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Abstract
Objective This qualitative study explored the experiences, preparedness, instructional practices and roles of preceptors supervising nursing students in a clinical setting.
Design Exploratory descriptive study employing semi-structured interviews.
Setting A district hospital in the Kumasi Metropolis accredited for training nursing students in clinical practice.
Participants 12 nurse preceptors, each holding at least a Bachelor of Science in Nursing.
Major findings Findings revealed gaps in the preparation of preceptors and a lack of a clear definition of preceptors’ roles and responsibilities from the outset, contributing to feelings of under-preparedness. While demonstrating inherent strengths like using probing questions, prompting techniques and assuming multifaceted roles, including role modelling, coaching and teaching, preceptors expressed uncertainty about over-reliance on passive demonstration-based teaching. Environmental barriers like noise concerns hindered the adoption of more interactive, student-centred pedagogies.
Conclusion The study highlights the need for comprehensive preceptor training programmes that provide robust onboarding, set clear expectations and equip preceptors with diverse evidence-based teaching methodologies tailored to healthcare contexts. Continued research involving larger samples, multimodal data and stakeholder perspectives can inform ongoing programme refinement.
- Nurses
- Nursing research
- EDUCATION & TRAINING (see Medical Education & Training)
- Education, Medical
Data availability statement
Data are available upon reasonable request. ‘Not applicable’.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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STRENGTHS AND LIMITATIONS OF THIS STUDY
The qualitative approach using in-depth semi-structured interviews allowed for a rich, detailed exploration of preceptors’ lived experiences and perspectives, providing nuanced insights that might not emerge through quantitative methods.
Data saturation was achieved during interviews, suggesting adequate sampling to capture the range of relevant experiences and themes within the studied context.
The single-site design and relatively small sample size may limit the transferability of findings to other healthcare settings or geographical contexts.
The absence of triangulation through multiple data sources (eg, student perspectives, faculty input, observational data) restricts the validation of preceptors’ self-reported practices.
Introduction
The clinical learning environment plays a pivotal role in shaping nursing students’ professional development and competency acquisition.1 At the forefront of facilitating these formative experiences are nurse preceptors—experienced clinicians tasked with mentoring, guiding and evaluating students during their clinical training sessions.2 3 Preceptors serve as a vital link between classroom-based instruction and the realities of professional nursing practice. Their influence extends beyond imparting clinical skills to encompassing the socialisation of students into the cultural norms, ethical principles and decision-making processes inherent to the nursing profession.4
Existing preceptor training programmes often aim to prepare these experienced clinicians for their instructional and mentorship roles. However, the content and structure of such programmes can vary widely. Many focus primarily on orienting preceptors to their administrative duties, such as student evaluation and documentation requirements.5 Others may incorporate teaching and learning principles, with modules on topics like learning styles, feedback delivery and facilitating reflective practice.6 More comprehensive programmes have been reported to include training on fostering critical thinking, interprofessional collaboration and student counselling.7
Internationally, research has identified certain preceptor training programme components associated with enhanced effectiveness. These include sustained, multisession formats rather than one-time workshops;8 opportunities for interactive, scenario-based activities;9 and integration of both teaching pedagogy and emotional/psychosocial mentorship skills.10
However, gaps persist in ensuring all preceptors receive adequate preparedness for their multifaceted responsibilities.11 Many preceptors report feeling underprepared and uncertain about the full scope of responsibilities they are expected to fulfil.12 13 Compounding this issue is a lack of clear, standardised guidelines that explicitly define the preceptor’s duties which can vary across healthcare settings.14 This ambiguity surrounding role delineation and expectations can hinder preceptors’ ability to optimally support student learning and professional development.4 13 15
Furthermore, while most preceptors possess extensive clinical expertise, fewer have received formal pedagogical training on evidence-based teaching methodologies, learning principles, assessment strategies and techniques for cultivating higher-order cognitive skills.16–18 Reliance on familiar yet potentially outdated instructional approaches could limit the effectiveness of the preceptorship experience for grooming practice-ready graduates.19 20
Given the pivotal contributions of preceptors, it is imperative to critically examine their preparedness, role enactment and familiarity with foundational educational concepts. Understanding these can illuminate potential gaps, inform efforts to enhance training programmes, clarify responsibilities and empower preceptors with contemporary pedagogical tools. Optimising the preceptorship experience is vital for ensuring nursing students receive high-quality clinical education that bridges theory and practice. Moreover, no aspect of preceptorship has been formally integrated into the curriculum of nursing and no course module or content has been developed for the precepting of student nurses in clinical practice in Ghana.4 21 Owing to this, little is known about the educational preparedness and formal roles of preceptors in clinical education in Ghana4 11
This study explored nurse preceptors’ experiences, perceived roles and responsibilities, level of preparation received and insight into their application of core teaching and learning principles during clinical instructional activities. By giving voice to these frontline clinical educators, valuable insights can be gleaned to strengthen preceptorship initiatives and the overall quality of nursing education.
