Challenges encountered by nursing trainees in clinical learning environments in Ghana: a Scoping Review

Introduction Clinical competence is universally recognised as a cornerstone of nursing education and professional practice. It integrates theoretical knowledge, clinical reasoning, psychomotor ability, ethical judgment, and communication skills essential for delivering high-quality, patient-centred care. As a practice-based discipline, nursing depends heavily on structured clinical education to equip students with the skills and confidence needed to meet complex healthcare demands (Lejonqvist et al., 2012; Maeda & Socha-Dietrich, 2021). Globally, regulatory bodies mandate clinical competency assessments as prerequisites for licensure, affirming the importance of clinical preparedness in nursing practice (Minton & Batten, 2016). Regulatory bodies across various countries have instituted clinical competency assessments as part of licensing processes to ensure that nursing graduates are prepared for the realities of patient care. In response, many countries have embraced competency-based training models to standardise learning outcomes and enhance patient safety. However, the implementation and impact of these models vary across different health and education systems (Anim-boamah, 2022). While competency-based training has become a global standard in nursing education, its implementation and effectiveness vary significantly between regions. High-income countries have made significant advances in this area through the use of simulation-based training, structured mentorship programmes, and the integration of validated competency assessment tools (Bvumbwe & Mtshali, 2018). These innovations support consistency and quality in clinical education and promote equitable trainee development across institutions. In contrast, low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa, face persistent challenges in delivering effective clinical education. Studies from several African countries have documented issues such as inadequate infrastructure, limited access to essential resources, overcrowded clinical sites, and gaps in supervision (Attallah & Hasan, 2022; Puri et al., 2017). These factors hinder students' ability to translate theoretical learning into competent clinical practice and may negatively affect their confidence and professional identity formation (Ngozika Ugwu et al., 2023). Despite these known regional challenges, the literature in many African countries remains fragmented, often institution-specific and geographically limited. This is especially true in Ghana, where nursing education has expanded considerably in recent decades to address growing healthcare needs. However, existing studies in the Ghanaian setting lack a comprehensive synthesis of the challenges that nursing trainees may be encountering in clinical learning environments (Quayson et al., 2024). Without this evidence, reform efforts remain constrained by a limited understanding of what truly affects students’ clinical learning. The lack of a comprehensive synthesis of evidence on this topic presents a barrier to policy reform and curriculum enhancement. Consequently, there is a pressing need to map and consolidate existing research to better understand the complex challenges nursing trainees encounter during clinical placements in Ghana. This scoping review seeks to address this gap by systematically identifying and synthesizing available literature on the challenges faced by nursing trainees in Ghana’s clinical learning environments. The review aims to uncover the prevailing barriers, categorize their nature and sources, and highlight knowledge gaps that could inform future studies and systematic reviews and additionally inform policy reforms. In doing so, the study contributes to broader efforts to strengthen nursing education systems in Ghana and aligns with the Sustainable Development Goals, particularly SDG 3 (Good Health and Well-being) and SDG 4 (Quality Education), which underscore the importance of a competent health workforce and inclusive quality education (William Colglazier, 2015).