Clinical competence in nursing education: a concept analysis
DOI:
https://doi.org/10.34011/jmp2k.v36i1.3465Keywords:
clinical competence, competency-based education, nursing education, nursing student, teaching and evaluationAbstract
Introduction: Clinical competence is a fundamental component of nursing education; however, the concept remains inconsistently defined across contexts. This lack of clarity hampers effective teaching, assessment, and the development of shared competency standards.
Objective: This study aimed to clarify the construct of clinical competence for prelicensure nursing students during clinical education and to identify its implications for the learning process and evaluation.
Methods: This study employed Walker and Avant’s concept analysis systematically following the sequential steps of concept selection, multidisciplinary literature exploration, and identification of defining attributes, antecedents, and consequences. A literature review was conducted using Scopus, Proquest, Springer, and SAGE Journal. Searches conducted from January 2018-December 2023 identified 70 records, of which 18 studies met the inclusion criteria. The analysed literature encompassed multiple health-related disciplines, including nursing, digital health, medicine, midwifery, dentistry, allied health, physical therapy, and obstetrics.
Results: Clinical competence is conceptualised as an integrative capability encompassing cognitive, affective, and psychomotor domains, strengthened by advanced nursing skills, soft skills, leadership, and professionalism. These capabilities develop through formal education and supervised clinical experiences and are influenced by both educational contexts and individual factors. Clinically competent students can deliver safe, effective, high-quality care, maintain nursing standards, and perform efficiently in professional settings.
Conclusion: This study provides a refined operational definition and key attributes of clinical competence, offering guidance for curriculum development, instructional strategies, and assessment practices in competency-based nursing education. The findings highlight the importance of standardised definitions to improve teaching quality and consistency in evaluating clinical competence
References
[1] A. Faraji, M. Karimi, S. Mohsen, M. Janatolmakan, dan A. Khatony, “Evaluation of clinical competence and its related factors among ICU nurses in Kermanshah-Iran : A cross-sectional study,” Int. J. Nurs. Sci., vol. 6, no. 4, hal. 421–425, 2019.
[2] G. Sherwood dan J. Barnsteiner, Ed., Quality and Safety in Nursing: A Competency Approach to Improving Outcomes. West Sussex: Willey Blackwell, 2012.
[3] T. F. Terefe et al., “Clinical competency and associated factors among undergraduate nursing students studying in universities of Southern regional state of Ethiopia , 2021,” Heliyon, vol. 9, no. 8, hal. e18677, 2023.
[4] Z. Nabizadeh-Gharghozar, N. M. Alavi, dan N. M. Ajorpaz, “Clinical competence in nursing: A hybrid concept analysis,” Nurse Educ. Today, vol. 97, no. November 2020, hal. 104728, 2021.
[5] H. Ö. Egilsdottir et al., “Factors associated with changes in students ’ self ‑ reported nursing competence after clinical rotations : a quantitative cohort study,” BMC Med. Educ., vol. 23, no. 107, hal. 1–15, 2023.
[6] Z. Jokar, M. Bijani, dan H. Haghshenas, “Explaining the challenges faced by nursing students in clinical learning environments during the post-COVID era : a qualitative content analysis,” BMC Res. Notes, vol. 18, hal. 320, 2025.
[7] E. Jarva, A. Oikarinen, J. Andersson, M. Tomietto, M. Kääriäinen, dan K. Mikkonen, “Healthcare professionals’ digital health competence and its core factors; development and psychometric testing of two instruments,” Int. J. Med. Inform., vol. 171, no. 104995, hal. 2–9, 2023.
[8] L. Collins, M. Johnson, dan C. Tyson, “Online interactive discussion boards : exploring student engagement when critically discussing the concept of confidentiality and telehealth,” vol. 7, hal. 0–7, 2023.
[9] P. Bromley, “A paradigm shift from competence to Capability in neonatal nursing,” J. Neonatal Nurs., vol. 25, no. 6, hal. 268–271, 2019.
