Nursing & Care Open Access Journal

Research Article Open Access

Factors and challenges influencing the acquisition of

clinical skills by student nurses during internship in
Buea Health District, Cameroon
Abstract Volume 10 Issue 4 - 2024

Background: Clinical learning is an important component of nursing education, which Eta VEA,1 Njie IE,1 Njeodo V,2 Ngala E,1
enhances the transfer of theoretical knowledge into practice enhancing the provision of
quality nursing care.
Nsagha DS,3 Achidi AE2
1
Department of Nursing, Faculty of Health Sciences University
Objective: This study was aimed at identifying factors and challenges that influence the of Buea, Cameroon
acquisition of clinical skills by student nurses during internship in the Buea Health District.
2
Faculty of Science University of Buea, Cameroon
3
Department of Public Health & Hygiene, Faculty of Health
Methods: The study employed a cross-sectional design. Purposive and simple random Sciences University of Buea, Cameroon, Faculty of Sciences
sampling techniques were used to select the study site and enroll participants to the study University of Buea, Cameroon
respectively. The study was conducted in four health facilities in the Buea Health District in
Fako Division, South West Region of Cameroon. The participants were made up of 2nd, 3rd, Correspondence: Eta VEA, Department of Nursing, Faculty
4th year student nurses on internship. Respondents who met the inclusion criteria and gave of Health Sciences, University of Buea, BP63 Buea, Cameroon,
their consent to participate in the study were selected. Data was collected using a pretested Email
semi-structured questionnaire made up of closed-ended questions. Data was collected on Received: September 15, 2024 | Published: October 01, 2024
the factors and challenges that influence the acquisition of clinical skills by student nurses.
The data collected was entered into Microsoft Excel and finally into Statistical Package for
Social Science 22 versions. Data was analyzed using quantitative method, and Chi square
test at a confidence interval of 95% was used to conduct bivariate analysis.
Results: A total of 212 respondents participated in the study. The study revealed that 118
(40.59%) respondents acquired communication skill and 164 (18.81%) leadership skills.
Factors that influenced the types of clinical skills acquired by respondents were age (COR:
0.031), level of preparedness to enter a clinical setting (COR: 0.355), source of motivation
(COR: 0.753). Limited time (25.25%), lack of support and supervision (24.26%) from
health personnel were the most frequent challenges that hindered the acquisition of clinical
skills by student nurses on internship in the Buea Health District.
Conclusion: The study concluded that even though the participants acquired communication
and leadership skills, there is need to enhance the acquisition of decision making skill in
order to promote the provision of prompt and quality nursing care. Also, health institutions
and health facilities should minimize challenges faced by student nurses in the acquisition
of clinical skills.

Keywords: factors, clinical practice, skills acquisition, student nurses, challenges.

Abbreviations to professional nurses. During clinical placements or internships

students are expected to interact with the clinical environment
AOR, adjusted odds ratio; BSI, body substance isolation; BSc, which includes clinical wards, nurses, physicians, patients and their
bachelor of science degree; COR, crude odds ratio; CI, confidence families as well as the clinical instructors.4–6 Therefore, the clinical
interval; ECG, electrocardiograph; HND, higher national diploma; environment enhances the transfer of theoretical knowledge into
HIV, human immuno deficiency; MKO, more knowledgeable others; practice and ultimately improves provision of quality health care.
SRN, state registered nurse; WHO, world health organization; ZPD, The knowledge gained makes it easier for the students to provide care
zone of proximal development; adequately according to their level of competencies. In areas with
limited or not available simulation learning takes place in the real
Introduction environment.7 For nursing students to be able to function within the
Nursing education comprises both theory and practical training, scope of professional practice, they need to be supported and guided
in which the application of theory is within the clinical environment so that they can become responsible, accountable and independent
where the students learn the art of nursing. It encompasses a professionals.8–10 Clinical training provides opportunity for students to
variety of knowledge, skills, concepts and practices which revolve apply their theoretical knowledge into actual health care provision,11,12
around the unique concepts of nursing.1–3 Clinical placement is an develop psychomotor skills, observe and adapt to the professional
essential educational component to undergraduate nursing students’ role. The clinical environment should be carefully selected, accepted
development. It provides an invaluable opportunity where students by nurse tutors and prearranged to be capable of transforming nursing
learn in the clinical environment and acquire knowledge and students into competent nursing practitioners.13 The accreditation
develop clinical reasoning skills, and are transformed from novices of student nurses occurs during clinical learning in a complex and

