Learning Strategies as Correlates of Clinical Skills among Nursing Students in North-West Nigeria

Abstract

Background: Competency-based nursing education requires students to demonstrate observable clinical skills, yet performance may vary according to how students organise, monitor and regulate their learning. Evidence linking multidimensional learning strategies with directly assessed clinical skills remains limited in Nigerian nursing education. Objective: To determine the relationship between learning strategies and clinical skills and to compare learning-strategy and clinical-skills scores between experimental and control groups of nursing students in North-West Nigeria. Methods: Quantitative quasi-experimental pre-test–post-test non-equivalent control-group study was conducted in two public nursing schools. Of 190 Year Two students, 152 agreed to participate and 128 were selected systematically: 64 in the experimental group and 64 in the control group. The experimental group received six weeks of structured academic coaching, while the control group continued routine instruction. Learning strategies were measured with the 64-item Learning and Study Strategies Inventory, and clinical skills were assessed using standardised checklists for taking vital signs, care of pressure areas, maintenance of oral hygiene and preparation of an unoccupied bed. Group comparisons, Pearson correlation, sensitivity analysis and hierarchical multiple linear regression were conducted. Results: At baseline, the groups did not differ significantly in overall learning strategies (experimental: 44.2 ± 13.0; control: 46.4 ± 12.5; p = 0.331) or overall clinical skills (43.9 ± 6.5 versus 45.0 ± 4.8; p = 0.278). At post-test, the experimental group had higher learning-strategy scores (72.0 ± 8.0 versus 53.8 ± 12.9; p < 0.001) and clinical-skills scores (78.4 ± 6.7 versus 59.3 ± 7.5; p < 0.001). Learning strategies were moderately correlated with clinical skills, r(126) = 0.556, 95% CI 0.423–0.665, p < 0.001, with a comparable Spearman coefficient (rho = 0.548, p < 0.001). In the adjusted model, learning strategies remained independently associated with clinical skills (B = 0.23, β = 0.27, p < 0.001). No substantial ceiling effect was observed for the overall outcomes. Conclusion: Stronger learning strategies were independently associated with higher observed clinical-skills scores after adjustment for group allocation, baseline scores, age and sex. Strategy-focused educational support may be beneficial when integrated with supervised clinical practice; however, the non-randomised school-level allocation and residual institutional confounding require cautious interpretation.