Effects of Clinical Coaching on Clinical Performances of Nursing Students at Nursing Schools in North-West Nigeria

Abstract

Clinical coaching is one educational intervention that researchers have identified to help students achieve their clinical performance goals. However, in northwest Nigerian nursing schools, coaching services are not available. The current study used a quantitative, quasi-experimental design with pre-post-test approach. Four clinical instructors received training on the coaching package before providing coaching to the study group. Data was collected using clinical checklists before coaching and two months later. The coaching was provided to the study group for six weeks. The study compares nursing students' clinical performance before and after coaching. It also established relationship between academic stress and clinical performance.

Keywords

clinical coaching clinical performance study group nursing students northwest Nigeria

Introduction

Students are an institution's greatest asset, and nursing schools are no exception. Students` performance helps to produce the highest-quality nurses, who go on to become outstanding nursing leaders and the workforce for their nation and profession (Kowalsky & Fresko, 2017).

Students that enrol in nursing programs have a variety of traits, some of which include various needs and learning styles. Nursing students' clinical competences are enhanced by well-structured clinical learning, which gives the very minimum clinical competencies needed to deliver nursing care (Tomietto et al., 2018). Coaching has the potential to enhance clinical performance, which contributes to overall student success. According to Anderson, (2018), coaching is a program that exposes students to self-evaluation, reflection, and goal-setting. In health institutions, two main types of coaching have been described: coaching in clinical skills and academic coaching. Coaching in clinical skills is a process by which a coach directly observes the students in the practicing a particular skill and then initiate the coaching process to improve the specific skill such as procedural training (Gagnon & Abbasi, 2017; Lovell, 2018; Rassbach & Blankenburg, 2018). This is the type of coaching conducted in this study. This study`s coaching was based a four-step theory approach to evaluate progress on goals (Swartz et al., 2015). The four steps included reviewing, evaluating, anticipating, and planning. The second type is academic coaching which is an intervention aimed to help students reflect on their interests and goals by focusing on barriers that may impede academic success such as poor organizational skills, poor time management skills, poor study skills, and poor study habits (Prevatt & Yelland, 2017; Robinson & Gahagan, 2019).

A tutor, mentor, or adviser will help a student build alternate abilities and understandings through the process of coaching, which also enables the learner to appreciate different types of knowledge (Stelter & Law, 2020). The coaching process enables students to concentrate on their educational experience, a challenge they must overcome, and their desired outcomes. This program aids students in identifying variables that may affect their academic experience and examines the learning environment. The academic coach's input enables students to pinpoint their areas for growth and develop a deeper comprehension of the learning strategy and their own behaviours.

Elder nurses have stated that nursing students' ability is lacking in terms of nursing standards, particularly when practicing in a clinical context (Liu & Aungsuroch, 2018). Older nurses in the clinical area have reported this instance, and as a result, they no longer feel safe giving them tasks (Agnes et al., 2017). This issue must be related to the type of education gained, particularly in clinical skills. The circumstances could corroborate the argument made by (Ironside et al., 2019) that students and instructors were more concerned with getting academic tasks finished than with developing a deeper understanding and readiness for practice, which has an impact on nursing practice as a whole. An additional problem is the lack of a coaching package for the nursing program, which led to its non-implementation in various schools of nursing in the region. Similarly, teaching methods may be inadequate, which has been linked to student nurses' acquisition of knowledge and clinical skills (Anarado et al., 2019; Azad et al., 2021). In many instances, even with an adequate teaching method, some factors can influence students` understanding and assimilation as well as the minimum clinical skills needed. Some of these include stress and adopting inappropriate learning strategies.

The Nursing and Midwifery Council of Nigeria advocated the use of preceptors for greater skills and familiarization with clinical environments due to the occurrence of these concerns in the nursing profession in Nigeria, similar to what was employed by the Egyptian government (Sinmileoluwa et al., 2020). In a similar vein, data from the Willis report (2019) showed that, beyond professional development and traditional clinical teaching, traditional one-to-one mentoring was no longer the most effective technique for imparting clinical skills. In order to support student practice learning, several new mentoring methods have been tested (Hill et al., 2020). In some ways, these are approaches to coaching's philosophy, principles, and techniques. There is an approaching vacuum in nursing because the majority of the literature on the subject of coaching focuses on staff development rather than student development and excludes diploma students in favour of graduate and registered nurses (Murray‐Gibbons & Gibbons, 2017). In light of this, a coaching program that focuses on diploma-seeking nursing students needs to be developed.