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©2024 Eta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and build upon your work non-commercially.
Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Copyright:
©2024 Eta et al. 124
Buea Health District, Cameroon

dynamic learning environment. Student nurses often experience Buea Regional Hospital and CMA Muea were purposively selected
challenges like shortage of clinical staffs and clinical instructors, lack for the study. These hospitals have a high number of student nurses on
of support supervision and interpersonal relationship, shortage of internship and a good number of beds and high patient in flow. These
materials, lack of role models, short practice time, and knowledge- health facilities render integrated health services to the population and
theory gap.14 Clinical learning is challenging, unpredictable, stressful as such are suitable for student nurses to learn, acquire and develop
and constantly changing. Negative clinical experiences affect trust, clinical skills. A questionnaire made-up of closed ended questions was
attitude, and student learning. They can waste a great deal of time and used to collect data. The target population was all the second, third,
energy, impose heavy financial burden on education system, mental and fourth year nursing students in the clinical sites. A simple random
tension, and cause students unable to handle or finish the course in technique was used to select the participants, which gave each student
the required time.15 an equal chance to participate in the study. The sample size for this
study was 212 participants, which was calculated using the Yamen’s
In Sub Saharan African settings, clinical practice is challenged by
formula; A minimum sample size of 212 participants was calculated
multitude of factors which can affect learning adversely. Some factors
using the Yamen’s formula:
reported to influence students’ learning in clinical area act at different
levels, namely individual level (student factors), hospital environment, n = N ÷ 1 + N (e)2
socio economic factors and nurse tutors factors. Studies have revealed
that lack of adequate supervision of students in the clinical area, Where
inexperienced teachers in schools, unconducive environment in the
clinical areas and lack of students’ involvement in planning their n = expected sample size to be determined
programs hinder clinical nursing skill acquisition.16 Constructive
N = estimated number of 2nd, 3rd, 4th year nursing students on
criticism improves clinical skills acquisition in the clinical setting
internship within the selected health facilities of the Buea Health
while negative criticism is an obstacle for effective clinical skills
District
acquisition. The sources of stress during clinical practice have been
observed by many researchers and include new environment, lack of e = precision level, having a confidence level of 95% (1.96) and
assessment before supervision, poor clinical orientation and shortage 0.05 error margin. Substituting these values in the formula:
of nurses.17 2
250 / 1 + 250 ( 0.05 ) n =
n= 211.8
In Cameroon, nursing education training programs offer theoretical
and practical training for general nursing and midwifery students.
Thus, a total of 212 student nurses were recruited in this study.
The structure of nurse training programs shows that students spend
a number of weeks, months at each level in placement settings with The probability proportionate to size sampling was used to
hospital facilitators. Therefore, it is imperative to find out whether the determine the number of participants for each site (Table 1). Data was
competencies that need to be acquired by these students in these three collected on the types of clinical skills acquired, factors influencing
domains of cognitive, psychomotor and affective are satisfactory or are the acquisition of skills and the challenges faced by students in
hampered by some factors. Thus, this study investigated factors and acquiring clinical skills during internship within the Buea Health
challenges that influenced the acquisition of clinical skills by student District. Before administering the questionnaire, it was pre-tested
nurses during internship in the Buea Health District. Specifically, we by administering 10 copies to ten students who were not part of the
identified skills acquired by students, factors that influenced skills study population. Their responses confirmed the clarity and validity
acquisition and challenges faced in acquisition of skills by nursing of the questions. Copies of the questionnaire were then administered
students. Findings from this study may provide a framework which to the study participants who completed the various sections of
could serve as a guide for clinical teaching and learning as well as the questionnaire. This study was authorized by the Department of
pre-placement orientation. Nursing, Faculty of Health Sciences, University of Buea, Cameroon.
Administrative authorization was first obtained from the Regional
Methodology Delegation of Public Health (No. 691/526) and then from the heads
This was a cross-sectional study conducted in some selected of the various health facilities. Before responding to the questionnaire
health facilities located in the Buea Health District from 13th March each respondent gave their consent by signing the consent form. Data
to 15th October, 2022. Buea is the capital of the South West Region of collected was entered into Microsoft Excel and finally into Statistical
Cameroon. This city is located on the eastern slopes of Mount Cameroon Package for Social Science 22 version. Data was analysed using the
in Fako Division. Buea Health District has seven health areas which quantitative method. Data was presented using frequency table and
are Bokwango, Bova, Buea Road, Buea Town, Molyko, Muea and charts. With the use of a descriptive statistical approach, calculation
Tole with several villages such as Bomaka, Bova, Bonjongo, Bokwai of mean, standard deviation and percentile was done. Frequency
and Likombe among others. There are health facilities in these health and percentage was used for categorical variables like gender, age,
areas that serve as clinical sites for students during internship. For the bivariate analysis was done using Chi square test and the level of
purpose of this study, the Buea Town Health Center, Buea-road (PMI), significance was established.
Table 1 Distribution of participants according to health facilities in Buea Health District 2022

