A review of the literature related to peer teaching and healthy work environments for nursing students revealed a number of pertinent findings. McKenna and French (2011) noted that peer teachers reported increased confidence in their knowledge, enhanced reflection on their own learning, and improved teaching skills which they expected to transfer to patient teaching as they entered practice. Brannagan, Dellinger, Thomas, Mitchell, Lewis-Trabeaux, and Dupre (2013) reported findings that were inconsistent with the literature noting that younger students did not report increased confidence or decreased anxiety when working with a more advanced peer tutor in skills lab. Peer tutors, however, noted improved communication skills and increased self-efficacy. In a report of research investigating the use of simulation to enhance preceptor preparation in practicing nurses, Wilson, Acuna, Ast, and Bodas (2013), reported on a quality improvement project that used simulation in addition to didactic content to improve a preceptor preparation course. Seventy-six percent of participants reported the addition of simulation as more helpful than the didactic instruction alone. Although simulation has been successfully used in nursing education as a substitute for up to 50% of clinical time (Hayden, Smiley, Alexander, Kardong-Edgren, Jeffries, 2014), there is a gap in the literature related to student participation as peer mentors in the simulation learning environment. Little is known about the potential role of senior nursing students as resources for junior students. The specific aims of this qualitative exploratory study were to:
Explore senior students’ perceptions of nursing education after participating in high fidelity simulation (HFS) as a resource person for junior students.
Enhance understanding of the effect noted by senior students on their perceived knowledge level and self-efficacy related to the condition covered in the simulation.
Increase understanding of junior students’ perceptions of learning from senior students.
Explore students’ perceptions of how activities like this might promote collegiality among nurses.
Methods: A purposive sample of 21 senior students was recruited from a final semester leadership course. They were assigned to HFS simulation labs to attend and actively participate as peer mentors. Junior students were assigned times to attend simulation lab in pairs or triplets by the junior level medical-surgical faculty. Seniors were given an orientation to simulation that included a single session lasting about one and a half hours. In this session they were introduced to theoretical concepts related to HFS, the specific simulation scenario that they would be assisting with, technical aspects of simulation, and principles of debriefing. During the simulation one senior was in the lab with students as a resource person while the other was in the control room to observe. At about the midpoint of the simulation they exchanged places so they were able to experience both roles. Following the simulation, seniors participated in debriefing with the simulation coordinator and junior students. Seniors were encouraged to offer supportive assistance during the simulation experience and to actively participate in the formative evaluation during debriefing. Leadership faculty observed in the simulation lab as well as in debriefing.
Immediately after debriefing, the two or three junior students who participated in the simulation were interviewed as a focus group by the principle investigator who is also the simulation coordinator. Half of the 12 groups were interviewed. Using a semi-structured interview guide students were asked to share their perceptions of the experience, the contribution the seniors made, and their thoughts related to the potential of activities like this to contribute to collegiality.
Seniors were asked to email their thoughts about the experience to the co-investigator who is also the course coordinator for the leadership course. They also were invited, but not required, to participate in focus groups which met about 2 weeks after the simulation experience.
Findings: Analysis of the data from the junior student focus groups revealed themes of appreciating having a resource person to ask questions of and feeling less intimidated with senior students than with faculty. Junior students reported being aware of the concept of incivility and lateral violence in nursing but were not sure about the contribution to future collegiality.
Data collected from senior students included observation by leadership faculty, students’ emailed comments, and focus group interviews. Focus groups were conducted using a semi structured interview guide. Analysis of focus group transcripts and emailed comments revealed several themes among students’ recommendations. More preparatory/prestudy work was suggested for the junior students coming to simulation lab to maximize the benefit of lab time. Seniors also noted that the experience made them aware of how much they had learned over the past year, increasing their confidence. Another common theme of the emailed feedback was the difficulty seniors experienced with knowing when to intervene and when to allow junior students to explore answers on their own. In observations, senior leadership faculty noted themes of empathy, reciprocal understanding and appreciation for the junior students’ initial awkwardness with tasks among the senior students. The senior students identified positive contributions to future collegiality.
Senior student focus group data revealed themes of learning theoretical considerations related to simulation, appreciating the work that goes into simulation, becoming more cognizant of thought processes in decision making, and recognizing the complexity of simulated situations.
Both junior and senior students were strongly positive about the experience and suggested that we continue to offer simulation this way. All seniors who participated stated they would like to assist in simulation lab again. All juniors who participated stated they hoped that we would continue to have seniors in simulation as a resource.
Implications: The experience of having seniors assisting juniors in simulation lab was a positive one for both groups. Juniors reported greater comfort and enhanced learning with having a resource person who was not a faculty member. Seniors reported increased confidence in their knowledge as advanced beginners and an appreciation of the complexity of the faculty role in developing and running high fidelity simulation. Seniors reported a sense of collegiality with faculty involved and expressed a sense of accomplishment in facilitating junior students’ learning.
Further research is needed to understand the ultimate contribution of this type of activity to nurses’ work environments and to the development of expertise in both junior and senior nursing students. . There is potential value in improved understanding of the intersection of enhancement of collegiality and the incidence of lateral violence during students’ academic careers and in the transition to post-graduate nursing.