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Latent Profiles of Teaching Self-Efficacy and Clinical Teaching Behaviors Among Clinical Nurse Preceptors and Factors Associated With Profile Membership: A Cross-Sectional Study

This cross-sectional study of 358 clinical nurse preceptors in China utilized latent profile analysis to identify three distinct subgroups based on teaching self-efficacy and clinical teaching behaviors, revealing that older age, established employment, higher professional titles, and more extensive experience and training are significantly associated with membership in higher-performing profiles.

Original authors: Yiman Hou, Li Zhang, Ming Jin, Yunying Li, Yuan Wang, Tong Cheng, Xiaoya Li, Zhiqiang Wang

Published 2026-07-05

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CC BY 4.0

Original authors: Yiman Hou, Li Zhang, Ming Jin, Yunying Li, Yuan Wang, Tong Cheng, Xiaoya Li, Zhiqiang Wang

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a hospital as a giant, bustling school where experienced nurses (the "preceptors") are tasked with teaching new students and fresh graduates how to survive and thrive in the real world of patient care. This study is like a snapshot taken of 358 of these teachers at Guangyuan Central Hospital in China to see how confident they feel about teaching and how they actually behave in the classroom.

Here is the story of what the researchers found, explained simply:

The Big Picture: Not All Teachers Are the Same

The researchers wanted to know: Do all these nurse teachers feel the same way and act the same way? Or are there different "types" of teachers?

To find out, they used a special statistical tool called Latent Profile Analysis. Think of this like sorting a bag of mixed marbles not just by color, but by a combination of size, weight, and shine to find distinct groups. They looked at two main things:

Teaching Self-Efficacy: How confident the nurses feel in their ability to teach (their "I can do this" belief).
Clinical Teaching Behaviors: What they actually do when teaching (giving feedback, showing care, explaining things).

The Three "Teacher Tribes"

The study found that the nurses didn't form one big, uniform group. Instead, they naturally sorted themselves into three distinct tribes:

The "Building Blocks" Group (Low-Level Profile): About 19% of the teachers. These nurses scored lower across the board. They felt less confident and did fewer of the "best practices" for teaching. They are like students who are just starting to learn how to build with blocks; they have the materials, but they haven't quite figured out the structure yet.
The "Solid Foundation" Group (Moderate-Level Profile): The largest group, at 47%. These teachers are doing a decent job. They have a good grasp of things but still have room to grow, especially in giving specific feedback and helping students think deeply. They are like a house with a solid foundation but maybe needs a fresh coat of paint or a better roof.
The "Master Builders" Group (High-Level Profile): About 34% of the teachers. These folks are confident and consistently use excellent teaching methods. They are the "veteran architects" who can guide a student through any storm.

What Makes a Teacher Move Up the Ladder?

The researchers asked: "What makes a teacher belong to the 'Master Builder' group instead of the 'Building Blocks' group?" They found that certain life and work factors acted like stepping stones:

Experience is Key: The older the nurse, the more years they've been a nurse, and the more years they've been a teacher, the more likely they were to be in the high-level group. It's like a chef; the more time you spend in the kitchen, the better your recipes get.
Job Security Matters: Nurses who had "established" (permanent) jobs were more likely to be high-level teachers than those on temporary or contract roles. It's as if having a permanent seat at the table gives you the stability to focus on teaching rather than worrying about your next paycheck.
Training is the Fuel: The single biggest "changeable" factor was training. Nurses who attended teaching workshops frequently were much more likely to be in the high-level group. Think of training as the "refueling station" for a car; the more you stop to refuel, the further and faster you can go.
Title and Role: Nurses with higher professional titles (like senior experts) and those in leadership roles (like head nurses) tended to be in the higher groups.

The "Feedback" Gap

Even the best teachers had a specific weak spot. While they were great at showing care and support (being a "big brother/sister" figure), they were weaker at giving feedback and evaluation.

Imagine a coach who is great at cheering on the team and hugging them after a game but struggles to tell them exactly what move they messed up and how to fix it. The study found that many nurses felt comfortable being supportive but found it harder to give the specific, critical feedback that helps students improve. This is often because the hospital is so busy that teachers don't have the time to sit down and carefully analyze a student's performance.

The Takeaway

The study concludes that you can't treat all nurse teachers the same. You can't just throw a "one-size-fits-all" training manual at everyone.

For the "Building Blocks" group: They need the most help. They need mentors, basic training, and a safe space to make mistakes so they can build their confidence.
For the "Master Builders": They should be used as role models to help the others.

The researchers suggest that hospital managers should look at who is in which group and give targeted support. Specifically, they should focus extra attention on younger nurses, those on temporary contracts, and those who haven't had much teaching training yet. By giving these specific groups the right tools (like better feedback training), the whole hospital's teaching quality could go up.

In short: Teaching confidence and teaching actions go hand-in-hand. While most nurses are doing okay, there's a clear split between the novices and the experts. The best way to turn a novice into an expert isn't just waiting for them to get older; it's giving them the right training and job security to grow.

