Peer Learning

257Peer Education · Parkin

Peer Education: The Nursing ExperienceVera Parkin, RN, MEd, MN, GNC(C)

Peer learning has significant influence over the be-haviors of children and adolescents, and is also op-

erational (formally or informally) in the personal and professional lives of adults. Among nurses, peer educa-tion is more formally recognized through the traditional preceptorship of nursing students and new staff nurses during orientation (Atwood, 1986). There is an expecta-tion within the nursing profession that frontline nurses should assume responsibilities for peer education. A quality of assurance requirement for nurses in Ontario is to seek peer feedback to evaluate their performance (Col-lege of Nurses of Ontario, 2005). Given today’s rapidly changing health care environment and how closely staff work with one another, nurses are in the best position to know what the changing clinical job demands are.

A peer education program was initiated in the nurs-ing department of a continuing care and rehabilitation hospital in south-central Ontario, Canada. Eleven regis-

tered nurses representing 11 hospital units were selected by each of their unit managers to be peer nurse teach-ers. This program was initiated following organizational restructuring that included the release of several nurse educators and assignment of the author (who previously worked at the hospital as a nurse educator) to general hospital educator responsibilities. The peer nurse teach-ers were designated to teach mostly technical skills to peer nurse learners, who were existing, experienced nursing staff members in the unit in which the peer nurse teachers worked. After peer education was formally im-plemented following a 6-hour preceptorship peer nurse teacher workshop, peer nurse teachers and peer nurse learners reported that they had many reservations about this model of learning. In an effort to learn about the po-tential viability of peer education as a method of profes-sional adult learning, the author explored the experiences of nurses involved in this peer education relationship.

LiTEraTurE rEviEwLiterature was found on peer education programs

for children and adolescents, college students, support groups (e.g., for clients with human immunodeficiency virus), and faculty. Limited literature was found specifi-cally about nurses and other healthcare professionals’ experiences with peer education. The term peer educa-tion is not well defined in the literature, but is used inter-changeably with peer tutoring, consultation, and review (Lincoln & McAllister, 1993). Green (2001) found that published reports on peer education do not include com-ments about the quality of peer education programs and how program development is informed by practice.

Edelstein and Gonyer (1993) and Gould and Lomax (1993) discussed the purpose and benefits of peer educa-

Ms. Parkin is Professor, Ryerson, Centennial George Brown Col-laborative Nursing Degree Program, George Brown College Site, To-ronto, Ontario, Canada.

Address correspondence to Vera Parkin, RN, MEd, MN, GNC(C), George Brown College, Centre for Nursing, P. O. Box 1015, Station B, Toronto, Ontario M5T 2T9, Canada.

Background: The two-fold purpose of this study was to explore the peer education experiences of registered nurses and solutions for developing peer education as an effective method of adult learning.

Methods: Eleven designated peer nurse teachers and 13 peer nurse learners were asked to complete a questionnaire. Three peer nurse teachers and three peer nurse learners were further interviewed in focus groups.

Results: The metathemes of peer role conflict, organi-zational stress, and the timing of new role integration were identified.

Conclusions: The study found nurses believed that to have a successful peer education program, the scope of the peer education program and the peer roles should be clarified, peer time should be available and accessible, positive motivational techniques (including a just peer selection process) should be present, and other resources should be provided.

abstract

258 The Journal of Continuing Education in Nursing · November/December 2006 · Vol 37, No 6

tion in the May 1993 issue of the Journal of American College Health. This issue identified the ways peer edu-cation has evolved and expanded to meet the needs of health promotion and risk reduction programs since the 1970s. It was reported that peer educators learn a great deal from their peers, which then affects the peer educa-tors’ health behaviors. Furthermore, sensitive education-al topics such as human sexuality, alcohol and drug use, and date rape are well received through peer education. These peer educators are accessible and have established credibility. However, experts warn that peer educators require supervision and that although peer education is an invaluable component of the educational methodol-ogy, it is not a panacea. Peer education should not be a substitute for the work that can be performed more ef-fectively by professionals.

Benner (1984, 2001) offered a well-known framework illustrating the progression of nurses’ expertise through five levels of proficiency (novice, advanced beginner, competent, proficient, and expert) throughout the nurs-es’ work experiences. Benner recognized the teaching–coaching function of nursing across professional and client groups. Benner, Hooper-Kyriakidis, and Stannard (1999) legitimized peer teaching within nursing, particu-larly in the context of clinical experts and formal leaders (e.g., advance practice nurses) who teach less experienced nursing staff. Benner (2001) suggested that instructional strategies be matched to the level of skill acquisition and supported the belief that nurses with an expert level of skill acquisition benefit most from staff education pro-grams that meet the expert’s learning style and needs for career advancement.