Materials and methods
Study setting and design
We employed an exploratory descriptive study, that used qualitative data collection method to gather data on preceptors’ roles, preparedness and familiarity with the basic principles of teaching and learning. This study was conducted at a public-funded health facility accepted and accredited by the Nursing and Midwifery Council of Ghana for the clinical training of nursing students. The hospital is located within the Manhyia South subdistrict in Kumasi Metropolis, about 400 metres east of the Manhyia Palace in the Ashanti Region. The sub-metro is found in the North Eastern part of Kumasi Metropolis and bonded by three sub-metros; to the north by the Manhyia North, the South by the Subin and to the East by the Asokwa sub-metros
Sampling and population
The study population was registered nurse preceptors engaged at the study site. The hospital has 15 nurse preceptors. The purposive sampling method was used to select 12 participants for the study.22
Nurse preceptors registered with the Nursing and Midwifery Council of Ghana and between the ages of 30 and 60 were considered for inclusion in the study. Other criteria considered were; preceptors with at least 1 year of experience in the role, preceptors who were full-time nurses at the time of the study and were ready to participate voluntarily in the study. All 15 preceptors were eligible for the study but only those who voluntarily consented were invited for the interviews.
Data collection
Data collection took place between 1 April 2020 and 2 March 2021. The semi-structured interview guide used in this study was developed through a collaborative process drawing on expert advice and feedback. First, the research team thoroughly reviewed existing literature on preceptorship, clinical education and teaching best practices in healthcare settings. This informed the initial draft of the interview guide which included broad, open-ended questions to explore preceptors’ experiences, perspectives and approaches.
Next, the draft guide was reviewed by a panel of three experienced nurse educators and clinical preceptors not directly involved in the study. This expert panel provided detailed feedback on the proposed questions’ clarity, relevance and comprehensiveness. Suggestions were incorporated to refine the wording, sequence and scope of the interview topics.
The revised guide was then piloted with two nurse preceptors outside the main study sample. Based on their input, minor adjustments were made to ensure the flow and phrasing of questions elicited rich, detailed responses from participants.
