Analysis of Factors Influencing Learning Outcome of Clinical Learning Competency among Nursing Students in Indonesia: Literature Review

ABSTRACT


INTRODUCTION
The quality of clinical education and the generation of nursing resources in Indonesia is influenced by the achievement of learning clinical nursing practice by students to train skills and knowledge and develop students' professionalism in a clinical environment to achieve clinical competence. According to Jamshidi et al. (2016), a nurse's competence is based on the knowledge and skills taught while they are in nursing education through clinical learning. Clinical learning is experience-based learning; students are expected to be able to apply theory and skills acquired during the academic period to real cases in clinical settings (Kusuma, 2017). Clinical learning in hospital practice aims to apply theoretical concepts so that students are required to be more active in action and be skilled and able to think critically in clinical decision-making (AINEC, 2016). According to Bouchlaghem & Mansouri (2018), clinical learning in nursing education is a key component that must be undertaken by nursing students in order to train skills, The achievement of clinical competence by clinical nursing students in various countries has various problems. Research in Iran has yet to achieve optimal clinical practice learning, and many students do not complete nursing care reports, lack clinical performance and have less than 70% achievement of competence (Rowbotham & Owen, 2015). Meanwhile, according to Warshawski et al. (2019), while undergoing clinical practice in the emergency room, nursing students experience stress, anxiety, fatigue, poor clinical performance, and an inability to solve problems, which lead to not achieving learning outcomes due to a lack of

METHODS
This study is a Literature Review, and was compiled using PRISMA guidelines Checklist (Moher et al, 2009).

Electronic Database
The articles used in this Literature review were compiled by searching published research articles. Data were obtained from electronic databases: Google Scholar, Science Direct, PubMed and Garuda between 2017-2022.

Keywords
The search keywords for the article in this 2) Articles that are not related to the topic of discussion.
3) Articles which do not have a complete structure.

Data analysis method
Data analysis is the descriptive analysis of data clinical practice, a total of 60 people.
have no common perception of student learning outcomes. 62% of students need help understanding the targets/learning outcomes that must be achieved during learning in the clinic. 47.4% of students said clinical guidance provided by clinical supervisors needed to be improved. Comparison of the number of students with clinical supervisors that are not comparable, the job descriptions of clinical supervisors overlap with the main tasks. The frequency of academic supervisor guidance is limited due to time and distance limitations.
Application of the OMP and SNAPPS models in the learning process of clinical leadership and nursing management Each model positively influences student competency achievement. The difference in the mean competency can be seen from the difference in the mean in each domain of cognitive, affective, psychomotor and critical thinking from before and after treatment, which has increased. A comparison of the differences in competency achievement between the OMP and SNAPPS groups shows the effect of a more specific model on each competency domain. The results of this study indicate that the OMP model has advantages and influences in terms of increasing competence in the cognitive domain and students' critical thinking. Meanwhile, the SNAPPS model is considered more influential in increasing affective competence. Whereas in the achievement of psychomotor domain competence, the observation results show that the OMP model is considered relatively better when compared to SNAPPS.

3.
Guru, Yustina Yantiana. The flipped-problem Learning method used in professional practice can help achieve emergency and critical nursing competencies. However, some clinical skills cannot be obtained at the puskesmas (Public health centre) because the puskesmas service standards are limited by regulations from the Indonesian Ministry of Health. Hence, some of these clinical skills are only available in hospitals. The Flipped-Problem Learning method for students' psychomotor and affective achievements must be exposed to the real environment. Interaction with room nurses and various patients will provide students with real learning.

4.
Desvitasari, H. (2019). There is a significant difference in the competency achievement of students who use the practicum module with the "Bedside Teaching Method" with the assignment method. This study also shows that the group studying with the "Bedside Teaching Method" gets better competency test results on the student assignment method. This study shows that the mean post-test scores for knowledge, attitudes, skills and cumulative preceptors are higher than the pre-test scores. The mean achievement, communication scores, skills and professional behaviour of the maternity nursing students were higher than those of the pediatric nursing students. There are differences in the achievement of nurse student competencies (communication, skills and professional behaviour) between pediatric nursing and maternity nursing after the intervention of the One Minute Preceptor (OMP) guidance method on the preceptor. The application of the OMP and SNAPPS models in the clinical learning process of leadership and nursing management shows a positive influence on increasing student competency achievement. The difference in the mean competency can be seen from the difference in the mean in each domain of cognitive, affective, psychomotor and critical thinking from before and after treatment, which has increased. A comparison of the differences in competency achievement between the OMP and SNAPPS groups shows the effect of a more specific model on each competency domain.

The Role of Clinical
The design The main informants in this Advisors have an important role in the development of the nursing profession. There is a relationship between the stress variable and the competency level variable, meaning that the higher the stress level experienced by students will greatly affect the results of achieving

Application of Clinical Learning Methods
Choosing the right clinical learning method can support and produce nurses who have good competence and performance (Kusumasari, 2017).  There is a positive relationship between abilities Self Directed Learning and achievement of learning outcomes. An increase also follows every increase in the score of Self-Directed Learning in achieving learning outcomes in the clinic. Students who have High Self-Directed Learning scores in this study can carry out all processes Self Directed Learning so that it has internalized values Self Directed Learning. Students have good self-management in learning, a strong desire to learn, good self-control, and dominant internal motivation in learning.
Clinical Experiential method had good predictions,