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Near Peer Learning to Facilitate Nursing Students' First Medical-Surgical Clinical Experience

Patricia Alfaro N., MSc(A) , Vanessa Di Criscio N., MSc(A)

Sandie Larouche, N., MSc(A) and Margaret Purden N., PhD.

DECLARATION OF POTENTIAL CONFLICT OF INTEREST

I do not have an affiliation

(financial or otherwise) with a commercial entity.

Background

The Clinical Practicum: A key pedagogical approach

Finding appropriate clinical experiences for students is a challenge.

! A global nursing shortage

! More acutely ill clientele

Wyte-Lake, Tran, Bowman, Needleman, & Dobalian, 2013;

Schatz, Marraffino, Allen, & Tanaka, 2013

Background

Health and Physical Assessment (HPA): A skill.

“The foundation of effective nursing care.”

Birks, Cant, James, Chung, & Davis, 2013

Near Peer Learning and HPA

Near Peer Learning: A strategy to ease students’ entry into the clinical setting

!  Provides a supportive learning environment

!  Encourages students to develop their skills such as HPA

Near Peer Learning Activity

!  To create an opportunity for early clinical exposure for U1 students, in the context of the Health and Physical Assessment course.

!  To create an opportunity for U2 students to demonstrate integration of knowledge and practice, and introduce leadership skills.

Near Peer Learning Activity

Purpose

To explore junior nursing students’ experience and perceptions of their first medical-surgical clinical practicum following their participation in a near peer learning activity(NPLA).

Study questions

1.  How did nursing students perceive their experience in their first medical-surgical practicum?

2.  What concerns did nursing students express about being in the practicum?

3.  How did nursing students experience performing a health and physical assessment (HPA)?

Methods

Qualitative descriptive design

!  Recruitment email sent by the class representative and an info session was held

!  Semi-structured interviews lasting on average 55 minutes

!  Audio-recorded and transcribed

!  Qualitative analysis

Sample

Consented to - Take part in the study

- Be audio-recorded

Students in the

NPLA-HPA

March 2015

21 7

3

Findings

Near Peer Learning: Making Nursing Real •  Becoming comfortable with hospital

environment/patient situation •  Getting excited about nursing •  Feeling prepared and confident to face

the reality of clinical •  Owning their HPA skills

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First Medical-Surgical Experience: Surmounting personal and contextual

challenges

Recognizing signs of skill development: •  Adjusting to the setting

and rhythm of unit •  Seeking out resources •  Performing tailored HPA

Becoming comfortable with hospital environment/patient situation

` “it opened my eyes to so many things I didn’t know… small things like people are not wearing anything underneath their gown, because I feel like those small things can really throw people off”(S6).

Getting excited about nursing

`

“When I got there and I saw that the second year student was doing all of these things…I was like oh wow, she’s doing that for real. So yeah, that made me excited to start my second year.” (S2)

Feeling prepared and confident to face the reality of clinical

` “I pick up things more quickly. So I don’t need to work on my confidence. I don’t need to spend time telling myself okay, you can do it, [...] Like, I’m above that level already, which is where I see other students are not there yet…”(S3).




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challenges




challenges

Unreceptive learning environments

“I feel like sometimes in the nurse's' eyes and in my instructor’s eyes, all they can see would be us still flopping around the first few days and not being able to do anything. […]We’re not really expected to do things right. So when we actually do things right, there is no feedback because that’s the way you’re supposed to do it […] And then when we make mistakes, however, we get scolded pretty badly. […] We don’t really know when we’re doing things right because we never really get recognized for that as well”(S6).




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challenges



Seeking out resources

“When other nurses are going to be performing those skills… I want to see exactly how they’re doing it. I always ask them what tips and tricks they can give me[...] it’s very nice that they’re helpful and they give you all that information (S5). ”

Performing tailored HPA

“[NPLA] gave me an idea of what it is … we have to focus on the problem. Definitely, it helped me learn how to narrow down my physical assessment” (S8).