The researcher`s experience with academic coaching was a useful step in bridging the gap between theory and practice for nursing students and may offer solutions to clinical challenges like stress and learning strategies. In addition, all the coaching articles read by the researcher focus on graduate nurses and registered nurses, leaving out student nurses, who need to be adequately prepared for clinical activities.

The status of coaching in Nigerian nursing institutions is mostly mentoring, focusing only on revision and protocol for answering exam questions, leaving out the major issues in knowledge inquiry and clinical competencies. More so, Agnes et al., (2017) confirm that no standardized coaching strategy has been adopted in north-west Nigeria for nursing students. As a result, the study was prompted by the need for the development and evaluation of coaching strategies with a focus on student nurses' clinical performance in north-western Nigeria.

Literature Review

Research supports the importance of improving students’ levels of students` performance. Improving engagement and academic performance are key objectives addressed by institutional retention strategies. Taylor (2018) stated that outcome-based teaching addresses important issues related to students’ persistence and completion rates by providing them with a meaningful learning experience. Researchers have studied the effectiveness of academic coaching in institutions of higher education as a support and supplemental instruction strategy that can be used to improve student academic engagement and performance (Robinson & Gahagan, 2018).

Ashley and O’Neil (2019) in US conducted a quantitative study to evaluate the effectiveness of test coaching, an intervention designed to enhance the performance of high-risk nursing students on exam. The sample consisted of fourteen students in intervention and the sixteen in the control group. Results showed that the intervention group not only achieved a higher passing rate than the equivalent comparison group, but they also achieved a passing rate comparable to students who were not at risk for failing exam.

Brown-O'Hara, (2018), in US, conducted a study over six weeks titled the influence of academic coaching on baccalaureate nursing students' academic success, perceptions of the academic coaching relationship, perceived NCLEX-RN readiness and success on the NCLEX-RN exam found statistically significant difference between the pre- and post-coaching HESI exit exam scores. The majority of students’ HESI scores increased after coaching as compared to before coaching. Some of the explanations for this increase could be due to the activities that occurred in the academic coaching sessions such as review of exam questions, study skills and test taking skill strategies. The eight-week clinical experience of students between pre- and post-coaching testing could be another factor for the increase, as well as the introduction of additional nursing content in their nursing courses over the time frame.

Jason et. al., (2020), in their intervention study Surgical Coaching for Operative Performance Enhancement (SCOPE): skill ratings and impact on surgeons’ practice. Eleven of 23 coachees (48/) completed three coaching sessions, three (13/) completed two sessions, and six (26/) completed one session. Participants self-reported enhanced cooperation abilities, communication abilities, and awareness within and outside the operating room with regard to patient care. Participants acknowledged that coaching had the ability to lower intraoperative stress and promote peer support, which can relieve burnout. Despite demonstrating how surgical coaching might enhance surgical ability, this study may have some limitations due to the small sample size and variety of coaching sessions that students attended. It is also limited due to the limited number of sessions conducted which may not be significant enough to elicit coaching impact. One area of improvement is to improve number of sessions and ensure the students attended the planned sessions. Variation in number of sessions attended by students could lead to variation in skills acquired which would have been explored by this study. However, that was not measured by their study despite the existence of the variations.

A comparative study was conducted using GPA as a measurement of success between the groups of three different learning strategies for student learning process (Sue-Chan & Latham, 2016). External coaching, peer coaching, and self-coaching were the study interventions (Sue-Chan & Latham, 2016). In comparison to peer coaching and self-coaching, the study's findings indicate that external coaching was thought to be a very important factor in exam achievement.

Morton (2006), as cited in Agnes, et al., (2017), studied the concept of remediation and its impact on NCLEX-RN pass rates. To address students' subpar NCLEX-RN performance, a workgroup at the school was established. To ensure that every student receives uniform and comprehensive knowledge, standard curricula were created. To improve their skills with student interaction and inquiry, teachers underwent training in test construction workshops. NCLEX-RN review questions that were subject-specific were added to the university's already-existing structured learning assistance sessions. The School of Nursing's NCLEX-RN pass percentage increased from 65/ to 92/ within two years. This demonstrates how an important factor in a student's performance was the inclusion of NCLEXRN review questions in the curriculum. Remediation has some of the hallmarks of coaching, building on foundation and moving upward toward knowledge and academic success. However, study by Mustapha, Onibokun and Abiodun, (2020), in Northwest Nigeria found no significant association between studying habits and academic outcome of the undergraduate nursing students.

