CHALLENGES OF NURSING EDUCATION: A CASE OF COLLEGE OF NURSING

SCIENCE GOMBE.

BY

MATHEW BLESSING JOSEPH

20002794

A Research Project-Proposal Submitted in Partial Fulfillment of the requirements for the award
of

Degree of Bachelor of Nursing Science

At the Faculty of Nursing Science

LAUTECH Open and Distance Learning Center, Ogbomosho, Oyo State.

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TABLE OF CONTENTS

Tittle Page……………………..……………………………………………………………i

CHAPTER ONE

Introduction………………………………………………………………………………...4

1.1 Background of the Study………………………………………………….…………...4

1.2 Statement of the problem………………………………………………….…………...6
1.3 Research Objective……………………………………………………………………..6
1.4 Research Question……………………………………………………………………...6
1.5 Significance of the Study………………………………………………………………7
1.6 Scope of Study…………………………………………………………………………7
1.7 Operational Definition of Terms………………………………………….…………....7

CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction………………………………………………….……………………...…9

2.1 Experiential Learning in Clinical Settings ……………………………………………10

2.1.1 Theory-Practice Gap in Nursing Education ……………………………….………..11

2.2 School Related Factors……………………………………………………….……….12

2.2.1 Teaching and learning environment……………………………………….…….….12

2.2.2. Professional Integration…………………………………………………….……...13

2.3. Economic Challenges……………………………………………………………......14

2.4 Social Factors………………………………………………………………………...16

2.5 Empirical Review……………………………………………………………….……17

2..5.1 Theory and practice gap…………………………………………………….……..18

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2.5.1 Factors that contribute to challenges of nursing education…………………….

CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction……………………………..….………………………………………..22

3.1 Research Design……………………………………………………………………..22

3.2 Research Setting……………………………………………………………………..22

3.3 Population of the Study………………………………………………………….….22

3.4 Sample Size……………………………………………………………………….....23

3.5 Sampling Technique……………………………………………………….…….….24

3.6 Instrument………………………………………………………………….….…….24

3.7 Pilot Study…………………………………………………………………….…….24

3.8 Validity of Instrument……………………………………………………….……....24

3.9 Reliability of Instrument……………………………………………………….…....24

3.11 Method of Data Analysis…………………………………………………………..25

3.12 Ethical Consideration……………………………………………………………....25

Appendix………………………………………………………………………………...26

Questionnaire……………………………………………………………………...…….27

REFERENCES…………………………………………………………………….…….31

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 CHAPTER ONE

Introduction

Nursing education is driven by two components namely the theoretical aspect which is the
knowledge that is rendered in the classroom and the clinical component where nursing students
are placed in clinical settings for experiential learning. Theoretical and clinical education is of
vital importance for undergraduate nursing students. Educational researchers worldwide are
interested in studying the challenges experienced by students from Higher Education Institution
(HEI) in general, but more specifically the challenges hindering academic performance and
success (Remtula et al., 2019). Academic performance and success are a complex phenomenon
that is influenced by the interaction of various factors (Weston, 2020). The theoretical aspect
provides understanding of the following: nursing history, professional ethics, values, different
divisions of the human body and psyche, as well as the processes of disease and illness (Saifan et
al., 2015).

1.1 Background of the Study

The healthcare industry is dependent upon schools of nursing to support the growing demand of
professionals. The healthcare industry expects schools of nursing to increase enrollment, increase
graduation rates, and increase graduate success on licensure to support their needs. These
expectations, however, are multifaceted. These expectations require an adequate number of
qualified nursing faculty, classrooms, clinical resources, and, most importantly, nursing students
who will be successful. Jeffreys (2015) proposed that undergraduate nursing students face
various challenges during their studies. These challenges may be the result of the interaction
between multiple levels of context (internal context, family context, school context and social,
economic and policy context) (Perna and Thomas, 2006). Internal student related challenges such
as the student’s profile, academic factors, psychological and emotional factors, as well as family

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factors such as family background and economics have been identified as some of the factors
that have an impact on the academic performance of nursing students (Weston, 2020;
Mthimunye and Daniel, 2019).

Other challenges bedeviling nursing education in Nigeria, these include multi-ethnicity, lack of
political will by the government to set things right, poor funding, inadequate infrastructures etc.
During the training of nursing profession students nurses have faces many hurdles, which
ultimately put a negative perception on the personality of nursing students and professional
growth. The state of the facilities in some schools of nursing is grossly inadequate. Quality
teaching and learning cannot be achieved if the basic nursing education programmes are not
provided with the required facilities and instructional materials to ensure the production of
quality graduates. (Mc Allister, 2016).

In the current dynamic healthcare systems, all nurses are challenged to be insightful and have
robust clinical reasoning and psychomotor skills in order to integrate theory into practice.
Therefore, they need to be accountable in ensuring that they perform optimally to meet the
extensive demands of clinical settings. Theory-practice integration is a major element that
sustains quality and drives best nursing practice. One of the barriers to theory practice integration
is the gap between theory and practice in nursing education. A large part of nursing education is
carried out in clinical environments. In Nigeria and many other countries, clinical education
forms more than half of the formal educational courses in nursing. Therefore, clinical education
is 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. Unlike classroom education, clinical
training in nursing occurs in a complex clinical learning environment which is influenced by
many factors. This environment provides an opportunity for nursing students to learn
experimentally and to convert theoretical knowledge to a variety of mental, psychological, and
psychomotor skills which are of significance for patient care. However, changes are happening
not only in healthcare, but in how education is conceptualized and delivered, creating
opportunities to live and learn in a whole new way (Carroll, 2021;Thomas and Rogers, 2020).

