Perceptions and satisfaction with the quality of clinical training placements among nursing and midwifery students in Northern Ghana

Clinical placements are vital for preparing student nurses and midwives to provide safe and effective care upon graduation. The setting of these placements, whether in hospitals, health centers or community environments, can significantly impact the learning experience. Students assigned to clinics often report higher levels of satisfaction due to increased hands-on opportunities and supportive learning conditions [1, 2]. Additionally, clinical placements enhance practical skills while fostering critical thinking and professional development, both of which are essential for tackling future healthcare challenges [3].

Modern nursing is built upon a foundation of theoretical instruction in classrooms and practical training in laboratories and clinical settings [4]. Nursing education programs worldwide incorporate clinical placement experiences to help learners integrate theory and practice effectively [5]. Clinical training, being complex and dynamic, offers real possibilities for students to apply their knowledge in practical circumstances [6, 7].

During nursing education, students are taught theoretical foundations and provided opportunities to practice skills in simulated environments (skills laboratories and demonstration rooms) before engaging in clinical placements throughout their studies. This approach equips individuals with the necessary knowledge, skills, and attitudes for providing quality nursing care [8, 9].

Nursing educators worldwide emphasize the importance of clinical skill acquisition in nursing education. For example, in the United States of America, New Zealand, and Europe, clinical teaching and learning play a crucial role in pre-registration nursing programs [10]. In Saudi Arabia, nursing and midwifery students must complete up to 75 credit hours of practical experience [11]. Australia, through the Australian Nursing and Midwifery Accreditation Council (ANMAC), sets minimum standards for clinical placements [12].

Practical learning occurs during clinical practice in various healthcare settings, including hospitals, primary care centres, elderly centres, community settings, and private clinics. Health training institutions are responsible for evaluating the educational process’s theoretical and practical aspects [13]. Consequently, numerous studies underscore the need to develop and train clinical mentors for nursing and midwifery students in diverse healthcare settings, utilizing innovative and effective strategies [14, 15]. Clinical teaching and learning empower students to translate classroom learning into patient care, facilitating their evolution into competent nurses and midwives [16].

Developing competent nurses is crucial for enhancing the quality of the healthcare system, necessitating quality nursing education to equip them with the required knowledge and skills [17].

The quality of clinical placements significantly influences how students acquire skills, knowledge, and clinical reasoning, as well as how they develop as professional nurses and midwives [18].

The Nursing and Midwifery Council of Ghana (NMC-Ghana) regulates and governs the nursing and midwifery professions and training [19]. Nursing and Midwifery students in Ghana spend approximately 55% of their time in clinical settings for intra-semester and inter-semester clinical placements [20]. Several studies have identified elements influencing student clinical experiences, including preparation for placement, supervision, and clinical settings [21, 22]. A study in Ghana revealed that being taught new things, being supervised, and having autonomy were the most significant factors promoting clinical learning. However, students in clinical areas perceived challenges such as poor application of teaching methods, staff attitude, and inadequate resources [23]. Notably, previous studies have focused on assessing the quality of the student experience rather than on clinical placements [5, 24].

In Ghana, there is a notable gap in research concerning the perceptions and satisfaction levels regarding the quality of clinical training placements for nursing and midwifery students, particularly in the northern region. While previous studies have primarily focused on students’ experiences during these placements [25‐27], further investigation is needed to assess the clinical training standards provided to nursing students. Addressing these gaps will enhance our understanding of the factors influencing training quality and student satisfaction in this context.

There is a growing need to enhance the clinical learning atmosphere for nursing and midwifery students, especially in settings where resources are limited [28]. Resource-limited environments frequently struggle with inadequate clinical facilities and equipment, which significantly hampers students’ hands-on learning experiences [29, 30]. Additionally, in many of these settings, the ratio of students to available practice assessors/supervisors is often disproportionate. This imbalance can lead to insufficient supervision and mentorship, both essential components for effective learning [31].

The assessment and evaluation of students during their clinical placements hold significant value, presenting an opportunity to enhance the overall quality of nursing and midwifery education. Additionally, evaluating students’ perceptions and satisfaction with their clinical placements can contribute to improving their educational experience. Therefore, this study aimed to evaluate the perceptions and satisfaction levels of student nurses and midwives regarding the quality of clinical training placements in Northern Ghana. This study seeks to identify factors that influence their experiences, ultimately contributing to the improvement of clinical education in the region.

Clinical placement is an essential component of nursing and midwifery education. For many students, clinical placements are the most important aspect of their education. Exploring the quality of clinical learning environments in sub-Saharan Africa is crucial, as this is where theoretical knowledge is applied to real-world healthcare scenarios [29, 37]. Therefore, our study evaluated the perceptions and satisfaction levels regarding the quality of clinical training placements among student nurses and midwives in Northern Ghana. The high response rate (95.3%) demonstrates the students’ willingness to participate in the study, enhancing the reliability of the findings.

