Evaluating a community health nursing internship using the Kirkpatrick four-level model: Evidence from Iran
DOI:
https://doi.org/10.21831/reid.v11i2.89693Keywords:
internship evaluation, Kirkpatrick model, program evaluation, program effectiveness, nursingAbstract
This study aimed to evaluate the effectiveness of a community health nursing internship course for final-year nursing students in comprehensive health centers in Tehran, Iran, using Kirkpatrick’s four-level model. The evaluation was performed in terms of the reaction, learning, behavior and outcomes dimensions based on the Kirkpatrick 4-level model. Fifty-six nursing students and 180 clients were randomly selected. Data were collected through researcher-made questionnaires and checklists and analyzed using descriptive and analytical statistical tests. At Level 1, students’ overall satisfaction averaged 61, with the highest satisfaction in clinical instructor performance (77.53%). At Level 2, the mean self-evaluation learning score was 66.29; the highest learning occurred in vaccination (89.28%) and growth monitoring/supplementary nutrition (69.64%). The overall performance evaluation averaged 70.14, with vaccination scoring the highest (91.07%). Clients reported high satisfaction with the care provided by students (Level 4 mean: 72.99). No significant association was found between students’ demographic characteristics and the first three levels of the model. The internship demonstrated effectiveness at all four Kirkpatrick levels. The findings support the value of structured community health internships and highlight the need for educational authorities to develop a standardized, evidence-based program that addresses the identified strengths and areas for improvement.
References
Abdelaliem, S. M. F., Alsleem, D. K., Aladdad, S. K., Alqahtani, A. S., Alenazi, R. K., Alotaibi, M. G., . . . Almarshad, L. B. (2025). The relationship between practical skills confidence and readiness for transition to practice among nursing internship students: Exploring the mediating role of preceptorship. Nurse Education Today, 147, 106587. doi:https://doi.org/10.1016/j.nedt.2025.106587
Aghaei, N., Babamohamadi, H., Asgari, M. R., & Dehghan-Nayeri, N. (2021). Barriers to and facilitators of nursing students’ adjustment to internship: A qualitative content analysis. Nurse Education Today, 99, 104825.
Ahanchian, M., Sharafi, S., Vafaee, M., & Hajiabadi, F. (2017). Evaluate the Effectiveness of internship program in nursing student using Kirkpatrick's model. Research in Medical Education, 9(1), 17-19.
Ahmadi, S., Abdi, A., Nazarianpirdosti, M., Rajati, F., Rahmati, M., & Abdi, A. (2020). Challenges of Clinical Nursing Training Through Internship Approach: A Qualitative Study. J Multidiscip Healthc, 13, 891-900. doi:10.2147/jmdh.s258112
Al Najjar, H., & Rawas, H. (2018). Factors Affecting the Clinical Practice of Nursing Interns at Tertiary Hospital Jeddah in Saudi Arabia. International Journal of Studies in Nursing, 3(3), 45.
Atakro, C. A., Armah, E., Menlah, A., Garti, I., Addo, S. B., Adatara, P., & Boni, G. S. (2019). Clinical placement experiences by undergraduate nursing students in selected teaching hospitals in Ghana. BMC nursing, 18(1), 1-10.
Ayaz-Alkaya, S., & Öztürk, F. (2021). The impact of internship on attitude towards nursing profession and peer caring behaviours: A prospective observational study. Int J Clin Pract, 75(10), e14632. doi:10.1111/ijcp.14632
Banaderakhshan, H., Mehrabi, Y., Sh, Y., Mortazavi, F., & Saedi, N. (2005). Comparing knowledge, attitude and practice of senior nursing students and graduates of Shahid Beheshti University of Medical Sciencess. Research in Medicine, 29(1), 37-43.
Baraz Pordanjani, S., Fereidooni Moghadam, M., & Loorizade, M. (2009). Clinical education status according to the nursing and midwifery students point of view Tehran University of Medical Sciences. Strides in Development of Medical Education, 5(2), 102-112.
Bennett, L. L. (2017). The Gap Between Nursing Education and Clinical Skills. ABNF Journal, 28(4).