Robinson and Gahagan (2018), in their study, they used 182 students on academic probation from the University of South Carolina to describe the impact of academic coaching on improving student progress. The coaching model included self-assessment, reflection, and goal setting. Out of 182 students who took part, 92/ had improvement in their cumulative GPA. Although their results are positive and their case example involved a large sample, a comparison group was not used, thus limiting internal validity.

The literature reviewed on coaching and its effects on clinical and academic performance have shown some promising results. However, only one study review evaluated the students` clinical skills; this study was by design a post-test only design. It could not establish pre-test measure to compare with post-test measure that give strong internal validity. Additionally, this study had small sample size and the coaching session attended varied among students. Other studies reviewed although, utilized pre and post-test design, but evaluated the effect of academic coaching on students` academic performance without specifying the students` clinical performance. Measures that could use to meet students` needs could vary between clinical skill demand and theoretical knowledge demand. It is therefore necessary to find the effect of coaching on nursing students` clinical skills which was not specifically assessed by the studies reviewed.

Purpose of the Research

The purpose of this study was to assess the effects of clinical coaching on nursing students` clinical performances in north-west Nigeria.

Objectives of the Study

The aim of this study was to achieve the following objectives:

To determine the students’ level of clinical performance before and after coaching intervention

To find out the relationship between level of academic stress and clinical performance

Hypothesis

H₀₁There is no significant difference in the clinical performance between control and study group before and after intervention

H₀₂There is no significant relationship between level of academic stress and clinical performance

Methodology

Design and setting

In addition to the quantitative method, the researcher employed a quasi-experimental study design with pre-post-test measures to examine the effects of clinical coaching on nursing students` clinical performances. This study was undertaken in north-west Nigeria with the School of Nursing in Zamfara State as the study school and the School of Nursing in Sokoto as the control school.

Sampling Technique

Multi-stage sampling technique was used.

First stage: School of nursing Sokoto and that of Zamfara were purposively selected.

Second Stage: The systematic sampling method was used to select samples from 128 students out of 190 populations. Thus, 64 respondents were selected from each institution, totalling 128.

Clinical Coaching Package

The academic coaching package developed contains stress management, clinical performance and learning strategies. The goals serve as overall indicators of student progress or achievement during the academic coaching process, as captured in the student goal form.

Each Academic Coaching session was approximately 60-90 minutes, and follows a consistent structure. During the initial meeting, the coach explained the process of coaching to the student and the student and coach discussed the student's interests, current clinical performance, stress, learning strategies and goals for nursing practical. In session 2, practical demonstration of procedure was done and at least 50/ of the students done the practice. This was followed by the establishment of goals. Subsequently, the students, with coach facilitation develop weekly objectives. Weekly objectives were small action steps that the students agree to implement in the upcoming week to achieve their overall goals

For the remaining 3-5 sessions, in addition to stress management discussion and learning strategies, the student and coach demonstrate a new clinical procedure, discuss progress toward goals and objectives, and then finish the session with a discussion of specific strategies and skills that the student agreed to use in the upcoming week. Each session used a four-step approach to evaluate progress on goals (Swartz et al., 2015). The four steps included reviewing, evaluating, anticipating, and planning. The coach and the student spent each session reviewing goals set at their previous session, assessing whether or not the student accomplished the goals or objectives, evaluating the barriers preventing goal completion, and finally engaging in a discussion about strategies and ways to avoid those barriers in order to make progress towards the goal for the next session. During the final session, the student and coach discussed overall progress for each goal and whether or not the student achieved the goals specified.

Intervention

After the pre-test, then the weekly coaching package delivery schedule was deliberated and finalized. To assist clinical instructors in understanding how academic coaching can support learning, a 3-day in-service training program on academic coaching strategies, including providing adequate feedback, encouraging student collaboration and effective communication, and monitoring students’ clinical improvement as well as stress reduction was conducted.