Number of nursing
Total number of nursing students Probability of selecting nursing students
SN Name of health facility students on internship
on internship on internship
selected
1 Buea regional hospital 300 0.448 95
2 Muea health center 190 0.284 60
3 Buea town health center 110 0.164 35
4 Buea road health center 70 0.104 22
Total 670 1 212

Citation: Eta VEA, Njie IE, Njeodo V, et al. Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Buea Health
District, Cameroon. Nurse Care Open Acces J. 2024;10(4):123‒130. DOI: 10.15406/ncoaj.2024.10.00302
Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Copyright:
©2024 Eta et al. 125
Buea Health District, Cameroon

Results 8.754; p = 0.008) and source of motivation for learning during clinical
practice (COR: 2.252; 95% CI: 1.351-3.858; p = 0.003) as shown in
All 212 students enrolled, participated in the study giving a response Table 4. Few of the student nurses on internship in the Buea Health
rate of 100%. The majority of the students nurses on internship in District most frequently faced challenges such as limited time 54
Buea Health District were females 174 (86.1%), 178 (88.1%) younger (25.2%) and lacked support and supervision 51 (24.3%) from health
than 30, and 142 (70.3%) of them were single. One hundred& twenty- personnel (Figure 3).
nine (63.9%) were pursuing a Higher National Diploma with 119
(58.9%) being in their second year (Table 2). Communication 86 Table 2 Distribution of participants’ characteristics in Buea Health District,
2022
(40.6%) and leadership 40 (18.8%) were the two main skills acquired
by students during clinical internships in the Buea Health District. Parameter n (%)
The least acquired skill among students was decision making 11 Gender Male 28 (13.9)
(5.4%) as depicted on (Figure 1). Majority of the students acquired Female 174 (86.1)
the communication 69 (32.7%) and leadership 42 (19.8%) skills in Age (years) < 30 178 (88.1)
their third year of training (Figure 2). The bivariate logistic regression
≥ 30 24 (11.9)
analysis revealed that, the acquisition of communication skill by
Marital status Single 142 (70.3)
student nurses in the Buea Health District during internship was
influenced by age (COR: 0.031; 95% CI: 0.158-0.915; p = 0.031), level Married 50 (24.8)
of preparedness to enter a clinical setting (COR:0.355;95%CI:0.198- Divorced 10 (5.0)
0.639;p=0.001), source of motivation for learning during clinical Study program HND 129 (63.9)
practice (COR: 0.753; 95% CI: 0.572-0.993; p = 0.044) and frequency SRN 19 (9.4)
of teachers’ hospital visits (COR: 2.779; 95% CI: 1.810-4.266; p = < BSc 54 (26.7)
0.001) as shown by their association in (Table 3). Similarly, this also Present year Year 2 77 (38.1)
showed that the acquisition of leadership skill by student nurses in the Year 3 119 (58.9)
Buea Health District during internship was influenced by the level of
Year 4 6 (3.0)
preparedness to enter a clinical setting (COR: 3.484; 95% CI: 1.387-

Table 3 Analysis of factors influencing the acquisition of communication skill by student nurses during internship in Buea Health District, 2022

