SNAPS+: Peer-to-Peer and Academic Support in Developing Clinical Skills

Saturday, 21 April 2018

Martin Christensen, PhD1
Sherree Gray, SN1
Matthew Wheat, SN1
Judy Craft, PhD2
(1)School of Nursing, Queensland University of Technology, Caboolture, Australia
(2)School of Biomedical Sciences, Queensland University of Technology, Caboolture, Australia


Peer-to-peer teaching is seen as a learning partnership between nursing students. In many respects it promotes a shift in responsibility and commitment of learning squarely on the students (White, Rowland, Pesis-Katz, 2012). Moreover, adopting a peer learning approach offers peer tutors a better appreciation of the difficulties experienced by their fellow students more so than their teachers and are therefore better placed to offer more succinct and tailored learning opportunities (Ravanipour, Bahreini, Ravanipour, 2015; Carey, Kent, Latour, 2016). Where these learning opportunities take place is often down to the discretion of peer tutors and as to what capacity their role takes in supporting other students. For example, a number of studies and systematic reviews have identified that the clinical environment is predominately where learning and support takes place with senior nursing students mentoring and buddying more junior colleagues (Palsson, Martensson, Swenne, et al., 2017; Stenberg, Carlson, 2015; Stone, Cooper, Cant, 2013; Owen, Wars-Smith, 2014).

The outcomes associated with peer learning are well recognised – enhanced critical thinking, an enriched sense of self-determination, empowered learning, and improved collaboration (Palsson, Martensson, Swenne, et al., 2017; Stone, Cooper, Cant, 2013). However, what is less evident is the relationship between peer tutors and nursing academic staff in supporting nursing student learning especially in teaching the clinical skills component of the bachelor of nursing degree.

Clinical Skills Labs

Sessions within the clinical skills lab were largely conducted according to student need, therefore the students were the drivers as to what it was they wanted to learn. These were conducted once a week for two hours per week throughout the thirteen week semester period. For the first years this was revisiting and enhancing their skills around taking vital signs observations such as blood pressure and pulse. The second years were concerned with injection technique and the setting up of intravenous fluid infusions and the constitution of drugs such as antibiotics. The role of the student peer teachers was to support learning by demonstrating the skill to the nursing students at a basic task level. The role of the nursing academic was to reinforce the skill at a more advanced level for example medico-legal aspects of the skill being undertaken, the application of physical assessment skills and the nuances of practice.


The aim of the project is to evaluate the effectives of a collaborative approach to student learning using peer-t-peer teaching in conjunction a nursing academic within the clinical skills labs.


Nursing students currently enrolled in an undergraduate bachelor of nursing programme (n=390) at a regional university campus were invited to attend peer-to-peer teaching of clinical skills over a one semester period. Of this sample a total of 41 first (n=14) and second (n=27) year nursing students attend these sessions. At completion of the labs the attending students were then asked to complete a nine item Likert scale (strongly agree to strongly disagree) and four opened ended questions of their experience of peer-to-peer teaching. The Likert scale posed statements such as “the peer-to-peer skills sessions have boasted my confidence in performing nursing skills; having an academic present with the peer tutors is good in helping me to understand and apply my nursing skills; I feel encouraged to actively participate within the peer-to-peer skills sessions”. These were offset with some negative responses so as not to cast the SNAPS programme as a complete success. These negative statements include: “I feel the student peers do not have enough clinical experience to be effective; the peer-to-peer learning should be just that peer-to-peer, a nursing academic should not be present. Descriptive statistics were used to evaluate and analyse the student responses. In line with institutional policy as this was an evaluation of teaching practice ethics approval was waived for this study.


There were two main drivers students attended the SNAPS sessions: for the first years it was because they had assessment due on their ability to undertake and interpret vital signs observation and for the second years it was because they were about to go out into clinical placement. That said the students were in favour of the peer-to-peer learning as a whole with 80% (n=33) strongly agreeing with the statement peer-to-peer learning boast my confidence and 83% (n=34) strongly agreeing that they felt encouraged to participate. Responses associated with the academic being present were also very favourable with 90% (n=37) feeling that having an academic present help them to understand and apply the skills more effectively. Using deductive content analysis three themes were identified from the open-ended questions: feeling grateful, feeling confident and identified skills deficit.


Peer-to-peer learning has been shown to improve confidence in those that attend. This project certainly demonstrated that with the added advantage that students’ felt able to be more inclusive in. Having and academic present also boasted confidence inasmuch that the peer tutors also had opportunities to learn from an experienced registered nurse as well as those students who attended to practice their skills.


It is readily accepted that the sample size was small (11%) given the total cohort number. However, we contend that as the SNAPS sessions were voluntary we were pleased with the number that attended. We were also disappointed that no third year nursing student attended and we put this down to the fact that they were not on clinical placement during this semester and therefore the necessity of practicing or enhancing their skills was not a priority. However, because of the popularity of the SNAPS sessions we are looking at running in the next academic semester so as to capture all three years simply because they will all be going out into clinical placement at some point during this time.

Implications for Nursing Education

It is evident from this project that peer-to-peer learning supports teaching of the clinical skills to a certain specified level; this level is often focused on skills mastery at an elementary level. The inclusion of a nursing academic supports application and integration of these skills by using clinical experience and constructive alignment strategies that supports deeper learning. The benefits to this approach ensure that the student feels comfortable and feels less pressure to perform in a safe environment. However, while the benefits are clear, this approach is resource intensive inasmuch that it requires an academic to present during specified times. In addition the skills sessions have to revolve around the peer tutors own clinical placement schedule as well as attending to their own study.

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