Most students (90.5%) were between 20 and 25 years old, reflecting the typical age range for students [38].

In our study, students had a positive perception of the quality of their clinical training placements. They strongly agreed that their clinical placements provided a good learning environment. Staff were willing to work with students, and students had opportunities to enhance their skills and knowledge. This is similar to the study conducted by Ziba et al. [30], which revealed that students had positive perceptions of their clinical placements (M = 3.24). In contrast, our study does not align with the research by Abuosi et al. [29], which indicated that most students perceived the quality of clinical placements as suboptimal, marking a contrast with our positive findings. The difference in students’ experiences could be attributed to variations in geographical locations, healthcare institutions, or specific clinical settings. Furthermore, students reported receiving regular and constructive feedback, with the lowest mean score being 3.71 out of 5. This suggests a neutral stance among students, indicating a need for improvement in feedback mechanisms. Our study differs from the findings of Baghdadi et al. [39], where students rated their placements as good learning environments, with staff willing to work with them, but these aspects had the lowest mean scores, 3.67 and 3.70 out of 5, respectively. Neutral ratings may indicate that these aspects do not meet students’ expectations. Educators and healthcare institutions must understand these differences and tailor interventions to address specific challenges, ensuring a positive and enriching clinical learning experience. Continuous dialogue and regular assessments can help foster improvements.

We found that students were satisfied with various aspects of their clinical training placement experiences (69.3%), consistent with previous studies by Ahmed et al. [40] and Papastavrou et al. [41], where the majority of students were satisfied with their clinical placement experiences. This reflects general satisfaction with the practical component of nursing and midwifery programs. However, despite the majority being satisfied, over 30% were unsatisfied, which remains a concern and highlights the need for continuous quality evaluation and placement reviews [42]. This finding emphasizes the importance of gaining more insights to uncover potential challenges and areas for improvement.

We hypothesized that there would be a difference in satisfaction between second-year and third-year students. An independent sample t-test was used to assess this difference, but no statistically significant distinction in satisfaction levels with clinical placements was found between second-year and third-year students. This indicates that students’ diploma levels do not significantly impact their satisfaction with clinical placements. Thus, our hypothesis is not supported by the results. This finding contradicts those of Baghdadi et al. [39], who discovered disparities in student satisfaction levels, particularly among second-year students, who had the lowest clinical placement evaluation scores. Previous studies have raised concerns about the scope of practice, supervisory issues, and workplace orientation [43, 44]. Therefore, the study suggests that to foster the development of students’ skills and competencies across various academic years, communication between educational institutions and their clinical partners must be enhanced.

This study has several limitations that may affect the interpretation and generalizability of the findings. First, the reliance on self-reported data introduces potential biases, such as social desirability and recall bias. The cross-sectional design limits the ability to observe changes in perceptions and satisfaction over time.

Additionally, the study lacks qualitative insights that could provide a deeper understanding of the factors behind students’ responses. Differences in resources and institutional contexts were not fully controlled, which may have influenced the comparisons between educational institutions. Furthermore, the focus on specific variables may have overlooked other factors, such as personal characteristics or external influences like the COVID-19 pandemic. The sample size and representativeness may also limit generalizability, particularly to other regions or healthcare systems. Non-response bias may have skewed the results, and the study did not fully examine the nature of feedback provided to students, which is a critical component of their learning experience. Finally, cultural factors and variations in educational systems were not thoroughly explored, which could influence student perceptions. Despite these limitations, the study provides valuable insights into student nurses’ and midwives’ perceptions and their overall satisfaction with the quality of their clinical placements in Northern Ghana.

According to our results, students generally have a good perception of the quality of their clinical training placements, with a significant majority indicating that their placements provided a good learning environment. However, satisfaction levels were somewhat moderate, with an average satisfaction score of 69.3%. Differences in perception and satisfaction were observed across educational institutions, with some schools outperforming others in these areas. While students’ perceptions of placement quality varied significantly between second- and third-year students, as well as across different institutions, no such differences were noted between programs of study. Moreover, satisfaction levels did not differ significantly between second- and third-year students or between students in different programs.

Importantly, a strong positive correlation was found between students’ perceptions of clinical placement quality and their overall satisfaction, emphasizing the influence of quality experiences on satisfaction levels. These findings highlight the importance of continuous improvements in clinical training environments to boost student satisfaction and educational outcomes. It is therefore recommended that clinical placement settings and educational institutions should work together to examine and develop specific teaching methods, supervision approaches, and learning frameworks that can improve clinical learning and teaching among students.