Implementation of diploma nurse-training curriculum in selected nurse training institutions in South- Rift Region, Kenya

Abstract

Background: Graduates of the Kenya Registered Community Health Nursing (KRCHN) diploma program are vital to the frontline healthcare workforce, delivering important services in various clinical settings. Successful implementation of the KRCHN diploma curriculum requires adequate resources, trained educators, supportive clinical placements, and technology integration to develop skilled nurses. However, concerns exist about the gap between theory and practice, questioning the readiness of newly qualified nurses to provide quality care. There is also limited research on the implementation of the diploma nurse training curriculum in Kenya. Objectives: The study aimed to evaluate the implementation of the diploma nurse training curriculum in selected nurse-training institutions. Specific objectives were to assess the adequacy of teaching resources, nurse educators’ level of preparedness, the capacity of clinical placement sites for developing students' clinical skills, and the integration of emerging healthcare trends and technologies into the curriculum. Methods: This study was based on John Dewey’s experiential learning theory, highlighting the value of hands-on experiences. A mixed-methods approach employed a descriptive cross-sectional design in selected nurse training institutions in the South-Rift region. The study included 159 senior nursing students selected through random sampling, along with purposively selected nurse educators, principals, and nurse managers. Data collection utilized questionnaires, Key Informant Interviews, and Focus Group Discussions. Quantitative data was analyzed with descriptive and inferential statistics, while qualitative data was thematically analyzed. Findings were presented in tables and narrative form. Results: Educators and students rated classroom resources as most inadequate (M=3.77, SD =1.06) and (M=3.95, SD = 0.43), but differed on the lowest adequacy, with library resources and simulation equipment, respectively. Students’ concern was the adequacy of simulation equipment (M=3.50, with the highest SD=1.43). Students rated educators’ preparedness highest for effective teaching methodologies (M = 4.18, SD = 1.06), use of practical examples (M = 4.00, SD = 1.09), and timely feedback (M = 3.97, SD = 1.25). Mentorship and guidance received lower ratings (M = 3.55, SD = 1.13). Educators rated integrating practical case studies into their teaching (M = 4.56, SD = 0.50), evidence-based methodologies (M = 4.27, SD = 0.65), and continuous professional development (M = 4.25, SD = 0.57) highly. Concerns were noted regarding institutional support for development (M = 3.88, SD = 0.86). Nurse managers noted knowledge gaps among some educators, especially when guiding students in areas outside their specialty. Students rated the adequacy of exposure to real patient care low (M = 3.71, SD = 1.13821) and supervision effectiveness (M = 3.79, SD = 1.37502). Educators also reported insufficient clinical exposure (M = 3.79, SD = 0.63). Nurse managers highlighted challenges with high student-to-instructor and student-to-patient ratios that affected clinical learning. Students rated use of technology-enhanced learning tools like simulators (M=3.8, SD = 0.94), while educators rated (3.59, SD= 0.62), suggesting moderate and low utilization of digital learning methods, respectively. Nurse managers noted that students lacked adequate exposure to emerging healthcare technologies. Conclusion: The successful implementation of the diploma nurse-training curriculum relies on adequate teaching resources, nurse educators’ preparedness, a supportive clinical environment, and adaptability to emerging technologies. However, resource shortages, inadequately prepared educators, and the deficiency in the capacity of clinical sites hinder optimal curriculum implementation. Recommendations: The Nursing Council of Kenya should ensure training institutions and clinical sites uphold standards for training safe, competent nurses. Institutions must invest in teaching resources, support educator development, utilize digital learning tools, and adhere to guidelines for student-to-instructor ratios. Further research on the relationship between students’ self-efficacy and curriculum implementation is also recommended.