society. Initially, nursing had
concentrated on the care and comfort of all the ill and injured but as a result of
advances in health sciences, the emphasis is now placed on promotive, preventive and
rehabilitative care. Therefore, nursing education aims at preparing competent
polyvalent nurse practitioners who will use problem solving skills in providing safe,
acceptable, effective and affordable health services to meet the health needs of
individuals, families and the community at all levels of care (N&MCN, 2001). To
achieve the aim of nursing education, there should be a systematic direction and
guidance of the students. This is to ensure that adequate nursing knowledge is
imparted to the students both theoretically and practically to achieve proper skill and
problem solving skills acquisition which will lead to efficient nursing care (Quinn
2001).

2.3 Overview of Nursing Education

Nursing education refers to formal learning and training in the science of nursing.
This includes the functions and duties in the physical care of patients, and a
combination of different disciplines that both accelerates the patient's return to health
and helps maintain it (Fernandes et al., 2020). Nursing education consists of the
theoretical and practical training provided to nurses with the purpose to prepare them
for their duties as nursing care professionals (Harerimana et al., 2020). This education
is provided to student nurses by experienced nurses and other medical professionals
who have qualified or experienced for educational tasks, traditionally in nursing

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schools (Okoroafor et al., 2022). Most countries like Nigeria offer nurse education
courses that can be relevant to general nursing or to specialized areas
including mental health nursing, pediatric nursing and post-operatory nursing.
Courses leading to autonomous registration as a nurse typically last four years. Nurse
education also provides post-qualification courses in specialist subjects within nursing
(Sharma, 2020). A nursing student can be enrolled in a program that leads to a
diploma, an associate degree or a Bachelor of Science in nursing (Jafaru et al., 2022).

2.3.1 Brief History of Nursing Education

The history of nursing education in Nigeria began with the concept of Florence
Nightingale originating from the Crimean war in 1854-1856 (Fernandes et al., 2020).
However, the ideology of nursing came into Nigeria through the early missionaries
with the amalgamation of Nigeria by the British colony (1861). Nursing in Nigeria
thus began informally with the spiritual duty of care for the physically sick and
injured individuals (Okoroafor et al., 2022). However, this duty of care motivated the
then missionaries to develop nursing homes and dispensaries to allow apprenticeship
in nursing, which began nursing education as a vocation, although this form of
informal nursing education was constrained by language barrier (Azad et al., 2020).
Furthermore, the International Council of Nurses developed the four domains, which
is to promote health, prevent illness, restore health and alleviate suffering to organize
nursing into a more formal form of profession (Harerimana et al., 2020). This led to
the establishment of the first formal nursing education, which is a school of nursing
founded in 1949 and the Nursing and Midwifery Council of Nigeria (NMCN), was
founded along sides to ensure standards of nursing education. Since the establishment
of the NMCN, there has been a marked transition in the nursing education (Azad et
al., 2020). This emergence and re-envision of nursing education from a vocation to a
high standard of professionalism has led to the development of nurses with a broad
educational background, scientific and technological advancement and increase
literacy level to meet up with the changing roles of the nursing profession
(Fernandes et al., 2020).
Similar to other countries like the UK, the Nursing education curriculum of Nigeria is
organized to establish a balance between theory and practice. Although, there has
been arguments that the difference between clinical practice and theory is

8
insignificant as it has not influenced the nursing education negatively given the fact
that nursing is more practical (Okoroafor et al., 2022); it is paramount that a balance
is maintained between theory and practice as theoretical knowledge helps to provide
evidenced based guidance for clinical competence and reflection (Azad et al., 2020).
In addition, both the theoretical and clinical education of Nigerian nurses has been
recognized for its high standard. However, it implements a more pedagogi style of
teaching because it utilizes a strictly designed lesson plan (Harerimana et al., 2020).

2.4 Concept Of Clinical Nursing Training

Clinical nursing is the process through which student nurses are exposed to real life
situations in order to acquire the skills inherent in nursing profession for effective
nursing practice. It provides the students with the necessary opportunity to acquire
knowledge and skills that help in critical 31 thinking and performance of needed
client’s/ patient’s care. According to Smith et al (2006), clinical nursing training plays
an important role in teaching learning process. It provides nursing students the
development and acquisition of nursing skills, self clinical experience and the ability
to apply the knowledge gained from the theoretical context to any emergency
situation or in general public health care. It is only in the clinical situations that
nursing care becomes a reality and the student nurse can observe the responses of
patients to the care given (Melone, 2010). The overriding purpose of clinical
education in nursing is to prepare nurses to meet the health care needs of the public;
therefore, clinical nursing programme must be well aligned with the changes arising
from health care reforms, (Ehiemere, 2009).The purpose of clinical nursing is to
promote client/patients well being and help to ease suffering and discomfort in a
manner that is legal, ethical and respectful, (Melone, 2010). The correlation of theory
and practice and the building of meaningful experiences must take place in the field of
clinical practice, whether in the school laboratory, hospital wards, clinic, or a patient’s
home.
Clinical work in nursing education is an important component of the Nursing
curriculum aimed at engaging student’s Nurses in activities necessary for the
acquisition of stalls needed for them to become competent nurses (Jafaru et al., 2022).
A large part of nursing education is carried out in clinical environments. In Iran and
many other countries, clinical education forms more than half of the formal
educational courses in nursing (Jyoti, 2021). Therefore, clinical education is

9
considered to be an essential and integral part of the nursing education program. Since
nursing is a performance-based profession, clinical learning environments play an
important role in the acquisition of professional abilities and train the nursing students
to enter the nursing profession and become a registered nurse (Fooladi et al., 2022).
The nurse learns to interact skillfully with these people and other members of the
health team. Ehiemere (2009) affirmed that the health practice environment is
becoming complex and health care is dramatically evolving to address the quality
changes. It then demands new competencies of nursing skills and practices. This in
turn demands transformation of clinical educational programmes and educational
practices to meet up with the transformation. According to Shariff 32 et al (2005), the
primary drivers of transformation in nursing clinical education are society’s need,
societal demand with increased patients’ awareness about health and nursing practice,
accountability for efficient and effective use of education resources which include
best clinical teaching practices based on research evidence. Therefore, good clinical
training based on sound nursing education is the only option to equip nurses with the
current trend in nursing practice (Ehiemere, 2009). Mellish et al (2000) emphasizes
the following principles with regard to clinical nursing training:
• Clinical training occurs in the real-life situations: it translates theory into practice.
• The student nurse is an active participant.
• It should be a small group activity. Physical limitations make the number of nurses
who can be involved at a stretch very small. It may even occur on the basis of one
patient, one teacher and one student.
• The student nurse is given the opportunity to develop self-confidence by performing
under expert guidance and supervision.
• It affords the student opportunities for observation and decision-making.
• It allows assessment of the degree to which educational objectives have been
attained.
• It centres on patient/client care.
• It is an invasion of the privacy of patients and therefore can be carried out only with
their consent except in cases where there is difficulty in doing this. In this case
patient’s relatives can be consulted. In line with this, N&MCN stipulated that the ratio
of registered nurse educators to students in the classroom and in the clinical setting
should be 1: 10, (Curriculum for General Nursing Education in Nigeria, 2001).This is
for efficient training and supervision.