Technical Summary: Latent Profiles of Teaching Self-Efficacy and Clinical Teaching Behaviors Among Clinical Nurse Preceptors

Problem Statement
Clinical nurse preceptors are pivotal in bridging theoretical instruction and clinical practice for nursing students and newly employed nurses. While existing literature acknowledges that teaching self-efficacy influences clinical teaching behaviors, most research has utilized variable-centered approaches. These methods focus on average associations between variables, potentially obscuring the within-group heterogeneity of preceptors. There is a lack of understanding regarding how psychological beliefs (teaching self-efficacy) and observable actions (clinical teaching behaviors) combine to form distinct subgroups. Furthermore, the specific sociodemographic and occupational factors associated with these distinct profiles remain underexplored, limiting the ability of nursing managers to implement stratified, targeted support systems.

Methodology
This study employed a cross-sectional design conducted between February and April 2026 at Guangyuan Central Hospital, China.

Participants: 358 clinical nurse preceptors were recruited via convenience sampling. Inclusion criteria required a valid registered nurse license, active clinical preceptorship responsibilities, and the ability to complete the questionnaire independently.
Instruments: Data were collected using three tools:
1. A sociodemographic and occupational information questionnaire (covering age, employment type, professional title, experience, training frequency, etc.).
2. The Chinese version of the Clinical Nurse Educator Skill Acquisition Assessment (CNESAA), measuring five dimensions of teaching self-efficacy (24 items).
3. The Clinical Teaching Behavior Inventory (CTBI-23), measuring six dimensions of clinical teaching behaviors (23 items).
Statistical Analysis:
- Latent Profile Analysis (LPA): Performed using Mplus 8.3. The analysis utilized the mean item scores of the five teaching self-efficacy dimensions and six clinical teaching behavior dimensions as manifest indicators. Models ranging from one to five profiles were fitted. Model selection was based on Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), sample-size adjusted BIC (aBIC), entropy, Lo–Mendell–Rubin likelihood ratio test (LMRT), and bootstrap likelihood ratio test (BLRT).
- Association Analysis: A chi-square ( $\chi^2$ ) test compared characteristics across profiles. Significant variables were entered into a multinomial logistic regression model (with the low-level profile as the reference) to identify factors associated with profile membership.
- Quality Control: Harman's single-factor test assessed common method bias, and Cronbach's $\alpha$ coefficients evaluated internal consistency.

Key Results

Overall Scores: The mean item scores for teaching self-efficacy and clinical teaching behaviors were 3.70 ± 0.54 and 3.65 ± 0.53, respectively, indicating moderate-to-high overall levels. However, specific deficits were noted: "participating in academic activities" had the lowest self-efficacy score, and "providing feedback and evaluation" had the lowest teaching behavior score.
Latent Profile Identification: A three-profile solution was selected as the optimal model based on fit indices (Entropy = 0.931; significant LMRT and BLRT). The profiles were:
1. Low-level profile (18.7%, n=67): Characterized by low scores across all dimensions of self-efficacy and teaching behaviors.
2. Moderate-level profile (47.2%, n=169): Characterized by intermediate scores across all dimensions.
3. High-level profile (34.1%, n=122): Characterized by high scores across all dimensions.
  The profiles demonstrated parallel curves, suggesting differences were primarily in overall level gradients rather than specific dimension imbalances.
Factors Associated with Profile Membership:
- Low-level vs. Moderate/High: Membership in the moderate and high-level profiles was significantly associated with older age, established (formal) employment, higher professional titles, longer preceptorship experience, and more frequent participation in clinical teaching training.
- Specific to High-level: In addition to the factors above, longer nursing experience was significantly associated with membership in the high-level profile compared to the low-level profile.
- Non-significant Factors: Sex, educational level, marital status, pre-service training, position (in the multivariable model), regular qualification review, and full-time preceptor status did not show statistically significant associations with profile membership in the final regression models.

Key Contributions

Person-Centered Approach: The study moves beyond variable-centered analyses to identify distinct latent subgroups of preceptors, revealing that the population is heterogeneous rather than uniform.
Integrated Framework: By simultaneously analyzing teaching self-efficacy and clinical teaching behaviors, the study demonstrates that these constructs vary in tandem, supporting the theoretical link between self-efficacy and behavioral output.
Stratified Evidence: The identification of specific demographic and occupational predictors (e.g., employment type, training frequency) provides empirical evidence for tailoring preceptor development programs.

Significance and Claims
The authors claim that the study provides a reference for optimizing teaching management through stratified training and targeted support.

Targeted Intervention: The findings suggest that development efforts should prioritize preceptors in the low-level profile, specifically those who are younger, hold junior titles, have non-established employment, possess less experience, and have participated less frequently in training.
Modifiable Pathways: The study highlights that while age and experience are stable factors, the frequency of clinical teaching training participation is a modifiable factor strongly associated with higher profile membership. This suggests that increasing training frequency could be an effective managerial intervention.
Focus Areas: The authors note that while overall levels are moderate-to-high, specific competencies in "feedback and evaluation" and "academic activities" require strengthening.
Limitations and Cautions: The authors explicitly state that due to the cross-sectional design, causal inferences cannot be made. They also note limitations regarding the single-center convenience sampling, potential self-report bias, and the use of the most likely profile membership in regression analysis without fully adjusting for classification uncertainty. Consequently, the findings regarding associated factors are presented as exploratory.