Assessment of determinants of limited specialization in nursing practice among student nurses at Adeleke University, Ede, Osun State

 Corresponding author: Antonia Oguguo Confidence ONYENWENYI Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Assessment of determinants of limited specialization in nursing practice among student nurses at Adeleke University, Ede, Osun State Anthonia Oguguo Confidence ONYENWENYI 1, *, Edun Christianah ABOSEDE 1, Treasure Ifeanyichukwu OJEI 1, Ifeabunike OKECHUKWU 2, Itunu Karimat JOLAYEMI 1, Josephine Amaka ANENE 1 and Abayomi Tolu OLARINMOYE 3 1 Department of Nursing Science, Faculty of Basic Medical Science, Adeleke University, Ede, Osun State, Nigeria. 2 Department of Community Medicine and Primary Health Care, Veritas University, Abuja, Nigeria. 3 Department of Public Health, Faculty of Basic Medical Science, Adeleke University Ede, Osun state, Nigeria. World Journal of Advanced Research and Reviews, 2025, 26(01), 3333-3345 Publication history: Received on 04 February 2025; revised on 16 April 2025; accepted on 19 April 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.26.1.0813 Abstract Nursing specialization is increasingly important for meeting the complex healthcare needs of modern society. This study assessed determinants of limited specialization in nursing practice among student nurses at Adeleke University. The study adopted a cross-sectional design and used Yamane’s formula to calculate the sample size. A total of 197 eligible respondents were selected using simple random sampling technique. Data was collected using a self-structured validated questionnaire which was analyzed using statistical package for the social sciences (SPSS). Results revealed that a significant proportion of respondents, 39.59% (78), strongly agreed, and 43.14% (85) agreed that the availability of mentor-ship opportunities influenced their choice of nursing specialization. Similarly, a strong majority (35.53% strongly agreed and 47.69% agreed) indicated that opportunities for professional development were pivotal in their specialization decisions. Financial constraints emerged as a notable barrier, with 40.10% (79) strongly agreeing and 33.51% (66) agreeing that such limitations hindered their decisions to specialization in nursing. Limited access to mentor-ship was reported by 79.19% of respondents, while uncertainty about career prospects in specific specialties concerned 76.13%. Work-life balance was another major factor, with 74.62% expressing concern. A lack of exposure to different specialty areas during clinical placements was noted by 81.22%, and 80.2% were concerned about the challenges of obtaining advanced certifications. Lastly, family or peer pressure influenced 67.52% of students in their specialization choices. Establish robust mentor-ship programs provide students with guidance from experienced nurses, helping them navigate their specialization choices and develop professional networks. Keywords: Nursing-specialization; Choices; Mentor-ship; Limitedspecialization 1. Introduction Nursing specialization is considered a significant professional requirement to meet the challenges and needs of the health systems under evolving epidemiological patterns and scientific, technological, and social advances [1]. Although nearly 70% of countries worldwide report having continuous professional development programmes for nurses, the definition and educational background of specialist nurses is still somewhat unclear [2]. The specialist nurses (SN) are seen as an umbrella term by the European Society of Specialist Nurses (ESNO) containing other terms such as advanced nurse practitioner (ANP) or nurse practitioner (NP) [3]. At the same time, ANP and NP are more often seen as a link between a nursing domain and a medical domain with advanced nursing skills, higher education and expanded scopes of practice [4]. When comparing SN education in different countries, there is limited information due to of lack of coordination of regulations [2]. A variation is also seen in the number of specialization areas and on the educational World Journal of Advanced Research and Reviews, 2025, 26(01), 3333-3345 3334 level worldwide. The same specialization area of the nursing field can in different countries, or even within one country, have different academic levels as a requirement for admission to the education. The duration of the education in different countries in the same specialization area of the nursing field can vary from a few days to two years. And more, there is no agreement about the role or level of independence when practicing as SN [2]. The nursing profession is undergoing a paradigm shift, with an increasing emphasis on specialization to meet the evolving healthcare needs of the people. As academics devoted to educating others about the importance of improving the health of populations, the future for the specialty as a component of the nursing profession appears bleak because of factors that are both self and externally inflicted [5]. The association between