The venue, date and time for the interview were discussed with the participants and a final determination of the venue (mainly at the hospital premises), date and time was made at the participants’ and researchers’ convenience. The duration for each interview was individualistic and determined by the quantum of information participants wanted to share. The interviews were face-to-face, conducted by DSB and in English. All participants were fluent in English since English is the official language for educational instruction in Ghana. The interviewer directed the course of the interview so that participants did not deviate from the questions. The nature of the interview was conversational. The conversation was initiated using the statement: kindly share with me, how prepared were you when you started your work as a preceptor. Probing questions were used such as: ‘Did you receive any training prior to your appointment as a preceptor?’; ‘Who did the training?’; ‘What roles do you play as a preceptor?’; ‘How familiar are you with the basic principles of teaching and learning?’. The interviewer also used prompts such as: ‘kindly elaborate further’; ‘How do you do that?’ to assist participants in describing their skills further and whether they had a good understanding of their role/job. After the initial 12 completed interviews, 7 follow-up interviews were conducted to explore further salient information that arose during the first interviews. Overall, a total of 19 interviews were conducted after which data saturation was achieved. The initial interviews ranged from 30 to 80 min while the follow-up interviews lasted between 20 and 40 min. All interviews were audio-recorded with participants’ consent and approval. Field notes were taken alongside to record non-verbal communications that could not be audio recorded. The interviewer is a registered nurse, university lecturer and PhD candidate. However, she did not work at the study site nor did she know the participants before the commencement of the study so could be considered an outsider.23 Employing an outsider—someone not embedded within the participants’ immediate professional environment—is a recognised strategy in qualitative research to promote reflexivity and ensure the final interpretations resonate with the experiences of the target population. This approach allowed participants to feel more comfortable sharing candid, unbiased insights, as the outsider’s presence may reduce any perceived judgement or repercussions from within their organisation.
Data analysis
Data gathering and analysis were carried out simultaneously. Reflexive thematic analysis as described by Braun and Clarke24 was done. An inductive thematic analysis approach was employed to analyse the data, allowing themes to emerge naturally from participants’ narratives rather than imposing pre-existing frameworks. The interview recordings were transcribed verbatim to ensure accuracy and maintain the authenticity of participants’ voices. The analysis process followed several systematic steps. First, the research team conducted multiple careful readings of the transcripts to ensure familiarisation with the data. This was followed by line-by-line open coding to identify significant statements, phrases and concepts expressed by participants. Initial codes were then grouped based on emerging patterns and relationships identified within the data. Through an iterative process of review and refinement, the research team collaboratively distilled these grouped codes into overarching themes that captured the essence of the preceptors’ experiences, perspectives and practices. This involved carefully examining the patterns, connections and nuances across the data set while maintaining constant comparisons between emerging themes and the original data to ensure authentic representation of participants’ voices.
The team engaged in regular discussions to reach a consensus on the interpretation and labelling of themes, helping minimise individual biases. Representative quotes were selected to illustrate and support each identified theme. This rigorous, bottom-up analytical approach, appropriate for descriptive qualitative research, ensured the final thematic structure was firmly grounded in the participants’ lived experiences rather than predetermined theoretical constructs.25
Finally, the research team met to discuss the accuracy and confirm the findings. The transcripts were reviewed alongside the audio recordings to ensure accuracy. They were then returned to the 10 participants who had agreed to review their respective transcripts for comments, corrections or removal of personal information. However, none of the 10 participants felt the need to make any changes to their transcripts. The recommendations of the Consolidated criteria for Reporting Qualitative research by Tong et al26 were followed in producing this report.
Trustworthiness
The four criteria for ensuring trustworthiness in qualitative research—credibility, dependability, transferability and confirmability were followed.27 The researchers ensured credibility through prolonged engagement and member checking. This ensured the questions measured what was intended and was a true reflection of the views of participants. We have described adequately in detail, the research context and the methodological processes involved in this work to help readers make judgements about the transferability of the findings to their setting.
Ethical consideration
Approval to conduct the study was sought from the hospital administration and the nurse preceptors at the study site. The ethical principles of the World Medical Association28 were considered and followed. These included the principles of beneficence, respect for human dignity and justice.
Patient and public involvement
None.
Findings
Characteristics of participants
Seven of the participants were between the ages of 30 and 35 years. All the participants recruited were women. 10 were bachelor’s degree holders and four had at least 1–3 years of experience as a preceptor. (Table 1)
Characteristics of participants
Main themes and subthemes
Inductive and deductive analysis of the data extracted the following themes which include: preparation towards precepting, preceptor’s role in clinical education and familiarity with the basic principles of teaching and learning. Subthemes were generated for each major theme. The main themes and subthemes are organised and presented in figure 1.