Discussion and conclusion

Discussion

! The challenges of clinical learning ! Early clinical exposure with a supportive near peer

– a powerful learning experience

The challenges of clinical learning

The perfect storm of:

!  Not measuring up

!  Unreceptive learning environment

Early clinical exposure with a supportive near peer

Structured and individualized accompaniment in early stages of clinical promotes:

!  Confidence in abilities

!  Sense of empowerment

Hickey, 2010

Implications: Near peer experience

! An early experiential learning experience in the clinical setting may be appropriate and even timely for novice students

!  The conditions defining a positive clinical learning experience may include being time-limited, structured and guided by a near peer.

Implications: Medical –Surgical experience

!  Providing a safe, supportive clinical learning environment is of paramount importance in ensuring that the teaching and learning experience is optimal

!  Coaching, supervision and constructive feedback are critical to promoting student learning and making them feel that they are measuring up

Limitations

!  Lack of a comparative student cohort

!  Phone interviews were shorter in duration

!  Some interviews were held later in the semester affecting recall

What the future holds…

Students have recommended

!  Prolonging the near peer relationship

!  Providing longer exposures in the clinical setting with a

near peer

What should the future hold…

Research directions

!  The senior student’s experience of a NPLA

!  Exploration of students’ perceptions of “not measuring up”

and the factors that influence their outlook

!  Comparative study of NPLA

Questions?

References

!  Alzayyat, A., & Al‐Gamal, E. (2014). A review of the literature regarding stress among nursing students during their clinical education. International Nursing Review, 61(3), 406-415.

!  Aston, L., & Molassiotis, A. (2003). Supervising and supporting student nurses in clinical placements: The peer support initiative. Nurse Education Today, 23(3), 202-210.

!  Baid, H. (2006). The process of conducting a physical assessment: A nursing perspective. British Journal of Nursing, 15(13), 710-714.

!  Becker, M. K., & Neuwirth, J. M. (2002). Teaching strategy to maximize clinical experience with beginning nursing students. The Journal of Nursing Education, 41(2), 89-91.

!  Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). Educating nurses: A call for radical transformation (Vol. 15). Standford, CA: John Wiley & Sons

!  Birks, M., Cant, R., James, A., Chung, C., & Davis, J. (2013). The use of physical assessment skills by registered nurses in Australia: Issues for nursing education. Collegian, 20(1), 27-33.

!  Burnard, P. (1991). A method of analysing interview transcripts in qualitative research. Nurse Education Today, 11(6), 461-466.

!  Carlson, S. (2003). Accompaniment needs of first year nursing students in the clinical learning environment. Curationis, 26(2), 30-39.

!  Chan, D. (2001). Development of an innovative tool to assess hospital learning environments. Nurse Education Today, 21(8), 624-631

!  Chan, D. (2002). Development of the clinical learning environment inventory: Using the theoretical framework of learning environment studies to assess nursing students' perceptions of the hospital as a learning environment. Journal of Nursing Education, 41(2), 69-75

!  Dadoun, A., Bhanji, F., & Dubrovsky, S. (2014). Peer Teaching: An effective method for simulation-based instruction [Abstract]. Simulation in Healthcare, 9(6), 406.

!  Dornan, T., Littlewood, S., Margolis, S. A., Scherpbier, A., Spencer, J., & Ypinazar, V. (2006). How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Medical Teacher, 28(1), 3-18

!  Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2011). The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse. JBI Library of Systematic Reviews, 9(53), 2215-2323.

!  Gaba, D. M. (2004). The future vision of simulation in health care. Quality and safety in Health care, 13(suppl 1), 2-10.

!  Garcon, S. (2014). Developing a Small Group Teaching Session for Mentors Using the Adaptive Mentoring Model. Unpublished manuscript, Ingram School of Nursing, McGill University, Montreal, Canada.