The coaching was delivered by the four clinical instructors over a period of six weeks. Group coaching was conducted in which students were divided into groups of 16 and assigned to a coach to allow coachees practical engagement. The schedules varied between instructors either with some hours different or a day. After weekend demonstration, students were given weekly assignment to conduct. This includes 2 skill practice at the school and one at clinical area.

After conducting the last session of the coaching (week 6) then post-test data was collected from the control and study groups within two months. Subsequently, based on the data collected, a suitable statistical test was used for proper analysis. The control group, which had been on traditional practical demonstration during coaching delivery, was also taken through the coaching process after the intervention.

Target Population

The target population of the study was nursing students in year two (2), with a total number of one hundred and ninety (190) (85 from the Zamfara School of Nursing and 105 from the Sokoto School of Nursing). Similarly, four (4) qualified and experienced nurse tutors and clinical instructors were recruited and trained on coaching strategies in the study school. An instructor was concerned with the practical skills of the students, either in the facility or in the schools.

Sample size determination: The sample size was calculated using a formula for comparing the differences in the mean between independent groups (Rusner, 2015).

n = 2SD² (Zα_/2 + Z_β)²

d²

where

Zα_/2 =is the critical value of the Normal distribution at α_/2 (e.g., for a confidence level of 95/, α is 0.05 and the critical value is 1.96),

Zβ =is the critical value of the Normal distribution at β (e.g., for a power of 80/, β is 0.2 and the critical value is 0.84),

d= effect size, is the population variance,

Therefore,

Zα²=1.96 (from Z table at type 1 error of 5/)

SD= 20 (Study by Sabine, Martin & Eva, (2020)

Z_β= 0.842 (from Z table) at 80/ power

d= effect size= 10/

n = (2*20)² (1.96 + 0.842)²

100

n = (40)² (2.802)²

100

n = (1600) (7.84)

100

n = 12544

100

n = 125.44+2.56

n=128/2 = 64 per group

Inclusion Criteria: The study included those students who are currently in the nursing program, presence during coaching period, took part in pre-test, scored 89 and below in clinical skill test, had moderate to high level stress and attended all the six mandatory sessions.

Exclusion Criteria:The study excluded those students who scored 90 and above in clinical skill test and less stress, as well as those in other schools of nursing beyond the chosen schools. It also excluded the students on sick leave during coaching, first year students and students who are preparing for final exam.

Tools and Instruments

For this study, all the instruments used were adopted, and this includes The Nursing and Midwifery Council of Nigeria (NMCN) Checklist was used to assess the clinical skill of students, and the Scale for Assessing Academic Stress (SAAS) (Sinha, Nepal, & Sharma, 2001) was utilized; the test-retest reliability and split-half reliability of the SAAS are both 0.88 and 0.75, respectively. The implementation of the coaching package was tracked using the Student Goal Form/Activity Checklist and the Coach-Student Interactions Checklist.

Data Analysis

In this study, the Statistical Package for the Social Sciences (SPSS), version 23, was used for data analysis. The analyses of the pre- and post-test scores include descriptive analyses and inferential statistics. Clinical performance was assessed using the mean and standard deviation, with a score of 0–49/ denoting poor performance, 50–69/ indicating average performance, and >70/ denoting good performance. The inferential statistics include the computation of paired and independent t-tests and Chi-square. Paired and independent t-tests were used to examine the statistically significant differences between the pre-test and post-test levels of clinical performance within and between groups, respectively. Finally, chi-square was used to find whether differences exist between the control and study groups in socio-demographic characteristics and different levels of clinical performance. The level of confidence was 95/, and the p value was.05.

Results

In Table 1 the distribution of the studied groups according to their socio-demographic characteristics is shown:

Table 1

Distribution of the Studied Groups According to their Socio-demographic Characteristics

	Study Group n=64		Control Group n=64		Χ²	P
Variable	F	/	F	/
Gender
Male	29	45.30	31	48.44	.141	0.707
Female	35	54.70	33	51.56
Age
18-22	33	51.56	35	54.69
23-27	18	28.13	19	29.69
28-32	10	15.63	9	14.06	.265	.966
Over 33	3	4.69	1	1.56
Marital status
Unmarried	50	78.1	53	82.81	.686	.408
Married	14	21.9	11	17.19
Secondary School
Private	28	43.75	31	48.44	.772	.380
Public	36	56.25	33	51.56
Tribe
Hausa	60	93.75	62	96.88	.675	.714
Yaruba	4	6.25	2	3.13
Igbo	0	0	2	3.13

A Chi-Square Test of Independence was used to assess differences in socio-demographic characteristics between the study and control groups. Findings suggested that there were no significant differences between the study group and control group in their gender, age, marital status, education, and tribe. A chi-square test was performed to compare the level of clinical skills.