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Klaus Schwab (2017) the aforementioned requirements are mandatory to function as a nurse.
Therefore, nursing students at the end of their training are expected to be independent critical
thinkers, who are efficient as well as effective in making sound clinical decisions and portray
safe clinical practice.

1.2 Statement of the problem

The challenges of nursing education in Nigeria is so enormous as they stem from Content-
overload curricula which is fragmented, outdated and static, here, there is hardly curriculum
update owing to the fact that there are two systems that produces Nursing in Nigeria: Nursing
training from the Universities that produces University graduate and hospital based training
school who trains the Diploma nurses. This dichotomy brings about serious disintegration,
inability to update curriculum, unhealthy rivalry between graduate nurses and diploma nurses,
which result to intra-professional dilemma and poor collaboration, lack of cooperation and
professional internal cohesion that led to external aggression and infiltration into the professional
autonomy.

Another challenges of Nursing education are shortages of faculty member and poor staffing: This
lead to excessive work overload and burn out Other challenges include lack of continuing
nursing education as well as advances in teaching-learning technologies and strategies, shifting
learning styles of students, and the push for outcome-based education all point to the necessity of
competency-based education (AACN, 2020). Research findings have indicated that educators do
not quickly accept new technologies. Even when they do, they are used to support prevailing
teaching practices, rather than to develop new pedagogies (Grainger et al., 2020). These
challenges however have spurred an interest to carry out the study.

1.3 Research Objective

The objective of the study is to;

1. Explore and describe the challenges experienced by undergraduate nursing students at the
College of Nursing Sciences Gombe State
2. Examine factors contributing to the challenges of nursing education

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3. Assess common strategies utilized by students to cope with the challenges of nursing
education.
4. Explore possible solutions to the challenges faced by nursing student

1.4 Research Question

The main research question for the present study is

1. What challenges are experienced by nursing students in College of Nursing Sciences

Gombe State?
2. What are the factors that contribute to the challenges of nursing education?
3. What are the common strategies utilized by students to cope with the challenges of
nursing education?
4. What are the possible solutions to the challenges facing nursing student?

1.5 Significance of the Study

This study highlights vital information which can be used by the institution to provide the
necessary support required by undergraduate nursing students to alleviate the challenges they
face and ultimately increase their academic performance and success. If the challenges
experienced by nursing students, and the possible strategies to address these challenges can be
identified, it will be possible to better apply theory into practice and thus, produce competent and
safe nursing practitioners. The present study provides recommendations to the college of nursing
science Gombe state on how to support nursing students when integrating theory with practice.

1.6 Scope of Study

The study is centered on challenges of Nursing students and how it affects their academics
performance. The study will be conducted at the College of Nursing Science Gombe State. The
study cut across all students admitted in the college. The college offers a three-year
undergraduate nursing programme with an extended curricular programme over five years
(HND).

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1.7 Operational Definition of Terms
 Theory: A set of principles abstracted from a reality

 Theory-practice gap: The discrepancy between nursing as taught in lecture settings and
nursing as it is practiced in the clinical setting.

 Integration: A process of combining theory and practice to ensure that they link. In nursing
education, it means combining theory and practice so that they work together to produce
effective outcomes.

 Clinical settings: A continuum of services, which could be hospitals, clinics, specialized

units and rehabilitation centres. These are used to promote health and provide care to
individuals and groups; the setting is also used as a platform where nursing students are
taught to convert theory into practice.

 Competence: The combination of knowledge and psychomotor, communication and

decision-making skills that enable an individual to perform a specific task to a defined level.

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 CHAPTER 2

LITERATURE REVIEW

2.0 Introduction

(Gray et al., 2014) describe a literature review as an organized written presentation. The
literature review indicates the researchers’ knowledge of the most recent existing data that have
been published on the topic by other scholars. The purpose of the literature review is to assist the
researcher to become familiar with the differences and similarities between the topic under study
and previous studies (Schulze and Patel, 2011). A literature review also assists the researcher to
identify gaps in existing knowledge with regards to the study.

Nursing education is an essential component of the healthcare system. It is a challenging and

demanding profession that requires a solid educational foundation. Academic achievement or
success is the degree that a learner, educator or organization has accomplished their short-term or
long-term learning goals (Mushtaq and Hussain, 2019). However, nursing education faces
several challenges that require ongoing attention and resources. Addressing these challenges will
require a collaborative effort between educators, healthcare organizations, and policymakers to
ensure that nursing students receive the education they need to provide high-quality care in an
ever-changing healthcare landscape. Hence, the success of nursing students is particularly
important given that they must provide quality care to patients, family members and the
community (Weston et al., 2020).

Academic performance in nursing programs includes advances in theoretical subjects and the
acquisition of practical skills in the clinic. A series of studies have shown that during the years of
study, nursing students face many difficulties that affect their learning skills and consequently,
their academic performance. (Dante et al., 2013) in a systematic review of the literature

9
regarding academic performance indicators confirmed the complex nature of academic
performance for nursing students, arguing that the influencing factors for one student may be
very different for another. This brought a conclusion that nursing students face difficulties such
as: part-time employment, off-campus stay, curriculum structure, insufficient academic and
clinical support, and unfavorable physical faculty environment (Mthimunye and Daniels 2020).
Previous studies have shown that during the years of study, nursing students face many
difficulties that affect their learning skills and consequently, their academic performance. By
identifying and recognizing the difficulties encountered by students during their years of study,
measures can be taken to reduce barriers and improve academic performance (Fooladi et al.,
2022). These challenges can be the result of the interaction of personal, family, school as well as
social, economic, and political context.