Emerged themes and subthemes.
Preparation towards precepting
In the context of the study, participants gave their opinions on the preceptorship preparation at their institution. The subtheme that emerged from this context was inadequate preparation, informal training and no formal guidelines.
No formal training
The participants had an experience with a workshop programme organised by the Nursing and Midwifery Council of Ghana. Participants mentioned being assigned the role of a preceptor after attending the workshop. However, they also indicated that the workshop was not structured like a formal training programme. They noted a lack of extensive preparation and coursework associated with the workshop.
I have had the opportunity to attend a workshop program organized by NMC once. I was given the preceptorship role after the workshop… It was not any formal training because there was not so much of preparation and courses that went into the workshop program. (Participant 1).
Despite its informal nature, participants seemed to have gained valuable experience from being assigned the preceptorship role. While participants’ reflection suggests that the workshop may not have been as formal as traditional training programmes, it still provided valuable opportunities for learning and skill development.
Inadequate preparation
The participants indicated that they were given the role of a preceptor, which is a position that involves training, guiding or mentoring others, after 3 years of service or experience in their field. However, analysis of their views suggests that they felt inadequately prepared or supported for this role. Some of them mentioned having had the ‘privilege’ of attending only a single workshop, emphasising insufficient training for taking on a preceptorship role which requires a significant level of knowledge, skills and expertise.
I was given the preceptor role after three years ofpractice as a bedside nurse, but honestly, I only had the chance to attend one workshop. It didn’t feel like enough preparation for a role that demands so much skill and experience. I felt thrown into it without the proper skills. (Participant 3)
A participant attributed her success to prior educational experiences which prevented her from struggling or underperforming when she was assigned preceptor duties, despite their employer’s inadequate preparation. Some expressed both criticism of the employer’s training shortcomings as well as the awareness that their success hinged on their previous educational background rather than anything their employer provided.
…even with that, I feel I was not properly prepared for this job. If not for the experience I had during my classroom training and clinical practice, I would have disgraced myself before these students. (Participant 3).
No predefined roles
Our analysis of the data revealed that the employer or organisation failed to comprehensively outline and define the full range of roles, responsibilities and expectations of preceptors from the outset. The preceptors were essentially left to figure out the broader scope of their work through trial and error on the job.
They never told us what our roles are. All we knew was we were preceptors who were supposed to teach students on clinical attachment. As time went on, we realized that our work as preceptors went beyond just clinical teaching. (Participants 7).
This lack of clear role definition and communication from leadership created confusion and forced the preceptors to learn the expansive nature of their role through first-hand experience rather than being properly prepared upfront. It suggests inadequate training, onboarding and oversight in terms of setting clear performance expectations for those assigned to the preceptor role.
The quote above further expresses frustration with this lack of preparedness and paints the picture of preceptors having to adapt and expand their understanding of the role beyond the limited initial guidance provided
Preceptor’s role in nurturing student nurses
Despite their roles not being predefined, participants at the time of the interview understood their varied roles as clinical educators and also knew their roles went beyond theoretical teaching. According to participants, they had learnt these roles through experience, observation and self-learning. Subthemes that emerged were; Coaching, Guiding, Inspiring, Teaching and Role modelling.
Coaching
The participants recognised that the students are not complete novices but rather have existing foundational knowledge and skills from their prior education/training. The role of the preceptor, in this instance, was, therefore, to facilitate the students’ further development and improvement of their existing knowledge/skills. Participants explained the role they play as coaches.
I believe the students already have some knowledge and skill so what I do is to help them so that they can improve. I don’t leave them alone. I observe them as they perform a task. When they forget a step, I chip in. (Participant 4).
