A predictive model of student nursing competency in clinical practicum: A structural equation modelling approach

Clinical teaching is the most important element in the development of students' nursing competencies. However, students' learning modalities in clinical settings are unclear.

To analyse path relationships affecting students' learning outcomes in clinical practicum using LISREL software.

A cross-sectional survey was administered.

Participants were 392 senior students who had completed their final internship recruited from two nursing programmes in central Taiwan.

Administration and completion of the following structured questionnaires: the Competency Inventory of Nursing Students, the Teaching Competence of Nurse Preceptor questionnaire, the Student Evaluation of the Clinical Education Environment, Level of Reflective Thinking, and the Metacognitive Inventory for Nursing Students.

The results suggested that teaching competence may indirectly affect nursing competence through metacognition and reflection. The clinical learning environment may directly affect nursing competence or indirectly affect nursing competence through metacognition. Both metacognition and reflection have direct effects on nursing competence, and reflection exerts indirect effects on nursing competence through metacognition. The path relationships differed according to the employment plan group.

Reflection and metacognition are essential skills for the development of nursing competence in clinical settings. Clinical instructors must facilitate student learning by fostering a positive learning environment and teach students the reflective and self-regulation skills necessary to achieve favourable learning outcomes in clinical settings.