The purpose of this research project was to investigate peer-assisted learning (PAL) with two levels of pre-licensure nursing students. Through PAL, students at different levels are actively involved in the teaching/learning process (Williams & Reddy, 2016). This collaborative educational strategy provides positive benefits for both the student learners and student teachers. Because nurses provide patient education and precept nurses and nursing students, teaching is an integral part of their professional role. Therefore, educational programs should encouraged this innovative teaching strategy (Irvine, Williams, & McKenna, 2017).
A subset of PAL is near-peer teaching, in which students who act as teachers have at least one additional year of experience than learners. According to McKenna and Williams (2017), near-peer learning allowed student learners to identify with their peer teachers and better understand the course expectations, alleviated students’ anxiety about clinical rotations, and helped them learn to manage difficult situations. Studies similar to this have been conducted with medical students. The benefits to the student learners included receiving helpful feedback on clinical skills and having a supportive learning environment. The advantages for the student teachers included developing their teaching skills and refining their own knowledge and clinical competence (Khaw & Raw, 2016; deMenezes & Premnath, 2016). Students were also introduced to role models through the near-peer teaching process, and the student teachers voiced a greater interest in being involved with medical education after the experience (Nelson et al., 2013). Brauer, Axelson, Emrich, Rowat, and Stafford (2014) found that a near-peer shadowing program alleviated students’ anxiety about the transition from the classroom setting to clinical rotations. In addition to improving clinical skills, near-peer teaching assisted the learners to develop (effective) communication skills (Aba Alkhail, 2015). In near-peer education with junior medical residents and third-year medical students, the junior residents felt that the experience helped them to become more aware of their own limitations, encouraged collaboration, and helped to stress the importance of using a systematic approach when evaluating sick patients (Antonelou, Krishnamoorthy, Walker, & Murch, 2014).
In undergraduate nursing programs, PAL has been incorporated through the use of standardized patients. By utilizing standardized patient simulation experiences, students are exposed to real-life scenarios within the confines of a nonthreatening environment. They are also a realistic way to evaluate the health assessment skills of nursing students (Sarmasoglu, Dinç, & Elçin, 2016). In addition, the debriefing process that occurs between the student teacher and student learner is an invaluable tool to provide feedback to the student learners. Sideras et al. (2013) also found that students’ communication skills were enhanced through the use of standardized patients. Students provided positive feedback about standardized patient experiences in which higher-level nursing students served the role of patients for first-year nursing students (Owen & Ward-Smith, 2014; Bryant 2017).
In this study, PAL was used among the first semester junior and second semester junior undergraduate nursing students in a rural, bachelor of science in nursing program. Eight second- semester junior students who were enrolled in the Adult Health I course were recruited to be standardized patients and student teachers for the 62 first semester junior Health Assessment students, who were in in the role of student learners. The first semester students randomly received one of six focused health assessment scenarios, and the second semester junior students provided feedback to students on their assessment skills after the conclusion of each standardized patient simulation. The research study was approved by the institution’s Institutional Review Board. Written informed consent was obtained prior to the simulation experience. The students completed an anonymous, online survey immediately following the standardized patient experience and then six weeks later. The survey was adapted from the instrument utilized in a similar, prior study and used with permission from the authors (Owen & Ward-Smith, 2014).
The participants in this study consisted of first semester junior (N=62) and second semester junior (N=8) undergraduate nursing students. Of the 70 prelicensure students who participated in the simulation experience, 100% completed the post-test survey (PT1) immediately following the experience, and 56 students (80%) completed the post-test survey administered six weeks later (PT2). Students’ opinions and perceptions of the simulation experience were measured on a Likert scale, with 1 being strongly agree and 5 being strongly disagree. The total median score for the ten perception questions was 2.3 at immediate post-test and 2.2 at six-weeks after the simulation experience, corresponding to a consistent level of agreement from immediate post-test to the six-week post-test. Participants were asked to provide qualitative feedback about their experience in both the immediate post-test and the six-week post-test after the simulation experience. General themes in responses included that working with nursing students at a different level in the program was helpful. Some participants reported feeling “intimidated” and “nervous” but felt that it was a helpful experience. Participants reported the “most useful” aspect of the experience was the feedback provided to by the second semester students. The predominate theme in responses regarding the “least useful” aspect of the experience was the time allowed for the scenario (8 minutes) and the limitation of only one standardized patient experience per semester. Many participants recommended this experience to all nursing students.
Our study has demonstrated benefits of PAL for student teachers and student learners alike. Peer-assisted learning (PAL) is a growing area of research in nursing education. Future PAL studies could research the experiences of students with at least one year between their program levels and could be conducted over a longer time frame. In addition, it may be helpful to have students participate in multiple standardized patient scenarios during a semester. In conclusion, intraprofessional simulation is an innovative teaching strategy which offers beneficial learning opportunities for all students involved.