No acquisition of Acquisition of
Parameter communication skill (n = Communication skill COR 95% CI P-Value
118) (n = 84)
Gender Male 19 9 0.625 0.268- 1.46 0.278
Female 99 75
Age (years) < 30 109 69 0.38 0.158- 0.915 0.031
≥ 30 15 9
Level of
preparedness to
Fully prepared 89 42 0.355 0.198- 0.639 0.001
enter a clinical
setting
Partially prepared 28 42
Not prepared 1 0
Right kind of clinical
No 33 28 1.288 0.702-2.316 0.413
supervisors
Yes 85 56
Source of
motivation for
Support from hospital staff 67 24 0.753 0.572-0.993 0.044
learning during
clinical practice
Use of different learning styles 28 46
Presence of available materials 15 1
Talented clinical instructors 3 13
All of the above 5 0
Method that
facilitates learning
Demonstration 42 24 0.883 0.715-1.092 0.251
during clinical
practice
Observation 33 21
Lectures 3 3
Hands-on practice 35 36
All of the above 5 0

Citation: Eta VEA, Njie IE, Njeodo V, et al. Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Buea Health
District, Cameroon. Nurse Care Open Acces J. 2024;10(4):123‒130. DOI: 10.15406/ncoaj.2024.10.00302
Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Copyright:
©2024 Eta et al. 126
Buea Health District, Cameroon

Table 3 Continued..

No acquisition of Acquisition of
Parameter communication skill (n = Communication skill COR 95% CI P-Value
118) (n = 84)
Frequency of follow-
No 0 0 1.405 NA 0.017
up of objectives
Yes 118 84
Frequency of school
teachers‟ hospital Regularly 12 27 2.779 1.810-4.266 < 0.001
visit
Sometimes 48 40
Never 58 17
COR, crude odds ratio; CI, confidence interval
Table 4 Analysis of factors influencing the acquisition of leadership skill by student nurses during internship in Buea Health District, 2022

No acquisition of Acquisition of
Parameter COR 95% CI P-Value
Leadership skill (n = 164) Leadership skill (n = 38)
Gender Male 26 2 0.295 0.067-1.301 0.107
Female 138 36
Age (years) < 30 144 34 1.181 0.379-3.679 0.775
≥ 30 20 4
Level of
preparedness to
Fully prepared 99 32 3.484 1.387-8.754 0.008
enter a clinical
setting
Partially prepared 64 6
Not prepared 1 0
Right kind of
No 51 10 0.791 0.358-1.751 0.563
clinical supervisors
Yes 113 28
Source of
motivation for
Support from hospital staff 60 31 2.252 1.351-3.858 0.003
learning during
clinical practice
Use of different learning styles 71 3
Presence of available materials 16 0
Talented clinical instructors 12 4
All of the above 5 0
Method that
facilitates learning
Demonstration 56 10 1.043 0.798-1.363 0.76
during clinical
practice
Observation 39 15
Lectures 6 0
Hands-on practice 58 13
All of the above 5 0
Frequencyof
follow-up of No 0 0 4.316 NA < 0.001
objectives
Yes 164 38
Frequency of
school teachers‟ Regularly 31 8 1.048 0.647-1.697 0.849
hospital visit
Sometimes 72 16
Never 61 14
COR, crude odds ratio; CI, confidence interval

Citation: Eta VEA, Njie IE, Njeodo V, et al. Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Buea Health
District, Cameroon. Nurse Care Open Acces J. 2024;10(4):123‒130. DOI: 10.15406/ncoaj.2024.10.00302
Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Copyright:
©2024 Eta et al. 127
Buea Health District, Cameroon

participated in this study. Majority of the student nurses were females

and were younger than 30years of age. These findings are similar
to the findings of related studies which showed that majority of the
student nurses and nurses were females18,19 and were below the age
of 30 years.20,21 About three quarter of the participants was single and
more than half were pursing their HND. Similarly, previous studies
conducted by Eta et al.18, Aslam et al.22 and Habasa23 found that
Diploma nurses were the most represented.