shortage of nurses, educational level of nurses and increase in patients' mortality rate are global issues, since most of the regions in the world report shortages of nurses [6]. Therefore, no conclusion can be drawn if a higher level of nursing education decreases mortality and the occurrence of adverse events. However, it has been shown that care given by experienced Registered Nurse anesthetists and anesthesiologists is associated with both lower occurrences of adverse events and patient mortality compared with being cared for by inexperienced nurses [7]. Since the level of experience and a higher proportion of Registered Nurses with a bachelor's degree makes a difference, probably also a higher number of SNs is of importance for the quality of the health care. Considering the growing significance of specialized knowledge in the field of nursing, this research endeavors to assess the determinants of limited specialization in nursing practice among student nurses at Adeleke University. Recognizing the pivotal role that specialization plays in shaping the future of nursing practice, this involved a comprehensive examination of various factors, including institutional policies, educational resources, factors facilitating support, mentor-ship issues and challenges encountered by student nurses in Adeleke University. 1.1. Goal and Objectives of the study The main objective of this research is to assess the determinants of limited specialization in nursing practice among student nurses at Adeleke University. Aligned with the overarching aim, the specific objectives are to: • Assess the level of knowledge on different choices of specialties in nursing practice among student nurses in Adeleke University, Ede, Osun state. • Identify factors facilitating choice of specialization in nursing practice among student nurses in Adeleke University, Ede.Osun state. • Identify perceived barriers affecting specialization decision among student nurses in Adeleke University, Ede, Osun state. 1.2. Research Questions The exploration of determinants of limited specialization in nursing practice among student nurses at Adeleke University is guided by the following research questions: • What is the level of knowledge on different choices of specialties available in nursing practice among student nurses in Adeleke University, Ede, Osun state? • What are the factors facilitating choice of specialization in nursing practice among student nurses in Adeleke University, Ede, Osun state? • What are the perceived barriers affecting specialization decision among student nurses in Adeleke University, Ede, Osun state? 1.3. Research Hypothesis HoThere is no significant relationship between the level of knowledge on various specialties and the choice of specialization in nursing practice among Adeleke University student nurses. 2. Literature review Specialization in nursing involves pursuing advanced education and training in specific areas of healthcare, such as pediatrics, oncology, or critical care. It allows nurses to develop deep expertise and skills tailored to particular patient populations or medical conditions, ultimately enhancing the quality of care provided [8]. Specialization in nursing significantly enhances the quality of patient care by ensuring that patients receive treatment from highly skilled and knowledgeable professionals who are experts in their field [9]. Specialized nurses are equipped World Journal of Advanced Research and Reviews, 2025, 26(01), 3333-3345 3335 to manage complex cases more effectively, provide tailored interventions, and improve patient outcomes through evidence-based practices specific to their area of expertise [10]. Moreover, specialized nurses can better advocate for their patients, understanding the intricacies of specific conditions and the latest advancements in treatment options, which leads to more informed decision-making and higher levels of patient satisfaction [11]. From a professional development perspective, specialization allows nurses to advance their careers by gaining specialized knowledge and skills that open up opportunities for leadership roles, higher salaries, and greater job satisfaction [12]. It encourages continuous learning and professional growth, as specialized nurses are often required to stay updated with the latest research, technologies, and best practices in their field [13]. This ongoing education fosters a culture of excellence and innovation within the nursing profession, promoting higher standards of care and professional competence [14]. Furthermore, the COVID-19 pandemic has had a profound impact on nursing specialization trends. The pandemic highlighted the critical need for nurses with expertise in public health, infection control, and disaster response [15]. As a result, there has been a surge in demand for nurses specializing in areas such as epidemiology, infection prevention, and telehealth nursing [9]. Additionally, the pandemic has underscored the importance of mental health support for both healthcare workers and patients, leading to increased interest in psychiatric-mental health nursing specialties [16]. 