الفهرس 
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Abstract
Summary
In the healthcare field, it is essential for nurses to be professionally competent in dealing with complex patients’ health issues. Nurses are expected to fulfill various roles, including caregivers, managers, educators, lifelong learners, and researchers. To excel in these responsibilities, nurses must possess effective communication and advanced critical thinking skills to analyze, synthesize, and solve the clinical problems. Traditional education methods such as lecture, presentation and demonstration cannot adequately develop these vital skills or fully prepare the students for the complexities of real clinical practice. Instead, an active peer learning is necessary to encourage the learning process through collaborative interactions, shared experiences, and constructive feedback from peers (Javaheri Arasteh et al., 2018).
The rise in critical care student enrollment without a proportional increase in educators has created obstacles in nursing skill training. Managing large student groups is difficult for instructors, hindering the acquisition of practical skills, staying current, prepared, and proficient in life-saving procedures like CPR. Quick and effective nurse response is vital during emergencies, especially cardiac arrests. Peer learning is acknowledged as a valuable method for imparting undergraduate CPR training, crucial for emergencies. (Kodikara, 2022).
During the past few decades, in the nursing associations, PL method has been utilized, however, there have been discrepancies in the academic achievement and students’ response. Undoubtedly, PL provides an academic support, still there is a gap in the literature about the way tutors may affect their peer tutees’ academic performance and skillset improvement (Abbas et al., 2018).
Hence, this study will assess the effect of PL strategy on the clinical performance of nursing students. Hopefully the findings will enrich the nursing education with a valuable approach which encourages engagement, facilitates interaction during the learning process and also increases the nursing students’ personal development for their future roles.
Aim of the Study:
This study aims to evaluate the effect of peer learning strategy on the nursing students’ clinical performance through:
1. Design a peer learning strategy for nursing students.
2. Implement the peer learning strategy for nursing students.
3. Assess the effect of peer learning strategy on the nursing students’ clinical performance (knowledge and practice).
Research Hypothesis:
The current study hypothesized that:
The nursing students who experienced peer learning strategy will exhibit better knowledge.
The nursing students who experienced peer learning strategy will exhibit better practice.
Operational Definitions:
“Peer” A person who is at the same age or at the same social position or has the same abilities as other people in the group (Cambridge University Press, 2018).
“Peer Learning” is the process of gaining, refining or improving knowledge and/or practice due to interaction with someone of the same age or attending the same university who is more knowledgeable or more experienced (Stone et al., 2013).
“Tutor” A student who has expressed adequate competency in a subject or a skill to help another student acquire a trade or idea. Peer tutors often receive a little training or help from the instructors (Cambridge University Press 2018).
“Tutee” person who is being tutored; the student of a tutor (Cambridge University Press, 2018).
Subjects and methods:
1-Technical Design:
The technical design included research design, setting, subjects and tools used for data collection.
Research Design:
This study was conducted through using a quasi-experimental design (study & control groups and pre/ posttest).
Setting:
The study conducted in the Nursing Department at Alexandria Technical Health Institute, Damanhur Branch.
Subjects:
A convenient sample of first-year nursing students who enrolled in nursing courses at the second semester of the academic year 2019/2020 (stratified into study and control group according to the previous semester academic achievement) (appendix I).
All subjects were divided into two groups as the following; study group including (peer tutors and tutees). Peer tutors: In total six students who were selected to be the peer tutors from the study group, had previous experience of the selected procedure (CPR) and performed these procedures with highest performance score prior to the study. Peer Tutees: the rest of study group were 62 students divided randomly and assigned into 6 subgroups of about 10 or 11 students in each group. Control group: were 67 students who exposed to the regular instructors teaching as the routine traditional teaching method.
Inclusion Criteria:
Peer tutors will be selected from the whole enrolled students in the study group who have learning, teaching abilities (through recording 3 minutes presentation video about interested topic), good manual skills according to the previous semester academic achievement, results of CPR pretest (knowledge and practice) and agreed to participate as peer tutors.
Exclusion Criteria will include students who attend previous adult CPR training courses, repeaters and those who will refuse to participate.
Data Collection Tools:
Tools for data collection:
Data were collected through the following tools (Appendix II):
Tool I: Structured Interview Questionnaire:
It was developed by the researcher based on the review of the relevant recent related literature (Bogle et al. 2016; American Heart Association 2016, Ghanem et al. 2018 and Panchal A. et al. 2019). This questionnaire was designed to assess the students’ performance (knowledge and practice). It consists of three parts as follows:
Part I: concerned with assessment of students’ demographic characteristics as age, gender, marital status, residence, attendance of previous clinical peer learning sessions and previous academic achievement in the first semester.
Part II: Cardiopulmonary Resuscitation Knowledge Questionnaire:
This part concerned assessing the student’s knowledge regarding adult CPR (CPR serves as a universally recognized and essential skill in the nursing profession, making it an ideal procedure to assess the impact of peer learning versus traditional learning on skill acquisition and retention among nursing students). It consisted of 3 subscales (20 multiple choice questions) regarding basic concepts of adults CPR.
Divided into the following;
Assessment and Timing: Six Questions.
Cardiac Arrest and Chest Compression: Eight Questions.
Airway Management and Application of AED: Six Questions.
Scoring system;
The participants were asked to respond to each question to select a correct answer. Each question was graded, one grade was given for a true answer, zero if the response was a false answer, or not been answered. A total score was calculated by summing up the grades of the questioner. The maximum possible total score was 40; the total score was converted into percentages as the following:
• High level of knowledge if the percent ≥ 75% score (30-40)
• Average level of knowledge if the percent = 60%: ˂ 75% score (24 - 29)
• Poor level of knowledge if the percent ˂ 60% score (0 -23)
Part III: Cardiopulmonary Resuscitation Practices Checklist:
This part concerned to assess the students’ practical skills regarding adult CPR steps. It consists of 4 subscales (21 Steps) divided into the following;
Assessment and Activation: four Steps.
