Peer Assisted Learning in a Simulated Emergency Department Experience for Undergraduate Nursing Students

The role of peer assisted learning (PAL) in simulation is an emerging concept in nursing education and collaborative learning. Peer assisted learning is defined as “the act or process of gaining knowledge, understanding, or skill from students who are either at different or equivalent academic or experiential levels” (Henning, Weidner, and Marty, 2008, p. 85). According to Topping (2001), learning through teaching others, a key element of PAL, is the highest level in the learning approach hierarchy. According to Stone, Cooper, and Cant (2013), peer learning has been utilized to promote the foundations of nursing practice such as critical thinking and the acquisition of clinical knowledge and skills. Social cognitive theory (SCT) supports the use of peer learning strategies by joining students in activities that have similar knowledge levels and outcome objectives to build confidence in learning (Owen & Ward-Smith, 2013). In an effort to address IOM mandates for safety in nursing communication and to incorporate innovation into simulation experiences, the faculty developed an undergraduate simulated experience using standardized patients in an emergency department (ED) scenario. Nursing students at the junior and senior level participate in a simulation focused on five patients presenting to the ED. The five live actors (three adult patients and two pediatric patients with parents) have applicable moulage applied and are instructed to portray the specified clinical manifestations of their disease or injury. The use of standardized patients is an excellent approach to hands-on learning and offers the students more complex interactions requiring spontaneous responses. This strategy promotes active learning through the use of a dynamic learning environment and the application of previous and current knowledge in a simulated practice setting. Prior to the initiation of the simulation experience, all students are oriented to the clinical expectations of the learning activity and the documents required for data collection. Two junior students are assigned to a specific standardized patient. They then conduct an admission assessment using interviewing techniques and document vital signs. Subsequently, the senior students enter the ED area with outcome objectives to receive a SBAR report from the junior students assigned to each patient, gather any additional data about the patients through collaborative questioning of the junior students and the patient, and ultimately prioritize the acuity of the five patients based on their data collection. The junior students gain confidence and competence by repeatedly presenting their patient information to each team of senior students who rotate through the data collection process for the five patient scenarios. Through the process of cognitive modeling, the junior students elevate their clinical reasoning skills by observing enhanced assessment and interviewing techniques demonstrated by senior students. The junior students are able to identify data gaps from their initial patient assessment that are illuminated by the actions of their higher level peers. Peer assisted learning offers several benefits to a simulation experience. Students at both levels gain critical knowledge and skills about nursing concepts (i.e., disease and nursing processes). They practice professional communication skills through collaborative efforts to understand the acute care needs of each patient and family. Each student gains increased self-confidence by having the opportunity to practice in a safe, learner-centered environment, by interacting with realistic patients with unknown symptomology and natural responses, and by developing positive reciprocal relationships with their peers. Through the use of peer assisted learning in a simulated educational environment, peers helping peers learn has been very effective.