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A pathway into the profession: The use, feasibility and outcomes of a peer learning intervention for nursing students and newly graduated nurses
University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Vårdvetenskap, Uppsala universitet.ORCID iD: 0000-0002-5436-3566
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2020. , p. 82
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1623
Keywords [en]
Clinical practice education, Intervention, Newly graduated nurses, Nursing students, Peer learning, Workplace introduction.
National Category
Nursing
Identifiers
URN: urn:nbn:se:hig:diva-34599ISBN: 978-91-513-0837-1 (print)OAI: oai:DiVA.org:hig-34599DiVA, id: diva2:1511887
Public defence
2020-02-18, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2021-01-05 Created: 2020-12-21 Last updated: 2021-01-05Bibliographically approved
List of papers
1. A peer learning intervention for nursing students in clinical practice education: a quasi-experimental study
Open this publication in new window or tab >>A peer learning intervention for nursing students in clinical practice education: a quasi-experimental study
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2017 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 51, p. 81-87Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Studies of peer learning indicate that the model enables students to practice skills useful in their future profession, such as communication, cooperation, reflection and independence. However, so far most studies have used a qualitative approach and none have used a quasi-experimental design to study effects of nursing students' peer learning in clinical practice.

OBJECTIVES: To investigate the effects of peer learning in clinical practice education on nursing students' self-rated performance.

DESIGN: Quasi-experimental.

SETTING: The study was conducted during nursing students' clinical practice.

PARTICIPANTS: All undergraduate nursing students (n=87) attending their first clinical practice were approached. Seventy students out of 87 answered the questionnaires at both baseline and follow-up (42 of 46 in the intervention group and 28 of 39 in the comparison group).

METHODS: During the first two weeks of the clinical practice period, all students were supervised traditionally. Thereafter, the intervention group received peer learning the last two weeks, and the comparison group received traditional supervision. Questionnaire data were collected on nursing students' self-rated performance during the second (baseline) and last (follow-up) week of their clinical practice.

RESULTS: Self-efficacy was improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. For the other self-rated variables/tests, there were no differences in changes over time between the groups. Studying each group separately, the intervention group significantly improved on thirteen of the twenty variables/tests over time and the comparison group improved on four.

CONCLUSIONS: The results indicate that peer learning is a useful method which improves nursing students' self-efficacy to a greater degree than traditional supervision does. Regarding the other self-rated performance variables, no interaction effects were found.

Keywords
Clinical practice education, Intervention, Nursing students, Peer learning, Quasi-experimental
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-23497 (URN)10.1016/j.nedt.2017.01.011 (DOI)000396957900012 ()28142097 (PubMedID)2-s2.0-85010807227 (Scopus ID)
Projects
Lärandets drivkraft
Available from: 2017-02-02 Created: 2017-02-02 Last updated: 2022-09-19Bibliographically approved
2. First-year nursing students' collaboration using peer learning during clinical practice education: An observational study.
Open this publication in new window or tab >>First-year nursing students' collaboration using peer learning during clinical practice education: An observational study.
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2021 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 50, article id 102946Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier Ltd, 2021
Keywords
Clinical practice education, Competencies, Nursing students, Peer learning, Skills
National Category
Health Sciences Educational Sciences
Identifiers
urn:nbn:se:hig:diva-34568 (URN)10.1016/j.nepr.2020.102946 (DOI)000614932700018 ()33310510 (PubMedID)2-s2.0-85097452968 (Scopus ID)
Available from: 2020-12-16 Created: 2020-12-16 Last updated: 2021-03-18Bibliographically approved
3. A peer learning intervention targeting newly graduated nurses: a feasibility study with a descriptive design based on Medical Research Council framework
Open this publication in new window or tab >>A peer learning intervention targeting newly graduated nurses: a feasibility study with a descriptive design based on Medical Research Council framework
2018 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74, no 5, p. 1127-1138Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
acceptability, compliance; feasibility; intervention; newly graduated nurses; peer learning; process evaluation
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-25509 (URN)10.1111/jan.13513 (DOI)000430121900015 ()29193242 (PubMedID)2-s2.0-85045520168 (Scopus ID)
Projects
Lärandets drivkraft
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2022-09-19Bibliographically approved
4. A peer learning intervention in workplace introduction - managers’ and new graduates’ perspectives
Open this publication in new window or tab >>A peer learning intervention in workplace introduction - managers’ and new graduates’ perspectives
2022 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, article id 12Article in journal (Refereed) Published
Abstract [en]

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).

Place, publisher, year, edition, pages
BMC, 2022
Keywords
Collaborative learning, Feasibility, Intervention, Medical Research Council (MRC) framework, Newly graduated nurses, Peer learning, Process evaluation, Randomized controlled trial, Social learning
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-34652 (URN)10.1186/s12912-021-00791-0 (DOI)000738633200001 ()34983518 (PubMedID)2-s2.0-85122329416 (Scopus ID)
Available from: 2019-12-09 Created: 2021-01-05 Last updated: 2022-09-20Bibliographically approved

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