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2.5 The Goals Of Clinical Nursing Training
The ultimate goal of clinical nursing education as indicated by SumariAyo (2006) is
to prepare the students to think critically, communicate accurately and perform
indicated therapeutic nursing interventions in patient care situations and exhibit the
caring behaviours inherent in nursing actions. They are also to apply an ethical
perspective in clinical decision making and function effectively as a team member
within the organizational structures surrounding the delivery of patient care.
The objectives of nursing clinical posting according to Sambrahm (2019) include but
not limited to:
 Apply nursing process in meeting the health needs of the individual and the
family as a whole.
 Appreciate the need for interpersonal relationship and an effective
communication.
 Develop skill in performing assessment of each body system.
 Develop skill in meeting the basic needs of an individual in a scientific way.
 Prepare first Aid equipments and meet the common emergencies.
 Manage some of the common problems in illness
 Practice nursing procedures in reliving the common problems and assist wherever
necessary.
 Follow the principal techniques for infection control and bio medical waste
management.
 Provide care to pre and post-operative patients
 Administer drugs in different routes and assist intravenous and intra thecal
administration & maintain drug bank book
 Provide care to the drying and the dead.
2.5.1 Actions To Ensure Effective Clinical Nursing Training
The contextual elements of clinical nursing training as identified by Iwasiw (2009)
which serve as a guide to action for the clinical teachers in nursing include the
following:
1) The language of clinical teaching: The use of well worded, simple and clear
language will go a long way in helping the teacher to convey the message to the
students and also make it easier for the students to understand the topic better.

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2) Clinical training is as important as the classroom teaching. Nursing is a
professional practice discipline, where clinical training provides real life experiences
and opportunities for transfer of knowledge to practice situations. Therefore, clinical
training should be giving adequate time and concern.
3) Clinical education should reflect the nature of professional practice. A professional
is an individual who possesses expert knowledge and skill in a specific domain,
acquired through formal education in an institution of higher learning and through
experience. The professional uses that knowledge and skill on behalf of the society by
serving specific clients. Therefore, as practice in clinical setting exposes students to
realities of professional practice that cannot be covered by a text book or a simulation,
teaching should reflect the nature of professional practice. Also clinical practice
requires critical thinking and problem solving abilities, specialized psychomotor and
technological skills and a professional value system.
4) The nursing students in the clinical areas are learners not qualified nurses. The role
of the student in nursing education should be primarily that of a learner not a qualified
nurse. Students should not practice without a supervisor.
5) Sufficient learning time should be provided before performance is evaluated. It
should be known that skill acquisition is a complex process that involves making
mistakes and learning how to correct and then prevent those mistakes in future.
Therefore, clinical teachers should give adequate learning time with ample
opportunities for feedback before evaluating students’ performance summatively.
6) Clinical teaching is supported by a climate of mutual trust and respect: Another
element as a guide to action is the importance of creating and maintaining a climate of
mutual trust and respect between the staff and the students to support learning and
students growth.
7) Clinical teaching and learning should focus on essential knowledge, skills and
attitude. Teaching and learning time should be used to maximum advantage by
focusing most of the time and effort on the most common practice problems that
students and staff members are likely to face.
8) The espoused curriculum may not be the curriculum in- use. Argyris and Schon
(1994) proposed that human behaviour is guided by operational theories of action that
operate at two levels. The first level, espoused theory (the paper curriculum) is what
individuals say that they believe and do. The other level, theory in use (the practice
theory curriculum) guides what individuals actually do in spontaneous behaviour with

12
others. Similarly, the espoused curriculum is the one that is used for accreditations or
state approval but the curriculum in-use is what actually happens. This disparity
happens often when clinical teachers do what seem right to them which are not in the
curriculum. Incongruity between espoused theory and theory in use can result in
ineffective individual practice as well as discord within a school system.
2.5.2 Factors Affecting Clinical Nursing Training
The major determinants of the effectiveness of clinical training are the context in
which they occur. According to Smedley and Penney (2010), clinical training in
nursing is performed in response to the professional, societal and educational
demands using available human intelligence, physical and financial resources as the
context of the curriculum. As far as the curriculum context is different for each
nursing program, so also the practice of clinical training should differ from one
nursing programme to another. This infers that there should be differences in the
factors that affect clinical training of nursing students. This implies that some of the
factors that could affect clinical training in nursing include the curriculum philosophy,
the context for clinical nursing training and resources needed for effective clinical
training in nursing. Therefore each school must make decisions that are congruent
with their planned curriculum for a successful acquisition of skill. The factors are:
1) The curriculum philosophy: The curriculum is a systematic plan of activities
which is made according to each school philosophy and mission in response to the
professional, societal and educational needs. This includes statement of belief about
the goals of nursing education, the nature of teaching and learning and the role of the
teachers and learners (Iwasiw, Goldenberg, Andrusyszyn, 2009). The values and
beliefs included in a curriculum philosophy provide structure and coherence for a
curriculum and provide clear actions to be followed. Statements of curriculum are
meaningless if they are contradicted by actual nursing educational practices. Although
traditionally, philosophy is viewed as essential tool in building a curriculum, some
nursing education leaders have suggested that a set of assumptions or one or more
theories could be used in planning the nursing curriculum, (Bevis, 2000). When used
as a curriculum foundation, learning theories such as behaviorism, cognitive theories
etc, reflect faculty belief about learning, teaching, student characteristics and the
educational environment. Iwasiw et al (2009) indicated that nursing theories such as
Rogers’ unitary person model, Newman’s model of health and Watson’s theory of
human caring may also serve as both theoretically and philosophically according to

