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The Relationship between Clinical Competence and Clinical Self- efficacy

among Nursing and Midwifery Students

Article  in  International Journal of Pediatrics · December 2015

DOI: 10.22038/ijp.2015.5222

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Original Article (Pages: 1117-1123)

The Relationship between Clinical Competence and Clinical Self-

efficacy among Nursing and Midwifery Students
Shahla Mohamadirizi1, Shahnaz Kohan 2, Fatemeh Shafei3, *Soheila Mohamadirizi41
1
Department of Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan,
Iran.
2
Department of Midwifery, Women Health Research Center, Isfahan University of Medical Sciences, Isfahan,
Iran.
3
Nursing and Midwifery School, Isfahan University of Medical Sciences, Isfahan, Iran.
4
Department of Midwifery, Women Health Research Center, School of Nursing and Midwifery, Isfahan
University of Medical Sciences, Isfahan, Iran.

Abstract
Introduction
Self-efficacy in clinical performance had an important role in applying competencies; also
competencies and self-efficacy in clinical performance influenced to quality care of nursing and
midwifery students. So the present study aimed to define the relationship between clinical
competencies and clinical self-efficacy among nursing and midwifery students.
Materials and Methods
This is a cross-sectional study conducted on 150 of nursing and midwifery students in Isfahan
University of Medical Science, selected through two stage sampling in 2014. The participant
completed questionnaires about personal/ educational characteristics and nursing competencies
questionnaire (18 items) and clinical self-efficacy scale (37 items). The data were analyzed by,
Pearson statistical test, t-test, variance analysis through SPSS version16.
Results
The results showed that 50% (n=75) and 37.4% (n=56) of nursing and midwifery students had good
clinical competence and clinical Self-Efficacy, respectively. Also the mean competencies and self-
efficacy in clinical performance scores were 35.05± 1.2 and 76.03± 0.4 respectively. Pearson
correlation coefficient showed that there was a positive linear correlation between the score of clinical
competence and clinical self-efficacy (P<0.05, r=0.73).
Conclusion
The results reveal that self-efficacy is a significant predictor of a student's clinical performance
therefore increasing clinical competence related to high clinical Self-efficacy.
Key Words: Clinical competence, Clinical performance, Self-efficacy, Students.

*Corresponding Author:
Soheila Mohamadirizi, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
Email: mohamadirizi@nm.mui.ac.ir
Received date: Aug 5, 2015 Accepted date: Aug 22, 2015

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Relationship between Self-efficacy and Clinical Competencies in Students

Introduction the competencies in order to be effective in

their clinical performance (8). In this
Clinical competence is defined as the
regard, Parsa Yekta conducted a study to
ability to solve complex problems using a
determine the clinical competence of 91
combination of knowledge, attitude and
nursing students. He showed that most
practical skills and its goal is to assess the
studied students had moderate clinical
practical capabilities of medical students in
competence (8). Whereas, Hakimzadeh’s
various fields in order to meet the needs of
study revealed that generally students have
public service (1). The undesirable
rated their clinical competence slightly
practical skills of medical students may be
above average (3). About acquisition of
due this reason that in most performance-
clinical competence in nursing and
based tests, basic and theoretical skills are
midwifery students, understanding the
ignored and not assessed and their success
influencing factors in its development is
on tests greatly depends on subjective
important (9). Furthermore, there are
memories and conceptions and in
appropriate solutions to predict students’
performance-based tests at the end of the
clinical skills that one of which is paying
course, a part of the score is for the
attention to students’ self-efficacy beliefs
diagnosis and treatment and consequences
for clinical skills evaluation. In fact, it
of the treatment (2, 3).
seems that obtaining multilateral
In fact, clinical competence is the ultimate information from intelligence capabilities
goal of nursing education and includes the and competencies of students can enrich
ability to apply professional knowledge the clinical evaluation. One of the most
and skills, communication and important information is the student’s
interpersonal skills, and advanced problem personal belief and understanding his own
solving and decision making skills (4). “effectiveness”. This variable can be a
According to the above-mentioned, reliable predictor of student’s clinical
competence in nursing and midwifery will competence and skills (10). Accordingly,
be considered as the ability to perform students’ evaluation of their own
nursing duties, and the ability to effectiveness is an appropriate guideline to
effectively integrate the cognitive, predict their clinical skills, because there is
affective and psychomotor skills while a significant positive relationship between
performing patient care (5). Assessment of the self-efficacy and performance of the
clinical competence, particularly in students (11, 12). In fact, the self-efficacy
identifying areas that need improvement as is one of the contributing factors that not
well as determining the educational needs only can affect the performance and
of nurses, is of great importance. So that is clinical competence of people working in
considered as the most important the healthcare field, but also can affect
responsibility of managers in clinical medical and paramedical students (13).
settings (6). In our country, recently, due Self-efficacy also mediates between the
to the increased community awareness and knowledge and behavior and is associated
expectations about receiving high-quality with professional competence (14). Rice’s
services, paying attention to the clinical study (2013) showed that there was no
competence of nurses and midwives has correlation between clinical competence
become more important (7). According to and self-clinical of students (15); whereas,
the Australian Nursing Association, the studies by Hasani and the Haqqani
nursing students should have sufficient (2013) and Yu (2006) showed that there
self-awareness about their professional was a significant correlation between these
qualifications when graduating and also two variables (13, 16, 17).
their attitudes should be positive toward