This demonstrates a nurturing preceptor style of active monitoring, gentle course correction when needed and facilitation of incremental skill improvement while validating the students’ existing knowledge base. It also paints the picture of an engaged preceptor using guided practice, coaching at the moment and creating a supportive learning environment for skill progression rather than an indifferent, hands-off approach.
Guiding
The participants viewed their role as not just an instructor of technical skills but as a moral guide and ambassador of the profession’s ethics and values. They perceived themselves as responsible for monitoring and providing feedback on professionalism, teaching the guiding principles and belief systems and shaping ethical conduct and decision-making. This holistic view ensured that preceptorship went beyond developing clinical competencies to encompass full professional acculturation and ethical development of students entering the field.
As a preceptor, I watch students’ behavior and practices and give advice when necessary to put them on the right path as the profession demands. As part of my role of precepting, I make them aware of the ethical principles, values and beliefs guiding the profession and I assist them behave and act in accordance with the ethics of the profession so they do not go astray. (Participant 7).
Inspiring
From the perspectives of the participants, their role as preceptors meant making a conscious effort to model exemplary behaviour—following proper protocols, executing techniques correctly and conducting themselves with professionalism in all aspects of their work. Their perspective was that, by demonstrating consummate professionalism and adherence to best practices themselves, they would motivate and inspire students to emulate those high standards of conduct and performance.
Once the students are around, I do the right things, perform procedures right, and do everything the right way, in a professional manner, and I believe it inspires them to do same. (Participant 5).
There was an implicit understanding that students are highly impacted by the behaviour they witness from their preceptors, a belief that students will be more inspired to ‘do the same’ by seeing professionalism embodied consistently by their mentor, rather than just being told what to do.
Teaching
Almost all the participants acknowledged their responsibility to provide instructions to the students. Their primary teaching method comprised replicating the pedagogical techniques used by their instructors when they were learning as students, implying a tendency to default to familiar teaching styles from their educational experiences.
I know I have to teach them. Yes! So just as I was taught during my days as a student, so I do for them … I mostly demonstrate for them to see first. I’m sure that’s the right thing to do. (Participant 8).
A core part of their approach involved hands-on demonstrations, where the preceptor models skills/procedures for students to observe before practising themselves, and was perceived as highly effective.
Role modelling
Our analysis revealed that preceptors are aware of their influential role as role models and mentors to their students. They understand that students closely observe and learn from their actions, conduct and behaviours. Consequently, preceptors perceive themselves as mentors who provide guidance beyond clinical instruction. Recognising that students will likely emulate what they see, participants made conscious efforts to consistently model exemplary professionalism, including appearance, dress standards, work ethic, habits and effective communication with patients. By leveraging their role, preceptors aim to instil professional norms, values and behaviours in their students.
As a role model, I know students watch my activities and behaviours to follow and imitate. I serve as a mentor to them. So, I try as much as possible to set a good example through my dressing, work and communication with patients for the students to emulate. (Participant 7)
Preceptor’s familiarity with the basic principles of teaching and learning
Interaction with participants showed they were familiar with the basic teaching and learning principles. Subthemes that emerged under this theme were: ensuring a constructive learning environment; teaching methods; and constructive feedback and questioning techniques.
Ensuring a constructive learning environment
Participants believed that the ward environment itself and students’ interaction with senior nurses, colleague student nurses and patients allow students to constructively build new knowledge on the foundation of the previous learning experience.
I believe the ward environment supports learning and so on the first day students come to the ward, I orient them to the ward environment, introduce them to the in-patients, and let them feel at home. I also introduce them to the nurses they will be working with to build a friendly relationship and boost their confidence for interaction. (Participant 12)
Others indicated that ensuring a constructive learning environment meant making provisions for resources and materials needed for learning but were unavailable by improvising.
I assist students to improvise for any equipment or tool that is needed for learning but is not available. (Participant 5)
Teaching methods
Participants of this study were more familiar with the demonstration method and mostly applied the demonstration teaching method during clinical practice. A few of the participants admitted to using the illustration method sometimes.