Bhatia, M., Stewart, A. E., Wallace, A., Kumar, A., & Malhotra, A. (2021). Evaluation of an In-Situ Neonatal Resuscitation Simulation Program Using the New World Kirkpatrick Model. Clinical Simulation in Nursing, 50, 27-37. doi:https://doi.org/10.1016/j.ecns.2020.09.006
Bijani, M., Rostami, K., Momennasab, M., & Yektatalab, S. (2018). Evaluating the Effectiveness of a Continuing Education Program for Prevention of Occupational Exposure to Needle Stick Injuries in Nursing Staff Based on Kirkpatrick's Model. Journal of the National Medical Association, 110(5), 459-463. doi:https://doi.org/10.1016/j.jnma.2017.11.002
Chen, S.-L., Sun, J.-L., & Jao, J.-Y. (2020). A predictive model of student nursing competency in clinical practicum: A structural equation modelling approach. Nurse Education Today, 95, 104579. doi:https://doi.org/10.1016/j.nedt.2020.104579
Çingöl, N., Karakaş, M., Zengin, S., & Celebi, E. (2020). The effect of psychiatric nursing students' internships on their beliefs about and attitudes toward mental health problems; a single-group experimental study. Nurse Education Today, 84, 104243.
Datta, S. R., Utsho, A. K., Fardus, F., Akter, S., Shohan, B. H., Nesad, I., . . . Akter, N. (2025). Satisfaction of Clinical Practice Among Nursing Students in Private Nursing College, Sylhet. Asia Pacific Journal of Nursing Research, 6(2), 4-16.
Dorri, S., Farahani, M. A., Maserat, E., & Haghani, H. (2019). Effect of role-playing on learning outcome of nursing students based on the Kirkpatrick evaluation model. J Educ Health Promot, 8, 197. doi:10.4103/jehp.jehp_138_19
Duprez, V., Vermote, B., Van Hecke, A., Verhaeghe, R., Vansteenkiste, M., & Malfait, S. (2021). Are internship experiences during a pandemic related to students’ commitment to nursing education? A cross-sectional study. Nurse Education Today, 107, 105124. doi:https://doi.org/10.1016/j.nedt.2021.105124
Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2011). The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse. JBI Evidence Synthesis, 9(53), 2215-2323.
Fricas, J. (2021). A yearlong population health internship: Operationalizing an innovative model for population health nursing education. Journal of Professional Nursing, 37(3), 662-672. doi:https://doi.org/10.1016/j.profnurs.2020.12.002
Furlong, E., & Smith, R. (2005). Advanced nursing practice: policy, education and role development. Journal of clinical nursing, 14(9), 1059-1066.
Ghodsbin, F., & Shafakhah, M. (2008). Facilitating and preventing factors in learning clinical skills from the viewpoints of the third year students of Fatemeh school of nursing and midwifery. Iranian journal of medical education, 7(2), 343-352.
Happell, B., & Gough, K. (2007). Employment through residency programs: A strategy to address the workforce crisis in psychiatric nursing. Archives of Psychiatric Nursing, 21(3), 126-131.
Jaffari, F., & Valiani, M. (2002). Evaluation of field training from the viewpoints of management and informatics students of Isfahan university of medical sciences. Iranian journal of medical education, 2(1), 19-26.
Johnstone, M.-J., Kanitsaki, O., & Currie, T. (2008). The nature and implications of support in graduate nurse transition programs: an Australian study. Journal of Professional Nursing, 24(1), 46-53.
Khamseh M.E., Aghili R., Baradaran H.R., & Arabi A. (2007). Patients satisfaction of medical care delivered in outpatient clinics of endocrinology and metabolism in Tehran, Iran. Payesh (Health Monitor) Journal, 6(1), 0-0.
Kotecki, C. N. (2002). Baccalaureate nursing students' communication process in the clinical setting (Vol. 41, pp. 61-68): Slack Incorporated Thorofare, NJ.
Leducq, M., Walsh, P., Hinsliff-Smith, K., & McGarry, J. (2012). A key transition for student nurses: The first placement experience. Nurse Education Today, 32(7).
Lee, J. E., & Sim, I. O. (2020). Gap between college education and clinical practice: Experience of newly graduated nurses. Nursing open, 7(1), 449-456.