ThE PEEr EducaTioN ProgramRelevant to the author’s research study are that most

nurses have worked together for many years and should have both expert clinical skills and competent, proficient, or expert teaching skills to be able to teach others. How-ever, most peer nurse teachers have not had appropriate education or leadership preparation to acquire the higher levels of teaching skills, nor do they have experts to guide them in this area. Therefore, it can be complicated to ap-ply nursing frameworks such as Benner’s to settings in which formal leaders, clinical teaching experts, and staff development programs are not available.

The literature reviewed suggested that the success of peer education programs depends on several factors, such as structured and unstructured approaches (including built-in supervision and support mechanisms for the peer teacher), recognition for appropriate terminology to clari-fy the parameters for the educator role, learning plan, and goals, and time investment. These factors should be scruti-

nized through more rigorous research studies. Examining the effects of the peer education experience among nurses, particularly in informal learning settings (i.e., nurses who work with each other versus nurses who go to school to-gether), would enrich this body of literature and provide further ground work for the development of more suc-cessful peer education programs.

The two-fold purpose of this study was to examine the experiences registered nurses have had with peer educa-tion and to explore what solutions they deem necessary to promote peer education as an effective means for adult learning. In examining the responses of both peer nurse learners and peer nurse teachers, necessary insights could inform peer education program planning and develop-ment. Implications for better understanding and further-ing the practices of peer education could be relevant to the broader nursing profession and any other area of adult education where peer education is practiced.

The following research questions were investigated:

1. What factors enhance the practice of peer education in the experience of peer nurse learners?

2. What factors hinder the practice of peer education in the experience of peer nurse learners?

3. How do the peer nurse learners think these hin-drances can be minimized?

4. What factors enhance the practice of peer education in the experience of peer nurse teachers?

5. What factors hinder the practice of peer education in the experience of peer nurse teachers?

6. How do peer nurse teachers think these hindrances can be minimized?

7. What insights do peer nurse teachers have about themselves in their role?

dEsigN aNd ProcEdurEsAs stated earlier, 11 hospital units, with approximately

30 staff members in each unit, participated in the study. One registered nurse from each unit was selected by the unit manager to be a peer nurse teacher for that unit. After a period of approximately 3 months, peer nurse teachers and peer nurse learners were asked to complete a ques-tionnaire regarding their experiences with the peer educa-tion program. It was hoped that common themes would be identified by studying the experiences of both groups.

This research study was descriptive, grounded in the perceptions of selected nurses involved as peer nurse teachers or peer nurse learners in the peer education program. A grounded theory approach (Glaser & Straus, 1967, as cited in Bogdan & Biklen, 1992) enables the discovery of constructs about phenomena within peer education, which is a topic about which little has been


made clear. After university ethical review and hospital approval, data were collected from the written responses to questionnaires given to the peer nurse teachers and the peer nurse learners. Additional data were gathered via focus groups with selected peer nurse teachers and peer nurse learners.

written Questionnaires for data collectionTwo previously tested, written questionnaires using spe-

cific questions were pilot tested with two peer nurse teach-ers and two peer nurse learners working the same shift. Following the pilot test, the questionnaire was modified to clarify the questions. Instead of the Likert scale format, the variables were arranged so that participants could choose positive effect, negative effect, no effect, or don’t know the effect. Another question asking participants to rate their overall experience with peer education was added.

A consent section was made explicit at the beginning of the survey and a page requesting a volunteer for a one-on-one follow-up interview or focus group interview was at-tached. Following the pilot test, nine additional peer nurse teachers were mailed a questionnaire with instructions for returning it. Only six of the peer nurse teachers returned the questionnaire; therefore, a total of eight peer nurse teacher respondents provided study data.

The author approached 13 peer nurse learners who were representative of the 11 units and were working the same week to participate in the study. Peer nurse learners were also representative of each of the 11 units. By per-sonally handing them the surveys, the author was able to field questions, explain more about the peer education study, and give examples of possible peer education ex-periences. All 13 peer nurse learners returned their com-pleted surveys close to the desired return deadline.

Focus group data collectionFollowing the return of the surveys, the author con-

ducted two focus group interviews. Two peer nurse learn-ers and two peer nurse teachers volunteered for the focus groups. A third participant who was working the same week as the volunteers was sought for each group (one peer nurse learner and one peer nurse teacher) so that each fo-cus group would have at least three participants. The three peer nurse learners were in one focus group and the three peer nurse teachers were in the other group. The three peer nurse teachers worked different shifts, so they agreed to use a half hour of work time and a half hour of non-work time to allow 1 continuous hour for the interview.