Table 2

Distribution of Studied Groups According to the Clinical skills Score Before Coaching Intervention

Schools	Study Group	Control Group
Clinical skills	Mean/SD	Mean/SD	t	P
Clinical Skill 1	37.8±14.4	42.1±8.0	-2.116	.037
Clinical Skill 2	28.0±10.4	45.4±7.4	-7.943	.021
Clinical Skill 3	48.0±12.2	44.7±9.3	1.765	.080
Clinical Skill 4	51.9±18.3	47.7±7.6	3.751	.011
Overall Scores	43.9±6.5	45.0±4.8	-1.018	.311

For the pre-test (Table 2) an independent t-test overall mean score and standard deviation for the intervention group are 43.9 6.5, which has not shown a statistically significant difference with the mean and standard deviation of the control group (45.0.4 4.8). p=0.311.

Table 3

Distribution of Studied Groups According to the Level of Clinical skills Before Coaching Intervention

Level	Study Group n=64		Control Group n=64
	F	/	F	/	Χ²	P
Poor	38	59.38	36	56.25
Average	25	39.06	26	40.63	0.65	.723
Good	1	1.56	2	3.13

Note: score of 0-49-poor, 50-69-average, >70-good

Table 3 shows that the majority of the respondents had poor skills in both study and control schools. The two groups are less likely to differ in their level of clinical skills before coaching intervention (Χ²=.723).

Table 4

Distribution of Studied Groups According to the Clinical skills Score after Coaching

	Study Group n=64	Control Group n=64	df	t	P
Clinical Skills	Mean/SD	Mean/SD	df	t	P
Clinical Skill 1	73.8±13.0	58.1±11.9	126	7.163	.000
Clinical Skill 2	78.6±12.0	61.9±11.1	126	8.168	.000
Clinical Skill 3	80.8±12.0	58.9±12.2	126	10.243	.000
Clinical Skill 4	80.1±13.1	58.2±11.5	126	10.022	.000
Overall Scores	78.4±6.7	59.3±7.5	126	15.071	.000

Note: Values are means ± standard deviation. Statistically significant at P < 0.05

The post-test mean scores of control and intervention schools differs with the intervention school having higher mean score and lower standard deviation (78.4±6.7 and 59.3±7.5), p = .000.

Table 5

Distribution of Studied Groups According to the level of Clinical skills After Coaching

Level	Study Group n=64		Control Group n=64
	F	/	F	/	Χ²	P
Poor	1	1.56	28	43.75
Average	35	54.69	31	48.55	132.35	.000
Good	28	43.75	5	7.81

Note: score of 0-49-poor, 50-69-average, >70-good

The study group, according to Table 5 above, after coaching have high level of average score with only one candidate having a poor level score. The result shows statistically significant as compared to control group (p=.000)

Table 6

Distribution of Study Group According to the Clinical skills before and After Coaching

Period	Pre-Coaching	Post-Coaching
Procedures	Mean/SD	Mean/SD	df	t	P
Clinical Skill 1	37.8±14.4	73.8±13.0	126	-14.887	.000
Clinical Skill 2	28.0±10.4	78.6±12.0	126	-25.571	.000
Clinical Skill 3	48.0±12.2	80.8±12.0	126	-15.358	.000
Clinical Skill 4	61.9±18.3	80.1±13.1	126	-6.487	.000
Overall Scores	43.9±6.5	78.4±6.7	126	-29.344	.000

Table 6 shows paired t-test of the clinical skills for pre and post- coaching of the intervention school. The overall pre-coaching mean score and standard deviation for the intervention group are 43.9±6.5 which show statistically significant difference as compared to the mean and standard deviation of the post-test scores (78.4±6.7). p=0.000.

