An Educational Model for Developing Clinical Competency among Undergraduate Nursing Students: A Structural Equation Modeling Study
Abstract
Background and Aim: Contemporary healthcare requires nursing graduates capable of delivering safe, high-quality patient care. Understanding how personal, academic, instructional, and clinical-environment factors influence nursing students’ clinical skills is essential. This study examined the relationships between these factors and clinical competency development. Materials and Methods: A descriptive-correlational, causal-comparative design incorporating structural equation modeling (SEM) was employed. Participants were 598 nursing students from three private higher education institutions in Iligan City, Philippines. Data were collected using a pilot-tested, validated researcher-developed questionnaire. Pearson correlation, multiple regression, confirmatory factor analysis (CFA), and SEM were performed using SPSS 29 and AMOS 29, with significance established at p < .05. Results: All predictor domains significantly influenced clinical skills development. The clinical environment demonstrated the strongest correlation with clinical skills (r = .747, p < .001). In multiple regression analysis, assessment emerged as the strongest predictor (β = .350), while the model explained 63.4% of the variance in clinical skills development (R² = .634). SEM identified the clinical environment as having the largest direct effect (β = .562). The model demonstrated good fit (CFI = .996; RMSEA = .032). Conclusion: The findings support the Apal Clinical Competency Development Model (ACCDM) as an integrated framework for explaining nursing students’ clinical skills development. The model provides a basis for evidence-informed curriculum redesign, competency-based assessment, simulation, digital learning, initiatives strengthening student self-efficacy, and improvements in clinical instruction. Its application may help nursing institutions create supportive learning environments and prepare graduates to meet standards for safe, competent, high-quality professional practice.