[10] P. E. Manocchi, “Fostering Academic Success in Nursing Students Through Mindfulness : A Literature Review,” Teach. Learn. Nurs., vol. 12, no. 2017, hal. 298–303, 2017.
[11] X. Feng, Y. Wang, L. Wei, dan K. Meng, “How to become an excellent pediatric resident : a qualitative comparative study from China,” BMC Health Serv. Res., vol. 23, no. 53, hal. 1–14, 2023.
[12] M. Charette, L. G. Mckenna, M. Maheu-cadotte, M. Deschênes, L. Ha, dan S. Merisier, “Measurement properties of scales assessing new graduate nurses ’ clinical competence : A systematic review of psychometric properties,” Int. J. Nurs. Stud., vol. 110, hal. 103734, 2020.
[13] M. Purabdollah, V. Zamanzadeh, A. Ghahramanian, L. Valizadeh, S. Mousavi, dan M. Ghasempour, “Competencies expected of undergraduate nursing students : A scoping review,” Nurs. Open, vol. 10, hal. 7487–7508, 2023.
[14] L. O. Walker dan K. C. Avant, Theory Construction In Nursing, 6th ed. New York: Pearson, 2019.
[15] M. Yu, H. Tong, S. Li, X. Vivien, J. Hong, dan W. Wang, “Clinical competence and its association with self-efficacy and clinical learning environments among Chinese undergraduate nursing students,” Nurse Educ. Pract., vol. 53, no. May 2020, hal. 103055, 2021.
[16] M. Kim, “Affecting Factors on Clinical Competence of Nursing Students,” vol. 16, no. 3, hal. 1884–1893, 2015.
[17] G. Lejonqvist, K. Eriksson, dan R. Meretoja, “Evaluating clinical competence during nursing education: A comprehensive integrative literature review,” Int. J. Nurs. Pract., vol. 22, no. 2, hal. 142–151, 2016.
[18] K. Neziha, Y. Y. Aktaş, dan D. K. Alemdar, “The relationship of clinical learning environment to nursing students ’ academic motivation,” Kontakt, vol. 1, no. 1, hal. 9–15, 2015.
[19] Y. Y. Aktaş dan N. Karabulut, “A Survey on Turkish nursing students’ perception of clinical learning environment and its association with academic motivation and clinical decision making,” Nurse Educ. Today, vol. 36, hal. 124–128, 2016.
[20] C. Ma dan W. Zhou, “Effects of unfolding case-based learning on academic achievement , critical thinking , and self-confidence in undergraduate nursing students learning health assessment skills,” Nurse Educ. Pract., vol. 60, no. 2022, hal. 103321, 2022.
[21] K. F. Hew dan C. K. Lo, “Flipped classroom improves student learning in health professions education : a meta-analysis,” BMC Med. Educ., vol. 18, no. 1, hal. 1–12, 2018.
[22] N. Lakhani, “Effect of Clinical Learning Environment on Nursing Students at Tertiary Care Hospitals,” Int. Res. J. Manag. Soc. Sci., vol. V, no. 2, hal. 1011–1019, 2024.
[23] M. Hakimi, M. Kheirkhah, J. Abolghasemi, dan R. Hakimi, “Investigating the effect of neonatal resuscitation simulation using a competency ‑ based approach on knowledge , skill , and self ‑ confidence of midwifery students using objective structured clinical examination ( OSCE ),” J. Fam. Med. Prim. Care |, vol. 10, no. 4, hal. 1766–1772, 2021.
[24] W. Ying, L. Mingxuan, Z. Qian, Z. Shuxian, G. Yufang, dan W. Kefang, “The mediating role of professional commitment between the clinical learning environment and learning engagement of nursing students in clinical practice : A cross-sectional study,” Nurse Educ. Today, vol. 121, no. 105677, hal. 1–7, 2023.