2.1. Experiential Learning in Clinical Settings

Clinical learning is seen as a means whereby nursing students are enabled to bridge the gap
between theory and practice and learn to apply nursing theory and facilitate it into practical skills
in clinical settings. That is regarded as the art and science of nursing (Fitzgerald et al., 2014). It
is through that process that nursing students build meaningful experience by acquiring
knowledge, skills and essential values that are needed in the professional practice of nursing; and
in that role they become socialized into nursing practices (Mabuda et al., 2008). Clinical settings
include hospitals, school clinics, health departments, hospice units, and other healthcare settings
used for nursing student learning. The clinical setting differs from the classroom or skills
laboratory setting in many ways. Typically, classrooms and laboratories are controlled by nurse
educators and clinical facilitators, which include formal lectures, tests, evaluations, student
conduct, break times, attitudes, and the atmosphere of the learning environment (Mabuda et al.,
2008).

The clinical setting is unpredictable and relatively out of the clinical preceptor’s control.
Attitudes, work ethics, staff members, the unit environment, equipment, patients and their family
members are elements of the clinical setting that cannot be controlled (Williams and De Wet.,
2014). This unpredictable environment is very different from the classroom and can be a major
shock for nursing students. On the other hand, clinical settings allow learning to be done in a
more contextual manner, which makes the information learned in the classroom easier to recall

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when similar experiences are encountered; therefore it prepares nursing students for all sorts of
challenges that they may experience as professionals.

According to ICN (2009) clinical practice teaching is an activity where student nurses are
guided, facilitated and stimulated by designing appropriate activities that allow the students to
experience learning. For the application of the theoretical side of nursing in clinical learning
settings, clinical teaching and coaching are highly necessary to facilitate more clinical practice
teaching (Botma et al., 2012). Also, Limited Access to Clinical Placements can hinder practical
training. This is due to the high demand for clinical placements and the limited number of
hospitals that offer them. Plenty of nursing colleges in Nigeria doesn’t have a parent hospital
especially many private colleges. Parent hospital is a requirement for any nursing college to train
its student nurses in various procedures. It provides the students with real-life experiences which
enhances the emotional intelligent in the students and refine the student’s practice.

2.1.1 Theory-Practice Gap in Nursing Education

Theory-practice gap is the discrepancies found between what nursing students learn in the formal
classroom setting, and what they experience in the clinical settings. In Australia, a study by
(Henderson and Walker 2012) revealed in a similar light that the ideas and values set by Higher
Educational Institutions were professional and included a patient-centered approach; but, when
nursing students embark on clinical learning, they witnessed that they had to conform to the
ways that clinical staff in the wards practiced, which were task and procedure-orientated. (Chan
2013) indicated that such nursing students experienced vulnerability and a sense of isolation
which left them feeling marginalized and unable to bridge the gap between theory and practice.

Another research conducted by (Sharif and Masoumi 2005) in Iran and (Safadi and Froelicher,
2012) in Jordan, students reported incongruences between what was learnt in class and
simulation laboratory, and the actual practice in clinical settings. Conflicting practices between
the ideal that nursing taught, and that of clinical settings, resulted in nursing students becoming
confused, stressed and anxious, which may indicate that students are not effectively learning to
prepare them for the work that they will do after qualifying.

From the studies reviewed, it is evident that the problem of the theory-practice gap persists,
despite the research. Adequate learning takes place when nursing students apply what they have

11
learned in classroom situations and practice in a simulation laboratory to the reality of nursing,
which is in the clinical setting. Several studies have illustrated measures to try to close the
theory-practice gap. Research has proposed the use of pedagogical approaches such as guided
reflection and Problem-Based Learning (PBL) to close the gap Remtula (2019).

2.2 School Related Factors

Some studies have also found that school related factors such as professional integration and the
teaching and learning environment, as well as social, economic and policy related factors have a
significant impact on the academic performance of undergraduate nursing students (Ali and
Naylor.,2010).

2.2.1 Teaching and learning environment

The educational environment in nursing includes both clinical and theoretical learning settings
(Billings and Halstead, 2016). In the education of nurses, the educational environment requires a
variety of fundamental components such as the physical infrastructure, the teaching and learning
processes, school resources/materials, and the teacher-student relationship (Swift and Leinster,
2012). Previous studies conducted across the world have reported that generally, undergraduate
nursing students have a positive perception towards the educational environment (Mthimunye
and Daniels, 2019; Ishtiaq and Parveen, 2016).

The clinical setting has psychological characteristics within its environment that influences a
conducive learning environment for nursing students. These characteristics include: mutual
respect and support, openness and authenticity, pleasure, collaboration and humanity. This
environment enables the nursing students to learn and grow within the nursing profession. The
support that students receive from clinical staff creates a therapeutic learning environment by
Kidd (1973). Thus, nursing student develop an attitude of eagerness to learn, wanting to achieve
competence of specific skills during the clinical setting placement, which is beneficial to the
professional development of students in the programme.

A study conducted by (Gerber and Mino 2013) reported that the student’s perception of their
learning environment is linked to spatial attributes such as room layout and furniture and ambient

12
attributes such as temperature and air quality. Similar results were found in an unpublished study
conducted by Furst (2011, p.6) aimed at evaluating “the perceptions of student nurses regarding
the effectiveness of the teaching methods which they experienced at a nursing college in the
Western Cape Province (Bulckens et al., 2014) states that students who perceive their workload
to be excessive will apply a surface learning approach. Furthermore, (Kyndt et al., 2014)
reported that the educational environment may have a positive or negative influence on the
students’ perception towards their workload. This suggests the significance of promoting an
effective and cooperative educational environment that minimizes environmental challenges
without making the workload seem overwhelming and promotes a strategic approach to learning
(Abualrub and Stensaker, 2013). Students should be provided with the opportunity to practice
and improve their skills in varieties of learning activities. (Agrawal et.al, 2016; Sheringham et
al., 2016)

In a study in Iran, (Cheraghi et al., 2007) came to the conclusion that during the learning process
regarding the acquisition of knowledge, there was not much attention to students and aspects of
learning (Cheragi et al., 2007). Assessment methods can have their share of negative impact on
quality student performance as they often result in a large amount of stress. Both (Boulton and
O'Connell, 2017) noted that the amount and difficulty of learning material in the nursing
program is a common stress for nursing students (Thomas and Rogers, 2020).