Int J Pediatr, Vol.3, N.6-2, Serial No.24, Dec 2015 1118

Mohamadrizi et al.

Given the above, obtaining clinical a medical history, I am able to establish a

competency is one of the important goals relation between separated information of
of medical education and its evaluation is the patient). This questionnaire has 5
also of utmost importance. Today, efforts separate areas including examining the
are made to adopt new approaches to patient, nursing diagnosis, planning care
assess and evaluate the capabilities of program, implementing care program, and
students of Medical Sciences in order to evaluation of care program. The overall
promote the quality of this part of score of this questionnaire is from 0 to 102
educational process (5, 6). (poor 0-37, medium 38-74, and good 75-
102). This questionnaire has been used in
In the present study, by introducing the
studies in Iran, including Cheraqi and the
concept of clinical self-efficacy in the field
Haqqani (2013) and its content validity
of clinical competency evaluation,
and reliability (Cronbach's alpha 0.92) has
appropriate complementary to assess and
been approved by the Haqqani’s study
judge on medical students’ clinical
(2013) (14, 16). The third part of the
capability is presented (8, 18). Given that
questionnaire is a shortened questionnaire
more than 80% of direct patient care is
of “clinical competence” which consists of
carried out by nurses and midwives (11,
18 items (for example: I try to provide
19) and also according to the few studies
standard care, I have a unique approach in
that have been conducted regarding the
planning patient care, when the patient
objective of the study and the
asks a question I show my logical thoughts
contradictory results (13, 15-17), this study
and behaviors), and is based on a 4 point
aimed to determine the relationship
Likert scale rated from 1 (completely true)
between clinical self-efficacy and clinical
to 4 (wrong).
competence in nursing and midwifery
students in Isfahan city, the center of Iran, To prove the face and content validity, the
in 2014. third part of the questionnaire was
translated and the necessary changes was
Materials and Methods made, then it was delivered to five experts
At a cross-sectional study, stratified in the field along with the English version
sampling method was applied for this to be revised. After proposed amendments
study. Then, in proportional to the number of the experts were applied, the tools were
of senior students in each field and based given to three professors for final
on the number of students, 100 nursing reviewing and approval. For determining
students and 50 midwifery students were the reliability of both questionnaires, test-
randomly selected. retest method was used (on ten students at
The researcher made questionnaire the beginning of the study), and it was
consists of three parts: the first part approved with a correlation coefficient of
includes reviewing the educational 0.96.
demographic characteristics (age, gender, To do the study, the researcher referred to
education level, field of Study, marital the place of students’ apprenticeship in
status); the second part of the each of the disciplines of nursing and
questionnaire is about “clinical self- midwifery and after explaining the purpose
efficacy” which contains 37 items based of the study and how to complete the
on a 4 point Likert scale rated from quite questionnaire, the researcher attempted to
always (0) to never (3) (for example, I am do sampling and carry out the research.
able to gather the necessary information After obtaining informed consent form
through physical examination, I am able to students, a three-part questionnaire that
gather the necessary information by taking included demographic/academic

Int J Pediatr, Vol.3, N.6-2, Serial No.24, Dec 2015 1119

Relationship between Self-efficacy and Clinical Competencies in Students

characteristics, clinical self-efficacy scale 23 ± 1.4 years. Also, 88 subjects (59%)

and clinical skills questionnaire was were single and 62 subjects (41%) were
completed by participants. The data were married.
analyzed by SPSS version 16, also P<0.05 Frequency distribution of subjects’ based
was considered as significant level. on clinical competence and clinical self-
Results efficacy level in (Table.1) and dimensions
of clinical self-efficacy are shown in
A total of 150 students participating,
(Table.2).
92 subjects (61.4%) were women and 58
subjects (38.6%). Subjects’ mean age was
Table 1: Frequency distribution of subjects’ based on clinical competence and clinical self-efficacy
levels
Variables N %

Clinical competence
Well (63-72) 75 50.5
Moderate (51-62) 72 48.4
Poor (34-50) 3 1.1
Total 150 100
Clinical self-efficacy
Well (92-111) 56 37.4
Moderate (71-91) 80 53.3
Poor (37-90) 14 9.3
Total 150 100

