Nurse Eduatim T&y ( 1989) 9,20%206

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WORK Learning from each other: peer teaching and learning in student nurse training

John Costello

From whom do student nurses learn practical skills? According to the small group of students questioned by the author they learn as much from fellow students as from staff nurses, and clinical teachers have little part in this type of learning. The author discusses this issue and asks whether teachers should be more involved in clinical practice.

INTRODUCTION

Some schools of nursing (my own included) have decided that ‘practical rooms’ within the school are of little value in teaching practical nursing skills as it is more appropriate to learn these skills in the clinical areas. In many instances the teaching of practical skills on the ward is signifi- cant and rewarding as a personal experience (Rogers 1969). In the clinical area there are more opportunities to learn and develop practical experiences by having a ‘hands on’ approach than by didactic instruction (Marson 1981) in a ‘ward type’ setting or a classroom. In the clinical area the role of the teacher may be taken by a number of people other than the nurse tutor or clinical teacher.

LITERATURE REVIEW

Current training programmes often fail to pro- vide student nurses with the knowledge and

John Costello AMN RGN DipN CertEd Nurse Tutor, South Manchester School of Nursing, Mauldeth House, Mauldeth Road West, Manchester M21 2RL (Requests for offprints to JC) Manuscript accepted 6 December 1966

skills they require to become competent prac- titioners. Much of the literature in the last decade concerning learning on the ward sug- gests that the ward ‘climate’ is an important factor in determining what kind of experiences students have on the ward (Fretwell 1979; Orton 1981). Some of the conclusions have indicated that the ward sister is the key person who controls the learning environment. An ideal learning environment is seen as one in which the educational needs of the student are met, and is created by the sister and other trained staff on the ward. Qualified staff have a major influence on ward teaching and learning as role models for students (Pembrey 1978; Marson 1981). Wyatt (1978) asked students the question ‘From whom do you learn?’ and the answer was ‘that teaching on the ward came from many sources, nurse teachers, ward staff and student colleagues.’

PEER TEACHING

The idea of using students as teachers is not new. Because of staffing difficulties, star pupils were often used to teach accomplished students in early schools and post graduates have been used as tutors in British Universities for years

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(Schiremerhorn 1973). The term ‘peer teaching’ has been applied to many different learning situations, the characteristics of which are usually governed by the demands of the course and the institution implementing the system. As well as students teaching groups of other students, they have also been used to teach their colleagues on an individual basis. In (Keller 1974) ‘proctors’ were used to supplement self- paced learning programmes in personalised systems of instruction and in (Goldschmid 197 1) students at the same level worked in pairs called the ‘learning cell’. In one form of the learning cell, students prepare the same material and then ask each other questions in a formal, structured way; in another form, different topics are prepared and students teach each other in turn. Goldschmid later found that this system can be used successfully with a number of other disciplines with apparently no restriction on the size of the class or the nature of the material. Research based on Goldschmid’s learning cell process has been carried out in this country Dunkin & Hook (1978). They examined the learning process of first year occupational therapy students studying anatomy, and found that the experience of teaching a fellow student enhanced the personal performance of the student who acted as the teacher. It seems that this method of learning may be no worse than other forms of teaching, such as lectures and seminars. The difference may be that although lectures and seminars are useful ways of acquir- ing theoretical knowledge, peer teaching is a useful method for developing practical skills. In both cases students are able to learn from each other. Whether this is desirable depends upon what is learnt.

WHERE DOES PEER TEACHING/ LEARNING OCCUR

According to the 18 students who completed my questionnaire peer teaching and learning does occur in clinical areas. The students said that practical skills were taught and learnt on seven out of the eight wards to which they had been

allocated. Obviously the quality of what is learnt may be questioned, as may the relevancy, and one may also ask whether the student teacher is actually teaching a skill or developing the prin- ciples already laid down elsewhere?

In these wards peer teaching takes place over and above the structured educational frame- work, in the ‘hidden curriculum’. The students were asked to identify from whom they learnt the most practical skills; 50% of the respondents claimed to have learnt most practical skills from their colleagues. There was also strong support for the view that what is taught in the classroom is not practised on the ward. This response is consistent with the notion that nurse prac- titioners and nurse educationalists view the acquisition of skills by learners very differently. The ‘ideological divide’ between service and education is reinforced by the response to another question which suggests that nurse teachers are not seen as a good source of learning on the ward. Many of the respondents said that students should teach each other practi- cal skills and those who saw themselves in a teaching situation said that they enjoyed the experience. When asked to rate the quality of what they learnt on a scale of one (useless) to nine (excellent), 55% rated the quality of the practical skills learnt between five and eight. However although the students found the learnt material useful, teachers may not accept it as edu- cationally sound.