2.1. Empirical review 2.1.1. Level of knowledge on different choices of specialties in nursing practice among student nurses In a longitudinal study conducted by Garcia and Martinez (2020), researchers followed a cohort of nursing students over a three-year period to assess their knowledge of different specialty choices in nursing practice. The study found that while students initially had limited exposure to specialized areas during their early years of training, their knowledge and awareness of different specialties significantly improved as they progressed through their nursing education. This improvement was attributed to structured clinical placements, mentor-ship programs, and elective courses focusing on specialized areas. The findings highlight the importance of longitudinal educational interventions in enhancing students' understanding of nursing specialties [17]. 2.1.2. Factors facilitating choice of specialization in nursing practice among student nurses Canales and Arnold (2022) conducted a cross-sectional study among student nurses to explore factors influencing their choice of specialization in nursing practice. The study involved surveying 500 nursing students from various educational institutions across the country. Findings revealed that the primary factors influencing specialization choice included personal interest (62%), clinical experiences (56%), role models (45%), and future job prospects (38%). Moreover, respondents expressed a preference for specialties with clear career pathways and opportunities for professional growth. These findings underscore the importance of individual preferences and experiential learning in shaping specialization decisions among student nurses [18] Another longitudinal study conducted by Saager (2022) to examine the factors facilitating the choice of specialization among nursing students over a three-year period. The study followed 300 nursing students from their first year of training until graduation. Results indicated that exposure to different clinical specialties during training significantly influenced students' specialization preferences. Additionally, mentor-ship and guidance from nursing faculty and preceptors played a crucial role in helping students navigate their career paths. Furthermore, the study identified financial considerations and job market trends as important factors shaping students' decisions regarding specialization. 2.1.3. Barriers affecting specialization decision among student nurses Saager and Arnold (2021) conducted a cross-sectional study among student nurses to investigate the barriers affecting specialization decisions. The study involved a sample of 500 nursing students from various educational institutions across the country. Results showed that the most reported barriers to specialization included financial constraints, lack of mentor-ship opportunities, and limited exposure to different specialty areas during clinical placements. Financial constraints were identified as a significant barrier, with many students expressing concerns about the cost of further education and certification in specialized fields. Additionally, the study found that students who lacked access to mentor-ship programs or guidance from experienced nurses were less likely to pursue specialization. Furthermore, students reported feeling limited by the opportunities available for exposure to different specialty areas during their clinical placements, suggesting that inadequate clinical experiences hindered their ability to make informed specialization decisions [7]. World Journal of Advanced Research and Reviews, 2025, 26(01), 3333-3345 3336 Garcia et al. (2021) conducted a longitudinal study to examine the barriers affecting specialization decisions among nursing students over a three-year period. The study followed a cohort of 300 nursing students from the beginning of their academic program until graduation. Results showed that while initial interest in specialization was high among students, many faced challenges navigating the educational and professional requirements necessary to pursue specialized roles. Over time, the study found that students' enthusiasm for specialization waned as they encountered barriers such as limited access to specialized training programs, financial constraints, and concerns about job market saturation in certain specialties. Moreover, the study identified a lack of support and guidance from academic advisors and faculty members as a significant barrier to specialization decision-making among students [17]. 