Leijser, J., & Spek, B. (2021). Level of clinical reasoning in intermediate nursing students explained by education year and days of internships per healthcare branches: A cross – sectional study. Nurse Education Today, 96, 104641. doi:https://doi.org/10.1016/j.nedt.2020.104641
Liu, H., Huang, H., Li, M., Mao, P., Zhang, A., Sun, Y., . . . Liu, J. (2025). The Effect of "Online-Simulation-Bedside" Three-Step Teaching Method in Team Cardiopulmonary Resuscitation Skills Training of Emergency Department and Critical Care Nursing Interns-An Analysis Based on Kirkpatrick Model. J Nurs Manag, 2025, 8624274. doi:10.1155/jonm/8624274
Momeni, H., Salehi, A., Seraji, A., Sanagoo, A., Karami, A., Mirshekari, M., & Mirshekari, L. (2015). Patient Satisfaction with the Care Given by Students: a Cross-Sectional Study. Journal of Research Development in Nursing and Midwifery, 12(1), 85-93.
Nouhi, E., Kohan, S., Haghdoost, A., & Nazari, R. (2007). Theoretical nursing courses application in clinical field: clinical nurse teachers & students perspectives in Mazandaran University of Medical Sciences. Iran Journal of Nursing, 20(52), 29-38.
Piryani, R. M., Dhungana, G. P., Piryani, S., & Neupane, M. S. (2018). Evaluation of teachers training workshop at Kirkpatrick level 1 using retro–pre questionnaire. Advances in medical education and practice, 9, 453.
Roush, K., Opsahl, A., & Ferren, M. (2021). Developing an internship program to support nursing student transition to clinical setting. Journal of Professional Nursing, 37(4), 696-701. doi:https://doi.org/10.1016/j.profnurs.2021.04.001
Sabzevari, S., Soltani Arabshahi, K., Shekarabi, R., & Koohpayehzadeh, J. (2006). Nursing Students’ Communication With Patients In Hospitals Affiliated To Kerman University Of Medical Sciences. Iranian journal of medical education, 6(1), 43-49.
Sandhusen, A. E. (2005). Third level evaluations of new graduate nurses' performance post internship programs: George Mason University.
Savul, S., Ikram, A., Khan, M. A., & Khan, M. A. (2021). EVALUATION OF INFECTION PREVENTION AND CONTROL TRAINING WORKSHOPS USING KIRKPATRICK'S MODEL. International Journal of Infectious Diseases, 112, 76-80. doi:https://doi.org/10.1016/j.ijid.2021.09.005
Shahsavari, H., Ghiyasvandian, S., Houser, M. L., Zakerimoghadam, M., Kermanshahi, S. S. N., & Torabi, S. (2017). Effect of a clinical skills refresher course on the clinical performance, anxiety and self-efficacy of the final year undergraduate nursing students. Nurse Education in Practice, 27, 151-156.
Shinohara, M., Nakamura, T., & Kunikata, N. (2020). A half-day stroke workshop based on the Kirkpatrick model to improve new clinical staff behavior. Journal of Advances in Medical Education & Professionalism, 8(1), 10.
Ulrich, B., Krozek, C., Early, S., Ashlock, C. H., Africa, L. M., & Carman, M. L. (2010). Improving retention, confidence, and competence of new graduate nurses: Results from a 10-year longitudinal database. Nursing economics, 28(6), 363.
Wei, L.-z., Zhou, S.-s., Hu, S., Zhou, Z., & Chen, J. (2021). Influences of nursing students’ career planning, internship experience, and other factors on professional identity. Nurse Education Today, 99, 104781.
Yang, M., Zhang, X., Han, R., Ding, X., Gao, R., Jing, Q., . . . Li, H. (2025). Evaluation of the effectiveness of rehabilitation nursing training for clinical nurses based on the Kirkpatrick model. BMC nursing, 24(1), 374. doi:10.1186/s12912-025-02889-1
Young, M. E., Stuenkel, D. L., & Bawel-Brinkley, K. (2008). Strategies for easing the role transformation of graduate nurses. Journal for Nurses in Professional Development, 24(3), 105-110.
Z Parsa, Y., & F Ramezani, B. (2006). Nursing students' viewpoints about their clinical competencies and its achievement level.
Zare, M., & Vizeshfar, F. (2019). Evaluation of Health Education Volunteering Program based on" Kirkpatrick Model. Journal of Health Promotion Management, 8(1), 30-34.
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