Table 7

Distribution of Study Group According to the Level of Clinical skills Before and After Coaching Intervention

Level	Before Coaching n=64		After Coaching n=64
	F	/	F	/	Χ²	P
Poor	38	59.38	1	1.56
Average	25	39.06	35	54.69	57.891	.000
Good	1	1.56	28	43.75

The clinical skills level in the intervention school shows that the majority of the students (59.38/) had poor performance before coaching (Table 7). After coaching, the majority (54.69/) of them were at an average level. A chi-square test reveals a significant difference between the intervention school's pre- and post-test scores.

Table 8

Relationship between overall clinical performance and academic stress among studied groups before intervention

	Clinical Performance
Clinical Performance	1
Academic Stress	-.442

Table 8 shows a moderate correlation between level of academic stress and clinical performance. The relationships was negatively correlated and statistically significant (r= -.442, p<0.06).

Discussions

The result of the recent study in clinical performance confirms those of Ashley and O’Neil (2019), and Connelly, et al., (2019), in the US. According to the current study's independent t-test, students in the study school had higher clinical skills than those in the control school after the intervention, even though the control group's mean clinical skill score was higher before the intervention. Furthermore, the independent t-test demonstrated that the improvement in the study school was statistically significant. The test was successful as it was able to identify students who showed improvement in their clinical skills after intervention. The result of the current research corroborates that of Ashley & O’Neil, (2019), who show that the passing rate of students at risk was as high as 92/ as compared to 50/ in the control group. Both in the current study and that of Ashley and O’Neil, results showed that the intervention group not only achieved a higher passing rate than the control group, but they also achieved a score comparable to that of students who were not at risk for failing the exam. One notable difference between the recent study and that of Ashley and O’Neil (2019), was that, their study adopted a post-test only design, and thus, the pre-coaching data was not recorded. In this study, pre-coaching data was assessed, and the clinical skills of the students at the intervention school, were higher after the intervention than the scores obtained before the coaching intervention. This could explain the reason for the higher score of the study group in the current study as compared to that of Ashley and O’Neil.

However, unlike the current study and Ashley and O'Neil (2017), Ludolph et al., (2017), found no significant difference in skill acquisition after the intervention between the control and study groups, but a significant difference was found within the study group. This differs in some ways with the finding of this study, where significant differences were found between and within the study groups. Donna et al.'s findings might be affected by the contamination of participant groups during the study. However, in the current study, the control group had no access to the intervention.

A paired t-test was used to compare the clinical performance scores of study group students before and after coaching. The results indicate a statistically significant difference between the clinical performance scores of the study group before and after coaching. There was an improvement in the clinical performance scores of study group students. The explanations that could be provided for this increase could be that, the increase was due to the coaching activities that occurred during the delivery of weekly clinical coaching sessions, such as the review of students` clinical skills, study skills, and test taking strategies and goal setting. Another factor contributing to the increase could be the six-week combination of weekly practical demonstration and clinical experience of students before and after coaching testing. This is in addition to the introduction of stress management strategies provided over the study period. The provision of resources and other supports by the coach, which were introduced during the 6 weeks of coaching, could also be a factor in the improved post-coaching scores.

A moderate relationship between academic stress and clinical skills has been reported in the literature (Lievens et al., 2020). Although there were inconsistencies in the studies reviewed regarding the relationship between academic stress and academic performance, the results of this study confirm that there is a moderately negative and significant relationship between academic stress and clinical skills. As a result, this study established that stress reduction is associated with improvements in students` clinical performance. This means that, stress, depending on its level in students, could affect the clinical performance of a student. This association could be one of the factors that contribute to improvement in students' clinical skills after coaching, as shown in this study. It seems possible that poor clinical performances are due to effects of stress such as anxiety, depression, and a lack of concentration on clinical activities. This finding broadly supports the work of other studies in this area linking stress with clinical skills (Crego et al., 2019; Oketch-Oboth & Odiemo, 2018). For instance, Oketch-Oboth, and Okunya, (2018), found the relationship between stress and academic performance to be statistically significant (χ2 =9.49, N=584, df=4, p=0.048). The current findings are significant in at least two ways, including the recognition of stress as a factor influencing clinical performance and the use of a suitable environment for students to achieve clinical success. Findings by Collin et al., (2020), Alyami et al., (2017), and Kötter et al., (2017), showed that there was no link between academic stress and clinical performance. This differs from the findings presented here. It could be argued that, nursing students face moderate levels of stress on a daily basis, so it is critical that nursing schools and clinical placements create an environment that promotes learning while focusing on students' needs and well-being. As a result, the findings of this study support the creation of more student-friendly environments, as well as the implementation of strategies designed to reduce students' academic and clinical pressures, such as stress management education, time management classes, counselling services, accessible academic and clinical advice, and increased support from faculty and clinical placements.