Participants did not receive remuneration; however, refreshments were provided for each focus group as an incentive to participate. Flipcharts that summarized ques-tionnaire results and provided sample questions to guide

the interview were prepared for each focus group. Con-sent paperwork was also prepared for participants to sign at the start of the interview and a tape recorder was used to record the interview. Participants were asked to keep their responses confidential after the interview. They were reassured that the author would use only group data with selected quotes in the report, and that all data would be se-cured for research purposes only. Both focus groups were conveniently conducted in the author’s office, which was away from the units in which the participants worked. The interviews were 80 minutes long for the peer nurse learners and 70 minutes long for the peer nurse teachers. The author later transcribed both interviews.

data analysisDue to the rich quality of focus group data, the re-

sults and analyses for this study focus to a greater extent on the final coding of focus group data. To maintain a meaningful study, data collection was concurrent with analysis (Bogdan & Biklen, 1992). Focus group ques-tions became more structured and analytic based on the participants’ responses from both questionnaires and the two focus groups. The peer nurse learners were still un-familiar with peer education as a formal concept. They needed the concept explained in concrete terms to be able to reflect on their peer learning experiences.

Dynamic interchange was made possible in the focus groups because discussion of the funneled survey data prompted further questions and discussion. With the author’s facilitation of the focus groups, participants analyzed their own summarized questionnaire data. Fol-lowing the focus group analysis, the author identified final thematic categories.

To analyze for final elements, patterns, and formal theoretical issues, the questionnaire and focus group data were coded by the author separately from four mechani-cally sorted piles of data: peer nurse learner question-naires, peer nurse teacher questionnaires, the peer nurse learner focus group interview, and the peer nurse teacher focus group interview. Following collection of the ques-tionnaire, data were coded according to questionnaire headings: variables in peer education, hindrances, solu-tions, additional comments, and overall experience with peer education. The author coded the focus group tran-scriptions using a line-by-line approach (Tesch, 1987). Once all of the data were coded, themes were identified and connected to the metathemes.

rEsuLTsDemographic information regarding the peer nurse

teacher and peer nurse learner participants are compiled in Table 1.


For peer nurse learners, the final coding categories re-garding hindrances in peer education were limited peer nurse teacher ability, confusion about peer roles, jealousy over who is chosen as a peer nurse teacher, poor peer nurse learner enthusiasm for learning, excess workload demands on nurses, poor staff morale, and lack of managerial sup-port. These final codes were further collapsed into two metathemes—peer role conflict and organizational stress. The coding categories for solutions to hindrances were identified as needs for other resources, motivation for the peer education program, an adequate selection process, and having the knowledge and experience to teach.

For peer nurse teachers, the final coding categories regarding hindrances in peer education were time for role integration, new role ambivalence, lack of mana-

gerial support, staff morale, time availability for teach-ing and learning, and teacher accessibility. Metathemes discovered were the timing of new role integration and organizational stress. The coding categories for solutions to hindrances were to improve time availability, teacher accessibility, and motivation.

See Table 2 for a summary of hindrances to peer edu-cation as perceived by peer nurse teachers and peer nurse learners.

discussioNThe discussion of these results for both the peer nurse

learners and the peer nurse teachers is mainly presented according to one of Bogdan and Biklen’s (1992) writing formats. Each metatheme (Tesch, 1987) is listed, state-ments are made about it, and excerpts from the question-naire responses and the focus group interviews are used to illustrate it.

Peer Nurse Learner metatheme: Peer role conflictConsiderable discussion with the peer nurse learn-

ers was centered on the peer nurse teachers’ abilities and attitude as teachers. Peer nurse learners expressed their concern regarding the peer nurse teachers’ lack of profi-ciency and willingness to teach. The focus group partici-pants indicated that sound knowledge was required for a teacher to teach and that this develops with experience. Consistent with focus group dialogue, the narrative re-sponses from the questionnaire included comments such as, “[Peer nurse teachers] lack motivation, knowledge, and expertise.”