13
the context of each curriculum. Therefore, the contemporary nursing curriculum
philosophies often are a blend of philosophy, nursing theory and learning theory. The
curriculum provides a framework that shows educational and clinical activities to be
followed in clinical training. Incongruity between the curriculum and the actual
activities of the school can result in ineffective individual learning/practice as well as
discord within a school system.
2) The context for clinical nursing training: This includes the medium or the actual
practical application of the training process. Those are the measures or actions
involved in the clinical training. Oermann and Gaberson (2009) asserted that every
clinical teacher has a philosophical approach to clinical training whether or not the
teacher realizes it. The context determines what the teacher understands as his role,
approaches to clinical training, selection of teaching and learning activities, use of
evaluation process and relationship with learners and others in the environment. It
includes also how the students play their own roles in the teaching learning process.
These beliefs serve as a guide to action and they affect how clinical teachers practice,
how students learn and how learning outcome are evaluated. Inadequacy in the
context jeopardizes the acquisition of required nursing skills.
3) Resources needed for effective clinical training in nursing. For efficient and
effective clinical training aimed at ensuring quality care, theoretical nursing taught in
the classroom must be repeated and in congruence with what the students practice in
the clinical areas (Oermann and Gaberson, 2009). To maintain this fact, there must be
competent personnel in the schools and the wards to supervise and handle the clinical
aspect of nursing effectively. The resources needed are:
A) Qualified and experienced nurses: There should be qualified and experienced
nurses and clinicians, mentors, preceptors, link teachers and teacher- lecturers in the
schools and hospitals or other places where the students go for their clinical training.
These nurses must be conversant with the new innovations in nursing research,
education and practice, so that they may be able to help the students under their care.
These human resources employed in clinical training of students help the students to
enhance the practical learning process and ensure production of qualitative, critical
thinking and benevolent nurses who will engage in decision making and evidence
based nursing care based on research findings.
B) Nurse educators and supervisors: These are professional nurses acting as teachers,
mentors, preceptors, clinical instructors and clinicians involved in planning,

14
facilitating and supervising of clinical training of nurses to ensure adequate nursing
skill acquisition. It is a well known fact that teachers and supervisors are crucial
factors in students’ school achievement. Some nurse educators and researchers like
Usufu (2005), Shariff and Masoumi (2005) seem emphatic that students’ academic
performance does to a large extent depend on the quality, adequacy and dedication of
teachers and their supervisors. It is also identified that expensive laboratories, nursing
equipment, costly reference libraries, superior text books, extensive clinical
experience areas and skillfully arranged courses of study are of little value in the
teaching of nursing science subjects unless they are presided over and administered by
the mind of an individual who knows and loves nursing profession and who has
acquired some nursing skills and the art of impacting this knowledge to others,
(Hopkins, 1994). This clearly shows that the role of qualified and experienced
teachers and supervisors in the teaching and learning of any skill or subject cannot be
underestimated. Commenting on the need and use of professionally trained teachers
and supervisors, Akambi (1998), said that they will ensure efficiency and make sure
that they impart the right knowledge, develop the needed skills and mental faculty of
the students they are teaching. He further stated that a professionally prepared teacher
can use even an inadequately structured curriculum to build a structured programme
of significant merit. Lohor (2005), cries out that in the many states of the country,
40% and 50% of nurse educators and clinical supervisors needed are lacking. One
resultant effect in this respect is that few available ones are faced with the problems of
coping with a large class of students for the classroom work and clinical training. In a
paper presented to the principals of schools of Nursing in Nigeria, Usufu (2005) stated
in line with the teachers’ factors that to some extent, the teacher judges his/her
performance from the performance of the students. Where the students perform poorly
both the students and the teachers should have cause to give serious consideration
about their teaching and learning.
C) Infrastructure/equipment in the schools and clinical settings Items or equipment
used in the schools and clinical areas are regarded as the life wire of any nursing
school and for there to be a meaningful nursing education, (Melone, 2010). There
must be that conscious effort to direct sufficient resources to such areas that will
ensure drawing maximum benefit from the equipment and infrastructure available.
For standard nursing education, lack of equipment sets back students’ performance
and creates a lot of tension and anxiety on the students because of poor performance.

15
Cannon (1997) emphasized strongly the unavoidable needs for adequate equipment,
noting that, “at all stages of skill acquisition, good demonstration with adequate
equipment is important and often a vital part of teaching in acquiring a skill we learn
by imitation”. Accordingly, Tonne (1999) observed that the most effective device for
the teaching of skill is teacher demonstration with appropriate equipment. For
example, a teacher who shows to students how to type using a computer saves time
and presents these students with useful tips more than he can give by merely talking.
It is therefore, a right deduction that no nursing school can function well without
proper and adequate equipment in the school and in the clinical areas. The schools
should have adequate and up to date text books in the library which 48 will serve as
reference materials for both the teachers and the students. Knowles (1990) and the
WHO (1999) indicated that appropriate clinical learning facilities such as laboratory,
library, equipment and supplies should always be made available and maintained
regularly to make learning concrete and easier to reproduce when needed.
D) Measures /designs for teaching clinical nursing skills include:
(i) Preparation and Planning Planning for clinical accompaniment of students is a
prior activity which should be done by involving all key players. Gerrish (1992) (in
Quinn 2001) maintains that teaching in practice placement areas requires a
commitment by the teachers, collaboration between education and service staff and
staff development for teachers in their new role in relation to practice. The
accompanists and the student nurses should participate in planning and preparation for
clinical accompaniment. The key features of effective clinical education are that it is
designed and conducted according to the learner’s characteristics and the use of
appropriate teaching and learning strategies. Several factors need to be considered
when drawing up a plan. According to (Quinn, 2001), the curriculum has an influence
on clinical nursing education by accommodating the essential principles and features
for an educational proposal in such a form that it is capable of effective translation
into practice. Therefore, the planning team should consider what has been described
in the curriculum in fulfilling clinical teaching and learning. The planning team
includes nurse educators, clinical instructors, preceptors, ward supervisors and
nursing students. The clinical training objectives should be taken into account when
practicing. Chun-Heung and French (1997) cautioned about students spending most of
their time doing routine work and menial tasks thus wasting time for clinical learning.
Nursing educators, preceptors and other clinical supervisors should select and agree