[25] S. A. Kumalasari dan K. Raani, “Self-Efficacy and Readiness Towards Early Clinical Exposure Among Nursing Students,” vol. 5, no. 2, hal. 104–111, 2021.
[26] F. Firoozehchian, A. Zareiyan, M. Geranmayeh, dan Z. B. Moghadam, “Domains of competence in midwifery students : a basis for developing a competence assessment tool for iranian undergraduate midwifery students,” BMC Med. Educ., vol. 22, no. 704, hal. 1–15, 2022.
[27] M. Q. Javed et al., “How Well Prepared Are Dental Students and New Graduates in Pakistan — A Cross-Sectional National Study,” Int. J. Environ. Res. Public Health, vol. 20, no. 1506, hal. 1–12, 2023.
[28] I. Motoya et al., “The Characteristics of the Clinical Competence of Novice Physical Therapists and Occupational Therapists at the Time of Hiring in a Single Institution in Japan,” Heal. Prof. Educ., vol. 6, no. 4, hal. 538–551, 2020.
[29] R. A. Zaitoun, N. B. Said, dan L. De Tantillo, “Clinical nurse competence and its effect on patient safety culture : a systematic review,” BMC Nurs., vol. 22, no. 1, hal. 173–183, 2023.
[30] S. C. Vincent, J. Arulappan, A. Amirtharaj, G. A. Matua, dan I. Al Hashmi, “Objective structured clinical examination vs traditional clinical examination to evaluate students ’ clinical competence : A systematic review of nursing faculty and students ’ perceptions and experiences,” Nurse Educ. Today, vol. 108, no. 105170, hal. 1–13, 2022.
[31] I. Jamieson, D. Sims, A. Basu, dan K. Pugh, “Readiness for practice: The views of New Zealand senior nursing students,” Nurse Educ. Pract., vol. 38, hal. 27–33, Jul 2019.
[32] M. Purabdollah, V. Zamanzadeh, A. Ghahramanian, L. Valizadeh, S. Mousavi, dan M. Ghasempour, “Competency gap among graduating nursing students : what they have achieved and what is expected of them,” BMC Med. Educ., vol. 24, no. 1, hal. 546, 2024.
[33] Z. A. Mani, “Transitioning to competency-based education in nursing : a scoping review of curriculum review and revision strategies,” BMC Nurs., vol. 24, no. 1, hal. 1111, 2025.
[34] J. A. Manz, M. Tracy, M. Hercinger, M. Todd, L. Iverson, dan K. Hawkins, “Assessing Competency : An Integrative Review of The Creighton Simulation Evaluation Instrument ( C-SEI ) and Creighton Competency Evaluation Instrument ( C-CEI ),” Clin. Simul. Nurs., vol. 66, hal. 66–75, 2022.
[35] C. Leal-Costa et al., “Nurse Education in Practice Development and psychometric testing of the non-technical skills scale in medical and surgical hospital units for nursing students,” Nurse Educ. Pract. J., vol. 67, hal. 103559, 2023.
[36] S. T. Lau, V. Lopez, S. Y. Liaw, dan Y. Lau, “Development and psychometric evaluation of the community care competency scale in multi ‐ ethnic undergraduate nursing students,” Heal. Soc. Care, vol. 27, no. May, hal. 802–814, 2019.
[37] A. T. H. Nguyen, W. Kunaviktikul, T. E. Stone, A. Sripusanapan, P. Thungjaroenkul, dan D. T. T. Pham, “The implementation of a competency-based nursing curriculum in a developing country : A qualitative descriptive,” F1000Research, vol. 11, hal. 969, 2025.
[38] H. Tseng, H. Ko, H. Wang, R. Wang, dan L.-M. Wu, “Psychometric Evaluation of the Capstone Core Competency Scale on Nursing Students in Taiwan,” J. Nurs. Res., vol. 30, no. 5, hal. 1–8, 2022.