2.2.2. Professional Integration

In recent years, various studies have been conducted focusing on the impact of hospital shifts in
nursing (Parr and Davies, 2015). However, conflicting findings have been reported. A recent
study conducted by (Reising et al., 2017, p.1) aiming to “compare opportunities for students to
develop their psychomotor skills in the clinical unit and the perception of clinical experience.

Previous research studies such as those of (Cooley and DeGagne 2016) have indicated the
importance of having good supervision to facilitate a smooth transition and ongoing support into
new environments. In nursing education, supervision refers to the clinical support provided to
students in the educational environment.

According to (Baraz et al., 2015), the clinical learning experience is at the heart of nursing
education and also in a study by (Papastavrou et al., 2016), the quality of nursing education

13
depends largely on the quality of clinical experience. Students suggest that more needs to be
done in regulating internships performed in hospitals, they seek a more supportive and hospitable
learning environment.

During clinical practice, students often face challenges, which make them feel vulnerable. This
requires the serious commitment of the faculty to facilitate the practice and create a supportive
environment for students. Other studies have argued that instructor incompetence, negative
attitudes, and poor student support can cause adverse effects on student academic as well as
clinical performance. Anthony (2011)

Another learning challenge from the perspective of most of nursing students was the lack of
reliability of clinical evaluation. This is because these assessments were not able to properly
assess students' scientific knowledge, practical skills, and professional conduct. This result is
consistent with the results of the study of (Bourbonnais et al. 2008). Also, the relationship
between faculty and student is an important part of student success during clinical practice
(Foreman et al., 2016). The environment where students study and practice include important
aspects such as social climate, care activities, communication, and interpersonal relationships as
well as reflection (Kamphinda and Chilemba 2019).

2.3. Economic Challenges

Nursing education faces several economic challenges that affect its quality and accessibility.
Some of these challenges include:

1. High Cost of Education: Nursing education is expensive, and the cost of tuition, books, and
other educational expenses can be a significant financial burden for many students. The high
cost of education can limit access to nursing programs for those who cannot afford it, leading
to a shortage of nurses in some areas.
2. Faculty Shortages: There is a shortage of nursing faculty, which limits the number of
students who can be admitted to nursing programs. The shortage of faculty is due to several
factors, including retirement of current faculty, low faculty salaries, and a lack of doctoral-
prepared nurses who can become faculty.
3. Shortage of Nurse Educators: There is a shortage of nurse educators, which has resulted in a
limited number of students being accepted into nursing programs. This shortage is due to

14
retirement, aging, and a lack of interest in the academic profession. We have hundreds of
nursing institutions which are deprived of adequate number of staffs. Most of the colleges are
having teachers who are tutoring subjects other than their specialty. Moreover, most of the
teachers in nursing institutes are not progressive, lags behind in conducting research, writing
a review, or guiding students in their research projects. Many of them are just afraid of
attempting one. Many experienced staffs who are working in clinics, hospitals and
multispecialty hospitals, encounter various issues and problems of nurses, but they straggle to
come forward to raise the awareness or to write about it.
The teaching and learning is a process of dialogue, in which the tutors and students learn
from each other’s, the tutors supported the students in education and provide an opportunity
to enhance knowledge, promote the theory and practical skills. Tutors provide a fertile space
for students to question openly and content review (Rodrigues et al., 2018). A good teacher is
who helps students in their learning. The teacher contributes in many ways. He or she will
provide information and having key roles in education. Nursing teachers have a role beyond
those in encouraging students to bond thorough theory with practice and practice with theory.
Within the clinical setting, there is a challenge for teacher nurses to make sure that they
remain credibly and learning and support, which is definitely established on practice and
theory.
The teaching method has a great role in the educational performance of any institution. The
students think the method of teaching, connection with the teacher, and barriers in
communication impede their academic performance. The teacher role is significant in
academic performance and hence strongly accountable for bad or good performance of
students (Alshammari et al., 2017). Nursing teachers have a role beyond those in encouraging
students to bond thorough theory with practice and practice with theory. Within the clinical
setting, there is a challenge for teacher nurses to make sure that they remain credibly and
learning and support, which is definitely established on practice and theory. Each student
learns differently and at a particular space. There may be definite factors that can stimulate
your learning skills and experiences. Therefore, in order to facilities learning, it is important
to identify and give due importance to these factors.

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4. Technology Costs: Advances in healthcare technology require nursing education programs to
invest in expensive equipment and software. These costs can be prohibitive for some nursing
programs, limiting their ability to provide high-quality education.
5. Low Reimbursement Rates: Nursing education programs rely heavily on reimbursement from
government and insurance programs, which may not cover the full cost of education. This
can lead to budget shortfalls and a reduction in the quality of education. : Nursing education
requires significant funding, which is often inadequate. This can lead to a lack of resources,
outdated equipment, and inadequate staffing, all of which can negatively impact the quality
of education.

Addressing these economic challenges requires a multi-faceted approach, including increased

funding for nursing education programs, recruitment and retention of nursing faculty, and
expansion of clinical placement opportunities. Additionally, nursing education programs can
explore innovative approaches, such as online learning and simulation technology, to reduce
costs and increase access to education.