I use demonstration most of the time. I allow the students to watch me while I perform a procedure (for example bed making, or catheter care) and when they have developed enough confidence, I allow them to practice it (procedure). (Participant 11)
Even though ‘discussion’ was mentioned as their second choice of teaching method, their responses revealed they rarely used it. Again, though they explained discussion made the teaching and learning experience more student-centred, the nature of the ward environment hardly permitted the discussion teaching strategy due to concerns about noisemaking and disturbance of patients’ peace.
Once in a while, I engage the students in discussion …of course discussion improves the students’ participation but the noise… we are afraid we might disturb the patients. (Participant 6).
Constructive feedback and questioning techniques
To receive feedback on students’ ongoing learning and performance, preceptors used various questioning techniques to assess students’ understanding and nurture critical thinking skills. According to participants, assessing students for feedback occurs throughout their clinical learning period and almost on all days students come to the ward for a practice experience. Participants were mostly familiar with two questioning techniques—probing and prompting.
Probing
The participants reported using a questioning technique involving probing or digging deeper into topics with students. Rather than asking impromptu questions, participants reported that they prepared questions in advance, suggesting an intentional and structured approach to this questioning method. These preplanned probing questions are posed to students during designated instructional or clinical hours when the preceptor has direct interaction with them.
I use probing… I pre-planned my questions most of the time and I ask these questions during contact hours with them to test students understanding and help them critically think. (Participant 2).
Their views demonstrate an understanding that effective teaching involves more than just lecturing—it requires actively engaging learners, probing their knowledge, identifying gaps and pushing their cognitive abilities. This also creates opportunities for preceptors to both evaluate and further develop students’ understanding and reasoning capabilities through interactive dialogue.
Prompting
The preceptor enjoys and makes it a regular practice to use prompting as an educational strategy with students. Prompting is particularly used when the preceptor notices a student having difficulty recalling knowledge or abilities they had presumably been taught before. From the participants’ inferred views, this prompting approach aims to facilitate the retrieval of knowledge/skills already encoded in the student’s mind, rather than having to re-encode it again from the beginning. It builds on established prior learning.
I love to prompt them. I do this especially when a student is finding it difficult to remember a previously learned skill or concept. (Participant 8).
This data reveals an awareness that judicious use of prompts can be an effective remediation technique to reactivate a student’s fragile or incomplete mastery of previously learnt material, without having to completely re-teach from square one.
Discussion
Preceptorship in nursing, especially in the clinical area, is critical to the transfer of knowledge, desired attitudes and clinical skills relevant to patient care. The development of these essential care competencies largely depends on the preceptor’s knowledge and skills acquired through a structured training programme. Nonetheless, such training programmes rarely exist in Ghana.4
In this study, some preceptors received informal training either before or after assuming their roles, but their expertise mainly developed through years of practice.29 Participants indicated a lack of formal, structured training programmes for preceptors. The challenges and experiences identified in this study both align with and differ from international findings on preceptorship. The lack of formal preparation for preceptors observed in Ghana mirrors challenges reported in several developing countries4 30 but contrasts sharply with structured programmes common in developed nations. For instance, Sweden requires all preceptors to complete undergraduate preceptorship education,31 while Australia implements comprehensive preparation programmes incorporating both theoretical and practical components.32 Marks-Maran et al5 argue that well-structured training programmes enable preceptors to positively influence their roles. Therefore, formal training is necessary for preceptors to become competent and confident.33
Drawing from our findings and international best practices, we propose a comprehensive framework for enhancing preceptorship in Ghana’s nursing education system through a structured, phased implementation approach. The immediate focus should be on establishing foundational elements of preceptor preparation. Nursing training institutions should incorporate preceptorship modules into the final year curriculum to prepare future preceptors.11 Simultaneously, teaching hospitals should designate dedicated clinical teaching spaces and establish formal preceptor positions with clear job descriptions. The Nursing and Midwifery Council of Ghana should develop mandatory preparation courses and certification programmes. These preparation programmes should integrate both theoretical foundations and practical applications,5 8 using a sustained, multisession format rather than single workshops, supported by regular mentoring and ongoing support mechanisms.33 The curriculum should encompass educational theory and practice, including adult learning principles, evidence-based teaching methodologies and assessment techniques6; mentorship skills, focusing on effective communication and supporting professional identity development34; clear role-specific competencies15 35 and evaluation frameworks to monitor preceptor effectiveness. For sustainable programme development, emphasis should be placed on strengthening partnerships between educational institutions and clinical facilities, establishing national guidelines for preceptor preparation, creating formal recognition of the preceptor role within the nursing professional structure and investing in clinical skills laboratories and teaching resources.