[39] L. Nguyen, B. Martina, dan M. Clyde, “Using Virtual Reality for Perioperative Nursing Education in Complex Neurosurgical Surgeries: A Feasibility and Acceptance Study,” Cureus, vol. 16, no. 3, 2024.
[40] M. Dehnavi et al., “The correlation between emotional intelligence and clinical competence in nurses working in special care units : A cross-sectional study,” Nurse Educ. Today, vol. 116, no. 105453, hal. 1–6, 2022.
[41] A. Falk dan V. Lindstr¨om, “Self-reported clinical competence before entering advanced level training in acute and prehospital emergency care among registered nurses in Sweden,” Int. Emerg. Nurs., vol. 61, no. 101146, hal. 1–5, 2022.
[42] M. Azimirad, C. Magnusson, A. Wiseman, T. Selander, I. Parviainen, dan H. Turunen, “A clinical competence approach to examine British and Finnish nurses ’ attitudes towards the rapid response system model : A study in two acute hospitals,” Aust. Crit. Care, vol. 35, no. 1, hal. 72–80, 2022.
[43] M. Mackay, C. Ford, L. E. Grant, A. Papadopoulos, dan J. E. Mcwhirter, “Developing public health competency statements and frameworks : a scoping review and thematic analysis of approaches,” BMC Public Health, vol. 23, hal. 2240, 2023.
[44] A. Leonardsen, V. Nystrøm, I.-J. S. Grimsrud, L. Hauge, dan B. F. Olsen, “Nursing Competence in caring for patients with respiratory insufficiency : A cross-sectional study,” Intensive Crit. Care, vol. 63, no. 102952, hal. 1–8, 2021.
[45] E. Lew, J. C. Allen, J. R. W. L. Goy, F. Ithnin, dan B. L. Sng, “Determining competence in performing obstetric combined spinal-epidural procedures in junior anesthesiology residents : results from a cumulative sum analysis,” Int. J. Obstet. Anesth., vol. 44, hal. 33–39, 2020.
[46] E. Prendi et al., “Measuring professional competencies of registered nurses and nursing students . A cross-sectional comparative study,” Acta Biomed., vol. 93, no. 5, hal. e202282, 2022.
[47] T. K. Ayyıldız, S. Özdemir, S. Balcı, M. Sönmez, dan D. Y. Tank, “Psychometric Properties of the Turkish Version of Nurse Professional Competence Scale-Short Form,” Hacettepe Univ. Fac. Heal. Sci. J., vol. 12, no. 1, hal. 252–267, 2025.
[48] M. Yılmaz dan F. Korkmaz, “Proficiency Evaluation Scales in Nursing: A Comprehensive Review,” in Asian Congress in Nursing Education, 2023, hal. 160.
[49] S. Perng dan R. Watson, “Psychometric Testing of an Instrument Measuring Core Competencies of Nursing Students An Application of Mokken Scaling,” Adv. Nurs. Sci., vol. 36, no. 2, hal. 146–157, 2013.
[50] S. Tsay, K. Kau, dan S.-C. Chang, “Development of the Acute Care Nurse Practitioner Competencies Scale : An Exploratory and Confirmatory Factor Analysis,” J. Nurs. Res., vol. 31, no. 3, hal. 1–8, 2023.
[51] L. Cadorin, S. Cheng, dan A. Palese, “Concurrent validity of self-rating scale of self-directed learning and self-directed learning instrument among Italian nursing students,” BMC Nurs., vol. 15, hal. 20, 2016.
[52] A. A. Franckowiak, “Graduate Record Examination Scores as Predictors of First Time Success on the National Certification Examination in a Midwest Nurse Anesthesia Program,” University of Michigan-Flint, 2021.
[53] F. M. Srnka-debnar, “Barriers And Facilitators To Successful Completion Of A Baccalaureate Nursing Program,” Binghamton University, 2015.
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