In prelicensure nursing programs, peer-assisted learning (PAL) has been incorporated with standardized patients (SPs). Through SP encounters, students experience real-life scenarios in a nonthreatening environment. This is a realistic way to evaluate the health assessment skills of nursing students.1 In addition, the debriefing process that occurs between learners and their peers as teachers is valuable to provide feedback to students. In 1 study, students' communication skills were enhanced through use of SPs.2 In other studies, students provided positive feedback about SP experiences in which higher-level nursing students served the role of SPs for first-semester nursing students.3,4

Methods

In our BSN program in rural South Carolina, 8 second-semester junior students enrolled in the first adult health course were recruited to be SPs and peer teachers for the 62 first-semester junior students in health assessment. The students who volunteered to be SPs were permitted to count the experience as clinical practice hours. The first-semester junior students received copies of the scenarios the day before the simulation. The SPs were instructed on the scenarios and their role prior to the experience. Approval for the study was received from the university's institutional review board.

The simulated experiences were implemented in examination rooms that resembled a realistic clinical environment. Students obtained a history and performed a focused physical assessment on the SP, who assessed their clinical competence in Observed Structured Clinical Examinations (OSCEs). Even though the OSCEs were not graded, students were encouraged to use this opportunity to refine their assessment skills before they were evaluated and graded on their head-to-toe assessment. There were 6 different scripted scenarios for the focused assessments, which included chest pain, cough, heartburn, palpitations, shortness of breath, and vomiting. Each first-semester junior student was randomly assigned to 1 of the 8-minute scenarios. Afterward, the SPs used 5 minutes to provide feedback to the first-semester nursing students, ask questions, and provide further clarification if needed. All participating students and faculty debriefed after the experience for questions and feedback.

Each student completed an anonymous online survey immediately following the experience. The survey was adapted with permission from the instrument developed by Owen and Ward-Smith.3 The survey consisted of 10 items rated on a 5-point Likert scale (1 = strongly agree and 5 = strongly disagree). In addition, 4 open-ended questions were included to collect qualitative data.

Results

Of the 70 students, all completed the survey. The majority of participants were female (84.3%) and white (60.0%). Most of the participants were between the ages of 18 and 25 years of age (78.6%). The overall mean score on the 10 survey questions was 2.3 of 4.0, with 67.5% of students agreeing or strongly agreeing with each item.

A total of 66 participants provided responses to the open-ended question, "How did you feel about working with nursing students who were at a different level during this simulation experience?" Students indicated this experience was helpful, as 1 participant reported: "It helped me see that what we learned in our first semester will be carried into the following semesters." Although some participants reported feeling "intimidated" and "nervous," it was valuable having peers as SPs because they understand the content taught in prior courses. The most useful aspect of the experience was the feedback provided by the peer SPs (n = 67): "Talking with the students immediately after the examination and having an open dialogue contributed to [my] learning and for conducting the exam." One of students who served as an SP commented: "Critiquing students made me think about what they should have done differently and gave me the opportunity to teach some of the skills I learned in my own clinical experience." The least useful aspect of the experience was the short time allowed for the scenario (8 minutes) and the limitation of only 1 practice (n = 57).

Limitations

A limitation to this study is that it was conducted over a single semester, and it is not known whether PAL combined with the SP scenarios will benefit students in a clinical setting. The nursing students were from 1 nursing program, so these findings are not generalizable to other groups. Furthermore, the study lacked a comparison or control group for assessment of impact.

Conclusion

Peer-assisted learning is a growing area of research in nursing education and provides benefits for students as peer teachers and students as learners. Several of these benefits include opportunities to provide teaching to lower-level students, peer feedback on assessment skills, and collaboration among nursing students. Because the second-semester junior nursing students had experienced the first semester of the nursing program, their feedback was perceived as supportive and genuine. In conclusion, intraprofessional PAL simulation is an innovative teaching strategy that offers beneficial learning opportunities for nursing students.

References