Our findings regarding unclear role definitions echo concerns raised in studies from the UK and Canada.5 34 However, these countries have made significant strides in addressing this through formal preceptor frameworks and competency standards.35 The USA has established the Commission on Collegiate Nursing Education standards for preceptorship, providing clear guidelines that could inform similar developments in Ghana.36 Setting clear expectations through robust onboarding and training is recommended.5 A predefined role for preceptors could enhance clinical nurse education and practice and support mentorship development in nursing.37 Most preceptors act as role models and coaches, aiming to exemplify professional norms, skills and ethics.14 16 This mentorship component is crucial for socialising students into professional identities and cultures.37 38 Research encourages preceptors to model desired behaviours, values and decision-making processes intentionally.37
Participants ensured a constructive learning environment by promoting students’ familiarity with the ward environments, encouraging healthy interactions between students and patients, senior nurses and colleagues on duty and improvising for equipment that was not readily available. Participants’ descriptions of how they ensured a constructive learning environment seem to collaborate with the constructivist theory which states that learning is made possible through social interaction and instantaneous exposure to cognitive experiences.39
Our study identified teaching approaches predominantly focused on demonstration and questioning techniques which align with practices reported globally. While these methods have merit, research increasingly emphasises the importance of transitioning toward more learner-centred, active learning strategies. Case-based discussions and guided questioning, for instance, have been shown to promote higher-order thinking skills among nursing students.19 20 40
Encouragingly, the prompting and probing techniques already employed by Ghanaian preceptors align with this evidence-based direction. However, there is potential to expand these teaching repertoires further by drawing from successful international experiences. Countries like Singapore and Norway, for example, have effectively integrated diverse pedagogical methods, including simulation-based teaching and structured reflection sessions.40 41 Their experiences offer valuable insights for enhancing preceptor teaching approaches within the Ghanaian context while building on existing practice.
Participants recognised the value of the discussion method for enabling two-way, student-centred teaching, which aligns with current pedagogical best practices.41 However, their reluctance to fully implement this approach due to concerns over noise disruption and compromising patient comfort highlights a significant challenge in the clinical training environment. While the benefits of interactive discussions for promoting active learning and higher-order cognitive skills are well-established,42 43 preceptors must balance instructional aims with the need to maintain a low-stimulus, healing environment for patients. This tension between pedagogical ideals and practical healthcare realities can hinder the adoption of more learner-centred approaches like case discussions.
Resource limitations significantly impact the quality of preceptorship in Ghana, particularly the absence of clinical skills laboratories in hospitals. This presents a distinct contrast to challenges encountered in high-resource settings. While developed nations like the Netherlands focus on optimising existing programmes,44 Ghana must first address fundamental infrastructure and support system needs.
The establishment of clinical skills laboratories within hospital wards presents a viable solution for creating dedicated spaces conducive to applied learning without disrupting patient care areas. These simulation labs and designated skills rooms can provide optimal settings for interactive teaching methods while upholding patient comfort and privacy45 while upholding patient comfort and privacy. Such facilities would enable preceptors to implement more diverse teaching strategies and provide students with opportunities for supervised practice in a controlled environment.
