"…instead of spending two hours in books, I’m discussing with my guy…": Students’ perspectives on their academic performance in a Ugandan nursing school.
DOI:
https://doi.org/10.51168/sjhrafrica.v6i9.1925Keywords:
Academic performance, Nursing education, Student perspectives, Institutional barriersAbstract
Background
Nurses and midwives constitute 50% of the global health workforce, yet critical shortages, especially in sub-Saharan Africa, limit healthcare delivery. Uganda reports one of the lowest staffing levels globally, with rural districts like Pallisa severely affected. While several educational enablers and barriers have been documented elsewhere, limited evidence exists locally. This study aimed to explore nursing and midwifery students’ perceptions of factors influencing their academic performance in Pallisa.
Methods
This was a qualitative, explorative study that employed focus group discussions (FGDs) with 28 certificate-level nursing and midwifery students at AAMSNM, stratified by year of study. Four FGDs were conducted, and data were collected using a semi-structured interview guide. Audio recordings were transcribed, coded, and analyzed thematically to identify institutional, teacher-related, and student-related factors influencing academic performance.
Results
Students identified a range of barriers to academic performance, including limited access to skills labs, power outages, strict institutional policies, and overlapping academic schedules. Teacher-related challenges such as fast-paced instruction, incomplete syllabus coverage, and lack of guidance were commonly reported. Personal factors like poor time management, exam-related stress, smartphone and romantic distractions, and inadequate preparation also emerged as critical issues. Positive contributors to academic success included peer group discussions, tutor engagement via WhatsApp, clinical exposure, and supportive administrative adjustments such as flexible exam policies and access to Wi-Fi.
Conclusion
Academic performance among nursing students is shaped by multifactorial challenges, many of which are modifiable. Addressing institutional constraints, enhancing teacher-student interaction, and promoting student-centered academic support systems can significantly improve student outcomes. Peer collaboration, structured exam preparation, and emotional support mechanisms are also vital in fostering success.
Recommendations
Academic institutions need to invest in mentorship, digital learning tools, and flexible academic structures to support students’ academic and emotional well-being.
References
WHO, Strengthening the nursing and midwifery agenda globally. 2022.
Kandjimi, E., Effects of the shortage of midwives on performance and quality of care, in maternity ward, Rundu Intermediate hospital and Nyangana district hospital, Kavango East region. 2021, University of Namibia.
Namaganda, G., et al., Making the transition to workload-based staffing: using the Workload Indicators of Staffing Need method in Uganda. Human Resources for Health, 2015. 13(1): p. 89. https://doi.org/10.1186/s12960-015-0066-7
PMid:26621251 PMCid:PMC4665896
Shikuku, D.N., et al., Evaluation of the feasibility of a midwifery educator continuous professional development (CPD) programme in Kenya and Nigeria: a mixed methods study. BMC Medical Education, 2024. 24(1): p. 534.
https://doi.org/10.1186/s12909-024-05524-w PMid:38745243 PMCid:PMC11095014
Ige, W.B., W.B. Ngcobo, and O. Afolabi, Implementation of competency-based education for quality midwifery programmes in Africa: a scoping review. BMC Nursing, 2024. 23(1): p. 685. https://doi.org/10.1186/s12912-024-02333-w PMid:39334130 PMCid:PMC11438267
Folkvord, S.E. and C.F. Risa, Factors that enhance midwifery students' learning and development of self-efficacy in clinical placement: A systematic qualitative review. Nurse Educ Pract, 2023. 66: p. 103510. https://doi.org/10.1016/j.nepr.2022.103510 PMid:36462273
Mwalabu, G. and A. Msosa, Factors influencing implementation of simulation in nursing and midwifery training in Malawi. 2024. 29: p. 2422. https://doi.org/10.4102/hsag.v29i0.2422 PMid:38841346 PMCid:PMC11151378
Mramel, M., M. El Alaoui, and R.E.J. Idrissi, Barriers to clinical learning skills development among midwifery students and newly qualified midwives in Morocco: a qualitative study. Belitung Nursing Journal, 2024. 10(2): p. 160.
https://doi.org/10.33546/bnj.3163 PMid:38690298 PMCid:PMC11056836
Gessesse, D.N., et al., Graduating midwifery students' confidence and associated factors to practice: a systematic review of sub-Saharan Africa. African Journal of Midwifery and Women's Health, 2024. 18(4): p. 1-20. https://doi.org/10.12968/ajmw.2023.0032
Abraha, T.A., et al., Opportunities and challenges in clinical learning of midwifery students in public Universities of Tigray Region, Ethiopia, 2020: a qualitative study. BMC Med Educ, 2023. 23(1): p. 801.
https://doi.org/10.1186/s12909-023-04765-5 PMid:37884955 PMCid:PMC10601281
Iwu, E., et al., Rapid assessment of pre-service midwifery education in conflict settings: findings from a cross-sectional study in Nigeria and Somalia. Human Resources for Health, 2025. 23(1): p. 6. https://doi.org/10.1186/s12960-025-00977-6
PMid:39901258 PMCid:PMC11792377
Laari, T.T., et al., Challenges of Novice Nurse Educators' Transition from Clinical Practice to Academia in Ghana: A Qualitative Study. 2023.
