NURSE EDUCATORS’ CLINICAL SKILL COMPETENCIES AND TEACHING SKILLS IN ETHIOPIA’S HIGHER EDUCATION INSTITUTIONS: A MIXED METHOD STUDY

Abstract

Background: Competent and well-trained faculties are necessary for quality education. The presence of with inadequate skill and knowledge is an indicator for the presence of gaps in education. However, the clinical competency and teaching skills of Ethiopian nurse educators has not been studied well. Objective: The objective of this study was to assess nurse educators’ clinical skill competency and clinical teaching skill following a mixed methods study design. Methods: I used a mixed study design following transcultural tool adaptation and validation. Quantitative data were collected from 282 nurse educators and 2820 nursing students across fourteen higher education institutions in Ethiopia selected by simple random sampling. The qualitative component employed purposive sampling. Objective III was the transcultural adaptation and validation of the Maastricht Clinical Teaching Questionnaire (MCTQ). This tool originally contains 14 items under five factors: modeling, coaching, articulation, exploration, and a safe learning environment. Virtual and face-to-face interviews were conducted (Objective II, and III), and skill performance was observed during Objective Structured Clinical Examinations (Objective I). Self-administered questionnaires were used for educators' self-assessment and students' appraisal of clinical educators (Objective IV). Analytical methods included Colaizzi's seven-step content analysis method, confirmatory factor analysis, Pearson correlation, logistic regression, and basic measures of central tendency. Findings were disseminated through presentations and publications in reputable journals to contribute to the scientific community's knowledge base. Result: Objective Structured Clinical Examination of nursing clinical skills showed competency levels ranging from 29.47% to 62.32%, with an overall competence rate of 27.05% among 207 nurse educators. While some skills, like cardiac history taking, showed higher competency level, areas like progress assessment showed lower levels. In-depth interviews with 12 educators revealed four themes and 24 sub-themes relating to challenge in skill acquisition and maintenance challenges. Themes were: feelings of inadequacy, seeking support, self-development, and decline of clinical skills. The Amharic version of the 18-item Maastricht Clinical Teaching Questionnaire (MCTQ) was found to be culturally appropriate and internal consistency (Cronbach's alpha = 0.94). The five-factor model fit the data well (CFI = 0.94, RMSEA = 0.069, chi-square/degree of xiv freedom = 0.92, TLI = 0.930). When used for self-assessment and student evaluations, educators' performance in the modeling, coaching, and exploration domains of clinical teaching was found to be low. Only 51.06% of educators proficient were in articulation, with just around one-third proficient in modeling (33.26%), coaching (33.04%), and exploration (30.38%). Students perceived 65.68% of clinical educators as effective in teaching and applying critical techniques. Conclusion and recommendations The study assessed Ethiopian nurse educators' clinical and teaching skills using various research methods. The finding from this study showed, critical gaps in the clinical and teaching skills of Ethiopian nurse educators, revealing challenges in role transition, limited clinical engagement, inadequate support for competence maintenance, and low skill performance. This underlines the urgent need for policy-level interventions to address significant shortcomings. This might include design of long tearm strategy for addressing gaps in educator capacity building, making clinical engagement for educator mandatory, revision of requirements to be an educator and increase clinical exposure opportunities. Furthermore, policymakers must allocate resources for further research aimed at identifying tailored interventions to address the specific needs of Ethiopian nurse educators. Lastly, enforcing educator commitment to continuous professional development is vital to ensure sustained improvements in clinical teaching quality and, ultimately, the provision of high-quality nursing education in Ethiopia.