16
on appropriate methods and materials, ensuring that they are available and relevant to
learning outcomes. Planning should be systematic and realistic to ensure that students
know what is expected of them and when. The plan should allow for flexibility in
order to meet unforeseen eventualities. Quinn (2001) suggests that in order to select
strategies that enable deep holistic learning to take place, nurse educators and
supervisors should be aware of students’ differences, ways that keep students
motivated and interested. Daft (2000) stresses the value of maintaining a good
working relationship with ward personnel, expertise like medical and paramedical in a
formal clinical education programme, so that they can be consulted when there is a
need. Division of the time available and allocation of personnel so that all students
have an equal opportunity to benefit is essential (Quinn, 2001). Specific times should
be set aside when students are released from the wards for formal activities, such as
demonstrations of procedures.
(ii)Techniques/ measures used for effective clinical training in nursing One of the
most important responsibilities of a clinical teacher is selecting and giving clinical
assignments that are related to desired outcome to students. This should be
appropriate to students’ levels of knowledge and skill and challenging enough to
motivate learning. Directing a learner to provide comprehensive nursing care to one
or more patients is a typical possible clinical assignment and not always the most
appropriate choice.
The techniques include:
• Giving assignment to students and correcting them
• Ongoing assessment in the clinical areas for early detection of lapses
• Proper supervision and prompt correction.
• Mentoring as students learn by imitation
• Motivation of students by encouraging their little efforts
• Evaluation to elicit learning outcome
2.5.3 Evaluation Techniques In Clinical Training
Evaluation is the process of eliciting the extent to which learners have achieved the
educational objectives. It is used also for assessment of both the teacher and the
students and its outcome helps both the teacher and the students to know areas of their
deficiencies and areas of strength. Evaluation can be formative or summative. Some
of the evaluation strategies in clinical nursing training according to Oermann et al
(2009) include written and oral assignments.

17
Written assignment: Written assignments should build on one another to progressively
develop student’s skills. It should be used to promote understanding, develop higher
level thinking skills, examine feelings, beliefs and value, develop writing skills, etc.
Examples of written assignments are:
• Use of case method and case study
• Evidence- based practice papers
• Development of teaching plan and nursing care plan
• Writing journals
• Giving tests and examinations
Oral practice assessment (practicum) or clinical evaluation. This means testing the
students’ ability to do the activities which they learnt during the clinical training. It
can be done formatively or summatively as is scheduled in the school’s programme
following the procedure and the schedule books. Factors associated with students.
In a study done by Baillie (1993) on the importance of showing an interest and taking
initiative by students, student nurses recognized that their own approach to
placements areas affected their learning. They also found that students prefer active
participation to observation. Furthermore, they suggested that good mentor,
communication and organizational environment were good for learning. According to
Sims (1997) students get satisfaction in doing things that interest them which promote
better learning. Consequently, better learning gives higher satisfaction and this cycle
continues. In a study by German (1994), it was observed that students’ attitude
towards school subjects can directly or indirectly influence their performance in those
subjects. Those that have positive attitude towards Biology were expected to be
interested in doing Biology and science like activities. This was proved to be true
from using path analytic model. He hypothesized that attitude towards Biology in
schools would influence students’ performance in biology because the students would
dread the subject they dislike. Students’ performance in nursing clinical experiences
depends on whether the student likes nursing science subjects’ classes, feels that
nursing science will be useful and is not afraid to ask questions during clinical
experiences (Meloni, 2010). Osang (1990) tried to find out the relationship between
students’ self concept and performance and noted that students’ performance in
nursing clinical training depended much on what the student thought of or believed
about him or herself with reference to nursing science. This result shows that self
concept is positively related to achievements by students. Gardnerr & Supplee (2010),

18
noted in their study that interest is a key factor for effective teaching and learning. It
has been recognized that where interest is manifested adequately, the inhibiting
influence of the limited background and ability of the student is reduced to
manageable proportions. It is then important to help students establish and develop
scientific spirit and experimental attitude needed in nursing to enhance practice,
(Ricks, 1999). Ricks (1999) stated also that effective nursing science programme
makes room for students to discover solutions to problems themselves and not make
them mere speculators. Other things that influence students’ attitude and performance
are students’ home environment, background knowledge of the subject and
motivation by the teachers and peers. In planning clinical activities for the students,
their learning styles should be considered to help them participate and learn better,
(Billings and Halstead, 2005).
2.5.4 Importance of Clinical Training
The following are the importance of clinical posting to nursing education according to
Jafaru et al. (2022):
 Hone Nursing Skills: Through nursing education, the nursing student usually
have the opportunity to learn nursing skills and techniques through coursework
and labs, but putting these into practice requires a real healthcare environment
and real patients. Taking vitals, administering medication, bathing and feeding
patients and more are all among the daily tasks the nursing student will have to
take on. Practicing these skills and techniques prepares the student for a career in
nursing. Assisting with other procedures will also expose the student to new
practices that they will perform as a registered nurse. Apart from task-based
skills, you’ll also get used to interacting with patients. The clinical posting gives
potential nurses all skills required to become a registered nurse (Ukaigwe et al.,
2020).
 Experience clinical variety: Within the top regional healthcare facilities, the
nursing student will encounter and learn to embrace a variety of specializations
and care scenarios in various subunits in the hospital, giving a wider view of
nursing care in different settings and specialties building the interest of the
student nurse in a particular specialty in Nursing. Those specialties include ICU,
ENT, Eye, Theatre, Renal, accident and emergency, orthopedics, anesthetics,
mental health, public health and others (Ukaigwe et al., 2020).

19
 Soft skills development: The clinical environment teaches nursing students how
to succeed in an ever-changing, growing field. Not only do clinicals refine the
hard nursing skills, but they also help the students improve their nursing skills. A
few of these soft skills include Compassion, Listening, Communication, Problem
solving, and attention to detail (Ukaigwe et al., 2020).
 Formation of Professional Connection: Through rotations at local health care
facilities and organized hospitals, nursing students are usually able to network
with various nursing professionals and other healthcare professionals within the
hospital community (Ukaigwe et al., 2020).
2.5.5 Challenges Associated With Clinical Posting
The challenges encountered by nursing students during clinical postings are
categorized into three main themes which are: ineffective communication, inadequate
readiness, and emotional reactions (Rana et al., 2022).
 Ineffective Communication: This main category consists of two subcategories of
improper treatment and discrimination (Rana et al., 2022).
 Improper treatment: Students encounter some challenges in dealing with clinical
learning environment and in interaction with instructors, patients, and department
personnel. Many students have experienced that they had the most interactions
with the instructors and believed that the way an instructor treats a student affects
their exposure to clinical learning environment (Rana et al., 2022).
 Discrimination: Discrimination is one issue that most students had experienced.
Many students complained about a series of discriminatory behaviors they
observed at the bedside that irritated them. The greatest discrimination in the
clinical setting was apparent in behaviors of nurses towards students (Rana et al.,
2022).
 Inadequate readiness: This category includes three subcategories of inadequate
knowledge, deficient practical skills, and insufficiently developed communication
skills (Rana et al., 2022).
 Inadequate knowledge: Many students, especially first and second year students
do not have sufficient knowledge to care at the bedside when dealing with clinical
learning environment for the first time, and this usually make it very challenging
for them to provide adequate care to the patients (Abazie et al., 2021).
 Deficient practical skills: Clinical environment is a suitable context for learning
skills needed to care for patients. However, some of those skills are considered