Types of clinical skills acquired by student nurses on

internship in the Buea health district
The findings of this study revealed that communication skill was
the most identifiable skill acquired by student nurses on internship.
Figure 1 Proportion of student nurses that acquired specific clinical skills
during internship in Buea Health District, 2022.
This finding is in line with Shukla24 who found that during clinical
training students form competence for clinical communication and
social competence in their explicit interaction with patients and their
relatives. The nature of the clinical training in our setting also imposes
mastering of communicative skills. The acquisition of communication
skills by nursing students in the clinical environment is paramount,
as this leads to an increase in their motivation. Similar to this finding
is that of Levay et al,25 who found that proper communication with
students increased their motivation.
Again, the results of this study revealed that the least skill acquired
by the participants was decision making. This could be due to the
fact that students are not usually exposed to critical clinical situations
during theoretical sessions and as a result during internship clinical
Figure 2 Clinical skills acquired by nursing students on internship based on evaluators do not allow them to decide on the critical situations. This
current year of studies in Buea Health District, 2022. disrupts the process of acquiring the clinical skills because most of
the ideal steps are missed, leading to incompetent and unsafe way to
practice. This finding is in line with a study conducted by Najafi et
al,26 who concluded that students learn a clinical skill better if they
are guided on how to perform that clinical skill. However, our finding
is contrary to that of a previous study where more than half of the
respondents obtained good leadership and decision making skills.27
The discrepancy in these findings could be due to the fact that nursing
students study both theory and practical simultaneously since their
institution has a teaching hospital which gives them the opportunities
to handle critical clinical conditions under the supervision of
their clinical mentors. Also, Camilla et al,28 stated that supportive
relationship of clinical nurses will cause the acceptance of students
as a part of the treatment team and help in proper learning. On the
other hand, improper communication of clinical nurses with students
hinders their learning.29

Factors influencing the types of clinical skills acquisition

Figure 3 Proportions of student nurses that faced specific challenges upon
the acquisition of clinical skills during internship in Buea Health District, 2022.
by student nurses during internship at the Buea health
district
Discussion For the factors influencing the acquisition of clinical skills
This study aimed at identifying factors and challenges that by students, the results of this study revealed that the source of
influence the acquisition of clinical skills by student nurses during motivation for learning during internship was associated with
internship in the Buea Health District. Findings from this study could acquisition of clinical skills by student nurses. Students’ motivation
serve as a guide for the designing and implementation of specific was observed to be outstanding as far as clinical skill acquisition
rules and regulations might enhance clinical teaching and learning is concerned. According to Cherry30 motivation gives a drive to a
and improve on skills acquisition by students in the clinical learning change in behavior by arousing, sustaining and directing it towards
environment. the successful attainment of a goal. Again, some students stated that
they were motivated to acquire the skills because they had knowledge
Participants’ characteristics which they gained from theory, and they wanted to achieve by
Findings showed that a total of 212 nursing students on internship practicing those skills. This finding is similar to a study conducted
from the four selected health facilities within the Buea Health District by McKenna et al,31 who found that background knowledge of the

Citation: Eta VEA, Njie IE, Njeodo V, et al. Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Buea Health
District, Cameroon. Nurse Care Open Acces J. 2024;10(4):123‒130. DOI: 10.15406/ncoaj.2024.10.00302
Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Copyright:
©2024 Eta et al. 128
Buea Health District, Cameroon