WHO IS INVOLVED IN PEER TEACHING

Of the 18 respondents 10 agreed with the statement that Staff Nurses were in a good position to teach practical skills on the ward. For these students Staff Nurses and student col- leagues share the responsibility for teaching practical skills fairly equally.

It is not surprising to find that nurse teachers were seen by these students as less likely to teach practical skills as in many instances they spend little time in the clinical area. The reasons for this vary. Many teachers do not see themselves in the

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‘hands on’ role partly because teaching commit- ments and the geography of the ward and school make this difficult. The opportunity for role

modelling is therefore limited. It may be that facilitating and supporting trained staff in their teaching role is a useful way for the teacher to be involved clinically. The responses made to the questionnaire indicate that the Staff Nurse and

the ‘knowledgeable colleague’ become role model and teacher in the peer teaching situation.

According to Davies (1986) nurses have one obvious characteristic in common - they are

committed to maintaining and improving pro- fessional expertise and that means learning from each other. The teaching of other nurses from a personal fund of knowledge and experience is a responsibility which Davies argues many nurses gladly accept.

Many nurses lack confidence and do not perceive themselves as teachers but whether we recognise it or not we as nurses are all teaching nursing by acting as a role model for those

around us. Do nurse teachers deprive learners of role models by not adopting an active ‘hands on’ approach in the clinical area? Perhaps teachers should spend more time in the clinical area and more attention should be given to developing the teaching skills of clinical staff.

DISCUSSION

Much of the ‘teaching’ undertaken by student

respondents related to what they saw as ‘basic’ aspects of nursing care, such as urine testing and the giving of enemas and suppositories. This is consistent with Goddard’s (1953) view that nurses see physical tasks as constituting basic skills. Within the interview sessions learners expressed anxiety about their proficiency to perform physical aspects of nursing care. In one instance, rather than admit that she felt unsure of the procedure or risk the embarrassment by admitting that she did not feel proficient, the nurse sought assistance from a senior colleague. This may have been because trained staff had been inconsistent in giving support to certain learners, or that trained staff on the ward believe

that once learners progress to a certain stage in their training they should be able to perform specific practical tasks without supervision or

instruction. This mismatch in expectations is brought about by the fact that Service and Education are not always aware of the true abilities of learners and it may be argued that Service Staff may not always be aware of changes in the curriculum.

This view is supported by Ogier (1982) who also pointed out that students perceptions of themselves varied; some students see themselves as workers rather than learners throughout their training.

CONCLUSION

In this small study half of the 18 students identified their colleagues as their main teachers for practical skills; the reasons for this varied.

Responses from those nurses interviewed after completing the questionnaire suggest that peer teaching is an asset to the student in both roles, both when teaching and in learning practi- cal skills. Perhaps the perceived differences in what constitutes teaching and learning between education and service ‘the ideological divide’ (Alexander 1982) allows for some inaccuracies in assessing levels of learner competence in practi- cal nursing skills. The mismatch in expectations on the ward may account for the atmosphere which causes students to seek help from col-

leagues rather than trained staff. Perhaps student nurses expect to be taught by their colleagues and in many instances peer teaching is actively encouraged. What is the role of the nurse teacher in peer teaching and learning and what are the trained staffs perceptions of peer teaching and learning in the clinical area? Further investigation is planned which may provide some answers to these questions and may be useful in developing teaching strategies in the clinical area.

References

Alexander M F 1982 Integrating theory 8c practice 1. Nursing Times 78, 18: 69-71

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Davies M 1986 Teaching nurses. Nursing Times, April 16th: 64-68

Dunkin E, Hook P 1978 An investigation into the efficiency of peer teaching. Assessment in Higher Education 4, 1: 22-26

Fretwell J E 1979 An enquiry into the ward learning environment. Nursing Times 76, Occasional Paper, No. 16,69-75

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Ogier M 1982 An ideal sister - a study of the leadership style and verbal interactions of ward sisters and learners in general hospitals. Royal College of Nursing

Orton H 1981 Ward learning climate and student nurse response. Occasional Paper, Nursing Times 77,65-68

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Wyatt J F’ 1978 Sociological perspectives on socialisation into a profession: a study of student nurses and their definition of learning. British Journal of Education Studies: 26, 263-276.