20
 basic health care skills and any deficit in them affects the quality of care. These
skills might actually be lacking in some nursing students during the clinical
posting, thereby affecting the quality of care rendered to patients (Amoo &
Enyan, 2022).
 Insufficiently developed communication skills: Many students are usually
plagued with the lack of communication skills during clinical posting, which is a
major reason for deficiency in communicating within the clinical learning
environment. Insufficiently developed communication skills sometimes cause
disruption in providing care for patients (Abazie et al., 2021).
 Emotional reactions: This class includes the following two subcategories of stress
and inferiority complex (Amoo & Enyan, 2022).
 Stress: Many students participating in clinical postings usually become distressed
and overwhelmed in dealing with new experiences within the clinical learning
environment. The presence in the clinical setting and exposure to new events
cause emotional reactions in students (Berhe & Gebretensaye, 2021).
 Inferiority complex: Inferiority complex is usually more evident among female
students than male ones. Students in lower semesters and lower classes also
always experience greater inferiority than students in higher classes (Berhe &
Gebretensaye, 2021).

2.6 Effect of Clinical Posting on Academic Performance of Student Nurses

Clinical postings play a crucial role in the education of student nurses, offering hands-
on experience in healthcare settings (Ghasemi et al., 2020). While they're immensely
beneficial, their impact on academic performance can vary:
 Enhanced Learning: Clinical postings provide practical application of theoretical
knowledge. This hands-on experience often reinforces classroom learning and
deepens understanding (Kuo et al., 2020).
 Improved skills: Working in clinical settings helps students develop critical skills
such as patient care, communication, and problem-solving, which can positively
influence academic performance (Ghasemi et al., 2020).

21
 Time commitment: Clinical postings demand a significant time commitment,
which may affect the time available for studying and academic assignments. This
could potentially impact grades if not managed well (Kuo et al., 2020).
 Stress and fatigue: Juggling clinical duties with academic requirements can lead
to stress and fatigue. This might impact concentration, affecting performance in
exams or assignments (Kim & Kim, 2021).
 Balancing priorities: Some students find it challenging to balance the demands of
clinical work with academic studies, affecting their ability to perform optimally
in both areas (Kuo et al., 2020).
 Practical applications: Students may grasp complex concepts better through real-
world application in clinical settings. This could lead to better academic
performance in related theoretical coursework (Ghasemi et al., 2020).
 Clinical feedback: Evaluations and feedback from clinical instructors can offer
insights into areas needing improvement, which students can then work on in
their academic studies (Kuo et al., 2020).
In summary, while clinical postings provide invaluable practical experience, they can
also pose challenges to academic performance due to time constraints and added
responsibilities (Kuo et al., 2020). However, they often complement theoretical
learning, contributing positively to a student's overall understanding and competence
in nursing practice. Success lies in effectively managing time, balancing
responsibilities, and using clinical experiences to reinforce academic knowledge
(Ghasemi et al., 2020).

2.7 Theoretical Review

The theoretical framework of this study is adopted from the David Kolb's Experiential
Learning Theory (ELT) which is aimed to assess the impact of clinical experience on
academic performance of nursing students in Lagos state college of nursing.
2.7.1 David Kolb's Experiential Learning Theory (ELT)
David Kolb's Experiential Learning Theory (ELT) is a powerful framework that
explains how people learn through their experiences. It revolves around a cycle of
four stages, emphasizing the importance of reflection and active engagement in the
learning process:

22
 Concrete Experience (CE): Learning starts with a hands-on experience or
encounter with something. This could be anything from a real-life situation, a
specific event, or a practical activity.
 Reflective observation (RO): After the experience, learners reflect on what
happened and try to understand it. They consider what worked well, what didn't,
and why. This stage involves introspection and analysis of the experience.
 Abstract conceptualization (AC): Building on reflections, learners create theories,
concepts, or generalizations. They attempt to make sense of their observations by
forming hypotheses or drawing connections to existing knowledge.
 Active experimentation (AE): Armed with new ideas or understandings, learners
apply them in different contexts or situations. This could involve testing theories,
trying out new approaches, or experimenting with the knowledge gained from
reflection.
What's significant about Kolb's model is that it's cyclical—learning is not a linear
process but a continuous cycle where each stage informs the next. Moreover,
individuals might have preferences for certain stages based on their learning styles.
Kolb identified four distinct learning styles based on where individuals tend to enter
the cycle:
 Diverging (CE/RO): People who prefer to start with concrete experiences and
then reflect on them. They are imaginative and tend to look at things from
multiple perspectives.
 Assimilating (AC/RO): Individuals who prefer to create concepts and theories
based on reflective observation. They are more interested in creating theoretical
models than in practical applications.
 Converging (AC/CE): Learners who prefer to apply their theories and concepts
actively. They are inclined towards practical application rather than reflection.
 Accommodating (CE/AE): Those who prefer to engage in hands-on experiences
and then apply their learnings actively. They thrive on experimentation and trying
out new things.
ELT has proven highly applicable in various educational contexts, training programs,
and professional development initiatives. It promotes a holistic approach to learning,
encouraging active engagement, critical reflection, and the integration of new
knowledge into practical scenarios. This model provides a versatile framework for

23
educators and trainers to design experiences that cater to diverse learning styles,
fostering effective and comprehensive learning experiences.
2.7.2 Application to the Study
Applying David Kolb's Experiential Learning Theory (ELT) to the study of the
impact of clinical experience on the academic performance of nursing students at
Lagos state college of nursing could provide a structured framework for
understanding how students learn through their practical experiences in clinical
settings.
 Concrete experience (CE): In the context of nursing, this refers to the hands-on
experiences that students gain during their clinical rotations. Research could
focus on specific clinical scenarios, interactions with patients, and healthcare
professionals to capture the richness of these experiences.
 Reflective Observation (RO): Following these experiences, students engage in
reflective observation. This phase involves reflecting on what they have observed
and experienced during their clinical rotations. Researchers can explore how
students process these experiences on how they reflect on patient interactions,
healthcare challenges, and their own performance during these practical sessions.
 Abstract Conceptualization (AC): This stage involves the process of making
sense of the observations and reflections by integrating them with existing
theoretical knowledge. For nursing students, this would be linking their clinical
experiences with the theoretical concepts learned in classrooms, textbooks, or
lectures. Researchers can investigate how students connect their practical
experiences with nursing theories, guidelines, and academic coursework.
 Active Experimentation (AE): Students engage in active experimentation when
they apply their newly acquired knowledge and reflections to future clinical
experiences or academic assessments. In this phase, researchers can explore how
students incorporate their learning from previous clinical encounters into their
subsequent practices and academic endeavors. This could include assessing how
improved skills, critical thinking, or confidence gained from clinical experiences
affect academic performance, such as exams, case studies, or presentations.
Utilizing ELT as a framework involves tracking students' progression through these
stages, understanding how each stage influences the next, and assessing how this
learning cycle impacts their academic performance in nursing coursework and
assessments. This approach can provide valuable insights into how clinical

24
experiences contribute to the holistic learning and development of nursing students at
Lagos state college of nursing.

