Background

Evaluation of a complex intervention are often described as being diminished by difficulties regarding acceptability, compliance, delivery of the intervention, recruitment and retention. Research of peer learning for nursing students have found several positive benefits while studies of peer learning for newly graduated nurses are lacking. This study aimed (1) to investigate the study process in terms of (a) first-line managers’ perspectives on the intervention study, the difficulties they face and how they handle these and (b) new graduates’ fidelity to the intervention and (2) to examine the effect of the peer learning intervention in workplace introduction for newly graduated nurses.

Methods

A mixed-methods approach using semi-structured interviews with eight managers, repeated checklist for fidelity and questionnaires conducted with 35 new graduates from June 2015 and January 2018, whereof 21 in the intervention group. The peer learning intervention’s central elements included pairs of new graduates starting their workplace introduction at the same time, working the same shift and sharing responsibility for a group of patients for 3 weeks. The intervention also included 3 months of regular peer reflection.

Results

Managers offered mostly positive descriptions of using peer learning during workplace introduction. The intervention fidelity was generally good. Because of recruitment problems and thereby small sample size, it was difficult to draw conclusions about peer learning effects and, thus, the study hypothesis could either be accepted or rejected. Thereby, the study should be regarded as a pilot.

Conclusions

The present study found positive experiences of, from managers, and fidelity to the peer learning intervention; regarding the experimental design, there were lessons learned.

Trial registration

Before starting data collection, a trial registration was registered at (Trial ID ISRCTN14737280).

AIM: to describe why registered nurses decide to leave their work and to investigate relationships between registered nurses' working life and turnover (leaving the unit versus the profession).

BACKGROUND: Much research has explored nurses' intention to leave, while less research has looked at turnover and especially leaving the profession.

METHODS: Data were collected using questionnaires and interviews.

RESULTS: The three most common reasons for both groups (leaving the profession, n=40; leaving unit but not profession, n=256) were high workload, low salary and applied for and got a new job. Multivariate logistic regression analysis revealed statistically significant relationships between turnover and empowering structures, such as access to resources and informal power as well as the factor learning in thriving.

CONCLUSIONS: Structural empowerment, such as good access to resources and informal power, is important to keeping nurses in the profession, while learning seems to increase the risk of leaving the profession when variables such as vitality, resources, informal power and age are held constant.

IMPLICATIONS FOR NURSING MANAGEMENT: To counteract nurses leaving the profession, managers must provide nurses with good access to resources, informal power, such as networks within and outside the organization, and focus on nurses' vitality.

The purpose of this observational study was to describe the collaboration between first-year nursing students using peer learning during their first clinical practice education. In earlier, predominantly interview studies, peer learning has been described as a model with several positive outcomes. However, no studies on how students act in collaboration in a real-life context have been found. The present study observed sixteen arbitrarily paired nursing students (eight pairs) on three to five occasions per pair, in total 164 h from September 2015 to March 2016. Repeated unstructured observations including informal conversations were used. Using qualitative content analysis, one theme 'Involuntary collaboration leads to growth in different competencies' emerged and three categories 'Practising nursing skills and abilities when working together', 'Establishing knowledge by helping each other to understand' and 'Sharing thoughts, feelings, and knowledge and put them into words'. In conclusion, nursing students using peer learning were observed practising several competencies, some of them not so easily elicited according to earlier research as organization, nursing leadership, teaching, and supervision.

Aim

The aim of the present study was to elucidate health-promoting and -impeding aspects of peer-learning by examining nursing students' descriptions of learning together as peers, and how this might interact with their health.

Background

Peer-learning is a useful strategy for teaching and learning in nursing students' clinical practice education. In the research, benefits such as improved cooperation and increased self-confidence have been described and labelled as health-promoting.

Design

A qualitative descriptive approach Method Thirteen first-year nursing students aged 22-45 years, who had completed their first clinical practice education on a medical or surgical hospital ward, participated in one-on-one semi-structured interviews. The interviews were analyzed using qualitative content analysis.

Result

Working as a pair was primarily described as positive, as the peers felt basic support from each other, even though they described negative experiences that limited their own development and challenged their patience.

Conclusion

Peer-learning as a model for supervision in clinical practice incorporates valuable health-promoting aspects, as the students felt safe, supported, increased self-confidence, and participation. The interaction between peers helped them grow as human beings, and the mutual support the peers felt was a vital health-promoting aspect that limited the impact of the described health-impeding aspects, which included sometimes finding peer-learning trying, stressful and irritating.

The overall aim of present thesis was to study the use, feasibility and outcomes of a peer learning intervention for nursing students and new graduates, including studies using a quasi-experimental (Study I and III), descriptive (Study II) and mixed-methods (Study IV) design. Data were collected using questionnaires, observations, checklists for intervention fidelity, individual interviews and group interviews. When studying peer learning outcomes among nursing students, peer learning seems to have a significant interaction effect on self-efficacy, based on a comparison of changes over time between the intervention (n=42) and comparison (n=28) groups. Studying each group separately over time, significant improvements were found in the intervention group on thirteen of the twenty variables, whereas the comparison group improved on four (Study I). Observations of how nursing students (n=16) used peer learning revealed that the student pairs collaborated to different extents and in different ways. All students were observed practicing several competencies together (Study II). Testing the peer learning model in new graduates’ workplace introduction (n=10) revealed that new graduates’ descriptions of peer learning were consistent with the theoretical description (Study III). Feasibility was tested in relation to compliance and acceptability, and lessons were learned. In Study IV, fidelity to the intervention was generally good. When first-line managers (n=8) described their perception of using the peer learning intervention with new graduates, predominantly positive outcomes were expressed. When examining the effect of peer learning in workplace introduction for newly graduated nurses (n=35), it was difficult to draw any conclusions due to recruitment problems (Study IV). The conclusions is that peer learning is a useful model for nursing students’ that seems to improve self-efficacy more than traditional supervision does. The model gives nursing students opportunities to practice several competencies on each other, and these competencies, e.g., leadership and organizational skills are useful in their future profession. The students practice teaching and supervision skills on each other, which seems to be a natural part of the peer relationship. Peer learning in the context of new graduates’ workplace introduction describes in a way consistent with the theoretical description of peer learning outcomes thus, also here it seems as a useful model. When developing and testing new interventions such as peer learning, it is important to do so systematically to minimize problems when conducting an evaluation, where the MRC framework can be useful. First-line managers generally expressed a positive attitude toward the peer learning model.