Bvumbwe, T. and N. Mtshali, Nursing education challenges and solutions in Sub-Saharan Africa: an integrative review. BMC Nursing, 2018. 17(1): p. 3. https://doi.org/10.1186/s12912-018-0272-4 PMid:29434521 PMCid:PMC5793415
Vuso, Z. and S. James, Effects of limited midwifery clinical education and practice standardisation of student preparedness. Nurse Education Today, 2017. 55: p. 134-139. https://doi.org/10.1016/j.nedt.2017.05.014 PMid:28595070
Dominic, R., Overcrowded classrooms: assessment and evaluation strategies by Science Secondary school teachers in Kericho County-Kenya. 2023.
Lidegran, I., et al., Insecurity, lack of support, and frustration: A sociological analysis of how three groups of students reflect on their distance education during the pandemic in Sweden. European Journal of Education, 2021. 56(4): p. 550-563.
https://doi.org/10.1111/ejed.12477 PMid:34898738 PMCid:PMC8646562
Deng, X. and R. Sun, Barriers to e-learning during crisis: a capital theory perspective on academic adversity. Journal of Information Systems Education, 2022. 33(1): p. 75.
Sudrajat, I. and N. Purnamasari, Overcrowded classrooms in the analysis of teacher-student interaction. JELA (Journal of English Language Teaching, Literature and Applied Linguistics), 2021. 3(2): p. 74-88. https://doi.org/10.37742/jela.v3i2.60
da Silva, T.L. and A.V. Ravindran, Contributors to academic failure in postsecondary education: A review and a Canadian context. International Journal of Noncommunicable Diseases, 2016. 1(1): p. 9-17. https://doi.org/10.4103/2468-8827.184854
Smale-Jacobse, A.E., et al., Differentiated instruction in secondary education: A systematic review of research evidence. Frontiers in Psychology, 2019. 10: p. 2366. https://doi.org/10.3389/fpsyg.2019.02366 PMid:31824362 PMCid:PMC6883934
Jumiaty, A.A. and H. Kuswoyo, UNDERGRADUATE STUDENTS' PERCEPTIONS TOWARDS LECTURER'S CLASSROOM MANAGEMENT IN THE INDONESIAN TERTIARY CONTEXT. Linguistics and Literature Journal, 2023. 4(1): p. 89-99.
Chew, S.L. and W.J. Cerbin, The cognitive challenges of effective teaching. The Journal of Economic Education, 2021. 52(1): p. 17-40. https://doi.org/10.1080/00220485.2020.1845266
Proscovia, N., F. Christopher, and O. Jill Margret, THE EFFECT OF TEACHERS' ABSENTEEISM ON STUDENTS' ACADEMIC PERFORMANCE IN LOWER SECONDARY SCHOOLS IN UGANDA. 2023.
Falchikov, N., Improving assessment through student involvement: Practical solutions for aiding learning in higher and further education. 2013: Routledge. https://doi.org/10.4324/9780203220993
Weaver, M.R., Do students value feedback? Student perceptions of tutors' written responses. Assessment & Evaluation in Higher Education, 2006. 31(3): p. 379-394. https://doi.org/10.1080/02602930500353061
Masenga, H.H., Assessment of the factors influencing low academic performance in final nursing examinations: a case of certificate and diploma programmes in Eastern Zone, Tanzania. 2015, The Open University Of Tanzania.
Duke, D.L., et al., Challenges facing principals of low-performing schools? Educational practice and theory, 2006. 28(2): p. 5-25. https://doi.org/10.7459/ept/28.2.02
Manyeruke, G. and D. Ergün, Mental health, loneliness, and social support during the COVID-19 pandemic among International University Students in North Cyprus. Kıbrıs Türk Psikiyatri ve Psikoloji Dergisi, 2022. 4(3): p. 211-221.
https://doi.org/10.35365/ctjpp.22.3.01
Suah, P.A., The Impact Of Smartphone Addiction And Distraction On The Psychological Well-being and Academic Performance Of University Students In North Cyprus. 2023, Thesis, Near East University.
Prada, E.D., M. Mareque, and M. Pino-Juste, Teamwork skills in higher education: Is university training contributing to their mastery? Psicologia: Reflexao e critica, 2022. 35: p. 5. https://doi.org/10.1186/s41155-022-00207-1 PMid:35141845 PMCid:PMC8828815
Tweedie, K., J. Yerrell, and K. Crozier, Collaborative coaching and learning in midwifery clinical placements. British Journal of Midwifery, 2019. 27(5): p. 324-329. https://doi.org/10.12968/bjom.2019.27.5.324
Kaabnezhadian, N., S. Mansouri, and R. Raznahan, Enhancing Self-Efficacy in Midwifery Education: A Narrative Review. International Journal of Medical Investigation, 2024. 13(4): p. 0-0.
Doegah, P.T. and E. Acquah, Promoting healthy lifestyles among nurse trainees: Perceptions on enablers and barriers to dietary and physical activity behaviours. PLoS One, 2022. 17(6): p. e0270353. https://doi.org/10.1371/journal.pone.0270353 PMid:35749412 PMCid:PMC9231720
Funa, A.A., Exploring clinical practice education for student midwives: Hospital and community opportunities and challenges. Midwifery, 2024: p. 104186. https://doi.org/10.1016/j.midw.2024.104186 PMid:39278088
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Ivan Lyagoba, John Michael Okusa , Irene Asekenye

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.