nursing profession from family members was what motivated the is in line with that of a previous study which showed that one of the
students to join the career. Therefore, it could be difficult for students challenges the students faced in the clinical learning environment was
to acquire the skills if not interested in the profession. In addition, lack of frequent supervision.36
the authors mentioned that if the teaching methods are monotonous
Most student nurses on internship in the Buea Health District had
students might be demotivated.
a good safety level in the hospital environment while a few of them
Furthermore, this study showed that the level of preparedness to had a poor safety level. Therefore, learning environment influenced
enter a clinical setting was associated with the acquisition of clinical the acquisition of clinical skills. Most of the student nurses on
skills by nursing interns. This finding is supported by Lee et al32 who internship received good treatment with courtesy and respect from
also found that registered nurses rated students lower, and indicated nursing personnel while a few of them were poorly treated. More than
that there was need for the students to be well prepared, unlike the half of the students said that nurses in the clinical environment were
nurses who generally felt that the students had enough knowledge and supportive. It is worth stating that good interpersonal relationship
there was no need to assist them. This is because it requires a nurse between the students and qualified nurses is the beginning of whatever
who is knowledgeable about the subject matter to assist the students the student is going to be in the future.39 If the tutors or qualified
in the clinical area. This meant that nurses who do not have enough nurses do not create a friendly atmosphere for students, it means that
knowledge can almost not transmit necessary skills to the learners. Eta students will not learn effectively due to the lack of trust.38 However,
et al,33 agrees with this by stating that clinical teachers or preceptors clinical instructors may encounter difficulties with students such as
may be worried about the theoretical basis of their own practice. personality conflicts and lack of respect on the part of the students
thereby hindering effective learning and the acquisition of skills.41
The question that often comes up is whether or not they are up
to date with knowledge and their ability to teach and model clinical Conclusion
skills. Similarly, a study by Mirna et al,34 also found that nurses who
had low education level felt that student did not need to be assisted Communication and leadership skills were the most skills acquired
as they felt inferior, unlike the nurses who were highly educated who by student nurses on internship in the Buea Health District, while the
were able to identify the needs of students. In like manner, since the least acquired skill among the student nurses was decision making
students are assisted by different cadres of different experience and skill. Age, level of preparedness to enter a clinical setting, source of
educational level in various hospitals, this could be true in regards to motivation for learning during clinical practice and the frequency
the knowledge gap which exist among these carders that eventually of teachers’ hospital visits were associated with the acquisition of
affects the transmission of skills to students.35 communication and leadership skills by nursing interns. The student
nurses on internship in the Buea Health District had as main challenges,
Our study results showed that the frequency of teachers’ hospital limited time and lack of support and supervision from health
visit influenced the acquisition of the types of clinical skills acquired personnel. Based on the findings of this study, it can be seen that there
by student nurses during internship. This finding is similar to that is still a need for nurse educators to increase the frequency of visits to
of a related study which revealed that students reported that they the wards when students are on clinical placement. Also, the training
want to spend their clinical training with knowledgeable and expert hospitals should improve on supervision and monitoring of clinical
instructors in their field for more effective learning, as instructors instructors. Furthermore, health institutions should set standards for
may serve as role models,36 who should be available/reachable.37 clinical instructors and mentors in the training of nurses. This might
Clinical teachers should be more involved in meeting students’ needs in turn minimize challenges face, enhance effective teaching and
and expectations,38 manage their time well, provide timely individual learning, and promote acquisition of clinical skills especially clinical
feedback and make assessments about students’ knowledge, skills and decision making skill. This could lead to the provision of prompt and
professional judgments.39 competent nursing care.
Challenges faced by student nurses on the acquisition
Limitations of the study
of clinical skills during internship
This study used a questionnaire to collect data; the disadvantage is
Concerning the challenges in the acquisition of clinical skills that it does not produce rich data. To compensate for this limitation,
by students on internship, it was revealed that student nurses on multiple options were provided for each question and copies of the
internship had limited time, lack support and supervision from health questionnaire were administered on a face-to-face basis. Also, the
personnel. This is in line with Amee et al,40 who stated that some of study used only four selected clinical sites within the Buea health
the challenges faced by students in the acquisition of clinical skills district, thus the results might not be generalized to all settings. A
during internship are lack of time on the part of nurse educators or more robust study could be conducted in the Buea Health District
the supervising persons due to workload or other commitments. In for a better understanding of the challenges encountered in skills
addition, some of the personnel who are concerned with clinical acquisition.
supervision are not interested in clinical teaching and learning partly
due to inappropriate curriculum and reference materials for teachers Authors contribution
and students as well as the lack of clearly written standard guidelines
and policies on clinical training of student nurses.41 Similarly, another All authors participated in different stages of the study from its
related study also revealed that learning environment was influencing commencement to writing. That is, conception and design, acquisition
acquisition of psychomotor skills by students.42 Again, it is stated that of data, analysis and interpretation of data as well as drafting, revising
students were not given enough time to practice skills in the clinical and approving the final manuscript.
area nor in the skill laboratory.37 Therefore, enough time must be set
aside for drilling practical skills and demonstrating their complexity.
Acknowledgments
The lack of support and supervision from health personnel was a The authors would like to thank all the students who participated
challenge of majority of the participants in this study. This finding in this study.