2.8 Empirical Review

2.8.1 Perception of Clinical Posting
Jyoti (2021) conducted a study on perception about clinical posting among nursing
student- a comparative study, which was aimed at assessing and comparing the
perception of clinical posting among 1st year B.Sc. nursing and 3rd year B.Sc.
nursing in selected College of nursing, Haryana. The findings of the study revealed
that more than half (60%) of students from 1st year B.Sc. nursing had positive
perception regarding clinical posting and as the year of study progresses, 3rd year
B.Sc. Nursing students’ perception were changed as more than half (70%) of students
from 3rd year B.Sc. nursing had also positive perception regarding clinical posting.
There is much less difference (10%) in their level of perception between 1st year
B.Sc. Nursing students and 3rd year B.Sc. nursing student regarding their clinical
posting. Nursing students were satisfied with their clinical posting and also have
positive perception about clinical posting.
Moktan & Mehta (2020) even conducted a study on Perception of nursing students on
clinical experience in the National Referral Hospital of Bhutan. The objective was to
explore how nursing students commonly perceive their clinical experience. A focus
group discussion was conducted with eight to ten students/group from three levels of
nursing education. The groups were 1st-, 2nd-, and 3rd-year students who expressed
their clinical experiences during the focus group discussions. The data were analyzed
by content analysis using a thematic analysis. The study findings revealed that four
themes emerged from the focus group discussion, which were “good exposure,”
“connect theory to practice,” “anxiety and fear,” and “learning by task participation
and helping.”
Amoo et al. (2022) also conducted another study on Nursing Students’ Perception of
Clinical Teaching and Learning in Ghana: A Descriptive Qualitative Study, aimed at
exploring nursing students’ perception of clinical teaching and learning in Ghana. The
findings of the study revealed that being taught new things, being supervised, and
having autonomy were the most significant factors that promoted clinical learning.
Participants also reported that clinical experience created learning opportunities that

25
helped develop clinical competence. They described learning experiences in the
clinical setting as good, albeit gaps in practice. Poor staff attitude, lack of equipment,
poor student attitude, inadequate learning opportunities, and lack of clinical
supervisors were perceived as challenges in the clinical environment.
2.8.2 Attitude towards Clinical Posting
In a study conducted by Aragaw et al. (2019) on Attitude of Nursing and Midwifery
students towards clinical practice and its associated factors in Northwest Ethiopia: a
cross-sectional study. The aim of this study was to assess the attitude of Nursing and
Midwifery students towards clinical practice and its associated factors at University of
Gondar, Northwest Ethiopia. 2018. This study showed that the prevalence of a
favorable attitude towards clinical practice was 42.9%. The odds of having favorable
attitude were found to be 2 times higher among students who prepared well for
clinical practice [AOR = 2.07, 95%, CI (1.25, 3.44)] compared with counterparts.
Similarly students who communicate well with clinical staffs [AOR = 1.89, 95%, CI
(1.05, 3.41)], practiced in well-equipped hospital [AOR = 1.76, 95%, CI (1.01, 3.06)],
and accompanying frequently by a clinical supervisor [AOR = 1.69, 95%, CI (1.02,
2.81)] were more likely to have favorable attitude compared with counterparts.
In another study conducted by Anagor et al. (2021) on Attitude of Nursing Students
Towards Work in the Clinical Learning Environment, which was aimed at reviewing
the attitude of nursing students towards work in the clinical learning environment.
This review revealed that there is a high rate of unauthorized student nurses’
absenteeism as majority are absent from clinical work without permission. There is
also an appalling display of lateness behavior as students arrive at work after the
scheduled time. Interestingly, most students are willing to carry out procedures while
some are nonchalant due to the stressful and anxiety provoking tasks. Student nurses
felt that there is an unspoken comparison, discrimination and disrespect displayed by
their seniors and medical colleagues towards them.
Avbuluimen & Chiejina (2021) also conducted a study on Perception and Attitude of
Nursing Students toward Clinical Experience in Primary, Secondary and Tertiary
Care Institution in Lagos State Nigeria. The aim of this study was to ascertain the
perception and attitude of nursing students toward clinical experience in the primary,
secondary and tertiary care institution in Lagos State Nigeria. A total of 332
respondents was selected using stratified sampling technique to elicit sample from
each level. The study findings revealed that the Overall mean score for nursing

26
students' perception towards clinical experience was 200 level (3.09±0.15), 300 level
(2.84±0), 400 level (2.94±0.19), and 500 level (2.86±0.22) while that of their attitude
was 3.31 ± 0.25 (200 level), 3.26 ± 0.43 (300 level), 3.27 ± 0.32 (400 level), and (3.05
± 0.36 (500 level) respectively.
2.8.3 Effect of Clinical Posting on Academic Performance
Gamtessa (2021) conducted a study on Correlation between academic and clinical
practice performance of nursing students at a pediatrics and Child Health Nursing
Course; Mizan-Tepi University, Ethiopia. The academic performance was strongly
correlated with practice performance of the 2015 (rs (394) = 0.7, p<0.001) and 2017
(rs (394) = 0.7, p<0.001) batches of regular students. However, there was a moderate
correlation between academic and practice performance for the batch of 2016 regular
students (rs(394) = 0.43, p<0.001). There was a moderate correlation between
academic and practice performance of the 2015 (rs (394) = 0.6) and 2016 (rs (394) =
0.51, p<0.001) batches of summer students. Linear regression analysis showed that
academic performance explained 17.9% to 44.1% of variability in practice
performance of the regular students. The linear regression analysis also showed that
academic performance explained 26.5% to 41.2% of the variability in the practice
performance of summer students. Independent T-test revealed significant mean
performance difference by admission type (academic (t (144.7) = 6.43, p<0.001) and
practice (t (115.5) = 5.71, p<0.001)). The mean performance difference significantly
varied with sex both at academic (t (394) = 3.38, p=0.001) and practice (t (394) =
4.57, p<0.001) levels.
Soriano et al. (2020) also conducted a study on Relationship between Students'
Academic and Clinical Performance in Maternal and Child Nursing Course in a
Selected College of Nursing. This study was conducted to determine the relationship
between academic performance in the classroom and clinical performance of nursing
students in a selected college of nursing in the Philippines. Data were analyzed using
SPSS and Pearson's R correlation result indicated that academic performance had a
statistically significant relationship with clinical performance. Academic performance
has a significant role in the clinical performance of nursing students. Nursing schools
should ensure that students are provided with good theoretical instruction in nursing
courses to enhance and facilitate success in the actual clinical placements.
Yilak (2023) still conducted a study on Correlation of academic and clinical practice
performance of nursing students in an obstetrics and gynecology nursing course; at