Table 2: Frequency distribution of subjects’ based on 5 dimension of clinical self-efficacy

5 Dimension of clinical self-efficacy SD ± Mean
Patient Survey 4.1±17.99
Nursing Diagnosis 3.4±17.25
Care Program Planning 4.4±17.1
Care Program Performing 3.4±13.97
Care Program Evaluating 3.7±14.82

Pearson correlation index showed a correlation between 5 dimension of

positive correlation between scores of clinical self-efficacy and clinical
clinical competence and clinical self- competence.
efficacy in a way that an increase in score In order to control confounding factors, all
of clinical competence increases score of quantitative variables were entered into
clinical self-efficacy (P=0.001, r=0.73). linear regression model through concurrent
Based on Pearson correlation index entrance method (Table 4).
(Table.3) showed that there was a positive

Int J Pediatr, Vol.3, N.6-2, Serial No.24, Dec 2015 1120

Mohamadrizi et al.

Table 3: Correlation between 5 dimension of clinical self-efficacy and clinical competence

5 Dimension of clinical self-efficacy P value Pearson’s correlation
coefficient
Patient Survey 0.006 0.45
Nursing Diagnosis 0.004 0.62
Care Program Planning 0.023 0.28
Care Program Performing 0.012 0.81
Care Program Evaluating 0.033 0.42

Table 4: Linear regression between predictor variables and dependent variables

Coefficient a
Predictor variables Standardized Coefficients Unstandardized P value
Coefficients

Beta Std. Error Beta

Clinical competence .091 .031 .133 .011
score
Age .089 .066 .031 .076
Courses .224 .086 .138 .609
a Dependent variable: Total clinical self-efficacy SCORE

Discussion In another study it is also stated that,

according to the participants, self-efficacy
The main results of the present study
along with clinical competence give the
showed that there was a significant
nurses a sense of self-sufficient. Sense of
positive correlation (r = 0.73) between
self-sufficient, in turn, makes them
total score of clinical competence of
creative in helping the patients and the
students and clinical efficacy as well as its
nurses can take more efficient decisions
five areas, so that with an increase in
(20). The study by Rice showed that there
clinical self-efficacy, students had more
was no correlation between clinical self-
clinical competence. In line with the
efficacy and the nursing students’ clinical
results of present study, the findings of the
competencies (15). Different educational
study by Hasani in Tehran showed that
environments and also different
nursing students during the field training
environments of educational hospitals and
believe that self-efficacy in clinical
also differences in the culture of each
performance is synonymous with obtaining
society and even each city, and the
clinical competency and providing proper
difference in the number of passed
care for the patient. These two are based
semesters (final-year students in the
on knowledge and experience within the
present study versus students in their sixth
framework of evaluating the patients,
semester and higher in Rice’s study) are
planning, implementation, and evaluating
some of the reasons for the difference and
nursing care (13).
inconsistency of the studies. One limitation

Int J Pediatr, Vol.3, N.6-2, Serial No.24, Dec 2015 1121

Relationship between Self-efficacy and Clinical Competencies in Students

of this study is that evaluating clinical results of present study can be used for
competence by using self-assessment educational planning of midwifery and
method can reduce the accuracy and nursing, implementing new training
objectivity of this evaluation method methods, and clinical evaluation by the
because the subjects may give themselves heads of departments and as a result they
unrealistic scores, that is why this method pay more attentions to the students’
of assessment of clinical competence performance in clinical settings.
should be evaluated as a part of an Furthermore, the results of this study can
approach, not all of it. Although the be used by nursing students for self-
researcher is aware of these limitations, he assessment of clinical performance.
believes that trusting in nursing and Feedback related to the results of the study
midwifery students can motivate them to will help the students to gain self-
think and take decisions about how to awareness and self-confidence about their
provide care; furthermore, it enables them professional capabilities. Also, based on
to fulfill their responsibilities in clinical their level of self-efficacy, they can assess
performance. However, given the their educational needs, develop strategies
foregoing discussion, it can be suggested for clinical learning, and monitor and
that for future studies researchers can use evaluate their own learning.
other methods to assess the clinical
competence, such as assessment of Acknowledgments
students by trainers and officials of the This study is part of a proposal,
wards with direct observation and approved 2014 with code 293215, Isfahan
evaluation of care outcomes. The other University of Medical Science, Iran which
limitation of this study that should be is sponsored with research deputy. Also,
noted is that the students did not hope that we greatly appreciate the support and
the results of the study would be used in cooperation of this Vice Chancellery, as
decision making related to their well as all nursing and midwifery students.
performance in clinical settings; therefore,
they did not show great interest in Conflict of Interest: None.
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