2.2. Theoretical review 2.2.1. The Social Cognitive Career Theory (SCCT) The Social Cognitive Career Theory (SCCT) was propounded in 1994 by Robert W. Lent, Steven D. Brown, and Gail Hackett. This theory builds on Albert Bandura's social cognitive theory, emphasizing the role of self-efficacy, outcome expectations, and personal goals in career development. SCCT posits that individuals' career choices are influenced by their beliefs about their abilities (self-efficacy), the outcomes they expect from their actions (outcome expectations), and their personal goals. These elements interact with environmental factors and learning experiences to shape career interests, choices, and performance. SCCT provides a comprehensive framework for understanding how personal and contextual factors influence career development, making it particularly relevant for exploring the determinants of limited specialization in nursing practice among student nurses. The theory highlights the importance of supporting students' self-efficacy and outcome expectations to encourage specialization in various nursing fields. 2.2.2. Self-Efficacy SCCT emphasizes the role of self-efficacy in career development. In the context of nursing specialization, self-efficacy refers to the students' belief in their ability to successfully perform tasks related to a particular nursing specialty. If student nurses have high self-efficacy regarding a specialty, they are more likely to pursue it. Conversely, low selfefficacy can deter them from specializing. 2.2.3. Outcome Expectations Outcome expectations, another core component of SCCT, involve students' beliefs about the outcomes of specializing in a particular field. These can include expectations about job satisfaction, financial rewards, career advancement opportunities, and work-life balance. If student nurses believe that specializing in a particular area will lead to positive outcomes, they are more likely to pursue it. Conversely, negative outcome expectations can discourage specialization. For example, if students perceive that a career in gerontology is less rewarding or offers fewer advancement opportunities compared to other specialties, they may avoid it. 2.2.4. Personal Goals Personal goals play a significant role in the SCCT framework. These are the aspirations and objectives that individuals set for their careers. In nursing, students with specific goals aligned with a particular specialty are more likely to further education and training in that field. For example, a student nurse with a goal to become a nurse practitioner in oncology is likely to seek out relevant educational and clinical experiences to achieve this. 2.2.5. Environmental Factors SCCT also considers the impact of environmental factors on career decisions. In the context of nursing specialization, these factors include the availability of specialized training programs, institutional support, and market demand for specific specialties. Limited access to specialized programs and resources can be a significant barrier to specialization. For instance, if a nursing school does not offer robust programs in mental health nursing, students interested in this field may be unable to pursue their interest. Healthcare institutions and educational programs should work to create more opportunities for specialization by offering a diverse range of specialty courses and clinical placements, as well as providing financial support and incentives for pursuing further education. 2.2.6. Learning Experiences Learning experiences are crucial in shaping students' interests and self-efficacy. Positive clinical experiences in various specialties can enhance students' confidence and interest in those fields. Conversely, negative experiences can deter students from pursuing certain specialties. For example, a rewarding internship in critical care can inspire a student to specialize in that area, while a lackluster experience in another field might lead to disinterest. World Journal of Advanced Research and Reviews, 2025, 26(01), 3333-3345 3337 3. Materials and methods 3.1. Research Design A cross-sectional study research design was conducted using a simple random sampling technique to assess the determinants of limited specialization in nursing practice. This design is adopted as it allows for the description of a population’s characteristics without manipulating variables. 3.2. Population The study population are One hundred and ninety-seven (197) Nursing students randomly selected from 300, 400 and 500 level in Adeleke University, Ede, Osun State, Nigeria. 3.3. Sample Technique A simple random sampling technique was used to select the 197 respondents as the research participants. 3.4. Instrumentation For this study, data was collected using an adapted questionnaire that was modified to gather responses from the participants. The instrument that was used in data collection was an electronically distributed questionnaire which consisted of four sections that included social demographic variables, knowledge on different choices of specialties in nursing practice, factors facilitating choice of specialization in nursing practice and barriers affecting specialization decision among student nurses. After the initial step of general distribution of questionnaires for responses to each variable, the questionnaires were retrieved and checked for completeness. Utilizing percentages, tables, graphs, frequency distribution, and charts unveiled patterns and trends within the collected data. Descriptive statistics, including mean, median, mode, and standard deviation, was computed to succinctly summarize the characteristics and variability of the data. Inferential statistics was employed to evaluate hypotheses and establish relationships between variables. The statistical package for the social sciences (SPSS) version 27 software was utilized. A significance level of 0.05 (5%) was set for the analysis. 