2.4 Social Factors

1. Technological Advancements: Nursing education must keep up with technological

advancements in healthcare, which can be challenging. This requires ongoing education and
training to stay current with the latest technologies and practices.
2. Increasing Complexity of Healthcare: The increasing complexity of healthcare requires
nurses to have a broader knowledge base and skillset. This requires ongoing education and
training to keep up with the changing landscape of healthcare.
3. Diverse Student Population: Nursing education must cater to a diverse student population,
including students from different cultural, linguistic, and socioeconomic backgrounds. This
requires a flexible and inclusive approach to education.
4. Work-Life Balance: Nursing education can be demanding, which can make it challenging for
students to maintain a work-life balance. This can lead to burnout and high levels of stress,
which can negatively impact the quality of education. Nursing students have less awareness
that in a medical or work environment chronic sleep deprivation may lead to personal and
patient safety problems. As a result of sleep deprivation and substances use to stay alert or
get sleep, students may be exposed to health problems acute and chronic. The number of

16
 consecutive clinical and work shifts must be reduced by nurse instructors and nurse
supervisors. Reduce overtime hours and provide students with better education on the
adverse influence of sleep deprivation (Thomas et al., 2017).

Nursing students are engaged in poor sleeping habits even they are aware of the appropriate
length of sleep. Poor sleep quality has adverse health effects, It has noticed that college
students who nap more than 2 hours more than 3 days a week, or later, between 6 p.m. and 9
p.m., worse quality of sleep at nighttime and they are at the high risk of sleep deprivation
(Johnson et al., 2015)

5. Time Management
Time management is an important skill that nursing students use, resulting in academic
success. The study showed that Time management and academic performance of nursing
students have a significant and positive relationship. It indicates that academic activation of
the student's Improvements in time by effective preparation and tracking of activities
(Naderi et al, 2017). Time management in nursing student’s academic life is an important
skill and career as they need to be prepared for unexpected crises and emergencies at work.
Therefore, knowing the essence of the notion of time and learning time management skills is
important for learners. “I am sorry, I have not had enough time to study and I have not had
time to complete the task” is the voice of a lot of students.

The predicament of not having sufficient time to perform the necessary tasks for education is
often a problem faced by students. Commitment is very important for time management
(Nayak, 2018).

2.5 Empirical Review

Having revealed the theoretical aspect of challenges of nursing education, it is necessary to take
a look at some important empirical contributions. Researchers around the world explored the
different predictors of academic performance based on demographic variables, socioeconomic
status, sleeping duration, academic study environment, parental education, income level, social
media affiliation, age, gender, income level, and many more. Family background of students,

17
study habits, home-related issues, school facilities, and teachers’ effectiveness has a significant
association with the academic performance of students’ (Olufemi et al., 2018).

2.5.1 Factors that contribute to challenges of nursing education

(Sharma et al., 2017) revealed that most significant factor that affects academic performance of
nursing students are personal attitude 78%, Teacher personality 50%, 89%, Availability of
resources (library, internet) 78% affect the academic performance of the students. Family factors
affect 5% to the academic performance of the nursing students. But in the study by (Fajar et al.,
2019), 89% school related factor have good academic performance and significant associated
with age gender and education of participants.65.4% home related factor have good academic
performance and significantly associated with gender, age and education of participants.
(Mushtaq and Khan 2012) found learning facilities, communication, proper guidance, and family
stress as the influencing factors of education. The study identified family stress as negative
motivators in academic performance.

2.6 Theory and practice gap

A research conducted by (Sharif and Masoumi 2005) in Iran and (Safadi and Froelicher, 2012) in
Jordan, students reported incongruences between what was learnt in class and simulation
laboratory, and the actual practice in clinical settings. Conflicting practices between the ideal
that nursing taught, and that of clinical settings, resulted in nursing students becoming confused,
stressed and anxious, which may indicate that students are not effectively learning to prepare
them for the work that they will do after qualifying. The results revealed from the students of
Iranian Medical University also shows imperative theoretical and clinical issues (88.9%) taught
in class are not practiced in clinical areas, (85.6%) theoretical aspects of the nursing procedure
are not being applied in practice (81.1%) teachers are not knowledgeable and professional
educators. (75.6%) are not following traditional routine-oriented ways in their nursing care. In
addition the results of a study by (Liu and Aungsuroch, 2018), clinical instructors do little efforts
to reduce the gap between the theoretical and practical (clinical function).

Another study found in Technical Nursing Institute Cairo University Egypt that 70.8% of
students’ are not equipped for their clinical placement. 74. 8% students are not prepared well for
the required competencies in clinical placement. 67.4% student less satisfied due to no

18
professional support during clinical placement. Most of the students received learning support
from the clinical supervisors but do not receive much attention from their clinical instructors. In
spite some staff nurses are interested to help new graduate students in clinical placement; they
are not much aware of the skills and strategies in clinical training and not act as a clinical
instructor.

Professional integration

(Madarshahian et al., 2016) also showed that using evidence based training instead of traditional
training would enhance knowledge, skill and high quality caring. As this is an important factor in
clinical competence, it ought to be included in nursing education. Based on this study, another
important factor influencing the clinical competence was the educators’ role. In (Masoodi et al.,
2014) studies, the educators had referred to lack of a suitable environment, and lack of enough
confidence for scientific discussions when necessary, as the two most prominent problems in
their work. (Valizade et al., 2013) had also put forward the challenges facing the nursing students
throughout their studies such as lack of integration of knowledge and practice, failure to apply
the theory (theoretical knowledge) to practice, not using nursing process and scientific principles
in clinical environment.