27
Woldia University, Ethiopia. The aim of this study was to ascertain the connection
between obstetrics and gynecology theoretical courses and obstetrics and gynecology
clinical practice. A total of 252 study participants comprised 174 (69.1%) male and 74
(30.9%) female nursing students included in the current study Clinical success in
obstetrics and gynecology was strongly and favorably correlated with academic
success in obstetrics and gynecology theoretical courses (rs = 0.7–0.89), p\.05.
moreover, linear regression results revealed 37.45% to coefficient determination for
regular students, 38.2% to 47.3% for summer nursing students and 18.1% to 33%
post-basic nursing students. To sum up, a significant positive association existed
between students’ achievements in theoretical and clinical practice of obstetrics and
gynecology nursing courses. Improving students’ academic performance in obstetrics
and gynecology can also enhance their performance in clinical obstetrics and
gynecology. However, the variance in performance in obstetrics and gynecology
clinical practice was explained by academic achievement in obstetrics and gynecology
theoretical courses by 22.35%.

CHAPTER THREE
RESEARCH METHODOLOGY
3.0 Introduction
This chapter provides an overview of the target population, research design, research
setting, sampling technique, instrument used, method of data collection, validity and
reliability, method of data analysis and ethical consideration.

3.1 Research Design

28
A cross sectional research design will be used for this study which is aimed to assess
the impact of clinical experience on academic performance of nursing students in
Lagos state college of nursing.

3.2 Target Population

The target population of this study will be undergraduate nursing students in Lagos
state college of nursing. On an average, there are about 460 undergraduate nursing
students in Lagos state college of nursing.

3.3 Sampling Technique

The sample for this study will be selected using a simple random sampling technique.
Undergraduate nursing students in Lagos state college of nursing will be selected at
random for this study.
3.3.1 Sample Size
Taro Yamane formula will be used to determine the sample size from the population.
Taro Yamane formula is given as;
n = N 1+N (e)2
Where N = Population of study (460)
n = Sample size (?)
e = Level of significance at 5% (0.05) 1 = Constant
Therefore; n = 460 = 460 = 460

1 + 460 (0.05)2 1+460 (0.0025) 1+1.15

n = 460 = 214

2.15
Attrition rate (10%) = 21
Therefore, the total sample size for this study will be 235 respondents.
3.4 Inclusion Criteria
The inclusion criteria for this research is being an undergraduate nursing student
currently studying in Lagos state college of nursing.

29
3.5 Exclusion Criteria
The exclusion criteria for this study will be year one undergraduate nursing students
in Lagos state college of nursing, and part time nursing students in the school, as well
as students in other departments and colleges in the school. These categories of
students will not be included in this study.

3.6 Instrument for Data Collection

A modified questionnaire from related studies will be used for this study. The
questionnaire will be divided into 4 sections based on the objectives of the study.
Section A – Socio Demographic data which will assess the socio demographic
characteristics of the respondents, this will include age, level, marital status, religion
and residence.
Section B – Perception of Clinical Posting Section C – Attitude towards Clinical
Posting
Section D – Impact of clinical posting on academic performance
3.6.1 Validity of Instrument
Validity is the ability of an instrument to measure what it is intended to measure. For
this research, two types of validity namely face and content validity will be used. Face
validity entails the questionnaire will be sequential, logical from simple to complex,
well organized and will focus on applicable areas while content validity will ensure
that questions asked will be able to assess what it is meant to measure and there won’t
be use of ambiguous language.
3.6.2 Reliability of Instrument
Reliability is the ability of an instrument to measure what it is meant to measure over
and over again. The test-retest method will be adopted for reliability of the instrument
to be used, meaning that the instrument will be administered to another group of
people at different times to compare the result. This will be done by administering the
questionnaire to about 24 random undergraduate students in Lagos state college of
nursing at two different times, which differ from the target population. Responses of
these students will be analyzed and a reliability coefficient of 0.7 will be used to judge
the reliability of the instrument.

3.7 Method of Data Collection

30
The questionnaire will be administered to undergraduate students, both males and
females in the department of Nursing Science in Lagos state college of nursing by the
researcher. Data collection will be done physically by the researcher and an assistant
for about 2 weeks.

3.8 Method of Data Analysis

Data will be coded, cleansed and entered into Statistical Package of Social Sciences
(SPSS) v23. Data will then be analyzed using Statistical Package of Social Science
(SPSS) v23. Measures of central tendency and measure of dispersion will be used to
describe the population while chi- square will be used to compare academic level and
perception towards clinical posting.

3.9 Ethical Consideration

The following ethical issues will be considered:
1. Permission to conduct the study
A proposal for research will be submitted to the ethical committee of the Lagos state
college of nursing for permission to conduct the study, and then a written permission
will be gotten from the committee as an approval to conduct the study.
2. Informed Consent
Written consent will be obtained from the participants after adequate explanation and
information would have been given to them.
3. Confidentiality
Information provided by the respondents will not be divulged to others without
express permission. No name or any form of identity will be required from the
participants so as to ensure confidentiality and anonymity, thus protecting the privacy
of respondents.