3.5. Method of Data Collection The data collection process was carried out within the period of 1st of October 2024 to January 2025 and continued until the predetermined sample size was achieved, with an estimated time-frame of 16weeks for the complete administration of the research instrument. 4. Results Table 1 Demographic Characteristics of respondents Question Option Number of Respondents Percentage (%) Gender Male 12 6.09 Female 180 91.83 Other 5 2.54 Age Group 18-20 56 28.43 21-23 92 46.70 24-26 49 28.87 27 and above 0 0 Year of Study Junior (3rd Year) 100 50.76 Senior (4th Year) 70 35.53 Graduate Student (5th year) 27 13.72 Program of Study Bachelor of Science in Nursing (BSN) 197 100 World Journal of Advanced Research and Reviews, 2025, 26(01), 3333-3345 3338 Master of Science in Nursing (MSN) 0 0 Doctor of Nursing Practice (DNP) 0 0 Other 0 0 Residential Status On-campus 195 98.98 Off-campus (within close proximity) 2 1.02 Off-campus (far from the university) 0 0 Ethnicity Yoruba 117 59.39 Igbo 62 31.53 Hausa 10 5.08 Other Nigerian Ethnicity 8 4.06 Non-Nigerian 0 0 From the table above, the majority of respondents were female (91.83%), indicating a strong female presence in nursing education. This suggests that nursing may continue to attract more female students compared to males, as evidenced by the 6.09% of male respondents and 2.54% identifying as other genders. Most respondents (39.59%) fell within the 21-23 age range, which is typical for undergraduate nursing students. However, a notable proportion of students (28.43%) are in the 18-20 age group, highlighting the influx of younger individuals into the nursing profession. A significant portion of respondents (50.76%) were in their third year, reflecting the typical distribution of students within nursing programs, with fewer in the fifth year (13.72%). All of the respondents (100%) were pursuing a Bachelor of Science in Nursing. Majority of the percentage (98.98%) live on-campus, while notably few lived off campus (1.02%) but within close proximity, suggesting a blend of lifestyles among students. Ethnic diversity was reflected in the responses, with 59.39% identifying as Yoruba and 31.53% as Igbo. Figure 1 Family income of participants The data indicates in figure re 4.2 above depicts a wide range of family income levels, with 35.53% of respondents reporting a family income between ₦50,000 - ₦100,000. World Journal of Advanced Research and Reviews, 2025, 26(01), 3333-3345 3339 Figure 2 Ethnicity of participants The Yorubas are in the majority followed by the Igbos. This is expected. 4.1. Research question 1 4.1.1. Knowledge on Different Choices of Specialties in Nursing Practice The analysis below shows the level of knowledge regarding various nursing specialties among student nurses at Adeleke University. In the question concerning which of the options is not a recognized specialty in nursing, a significant majority (76.07%) correctly identified Family Medicine as not being a recognized nursing specialty. The lower recognition of Pediatrics (6.59%), Oncology (3.55%), and Critical Care (13.71%) as unrecognized specialties indicates that most students are well-informed about established nursing domains. Table 2 Responses on Level of Knowledge on Different Choices of Specialties in Nursing Practice Question Option Number of Respondents Percentage (%) Which of the following is not a recognized specialty in nursing practice? Pediatrics 13 6.59 Oncology 7 3.55 Family Medicine 150 76.07 Critical Care 27 13.71 Specialization in nursing practice requires additional certification beyond basic nursing education. Yes 180 91.83 No 17 8.63 Which specialty area focuses on the care of patients with mental health disorders? Pediatrics 9 4.57 Oncology 8 4.06 Critical Care 8 4.06 Mental Health 172 87.30 Which of the following specialties deals with the treatment and management of cancer patients? Pediatrics 5 2.54 Oncology 174 88.32 Emergency Medicine 10 5.08 World Journal of Advanced Research and Reviews, 2025, 26(01), 3333-3345 3340 Geriatrics 8 4.06 Which specialty area involves providing comprehensive care to elderly patients? Pediatrics 5 2.54 Oncology 10 5.08 Geriatrics 172 87.30 Mental Health 10 5.08 Specializing in nursing practice limits career advancement opportunities. Yes 65 32.99 No 132 67.01 Have you had exposure to different specialty areas during your clinical placements? Yes 170 86.32 No 27 13.68 When asked if specialization in nursing requires additional certification beyond basic nursing education, an overwhelming 91.83% responded affirmatively. Regarding