Study in Tanzania revealed that lack of adequate supervision of students in the clinical areas;
inexperienced teachers in the schools; un-conducive environment in the school and in the clinical
areas and lack of students’ involvement in planning their programs hinders clinical nursing skill
acquisition Ayo (2016).

Teaching and learning environment

According to Udoh (2011) his study showed that schools mostly have no light, deficient
facilities, revolting buildings and no exposure to air. Under these situations the health of learners
and teachers may be unpleasantly affected which will cause unpleasant effect on students’
performance. To make the students to carry her/his learning successfully and proficiently it is
compulsory that learning should be done in favorable environment (Udoh, 2011).

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Therefore, it is appropriate to look at the factors that affect academic performance of the students
and also measures which can help to improve them and to make some commendations (Udoh,
2011). In Ethiopia the apparent gap between theory and practice is one of the demanding issues
in nursing, both locally and abroad (Andreas and Daniel, 2017). Furthermore, (Kyndt et al.,
2014) reported that the educational environment may have a positive or negative influence on the
students’ perception towards their workload. This suggests the significance of promoting an
effective and cooperative educational environment that minimizes environmental challenges
without making the workload seem overwhelming and promotes a strategic approach to learning
(Abualrub et al., 2013).

Socio-economic factors

A recent study by (Prabhakaran and Suresh 2020) on socio-economic status and related
influence on academic achievement of the students in Tamilnadu, India revealed that economic
support, academic needs, academic decisions, and financial interdependence are the dominant
predictors in academic performance. (Yinusa and Basil 2008) identified parental income, family
type, and the funding systems of the government as the predictors of academic performance.
Researchers in the present days are trying to assess the level of influence of social media and
media sharing networks such as Facebook, Twitter, LinkedIn, Instagram, Snapchat, YouTube,
etc. on academic performance. Gorhe (2019) found both positive and negative influence of social
media on performance. He deduced that careful use of media is not harmful, but the unconscious
use is detrimental to academic performance. The Study conducted by (Mensah and Nizam 2016)
also reveals the same finding

(Arora and Singh 2017) showed that study habits, educators’ teaching efficacy, and the family
environment of the participants as significant predictors of the academic achievement of college
students. Also (Mohamed et al., 2018) found that academic achievement is affected by some
specific variables such as study habits, home-related aspects, learning techniques, and physical
resources. (Singh et al., 2016) concluded with the statement that communication skills, learning
facilities as well as appropriate guidance by parents have a significant positive association with
academic achievement. Students’ motivation and individual expectations are vital parts of
acquiring sound education. Hope and optimism were internal protective factors that enhanced the
resilience of nurse academics Glass (2007). Chen (2011) also suggested that supportive

20
relationships with teachers who are willing to engage with students could promote the
development of student resilience.

2.6. Theoretical framework

There are several theoretical frameworks that could be used in addressing Challenges of Nursing
Education.

Here are a few theories commonly discussed in relation to nursing education challenges:

 The Theory of Mental Self-Government

 Social Learning Theory
 Experiential Learning Theory

The Theory of Mental Self-Government

Furthermore, research by Sternberg emphasizes that student learning and thinking styles which
are usually ignored, The Theory of Mental Self-Government refers to an inventory of different
thinking styles that gives an indication of people's preference of thinking patterns.

In light of the above theories, this study adopted the theory of mental self-Government as the
most appropriate one in enhancing students ‘academic performance in this study. The reason is
that, the learning and thinking styles of students at campus can either be reinforced leading to
excellent academic performance or hindered leading to poor academic performance. This is
heavily contingent upon the availability and provision of a number of essential facilities such as
good study materials, accommodation, conducive learning environment (lecture theatres), good
water and sanitation facilities among others. These being available and in provision, students’
potential abilities of being analytical, creative and practical as described in triarchic theory also
become reinforced.

Social Learning Theory

Social learning theory, developed by Albert Bandura, is a psychological theory that emphasizes
the importance of observing and modeling the behaviors, attitudes, and emotional reactions of
others in order to acquire new behaviors. Bandura proposed that learning occurs in a social
context through a process called observational learning or modeling.

21
 Social learning theory emphasizes the importance of observational learning and social
interactions in the learning process. In nursing education, this theory suggests that students learn
not only from formal instruction but also through observing and interacting with their peers,
faculty, and clinical preceptors. Applying this theory, nursing education programs can create
collaborative learning environments that promote peer-to-peer learning, role modeling, and
mentorship to address challenges such as faculty shortage and clinical placement availability.

Key Concepts of Social Learning Theory:

i. Observational Learning: Bandura argued that individuals learn by observing others and
imitating their behavior. This observational learning process involves attention, retention,
reproduction, and motivation. Attention refers to actively observing the model's behavior and
its consequences. Retention involves remembering the observed behavior. Reproduction is
the ability to replicate the observed behavior. Motivation refers to the internal or external
factors that drive an individual to engage in the observed behavior.
ii. Modeling: Modeling is a central concept in social learning theory. Individuals learn by
watching others, known as models, and imitating their behavior. Models can be real or
symbolic, such as parents, teachers, peers, or characters portrayed in media. Bandura
identified four types of models: live models (real people), verbal instructional models
(descriptions or explanations), symbolic models (fictional characters), and self-modeling
(watching oneself on video).
iii. Vicarious Reinforcement and Punishment: According to social learning theory, individuals
are also influenced by the consequences (rewards or punishments) experienced by models.
This is known as vicarious reinforcement or punishment. When individuals observe a model
being rewarded for a behavior, they are more likely to imitate that behavior. Conversely, if
they observe a model being punished, they are less likely to imitate the behavior.
iv. Self-Efficacy: Bandura introduced the concept of self-efficacy, which refers to an individual's
belief in their own ability to perform a specific behavior successfully. Self-efficacy plays a
crucial role in social learning theory because it influences an individual's motivation to
imitate a behavior. Individuals with high self-efficacy are more likely to engage in behaviors

22
 they believe they can accomplish, while those with low self-efficacy may be more hesitant to
try new behaviors.

