Nursing open · 2026
Nursing Process Competency Among Nursing Interns and Its Associated Psychological, Cognitive, and Environmental/Social Factors: A Cross-Sectional Study.
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Xi Xinxue, Le Jing, Zhou Chenxi, Zhang Keke, Zeng Tieying, Wang Ying, Mao Jing
Аннотация
BACKGROUND: Nursing process competency is essential for clinical reasoning and the delivery of systematic and individualised nursing care. However, evidence remains limited regarding the level of this competency among nursing interns and the psychological, cognitive, and environmental and social factors associated with it.
AIM(S): Guided by the Clinical Learning Environment Model, this study aimed to describe the level of nursing process competency among nursing interns and identify the psychological, cognitive, environmental and social factors associated with this competency.
METHODS: A single-centre, hospital-based cross-sectional study was conducted in a tertiary teaching hospital in China. A self-selected non-probability sample of 348 final-year nursing interns completed a structured online survey. The survey included the Competency of Nursing Process Questionnaire, the Belongingness Scale-Clinical Placement Experience, the Academic Support in the Practicum Scale, and investigator-developed indicators of cognitive and skill-related and environmental and social factors. Data were analysed using descriptive statistics, bivariate analyses, and multiple linear regression, with all prespecified variables entered simultaneously into the regression model.
RESULTS: The mean nursing process competency score was 81.35 (SD = 12.22; observed range: 26-105), with diagnosis and planning having the lowest item-level mean scores. The fully adjusted regression model was statistically significant, F(27, 320) = 30.51, p < 0.001, and explained 72.0% of the variance in nursing process competency (adjusted R2 = 0.697). Clinical belongingness showed the strongest positive mutually adjusted association with competency (β = 0.732, p < 0.001; semi-partial R2 = 0.2742), followed by self-rated theoretical nursing knowledge (β = 0.137, p = 0.009; semi-partial R2 = 0.0061). Perceived support from physicians showed a smaller positive association in the primary model (β = 0.115, p = 0.048; semi-partial R2 = 0.0034), but this association was not statistically significant in the sensitivity analysis (p = 0.058) and was therefore interpreted as exploratory.
CONCLUSION: Clinical belongingness was the factor most strongly associated with nursing process competency, highlighting the potential relevance of interns' sense of acceptance and connection within the clinical learning environment. Self-rated theoretical nursing knowledge was also associated with competency after mutual adjustment. The smaller association involving perceived support from physicians was not robust to sensitivity analysis and requires further investigation. Given the cross-sectional design, these findings should not be interpreted as evidence of causal relationships.
IMPLICATIONS FOR NURSING PRACTISE: The findings suggest that nurse educators, preceptors, and clinical managers should consider structured orientation, inclusive team communication, continuity of preceptorship, and regular feedback to foster interns' clinical belongingness, alongside supervised opportunities to apply theoretical knowledge during assessment, diagnosis, and care planning. These strategies should be prospectively evaluated before their effectiveness is assumed.
REPORTING METHOD: This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and its checklist for cross-sectional studies.
NO PATIENT OR PUBLIC CONTRIBUTION: Nursing interns participated only as survey respondents and were not involved in the study design, conduct, data analysis, interpretation, reporting, or dissemination.
AIM(S): Guided by the Clinical Learning Environment Model, this study aimed to describe the level of nursing process competency among nursing interns and identify the psychological, cognitive, environmental and social factors associated with this competency.
METHODS: A single-centre, hospital-based cross-sectional study was conducted in a tertiary teaching hospital in China. A self-selected non-probability sample of 348 final-year nursing interns completed a structured online survey. The survey included the Competency of Nursing Process Questionnaire, the Belongingness Scale-Clinical Placement Experience, the Academic Support in the Practicum Scale, and investigator-developed indicators of cognitive and skill-related and environmental and social factors. Data were analysed using descriptive statistics, bivariate analyses, and multiple linear regression, with all prespecified variables entered simultaneously into the regression model.
RESULTS: The mean nursing process competency score was 81.35 (SD = 12.22; observed range: 26-105), with diagnosis and planning having the lowest item-level mean scores. The fully adjusted regression model was statistically significant, F(27, 320) = 30.51, p < 0.001, and explained 72.0% of the variance in nursing process competency (adjusted R2 = 0.697). Clinical belongingness showed the strongest positive mutually adjusted association with competency (β = 0.732, p < 0.001; semi-partial R2 = 0.2742), followed by self-rated theoretical nursing knowledge (β = 0.137, p = 0.009; semi-partial R2 = 0.0061). Perceived support from physicians showed a smaller positive association in the primary model (β = 0.115, p = 0.048; semi-partial R2 = 0.0034), but this association was not statistically significant in the sensitivity analysis (p = 0.058) and was therefore interpreted as exploratory.
CONCLUSION: Clinical belongingness was the factor most strongly associated with nursing process competency, highlighting the potential relevance of interns' sense of acceptance and connection within the clinical learning environment. Self-rated theoretical nursing knowledge was also associated with competency after mutual adjustment. The smaller association involving perceived support from physicians was not robust to sensitivity analysis and requires further investigation. Given the cross-sectional design, these findings should not be interpreted as evidence of causal relationships.
IMPLICATIONS FOR NURSING PRACTISE: The findings suggest that nurse educators, preceptors, and clinical managers should consider structured orientation, inclusive team communication, continuity of preceptorship, and regular feedback to foster interns' clinical belongingness, alongside supervised opportunities to apply theoretical knowledge during assessment, diagnosis, and care planning. These strategies should be prospectively evaluated before their effectiveness is assumed.
REPORTING METHOD: This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and its checklist for cross-sectional studies.
NO PATIENT OR PUBLIC CONTRIBUTION: Nursing interns participated only as survey respondents and were not involved in the study design, conduct, data analysis, interpretation, reporting, or dissemination.