!  Garrett, B., MacPHEE, M., & Jackson, C. (2010). High-fidelity patient simulation: Considerations for effective learning. Nursing Education Perspectives, 31(5), 309-313.

!  Graneheim, U. H. & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112.

!  Green, J., Willis, K., Hughes, E., Small, R., Welch, N., Gibbs, L., & Daly, J. (2007). Generating best evidence from qualitative research: The role of data analysis. Australian and New Zealand Journal of Public Health, 31(6), 545-550. doi:10.1111/j.1753-6405.2007.00141.x

!  Hickey, M. T. (2010). Baccalaureate nursing graduates' perceptions of their clinical instructional experiences and preparation for practice. Journal of Professional Nursing, 26(1), 35-41.

!  Khanal, S., Bhusal, M., Sigdel, M., & Bajracharya, S. (2016). Acquisition of history taking, physical examination and communication skills through early clinical exposure among pre-clinical students. Journal of Institute of Medicine, 39(1

!  Kleehammer, K., Hart, A., & Keck, J. F. (1990). Nursing students' perceptions of anxiety-producing situations in the clinical setting. The Journal of Nursing Education, 29(4), 183-187.

!  Milton-Wildey, K., Kenny, P., Parmenter, G., & Hall, J. (2014). Educational preparation for clinical nursing: The satisfaction of students and new graduates from two Australian universities. Nurse Education Today, 34(4), 648-654.

!  Naeger, D. M., Conrad, M., Nguyen, J., Kohi, M. P., & Webb, E. M. (2013). Students teaching students: Evaluation of a “near-peer” teaching experience. Academic Radiology, 20(9), 1177-1182.

!  Norman, J. (2012). A Systematic Review of the Literature on Simulation in Nursing Education. ABNF Journal, 23(2), 24.

!  OIIQ. (2009). Recommandations sur les stages cliniques dans la formation infirmière intégrée.

!  Owens, L. D., & Walden, D. J. (2001). Peer instruction in the learning laboratory: A strategy to decrease student anxiety. Journal of Nursing Education, 40(8), 375-377.

!  Pitt, V., Powis, D., Levett-Jones, T., & Hunter, S. (2012). Factors influencing nursing students' academic and clinical performance and attrition: an integrative literature review. Nurse Education Today, 32(8), 903-913.

!  Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

!  Rashid, M. S., Sobowale, O., & Gore, D. (2011). A near-peer teaching program designed, developed and delivered exclusively by recent medical graduates for final year medical students sitting the final objective structured clinical examination (OSCE).

BMC Medical Education, 11(-1), 1-7.

!  Sandelowski, M. (2000). Focus on research methods: Whatever happened to qualitative description? Research in Nursing & Health, 23, 334-340.

!  Schatz, S., Marraffino, A., Allen, C., & Tanaka, A. (2013). Human–Systems Integration, Simulation, and the Nursing Shortage. Paper presented at the Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare.

!  Sheu, S., Lin, H.-S., & Hwang, S.-L. (2002). Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice: the effect of coping behaviors. Int J Nurs Stud, 39(2), 165-175

!  Sprengel, A. D., & Job, L. (2004). Reducing student anxiety by using clinical peer mentoring with beginning nursing students. Nurse Educator, 29(6), 246-250.

!  Wyte-Lake, T., Tran, K., Bowman, C. C., Needleman, J., & Dobalian, A. (2013). A systematic review of strategies to address the clinical nursing faculty shortage. The Journal of Nursing Education, 52(5), 245-252.

!  Yates, P., Cunningham, J., Moyle, W., & Wollin, J. (1997). Peer mentorship in clinical education: Outcomes of a pilot programme for the first year students. Nurse Education Today, 17, 508-514.

!  Yardley, S., Littlewood, S., Margolis, S. A., Scherpbier, A., Spencer, J., Ypinazar, V., & Dornan, T. (2010). What has changed in the evidence for early experience? Update of a BEME systematic review. Medical Teacher, 32(9), 740-746.




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