Experiential Learning Theory

Experiential Learning Theory (ELT) is a theoretical framework developed by David A. Kolb, an

American educational theorist and psychologist. Kolb's theory is based on the idea that learning
is a continuous process that involves the transformation of experience into knowledge.

Experiential learning emphasizes the importance of concrete experiences, reflective observation,

abstract conceptualization, and active experimentation in the learning process. In nursing
education, this theory supports the incorporation of hands-on clinical experiences, debriefing
sessions, and opportunities for students to apply theoretical knowledge in practice. By providing
structured opportunities for reflection and feedback, nursing education can enhance the
development of clinical skills and bridge the gap between theory and practice

According to Kolb, learning occurs through a four-stage cycle known as the experiential learning
cycle. The cycle consists of four elements: concrete experience, reflective observation, abstract
conceptualization, and active experimentation. Let's explore each stage in more detail:

i. Concrete Experience: This stage involves actively engaging in a new experience or situation.
It could be anything from a real-life experience to a simulated or hypothetical situation. The
learner gains new information through direct involvement and personal experience.
ii. Reflective Observation: After the concrete experience, the learner reflects on what happened
and observes the experience from different perspectives. This stage involves stepping back
and carefully considering the experience, analyzing it, and identifying any patterns or
connections.
iii. Abstract Conceptualization: In this stage, the learner seeks to understand the experience by
conceptualizing it. They try to make sense of the observations and experiences by developing
theories, models, or generalizations. Abstract conceptualization involves thinking critically
and creating new ideas or concepts based on the reflections.
iv. Active Experimentation: The final stage of the cycle is where the learner applies the new
knowledge or concepts gained from the previous stages. They test their theories or ideas by
actively engaging in new experiences or situations. Through experimentation, they verify

23
 their understanding and gain further practical insights, which then become the basis for new
concrete experiences.

Kolb emphasizes that effective learning involves all four stages of the experiential learning
cycle. He suggests that learners should engage in a continuous process of experiencing,
reflecting, conceptualizing, and experimenting to enhance their learning outcomes.

Moreover, Kolb identified four learning styles that are associated with different preferences for
the stages of the learning cycle. These learning styles include:

1. Converging: Individuals with a converging learning style prefer abstract conceptualization and
active experimentation. They excel in problem-solving and decision-making situations and are
more inclined towards technical or specialized knowledge.

2. Diverging: Diverging learners excel in concrete experience and reflective observation. They
have a preference for observing situations from multiple perspectives and are good at generating
ideas and understanding diverse viewpoints.

3. Assimilating: Assimilating learners excel in reflective observation and abstract

conceptualization. They are more focused on creating theoretical models and frameworks and
prefer to analyze and synthesize information.

4. Accommodating: Accommodating learners prefer concrete experience and active

experimentation. They are hands-on, practical, and enjoy working in real-life situations. They are
open to taking risks and are good at adapting to new circumstances.

In summary, David Kolb's Experiential Learning Theory provides a framework for

understanding how individuals learn through their experiences. By engaging in a continuous
cycle of concrete experience, reflective observation, abstract conceptualization, and active
experimentation, learners can enhance their understanding and application of knowledge. The
theory also highlights the existence of different learning styles, which can influence how
individuals engage with the learning process. Experiential Learning Theory is highly relevant to
education as it advocates for a learner-centered approach that emphasizes active engagement and
reflection. It suggests that students learn best when they actively participate in meaningful
experiences and reflect on them. By incorporating Experiential Learning Theory into educational

24
practices, educators can create more engaging and effective learning experiences that promote
deep understanding, critical thinking, and practical application of knowledge.

CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

This chapter describes the methodology in research design, which includes: study setting, target
population, sample and sampling technique, instrument for data collection, validity and
reliability of instruments method of analysis and ethical consideration.

3.1 Research Design

A non-experimental descriptive survey research design will be used for the study. It is structured
to find, describe and interpret an existing phenomenon in relation to the population

3.2 Research Setting

The research will be carried out in College of Nursing Sciences Gombe, Local Government Area
Gombe State. The college is located in the metropolitan of the state at Jekadafari area close to
Gombe State Specialist Hospital, along Gombe-Bauchi Road. The college is mandated to
produce competent nurses and midwives that can deliver quality health care services nationally
and internationally. The college offers midwifery, general nursing, and post basic nursing
program.

3.3 Population of the Study

College of Nursing Sciences Gombe State has a total population of 758 students.

25
Type of program Duration of program
HND Nursing 4 years
Basic midwifery 3 years
Post Basic Nursing 18 months
The target population of the study will be all students of the college.

3.4 Sample Size

The sample size will be calculated using the Taro Yamane formula. The Taro Yamane is a
formula that is used in estimating and determining sample size in respect to the population under
study, thereby allowing inferences and conclusions to be drawn from the survey to be applied to
the complete population from which the sample was drawn.

According to Taro Yamani sample size can be calculated as follows:

n=N/(K+N) (e) ^2

Where

n=sample size

N= population of the study (758)

e=marginal error (0.05)

K= constant (1)

n= 758/ (1+758)(0.05)^2

n= 758/ (1+758)(0.0025)

n= 758/ (1+758×0.0025

n= 758/ 1+ 1.895000

n= 758/2.895000

26
n=261.83

n=262 (approximately)

The study sample size consisted of 262 students

3.5 Sampling Technique

The sampling technique to be adopted in this study will be Simple Random Sampling technique;
it is the method of drawing a portion or sample of the population so that each member of the
population has an equal chance of being selected.