Limitations

The study had its own limitations. The study was limited to students in their second year and only two nursing schools in northern Nigeria. Some sessions were conducted by the coaches without the presences of the researcher due to higher rate of insecurity in the region which sometimes led to rescheduling of supervision. Moreover, unlike qualitative studies, the use of a quantitative approach may not allow for in-depth exploration of other factors that could affect students` clinical skills. The study has a relatively small sample size and the effect was assessed within two months after intervention.

Conclusion

The present study was designed to determine the effect of clinical coaching on nursing students` clinical performance. The second aim of this study was to investigate the relationship between academic stress and clinical performance. One of the more significant findings to emerge from this study is that coaching program is an essential tool for improving clinical performance of student nurses. The second major finding was that significant moderately negative relationship exists between academic stress and clinical performance.

These findings have significant implications for the understanding of how students` clinical skill can be improved using coaching program and how stress is significantly related to clinical performance. The contribution of this study has been to confirm if coaching can influence the acquisition of skills of student nurses beyond the traditional way of practical skill delivery. These results add to the rapidly expanding field of coaching knowledge and practice that require evidence to ensure quality skills delivery to student nurses. The present study adds to the growing body of research that indicates coaching program can significantly improve student clinical skills. This is the first study that has investigated the effects of clinical coaching among student nurses in Nigeria. A key strength of the present study was the use of experimental study to evaluate the coaching effect and comparing the two independent groups. However, it is limited by the small sample size and the effect was assessed within only two months after intervention. A further study could assess the long-term effects of coaching on clinical skills of nursing students. Further studies need to be carried out in order to validate the current finding which shows significant negative relation between stress and clinical skill exists. This particular research finding also points to the need for the use of coaching in teaching nursing students a clinical skills.

Footnotes

Ethical approval

Ethical approval was sought from the Zamfara state ministry of health ethical committee with approval number ZSHREC0308202. The purpose of the study was explained to each participant, and only those who voluntarily agreed to participate were given the consent form for further explanation. All ethical principles guiding conduct were duly observed. No withdrawal from the study by the respondents.

References

Agnes

Anarado

Grace

Agu

Eunice

Nwonu

(2017). Factors hindering clinical training of students in selected nursing educational institutions in Southeastern Nigeria. Nurse Education Today 40(3), 140–145. 10.1016/j.nedt.2016.02.022

Alyami

Melyani

Johani

A. A.

Ullah

Alyami

Sundram

Hill

Henning

(2017). The Impact of Self-Esteem, Academic Self-Efficacy and Perceived Stress on Academic Performance: A Cross-Sectional Study of Saudi Psychology Students. The European Journal of Educational Sciences, 04(04), Article 04. 10.19044/ejes.v4no3a5

Anarado

A. N.

Agu

G. U.

Nwonu

E. I.

(2019). Factors hindering clinical training of students in selected nursing educational institutions in Southeastern Nigeria. Nurse Education Today , 40, 140–145. 10.1016/j.nedt.2016.02.022

Anderson

(2018). Untying the knots . In the CHI symposium Coaching in the Moment.

Ashley

O’Neil

(2019). The effectiveness of an intervention to promote successful performance on NCLEX-RN for baccalaureate students at risk for failure. The Journal of Nursing Education , 30(8), 360–366. 10.3928/0148-4834-19911001-07

Azad

M. B.

Konya

Persaud

R. R.

et al & CHILD Study Investigators. (2021). Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: A prospective cohort study. BJOG: An International Journal of Obstetrics and Gynaecology , 123(6), 983–993. 10.1111/1471-0528.13601

Collin

O’Selmo

Whitehead

(2020). Stress, psychological distress, burnout and perfectionism in UK dental students. British Dental Journal, 229(9), Article 9. 10.1038/s41415-020-2281-4

Crego

Carrillo-Diaz

Armfield

J. M.

Romero

(2019). Stress and Academic Performance in Dental Students: The Role of Coping Strategies and Examination-Related Self-Efficacy. Journal of Dental Education , 80(2), 165–172. 10.1002/j.0022-0337.2016.80.2.tb06072.x

Gagnon

L.-H.