mental health, 87.30% of respondents accurately identified it as the specialty area focused on patients with mental health disorders. Similarly, when assessing knowledge about cancer management, 88.32% of students correctly identified oncology as the specialty that deals with the treatment and management of cancer patients. In terms of elderly care, 87.30% of respondents recognized geriatrics as the specialty involving comprehensive care for elderly patients. The question about the impact of specialization on career advancement yielded mixed results, with 32.99% of respondents believing that specialization limits opportunities for career advancement, while 67.01% disagreed. Lastly, the majority (86.32%) reported having had exposure to different specialty areas during their clinical placements. Figure 3 Pie chart showing level of knowledge on different specialties The above pie chart shows the overall level of knowledge on different choices of specialties in Nursing Practice among nursing students. it was revealed that 76% of the participants demonstrated a high level of knowledge. 20% of the participants fell under the moderate knowledge category, indicating that nearly half of the respondents had a moderate understanding. 4% of the participants had low knowledge, representing the smallest proportion of the group. 4.2. Research question 2 World Journal of Advanced Research and Reviews, 2025, 26(01), 3333-3345 3341 4.2.1. Factors Facilitating Choice of Specialization in Nursing Practice The analysis of the table below shows the factors facilitating the choice of specialization in nursing practice among student nurses at Adeleke University. A significant proportion of respondents, 39.59% (78), strongly agreed, and 43.14% (85) agreed that the availability of mentor-ship opportunities influenced their choice of nursing specialization. Similarly, a strong majority (35.53% strongly agreed and 47.69% agreed) indicated that opportunities for professional development were pivotal in their specialization decisions. The perceived demand for nurses in specific specialties also emerged as a notable factor, with 41.62% (82) strongly agreeing and 43.66% (86) agreeing that this perception influenced their specialization choice. Table 3 Responses on Factors Facilitating Choice of Specialization in Nursing Practice Questions Strongly Agreed Agreed Neutral Disagreed Strongly Disagreed The availability of mentor-ship opportunities influenced my choice of nursing specialization. 78 (39.59%) 85 (43.14%) 24 (12.16%) 7 (3.55%) 3 (1.52%) Opportunities for professional development were a factor in my decision to specialize in nursing. 70 (35.53%) 94 (47.69%) 25 (12.66%) 6 (3.05%) 2 (1.02%) The perceived demand for nurses in a particular specialty influenced my specialization choice. 82 (41.62%) 86 (43.66%) 21 (10.66%) 7 (3.55%) 1 (0.51%) Personal interest and passion played a significant role in determining my chosen nursing specialty. 92 (46.67%) 85 (43.14%) 15 (7.61%) 3 (1.52%) 2 (1.02%) Exposure to different specialty areas during clinical rotations influenced my specialization decision. 81 (41.12%) 90 (45.68%) 20 (10.16%) 5 (2.54%) 1 (0.51%) The potential for career advancement in a specific nursing specialty influenced my decision. 90 (45.68%) 87 (44.16%) 16 (8.12%) 4 (2.03%) 0 (0.00%) Family or peer influence played a role in my choice of nursing specialization. 63 (31.96%) 75 (38.07%) 32 (16.24%) 21 (10.66%) 6 (3.05%) Personal interest and passion played a substantial role in determining chosen specialties, with 46.67% (92) strongly agreeing and 43.14% (85) agreeing. This emphasizes the intrinsic motivation of student nurses, which is vital for longterm career satisfaction and success. Exposure to different specialty areas during clinical rotations was similarly influential, with 41.12% (81) strongly agreeing and 45.68% (90) agreeing. The potential for career advancement in specific nursing specialties was also a strong motivator for students, with 45.68% (90) strongly agreeing and 44.16% (87) agreeing. Finally, family or peer influence played a less dominant role in specialization choices, with 31.96% (63) strongly agreeing and 38.07% (75) agreeing. 4.3. Research question 3 4.3.1. Perceived Barriers Affecting Specialization Decision The analysis of perceived barriers affecting specialization decisions among student nurses at Adeleke University reveals several significant challenges faced by the respondents. Financial constraints emerged as a notable barrier, with 40.10% (79) strongly agreeing and 33.51% (66) agreeing that such limitations hindered their decisions to specialize in nursing. Limited access to mentorship opportunities was also identified as a barrier, with 38.07% (75) strongly agreeing and 41.12% (81) agreeing. Uncertainty about future career prospects in specific specialties was reported as a concern, with 34.51% (68) strongly agreeing and 41.62% (82) agreeing. Concerns about work-life balance were also significant, as indicated by 35.53% (70) strongly agreeing and 39.09% (77) agreeing.