AIMS:

To describe the feasibility of a peer learning intervention targeting newly graduated nurses. Feasibility was tested concerning consistency of the theoretical description of peer learning with empirical findings in a new context, compliance and acceptability, as well as usability of a questionnaire measuring the intended future outcome variables.

BACKGROUND:

Newly graduated nurses who meet, socialize and share experiences have described supporting each other's ability to cope with stress. Peer learning involves individuals in a similar situation learning from and with each other through interaction. When implementing new interventions, feasibility studies are used to minimize problems in future evaluation studies.

DESIGN:

Quasi-experimental design with an intervention group, followed over time using descriptive methods. The study was based on the Medical Research Council framework.

METHODS:

Repeated semi-structured interviews, a checklist for fidelity and a questionnaire were conducted with 10 newly graduated nurses from January - March 2015. The intervention's main component included pairs of newly graduated nurses working the same shift and having joint responsibility for a group of patients for a period of three weeks. The intervention also included three months of regular reflection by the pair.

FINDINGS:

Using deductive analysis, the peer learning intervention was found to be consistent with the theoretical description. Due to the compliance and acceptability, there were lessons learned. The tested questionnaire was found to be useful.

CONCLUSIONS: This peer learning intervention seems to be feasible in this context. The present study will serve as the basis for a future full-scale evaluation study.

En intervention om peer learning som riktar sig mot nyutexaminerade sjuksköterskor

Pålsson Y, Engström M, Leo Swenne C, Mårtensson G. A peer learning intervention targeting newly graduated nurses: A feasibility study with a descriptive design based on the Medical Research Council framework. J Adv Nurs. 2017;00:1–12. https://doi.org/10.1111/jan.13513

Bakgrund : Studier har visat att nyutexaminerade sjuksköterskor som träffas, socialiseras och delar erfarenheter med varandra stödjer varandra i att hantera stress. Peer learning är en läran-destrategi där personer i liknande situation lär av och med varandra genom inter-aktion. Studier där nyutexaminerade sjuksköterskor använder peer learning i sin introduk-tion har inte hittats. När en ny intervention ska implementeras rekommenderar Medical Research Council att genomförbarhetsstudier genomförs för att minimera problem inför framtida större utvärderingsstudier.

Syfte: Att beskriva genomförbarheten av en intervention rörande peer learning som riktar sig mot nyutexaminerade sjuksköterskor. Genomförbarheten testades beträffande samstäm-mighet mellan den teoretiska beskrivningen av peer learning och empiriska fynd i den nya kontexten samt följsamhet och acceptans till interventionen.

Metod: Data samlades in från tio nyutexaminerade sjuksköterskor (fem par) från januari till mars 2015 genom upprepade semi-strukturerade intervjuer samt checklista för att se följsam-heten till interventionen. Interventionens huvuddelar innefattade att ett par nyutexami-nerade sjuksköterskor arbetade samma skift och hade ett gemensamt ansvar för en grupp patienter under tre veckor. Vidare innefattade interventionen att paret under tre månaders tid hade reflektion tillsammans.

Resultat: Den deduktiva dataanalysen visade att den teoretiska beskrivningen gällande peer learning och de empiriska fynden i de nyutexaminerade sjuksköterskornas intervjuer var samstämmiga. Guidad av teoretisk beskrivning av peer learning kodades de transkri-berade intervjuerna in i fyra kategorier: (1) arbeta med andra – definierad som att paret delade upplevelser och känslor med varandra; (2) diskutera och kritiskt reflektera över uppfattningar – definierad som att paret lärde av och med varandra genom att dela och diskutera sina uppfattningar; (3) hantera sitt lärande – definierad som att lära genom att dela kunskap och kompetens med varandra; (4) bedöma sig själv och kamraten – defin-ierad som att paret gav och fick återkoppling samt bekräftelse på varandras arbete.

I resultatet om följsamhet och acceptans till interventionen användes data från checklistor samt beskrivningar av följsamhet och acceptans från intervjuerna. Under interventionens tre första veckor beskrev alla fem paren att de hade delat ansvar för en grupp patienter, vissa nyutexaminerade sjuksköterskor delade upp så de hade ett större ansvar för några patienter var medans andra delade sysslor. På grund av sjukdom arbetade de inte alla arbetsskift tillsammans. De tre första veckorna hade paren daglig reflektion, därefter tog paren sällan sig tid att reflektera tillsammans. Sammanfattningsvis kan sägas att interven-tionen gällande peer learning verkar genomförbar i den nya kontexten. Lärdomar som drogs angående studiens följsamhet och acceptans kommer att användas i framtida större studier.