Abbasi

(2017). Systematic review of randomized controlled trials on the role of coaching in surgery to improve learner outcomes. The American Journal of Surgery, 216. 10.1016/j.amjsurg.2017.05.003

10.

Hill

Woodward

Arthur

(2020). Collaborative Learning in Practice (CLIP): Evaluation of a new approach to clinical learning. Nurse Education Today, 85, 104295. 10.1016/j.nedt.2019.104295

11.

Ironside

Mcnelis

Ebright

(2019). Clinical Education in Nursing: Re-thinking Learning in Practice Settings. Nursing Outlook, 62. 10.1016/j.outlook.2013.12.004

12.

Kötter, T., Wagner, J., Brüheim, L., & Voltmer, E. (2017). Perceived Medical School stress of undergraduate medical students predicts academic performance: An observational study. BMC Medical Education , 17(1), 256. 10.1186/s12909-017-1091-0

13.

Kowalsky

Fresko

(2017). Peer Tutoring for College Students with Disabilities. Higher Education Research & Development , 21(3), 259–271. 10.1080/0729436022000020760

14.

Lievens

Coetsier

De Fruyt

De Maeseneer

(2020). Medical students’ personality characteristics and academic performance: A five-factor model perspective. Medical Education , 36(11), 1050–1056. 10.1046/j.1365-2923.2002.01328.x

15.

Liu

Aungsuroch

(2018). Current Literature Review of Registered Nurses’ Competency in the Global Community. Journal of Nursing Scholarship , 50(2), 191–199. 10.1111/jnu.12361

16.

Lovell

(2018). What do we know about coaching in medical education? A literature review. Medical Education , 52(4), 376–390. 10.1111/medu.13482

17.

Ludolph

Giese

M. A.

Ilg

(2017). Interacting Learning Processes during Skill Acquisition: Learning to control with gradually changing system dynamics. Scientific Reports, 7(1), Article 1. 10.1038/s41598-017-13510-0

18.

Murray‐Gibbons

Gibbons

(2007). Occupational stress in the chef profession. International Journal of Contemporary Hospitality Management , 19(1), 32–42. 10.1108/09596110710724143

19.

Oketch-Oboth

Odiemo

(2018). The Relationship Between Levels of Stress and Academic Performance Among University of Nairobi Students. International Journal of Learning and Development, 8. 10.5296/ijld.v8i4.13840

20.

Prevatt

Yelland

(2017). An Empirical Evaluation of ADHD Coaching in College Students. Journal of Attention Disorders , 19(8), 666–677. 10.1177/1087054713480036

21.

Rassbach

C. E.

Blankenburg

(2018). A Novel Pediatric Residency Coaching Program: Outcomes After One Year. Academic Medicine , 93(3), 430–434. 10.1097/ACM.0000000000001825

22.

Robinson

Gahagan

(2010). Coaching Students to Academic Success and Engagement on Campus. About Campus , 15(4), 26–29. 10.1002/abc.20032

23.

Rusner (2015). Rearranging formulae—Higher—Algebraic formulae—AQA - GCSE Maths Revision—AQA. BBC Bitesize. https://www.bbc.co.uk/bitesize/guides/zqpfcj6/revision/5

24.

Sinmileoluwa

Onibokun

Abiodun

(2020). Implications of Stress and Study Habits on Academic Outcome of Undergraduate Nursing Students in Selected Universities in South-West, Nigeria. Journal of Education, Society and Behavioural Science, 1–14. 10.9734/jesbs/2020/v33i730239

25.

Stelter

Law

(2015). Coaching – narrative-collaborative practice. International Coaching Psychology Review, 5. 10.53841/bpsicpr.2010.5.2.152

26.

Tomietto

Rappagliosi

C. M.

Sartori

Battistelli

(2018). Newcomer nurses’ organisational socialisation and turnover intention during the first 2 years of employment. Journal of Nursing Management , 23(7), 851–858. 10.1111/jonm.12224