Recognising resource constraints, Ghana can draw inspiration from innovative solutions implemented in other resource-limited settings. For instance, South Africa has successfully established peer mentoring networks,46 while Kenya has leveraged mobile learning platforms to support clinical education.47 These adaptable approaches demonstrate how creative solutions can enhance preceptorship quality even within resource-constrained environments.
Despite lacking formal preceptor training, participants demonstrated a solid understanding of basic teaching and learning principles, likely due to their bachelor’s degrees, which included some educational theory and instructional design. Notably, participants frequently used techniques like probing questions and strategic prompting with students, aligning with educational recommendations for promoting critical thinking and higher-order cognitive skills.48 49
Despite the identified training gaps, Ghanaian preceptors demonstrate inherent strengths, particularly in their effective use of guided questioning and prompting techniques. This foundation could be further enhanced through additional training in advanced questioning strategies, group facilitation and diverse active learning methods to better develop students’ critical thinking abilities in clinical settings.50 The professional development needs expressed by Ghanaian preceptors echo international findings. While countries like Japan and Canada have established comprehensive continuous professional development (CPD) pathways for preceptors,51 Ghana’s unique context necessitates developing sustainable, culturally appropriate support systems. New Zealand’s successful integration of cultural competency in preceptor training52 provides valuable insights for developing locally relevant programmes.
We propose integrating preceptor training into Ghana’s existing CPD framework to standardise clinical teaching as an essential nursing competency. This approach would formalise mentorship, clinical instruction and role modelling as vital components of nursing practice while aligning with nursing standards’ emphasis on teaching as a key professional role. It would strengthen both preceptor capabilities and overall clinical education quality, ensuring sustainable professional development pathways for preceptors.
Limitations of the study
While this study provides valuable insights into the experiences and perspectives of nurse preceptors, several limitations should be acknowledged. First, the research involved a relatively small sample size drawn from a single health facility. Although data saturation within this sample indicates adequate information richness, the findings may not be fully transferable to preceptors across diverse healthcare settings or geographical regions. Larger, multisite studies could enhance transferability. Additionally, the inability to incorporate viewpoints from key stakeholders like student nurses and faculty overseeing clinical education represents a limitation. A more comprehensive examination capturing these interconnected perspectives is warranted. It is also important to recognise that data collection occurred exclusively through individual interviews with preceptors. Observational data may uncover additional insights into the realities of applied teaching and learning in healthcare contexts.
Conclusion
The findings highlight several key areas warranting further attention to optimise the effectiveness of preceptorship programmes and the quality of clinical education experiences. First and foremost, the identified gaps in clearly defining preceptor roles, responsibilities and expectations from the outset reinforce the critical need for robust preceptor training and professional development initiatives. While the preceptors demonstrate numerous strengths despite their inadequate preparation and formal training, this study illuminates clear pathways for enhancing role preparation, instructional practices, supportive resources and sustained iterative programme improvement. Investing in preceptor development and optimising the clinical learning environment can empower these influential preceptors to effectively impart knowledge, skills and professional acumen to future generations of healthcare providers.
Supplemental material
Data availability statement
Data are available upon reasonable request. ‘Not applicable’.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by Committee on Human Research, Publication and Ethics (CHRPE), Kwame Nkrumah University of Science and Technology (CHRPE/AP/571/21). Participants gave informed consent to participate in the study before taking part.
Acknowledgments
We wish to thank the district hospital for granting us approval and consent and most particularly their nurse preceptors whose views and experience made this paper a success.
References
Footnotes
Contributors DSB, VMKA, JY and JO conceptualised and designed the study. DSB and VMKA wrote the first draft of the manuscript. DSB and EAB analysed the entire data set. DSB, VMKA, EAB and JA reviewed and edited the manuscript. All authors read the final draft and approved the published version. DSB is the guarantor responsible for the overall content of the protocol.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.