Citation: Eta VEA, Njie IE, Njeodo V, et al. Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Buea Health
District, Cameroon. Nurse Care Open Acces J. 2024;10(4):123‒130. DOI: 10.15406/ncoaj.2024.10.00302
Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Copyright:
©2024 Eta et al. 129
Buea Health District, Cameroon

Conflicts of interest 19. Hala AES, Manal HM. Effectiveness of structured educational program
on knowledge and practice among nurses regarding body fluid balance
The authors declare that they have no conflicts of interest. assessment for critically ill patients. IOSR J Nursing Health Sci.
2018;7:74–83
References 20. Shumaila A, Muhammad A, Robina K, et al. The assessment of nurses’
1. Mika F. Nursing competency: definition, structure and development. knowledge and practices about fluid and electrolytes monitoring and
Yonaga Acta Med. 2018;61(1):1–7. administration among cardiac surgery patients: a case of Punjab institute
of cardiology. Int Appl Science Biotechnol. 2017;5(2 ):208– 215.
2. Hassan N, Kholy G, Omran A, et al. Nursing students achievement in
normal labor: impact of simulation modules. American J Education Res. 21. Ghada SKM, Asmaa AM, Mosafa SA. The effect of scenario based
2018;6(12):1726–1731. teaching for critical care nurses and physicians on their knowledge of
fluid creep. J Nursing Education Practice. 2018.
3. Abd EN, Kholy G, Hassan A, et al. Call for activation of simulation
modules for nursing students’ achievement and satisfaction of 22. Cathala X , Moorley C. Skills for newly qualified nurses 1: understanding
normal labor: a quasi-experimental study. ARC J Nurs Healthcare. and managing accountability. Nursing Times. 2020; 116.
2018;4(2):24–39.
23. Habasa D. Factors affecting utilization of fluid balance charts by nurses
4. Seyedeh RJ, Ali Z , Mojtaba QQ. The challenges of supporting nursing on surgical ward at Kampala international university teaching hospital,
students in clinical education. J Educ Health Promot. 2020;9:216. Bushenyi district. 2017.

5. Abd EN, Kholy G, Omran A, et al. Effect of simulation on students’ 24. Shukla R. How to improve effective communication skills in students
achievement in normal labor modules. Menoufia Nursing J. and be presentable. 2021.
2019;4(1):71–84.
25. Levay K, Miller T, Down L. Communicating about students motivation.
6. Zagloul M, Hassan S, Sheha E, et al. Postnatal evidence based nursing 2019.
practice: effect of an educational guideline on internship student’s 26. Najafi KM, Jamshidi N. How do nursing students experience the clinical
knowledge and skills. Egyptian J Health Care. 2022;13(2):437–447. learning environment and respond to their experiences? a qualitative
7. Ayodele MO. Attitude, self-concept and achievement of junior secondary study. BMJ Open. 2019;9:e028052.
school students in basic science in Ekiti state, Nigeria. J Educ Soc Res. 27. Sanchis GL, Lacomba TL, Prado GV, et al. Attitudes towards
2016;6(1):167. communication in nursing students and nurses: are social skills and
emotional intelligence important? Healthcare(Basel). 2023;11(8):1119.
8. Zehr SM, Korte R. Student internship experiences: learning about the
workplace. Educat Train. 2020;62(3):311–324. 28. Camilla A, Helen D, Markus H. Nursing students’ experiences of
applying problem based learning to train the core competence teamwork
9. Hassan H. The impact of evidence-based nursing as the foundation and collaboration: an interview study. Nurs Open. 2021;9(1):569–577.
for professional maternity nursing practices. Open Access J Reproduct
System Sexual Disorder. 2019;2(2):195–197. 29. Ngaiyaye P, Ellemes E. Challenges in neonatal nursing clinical teaching
to Nurses. J Nurs Educ. 2017;2015–2221.
10. Hassan H. Evidence-based practice in midwifery and maternity nursing
for excellent quality of care outcomes. American J Nursing Res. 30. Cherry K. Motivation: the driving force behind our actions. 2023.
2020;8(6):606–607.
31. McKenna L, Mambu I R, Sommers C L, et al. Nurses and nursing
11. Lauren MT, Nicole MP, Maxine D. Factors influencing nursing student students reasons for entering the profession: content analysis of open
learning during clinical placements: a modified Delphi study. J Nurs ended questions. BMC Nurs. 2023;22(1):152.
Educ. 2023;62(6):333–341.
32. Lee JJ, Clarke CL, Carson MN. Nursing students learning dynamics and
12. Siri VB, Jonas D. The learning environment of student nurses during influencing factors in clinical contexts. Nurse Educ Pract. 2018;29:103–
clinical placement: a qualitative case study of a student-dense ward. 109.
SAGE open Nurs. 2021. 33. Eta VEA, Vibem CV, Nsagha DS. Preceptors experiences and preceptees
views regarding the clinical learning environment for nursing in the Buea
13. Mary AJ. An update on clinical judgment in nursing and implications
regional hospital, Cameroon. J Basic Appl Res Int. 2022;28(6):8–21.
for education, practice and regulation. J Nurs Reg. 2021;12(3):50–60.
34. Mirna AF, Ayman MH, Ahmad T. Challenges facing nursing education
14. Shorey S, Chua C. Nurses and nursing students’ experience on pediatric in the advanced healthcare environment. Int J Africa Nurs Sci.
end-of-life care and death: a qualitative systematic review. Nurse Educ 2018;9:1005–1110.
Today. 2022;112:105332.
35. Vuckovic V, Karlsson K, Sunnqvist C. Preceptors and nursing students’
15. Lenka M, Elena G, Lenka S. Nursing students’ perceived stress and experiences of peer learning in a psychiatric context: a qualitative study.
clinical learning experience. Nurse Educ Prac. 2022;64: 103457. Nurse Educ Pract. 2019.
16. Semarya B, Tigistu G. Nursing students’ challenges towards clinical 36. Zhang J, Shields j, Ma, B. et al. The clinical learning environment,
learning at the school of nursing and midwifery in addis ababa university: supervision and future intention to work as a nurse in nursing students:
a qualitative study. Int J Africa Nurs Sci. 2021;15:100378. a cross-sectional and descriptive study. BMC Med Educ. 2022;22(548).