3.6 Instrument

This research will us an instrument of a 5 point Likert scale questionnaire to collect data from the
participants. For effective elicit response from the respondents without any ambiguity. It will be
constructed in 3 sections (A, B and C).
Section A= for personal data of the respondent
Section B and C = for questionnaire items based on the research question Self-Structured
question will be used.

3.7 Pilot Study

A Pilot study will be carried out on 18 nursing students from College of Nursing Sciences
Gombe who represents about 10 % of the study subjects. The purpose of the pilot study is to test
the applicability, feasibility, and objectivity of the study tools before starting data collection, and
estimate the needed time to complete the questionnaire

3.8 Validity of Instrument

This research will be tested for accuracy and validity by conducting a pilot study. To ensure
validity of the instrument the questions will be presented to my project supervisor for criticism,
suggestion correction and modification on the face validity in relation to the topic of the study.

3.9 Reliability of Instrument

27
Cronbach’s alpha coefficient will be used to measure the reliability and internal consistency of
the questionnaire.

3.10 Method of Data Collection

The method of data collection will be a structured questionnaire to be issued out to the
respondents by the researcher for some days.

The questionnaire will consist of 3 parts:

First part includes: Personal characteristics data that was developed by researcher and it include
data such as age, sex, gender, year in school, marital status, work history, their personal desire to
enroll institute, If any family members work in nursing profession, reasons for joining the
nursing profession, opinions about nursing profession, and your participation in nursing activities
during study.

Second part: will be used to assess factors affecting academic performance among nursing
students,(school factor, social factor, economic factor, etc. )

Third part: will evaluate strategies utilized by student to cope with the challenges of nursing
education.

3.11 Method of Data Analysis

The data will be entered in Microsoft Excel and be computed by SPSS version 25. Also,
descriptive statistics (percentage and frequency) will be used for selected demographic profile
and challenges at educational and clinical environment.

3.12 Ethical Consideration

Permission will be obtained from the management of the school and the information that will be
obtained from the respondents will be treated with absolute confidentiality and will only be used
for academic purpose only.

An informed consent will also be obtained from the nurse students to participate in the study
after explaining the purpose and the nature of the study.

28
 Appendix

LADOKE AKINTOLA UNIVERSITY OF TECHNOLOGY

OPEN AND DISTANCE LEARNING OGBOMOSHO,

OYO STATE.

QUESTIONNAIRE

Dear Respondents,

The researcher is a student of the above mentioned institution conducting a

research on Challenges of Nursing Education: A Case of College of Nursing Science Gombe.

Mathew Blessing Joseph

29
 Section A

Sex Male [ ] Female[ ]

Age 17-25[ ] 26-35 [ ]

Marital status Single [ ] Married [ ] Others [ ]

Type of program Post basic nursing [ ] Nursing [ ] Basic Midwifery [ ]

Year of study 1st year [ ] 2nd year [ ] 3rd year [ ] 4th year [ ]

Section B

1. What is the biggest challenge of nursing education in the College of Nursing and
Midwifery Gombe?
o High cost of tuition
o Difficulty in finding qualified instructors
o Lack of access to technology
o Shortage of qualified teachers
o Inadequate physical infrastructure

2. What are the primary challenges of nursing education to you as a student?

Heavy workload
o Time management
o Clinical experience
o Ethical dilemmas and cultural diversity
o Technological advancement
o Emotional stress
o Communication and teamwork

3. What strategies could be used to address the challenges associated with nursing
education?
o Provide financial incentives for aspiring nurses
o Hire more qualified instructors

30
 o Provide better access to technology
o Increase external funding for nursing programs
o Promote awareness of the profession

Section C
5- Always 4- often 3-sometimes 2-rarely 1- never

S/N Challenges of Education 5 4 3 2 1

Clinical Environment
11 When allocated in the clinical learning
environment, you supported by a preceptor
and clinical facilitator (good supervision)?
2 Clinical skills in relation to your level of
training were available at the clinical
facility
3 Did you face conflicting practices between
the ideal that was taught in class and that of
clinical settings?
4 Did you encounter difficulties in balancing
academic requirements with clinical
practice?
Educational Environment
1 Is the college having an adequate physical
infrastructure to meet your learning
requirement
2 Are School resources and materials
available and accessible to all students?
3 Are the curriculum and syllabus meeting
your learning requirement?
Student factors (interest and motivation)
1 How well do you pick interest in the
courses you are taking right now?
2 Do you study harder to improve your
performance when you get lower grades?
3 Do you have problems adapting to the
college environment?
4 How well do you manage stress
University infrastructure factors
1 Do you use the learning facilities provided
by the university (library, computer lab, and
classroom) in performing your course

31
 work?
2 How well do you think the facilities
provided by the university meet the
standards for physical requirements
(classroom size, lighting, air conditioning,
tables, and chairs)?
3 How well can you easily access the internet
provided by the school?
4 Do you use the internet access provided by
the university in performing your course
work?
5 Do you find it difficult to comprehend some
activities due to the absence of physical
contact of the instructor/s
6 Are there any financial challenges faced by
nursing students, such as tuition fees,
textbooks, or other educational expenses?
Lecturer/ teacher related factors

1 Are there any challenges related to faculty

and staffing that impact the quality of
nursing education?

2 Do your lecturers have a good relationship

with the students?
3 Do your lecturers impose proper discipline
and are not lenient in following the
prescribed rules?
4 Are your lecturers open to suggestions and
opinions?

What strategies or improvements can be implemented to address the challenges faced by nursing
students in their education?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
__________________________________________________________________________

32
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