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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

As stu

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d su

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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

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

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).

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

As stu

de

nts e

nte

r the

me

d su

rg

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

First Medical-Surgical Experience: Surmounting personal and contextual

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).

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

As stu

de

nts e

nte

r the

me

d su

rg

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

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

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?

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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

As stu

de

nts e

nte

r the

me

d su

rg

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