High Quality Compression: Six Steps
Airway Management and Application of AED: Eight Steps
Resume Compressions and Post Resuscitation Care: Three steps
Scoring system:
The total score of practice was (42 marks); on three-point Likert scale ranging from “not performed” equal to 0, “incompetently performed” equal to 1 and “competently performed” equal to 2. The total score was distributed as the following;
• Satisfactory Level if the percent ≥ 75% score (32-42)
• Unsatisfactory Level if the percent ˂ 75% score (0 ˂ 32)
Part II and III of this tool were applied as pre and posttest for both study and control groups.
Tool II: Peer learning Strategy Experience Questionnaire:
This tool consists of two parts as follows:
The 1st part: Peer Learning Strategy Tutees’ Preference Questionnaire:
This tool adapted from Iwasiw and Goldenberg, (1993) to assess nursing tutees’ preference of the peer learning strategy. This tool applied only once for the tutees in the study group after the application of peer learning strategy. It consists of 4 subscales (11 statements). Divided into the following;
Teaching and Learning: four Statements.
Assessment and feedback: Two Statements.
Skills Development: Three Statements.
Engagement: Two Statements.
Scoring system:
The Likert scale was assessed against three points scale of agree, somewhat, and disagree. ”agree’’ equal to 3, “Somewhat ” equal to 2 and “disagree” equal 1. The maximum possible total score was (33).
• High Level of Preference ≥ 75% score (25-33)
• Average Level of Preference 60%: ˂ 75% score (20-24)
• Low Level of Preference if the percent ˂ 60% score (11-19)
The 2nd part: Peer Learning Strategy Tutors’ Experience Questionnaire:
This tool adapted from McKenna and French, (2011) to assess nursing tutors’ experience gained from peer learning strategy practice. This tool applied only once for the tutors in the study group after the application of the peer learning strategy. It consists of 3 subscales (14 statements).
Divided into the following;
Academic Performance and Learning: Three Statements.
Self-Confidence and Fulfillment: Five Statements.
Professional and Social Skills: six Statements.
Scoring system:
It consists of 14 statements with three-points Likert scale ”agree’’ equal to 3, “Somewhat ” equal to 2 and “disagree” equal 1. The maximum total score was (42)
• High if the percent ≥ 75% score (32- 42)
• Average if the percent = 60%: ˂ 75% score (26-31)
• Low if the percent ˂ 60% score (14- 25)
Results:
The main findings of the current study revealed that:
There was a statistically significant improvement between the pre and post study phases’ among the students’ tutors regarding all CPR knowledge variables. Also, there was a statistically significant improvement in CPR practice between the pre and post study phases among the students’ tutors.
No statistically significant difference noticed between the studied students (students’ tutees and control group) regarding the all CPR knowledge variables before the implementation of the peer learning strategy. While, there was a statistically significant difference between them after the implementation of the peer learning strategy regarding all CPR knowledge variables.
There was no statistically significant difference between the students’ tutees and control group regarding CPR practice before the implementation of the peer learning strategy. Also, at the post implementation of the peer learning strategy, the students in both groups competently performed the CPR practice with a non-statistically significant difference between both groups.
87.1% of the students’ tutees had high level of the total preference score regarding the peer learning strategy.
All the students’ tutors had high positive experience regarding peer learning strategy.
There was no significant relationship between the students’ tutees’ socio demographic characteristics and their total knowledge and practice scores regarding cardiopulmonary resuscitation at the pre and post peer learning implementation phases (P ˃ 0.05).
A positive significant correlation was noticed between the students’ tutees’ total score of knowledge and practice at the post peer learning implementation phase and their preference of the peer learning total score p= 0.002 and p = 0.008 respectively.
Conclusion
Based on the research findings, it can be concluded that:
Nursing students who participated in the peer learning strategy demonstrated significantly better knowledge and exhibited significantly improvement in the practical skills. These results underscore the effectiveness of the peer learning method as a teaching strategy, surpassing traditional methods, in enhancing nursing students’ clinical performance (knowledge and practice). The substantial improvements observed in the studied groups regarding adult cardiopulmonary resuscitation knowledge and skills validate the potential of peer learning as a valuable and impactful approach for enhancing the context of nursing clinical training. Therefore, this study confirms that peer learning is a beneficial educational approach with promising results, ultimately enhancing the overall clinical learning experience for nursing students.
Recommendations
Based on the current study findings, the following recommendations are suggested:
Education:
Develop structured written formal peer learning strategy guidelines with outlined desired outcomes and annual assessment.
Assign one or group of senior individuals across the nursing institution to act as a facilitator to inform the junior students about the advantages of peer learning and assist/ train them in groups.
Organize peer learning workshops which include senior, junior students and teachers where students and teachers can exchange the rules through informal ways as a preparation phase for the actual application of the strategy.
Research: Future research aimed to;
Apply studies on large number of senior and junior students from various nursing educational institutions over a longer period of time.
Assess the clinical instructors’ and clinical staff feedback about the application of the peer learning strategy in the clinical environment.
Examine the impact of implementing the peer learning strategy across various courses on students’ overall academic and clinical performance.
Study the acquisition and mastery of the clinical skills, self-reflection, critical thinking, and interprofessional team work of the students who were thought by the peer learning strategy in the clinical work after graduation comparing with those who thought by traditional methods.
Search the factors influencing the successful peer learning in nursing education.
Conduct qualitative research to explore nursing students’ perception toward the peer learning approach.