title: The influence of near-peer teaching on undergraduate nursing students' self-efficacy beliefs
Creators: name: Pierce, Elizabeth
Publisher: name: Griffith University
Year: 2024
Subjects: subject: near-peer teaching (NPT)
subject: nursing students
subject: self-efficacy

description: Worldwide, nurses are recognised as educators, qualified to teach people in a range of healthcare and education settings. Within nursing, teaching includes the provision of health-related education to patients, families and groups (termed health teaching) and the training and mentoring of other nurses, health professionals and nursing students (termed clinical teaching). Such teaching activities are essential to the provision of safe quality healthcare. Despite this, graduating nursing students report their teaching capabilities to be poor compared to other nursing competencies. In recent years, an initiative termed near-peer teaching (NPT) has gained traction as a way of strengthening undergraduate nursing students' capabilities. Near-peer teaching involves senior students teaching junior students from the same disciplinary program. While research suggests NPT develops students' knowledge and skills, little is known about its influence on their self-efficacy beliefs, which are important predictors of future engagement with activities like teaching. The primary aim of this research was to investigate the influence of NPT participation during clinical placement on senior (final year) nursing students' self-efficacy in clinical teaching and self-efficacy in clinical performance, and junior (first year) nursing students' self-efficacy in clinical performance. To address the aim, a mixed methods methodology was used, underpinned by Constructivist Education Theory, Sociocultural Theory and Social Cognitive Theory. The main study, a mixed methods explanatory sequential design, involved quasi-experiments and interviews. It was preceded by an integrative review and psychometric testing of two modified self-efficacy instruments with undergraduate nursing students - the Modified Self-Efficacy in Clinical Teaching (M-SECT) Scale and the Modified Self-Efficacy in Clinical Performance (M-SECP) Scale. For the quasi-experiments, senior and junior nursing students participated in either an NPT (intervention) or traditional clinical facilitator-led (control) supervision model for two weeks of a clinical placement experience. With the intervention, senior NPT participants educated and supported junior NPT participants. At the start and end of the experimental period, all senior participants completed the M-SECT and M-SECP Scales; all junior participants completed the M-SECP Scale. Following the quasi-experiments, survey responses were statistically analysed to determine the effect, if any, of NPT participation on senior students' self-efficacy in clinical teaching and self-efficacy in clinical performance, and junior students' self-efficacy in clinical performance. These results informed semi-structured interviews, conducted with senior and junior NPT participants. Interview transcripts were thematically analysed to help explain the quasi-experimental results. In the quasi-experiments, senior NPT participants (n = 33) had a significant increase in their self-efficacy in clinical teaching (p &lt; .001) and self-efficacy in clinical performance (p &lt; .001). Senior control participants (n = 38) had no change in their self-efficacy in clinical teaching (p = .726), however their self-efficacy in clinical performance significantly increased (p = .021). When a Bonferroni correction was applied, the change in the senior control participants' self-efficacy in clinical performance was not statistically significant. Despite their own concerns that NPT might detract from their learning during clinical placement, senior NPT interview participants (n = 12) reported that their beliefs in their clinical teaching capabilities and clinical activities were enhanced with NPT participation. Having previous peer teaching experience, being able to repeatedly observe and engage in teaching during NPT, and receiving positive feedback from their clinical facilitators and junior peers about their teaching enhanced their self-efficacy beliefs and reinforced their practice-readiness. Both junior NPT participants' (n = 32) and control participants' (n = 30) self-efficacy in clinical performance significantly increased (p &lt; .001) during their clinical placement. All junior NPT interview participants (n = 12) reported enhanced belief in their ability to perform clinical activities with NPT participation. Initially, participants were reassured to be paired with a senior peer, who had been in their same position a few years earlier. During the experiment, they benefitted from observing senior peers perform clinical activities that were both within and beyond their first-year scope of practice. They also valued the opportunity to practice skills and clarify uncertainties with their senior peer in a non-threatening learning environment. For junior participants, NPT participation provided insight into what was to come in their nursing program, enhancing their belief in their ability to perform clinical activities in the future. In summary, this doctoral work found that NPT participation during clinical placement supported the development of senior nursing students' self-efficacy in clinical teaching and was as successful as the traditional clinical facilitator-led supervision model at enhancing both senior and junior nursing students' self-efficacy in clinical performance. Although grounded in nursing, these understandings may be of interest to university faculty in various health disciplines who, like nursing academics and clinical facilitators, must prepare students for essential teaching roles in healthcare contexts, while ensuring students feel capable of performing clinical activities within those settings.