17. Burcu A, Yaprak O, Dilek Y. Undergraduate nursing students experience 37. Berhe S, Gebretensaye T. Nursing students challenges towards clinical
related to their clinical learning environment and factors affecting to learning environment at the school of nursing and midwifery in
their clinical learning process. Nurs Educ Prac. 2018;29:127–132. Addis Ababa university: a qualitative study. Int J Africa Nursing Sci.
2021;15(100378).
18. Eta VEA, Akong ER, Bassah N, et al. Nurses practices of input and
38. Silén C, Kalén S, Lundh P, et al. Students learning in clinical practice-a
output monitoring of patients on intravenous fluid therapy within Fako
scoping review of characteristics of research in the nordic countries.
Division. Universal Library Clinic Nursing. 2024;1(1):17–28.
Med Educ Online. 2023:28(1):2279347.

Citation: Eta VEA, Njie IE, Njeodo V, et al. Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Buea Health
District, Cameroon. Nurse Care Open Acces J. 2024;10(4):123‒130. DOI: 10.15406/ncoaj.2024.10.00302
Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Copyright:
©2024 Eta et al. 130
Buea Health District, Cameroon

39. Camilla O, Ingunn A, Simen AS. Supplementing clinical practice in 41. Lee NPM, Chiang VCL. The mentorship experience of students and
nursing homes with simulation training: a qualitative study of nursing nurses in pre-registration nursing education: a thematic synthesis of
students experiences. SAGE Open Nurs. 2020;6:2377960820981786. qualitative studies. Nurs Health Sci. 2021;23(1):69–86.
40. Amee A, JungGi M, Sharjeel S, et al. Continued nursing education in 42. Eta VEA, Mbeng B. Improving clinical learning environment: views and
low-income and middle-income countries: a narrative synthesis. BMJ expectations of student nurses in Limbe regional hospital, Cameroon.
Glob Health. 2019;5(2). e001981. Afr J Integ Health. 2020;10(02):18–23.

Citation: Eta VEA, Njie IE, Njeodo V, et al. Factors and challenges influencing the acquisition of clinical skills by student nurses during internship in Buea Health
District, Cameroon. Nurse Care Open Acces J. 2024;10(4):123‒130. DOI: 10.15406/ncoaj.2024.10.00302