31
 CHAPTER FOUR
PRESENTATION ANALYSIS INTERPRETATION OF DATA
4.1 Introduction
Efforts will be made at this stage to present, analyze and interpret the data collected
during the field survey. This presentation will be based on the responses from the
completed questionnaires. The result of this exercise will be summarized in tabular
forms for easy references and analysis. It will also show answers to questions relating
to the research questions for this research study. The researcher employed simple
percentage in the analysis.
DATA ANALYSIS
The data collected from the respondents were analyzed in tabular form with simple
percentage for easy understanding.
A total of 133(one hundred and thirty three) questionnaires were distributed and 133
questionnaires were returned.
Question 1
Gender distribution of the respondents.
TABLE I
Gender distribution of the respondents
Response Frequency Percent Valid Percent Cumulative
Percent
Male 77 57.9 57.9 57.9
Valid Female 56 42.1 42.1 100.0
Total 133 100.0 100.0

32
From the above table it shows that 57.9% of the respondents were male while 42.1%
of the respondents were female.
Question 2
The positions held by respondents
TABLE II
The positions held by respondents
Response Frequency Percent Valid Cumulative Percent
Percent

Final year students 37 27.8 27.8 27.8

Year four students 50 37.6 37.6 65.4

Valid
Year 3 students 23 17.3 17.3 82.7
Year 2 students 23 17.3 17.3 100.0
Total 133 100.0 100.0

The above tables shown that 37 respondents which represent27.8% of the

respondents are final year students, 50 respondents which represents 37.6 % are year
four students, 23 respondents which represents 17.3% of the respondents are year 3
students, while 23 respondents which represents 17.3% of the respondents year 2
students.

TEST OF HYPOTHESES
there is relationship between clinical experience and academic performance of
midwife student.
Table III
there is relationship between clinical experience and
academic performance of midwife student.
Response Observed N Expected N Residual
Agreed 40 33.3 6.8
strongly agreed 50 33.3 16.8

33
Disagreed 26 33.3 -7.3
strongly disagreed 17 33.3 -16.3
Total 133

there is relationship between clinical experience and

academic performance of midwife student.
Chi-Square 19.331a
Df 3
Asymp. Sig. .000
a. 0 cells (0.0%) have expected frequencies less than 5. The
minimum expected cell frequency is 33.3.

Decision rule:
There researcher therefore reject the null hypothesis that state there is no relationship
between clinical experience and academic performance of midwife student as the
calculated value of 19.331 is greater than the critical value of 7.82

TEST OF HYPOTHESIS TWO

there are issues encountered by the nursing students during their clinical practice
placement
Table V
there are issues encountered by the nursing students
during their clinical practice placement.
Response Observed N Expected N Residual
Yes 73 44.3 28.7
No 33 44.3 -11.3
Undecided 27 44.3 -17.3
Total 133

34
Test Statistics
there are issues encountered by the nursing students
during their clinical practice placement
Chi-Square 28.211a
Df 2
Asymp. Sig. .000
a. 0 cells (0.0%) have expected frequencies less than 5. The
minimum expected cell frequency is 44.3.

Decision rule:
There researcher therefore reject the null hypothesis that state that there are no issues
encountered by the nursing students during their clinical practice placement as the
calculated value of 28.211 is greater than the critical value of 5.99
Therefore the alternate hypothesis is accepted that state that there are issues
encountered by the nursing students during their clinical practice placement

CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
5.1 Introduction
It is important to ascertain that the objective of this study was on evaluating the
influence of clinical experience on the academic performance of student midwives. In
the preceding chapter, the relevant data collected for this study were presented,
critically analyzed and appropriate interpretation given. In this chapter, certain
recommendations made which in the opinion of the researcher will be of benefits in

35
addressing the challenges of clinical experience on the academic performance of
student midwives.

5.2 Summary
This study was on evaluating the influence of clinical experience on the academic
performance of student midwives. Three objectives were raised which included: To
ascertain the attitude of midwife towards clinical experience, to ascertain the
relationship between clinical experience and academic performance of midwife
student and to identify issues encountered by the nursing students during their clinical
practice placement. In line with these objectives, two research hypotheses were
formulated and two null hypotheses were posited. The total population for the study is
200 students of selected nursing schools in Lagos state college of nursing. The
researcher used questionnaires as the instrument for the data collection. Descriptive
Survey research design was adopted for this study. A total of 133 respondents made
up final year students, year 4 students, year 3 students and year 2 students were used
for the study. The data collected were presented in tables and analyzed using simple
percentages and frequencies

5.3 Conclusion
Students who had good communications with clinical staffs, prepared well for
clinical practice, practiced in well-equipped hospital, and accompanied frequently by
clinical-supervisors in a clinical setting had a favorable attitude towards clinical
practice.

5.4 Recommendation
Educational institutions, practicing nurses, and student nurses must ensure that
clinical learning is optimized.
It is desirable to provide consistent instructors for clinical education of novice
students to reduce their confusion because of seeing different ways of doing things.
Moreover, the methods of per-forming procedures should be unified between different
clinical trainers by periodic coordination programs. Finally, we suggest that a similar

36
study to this one should be carried out in other universities to gain a better insight of
the current status of midwifery education

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 QUESTIONNAIRE
INSTRUCTION
Please tick or fill in where necessary as the case may be.
Section A
Gender of respondent
A male { }
B female { }
Age distribution of respondents
15-20 { }
21-30 { }
31-40 { }
41-50 { }
51 and above { }
Marital status of respondents?
married [ ]
single [ ]
divorce [ ]
Educational qualification off respondents
SSCE/OND { }
HND/BSC { }
PGD/MSC { }
PHD { }
Others……………………………….
How long have you been in nursing school
0-2 years { }
3-5 years { }
6-11 years { }
11 years and above……….
Position held by the respondent in nursing school
Final year student { }
Year 4 student { }

41
Year 3 student { }
Year 2 student { }
How long have you been in nursing school
0-2 years { }
3-5 years { }
6-11 years { }
11 years and above……….
SECTION B
the nursing students performing academically in the clinical practice course?
Agrees { }
Strongly agreed { }
Disagreed { }
Strongly disagreed { }
there is relationship between the students’ perceptions and their performance in the
clinical practice course?
(a) Agrees { }
(b) Strongly agreed { }
(c) Disagreed { }
(d) Strongly disagreed { }
Not all midwife students know theoretical part of nursing.
Agreed { }
Strongly agreed { }
Disagreed { }
Strongly disagreed { }
There are challenges face by midwife student
Agreed { }
Strongly agreed { }
Disagreed { }
Strongly disagreed { }
attitude of Nursing and Midwifery students towards clinical practice is positive
Agreed { }
Strongly agreed { }
Disagreed { }
Strongly disagreed { }

42
Not all midwives’ student know clinical experience
Agreed { }
Strongly agreed { }
Disagreed { }
Strongly disagreed { }
There is relationship between clinical experience and academic performance
Agreed { }
Strongly agreed { }
Disagreed { }
Strongly disagreed { }
There are factors that affect clinical training of nursing students?
Agreed { }
Strongly agreed { }
Disagreed { }
Strongly disagreed { }

43