TablE 1

dEmograPhics oF ParTiciPaNTs

Nursing duty (Y) Title degree

degree in Progress

course work Prep to Teach

others

Peer Nurse Teachers (n = 11)a

27 RN No Yes Yes

23 RN No No No

1 RN Yes – No

22 RN Yes – –

26 RN No No Yes

11 RN No Yes No

30 RN No No No

11 RN No Yes No

Peer Nurse Learners (n = 13)

21 RN No No No

16 RN No No No

3 RN No Yes Yes

30 RN No No Yes

25 RN No No No

25 RN No No No

30 RN No No Yes

5 RN No Yes Yes

25 RN No No Yes

30 RN No No No

6 RN No No No

26 RN No No No

7 RN No – Noa Three participants did not return the questionnaire, so data are included for only eight participants.

TablE 2

whaT PEEr NursE TEachErs aNd PEEr NursE LEarNErs PErcEivE as hiNdraNcEs

To PEEr EducaTioN

Peer Nurse Teachers Peer Nurse Learners

Time for role adaptation limited peer nurse teacher ability

New role ambivalence Confusion regarding peer roles

Teacher accessibility Jealousy over who becomes peer nurse teachers

Poor peer nurse learner enthusiasm for learning

Poor peer nurse learner enthusiasm for learning

Time availability for teaching and learning

Excess workload demands on nurses

Poor staff morale Poor staff morale

lack of managerial support

lack of managerial support


Peer nurse learners often talked about the deletion of the former nurse educator positions. Peer nurse learners felt that peer nurse teachers could not replace the nurse educators, explaining that peer nurse learners do not have the same level of knowledge, commitment, and experi-ence. One peer nurse learner stated, “The title of teacher means you have gone to school to be a teacher. . .like a nursing teacher [for students].” Peer nurse learners seem to be saying teachers become teachers because they are willing to teach and, with the right attitude, commit them-selves to the role and develop their skills through expe-rience, which the peer nurse learners did not believe the peer nurse teachers did throughout this program.

In the questionnaire data and the dialogue with focus group members, it became apparent that the role of peer nurse teacher was a source of conflict and confusion for the peer nurse learners, who did not distinguish themselves as either peer nurse teacher or peer nurse learner. During the focus group, peer nurse learners identified with their own informal peer teaching role and also suggested how peer teaching should be done. One of the participants stated, “Being an RN, not a [peer nurse teacher], I’m being called on over and over to reinforce [another’s learning]. I get approached a lot because I feel it’s my job.” On the other hand, the participant recognized there is a boundary to the teaching role by stating, “From a union standpoint, you’re hired as a nurse—not a teacher.”

Peer nurse learners also acknowledged a role boundary issue when it came to learning performance problems be-cause they do not have the administrative power that the nurse educator or manager has. Conflict seemed to occur in relation to the diffusion of the peer nurse learner and peer nurse teacher roles. Although these nurses were familiar with informal teaching and learning, they were not famil-iar with the concept and structure of peer education as a formally recognized part of their practice. How the peer nurse teacher role is different from informal peer teaching was not made explicit at the beginning of the program.

Narrative responses on the questionnaires further sup-ported by the focus group dialogue identified that peer nurse learner jealousy exists when a peer nurse teacher is selected. Nurses viewed this as a hindrance that com-plicates the peer role conflict further. One peer nurse learner stated, “There’s outright jealousy that they’re not chosen as a preceptor. It feels good to be chosen; con-versely others are not thought highly of.”

Poor learner enthusiasm was identified as another hindrance. The focus group participants pointed out the resistance of learners to own their learning and learners maintaining a worker mentality as barriers. One peer nurse learner stated, “[Peer nurse learners] say why should I learn that? I’m not getting paid for that. Some

people [are] in it for the financial only. . .[and] need to find it in themselves beyond that paycheck.” By this example, they identified with a formal teacher who struggles with similar learner issues. There is some recognition that both the peer nurse learners and peer nurse teachers need to build enthusiasm for peer education roles. The peer nurse learners also expressed a feeling that the responsi-bility for enthusiasm should lie primarily with the peer nurse learner, who needs to see beyond financial gains of the job and own the responsibility for learning.

Peer Nurse Learner metatheme: organizational stress

Many organizational changes at the time of this study included staff cutbacks that resulted in increased workloads, uncertainty, and compromised morale in the hospital. The effect of this on the peer education initia-tive was mostly articulated in the focus groups, whereas responses on the questionnaires did not clearly identify any organizational effect. The group spoke freely about the poor morale; it is not surprising how this newly per-ceived concept of peer education seemed to be something that staff felt they had limited energy for. One peer nurse learner stated, “On our floor [morale] is low. Everyone is getting to burnout. You can’t see the positive [of peer education and change].”

There was also a perception that peer education is something that occurs over and above the regular work duties and that peer nurse teachers do not have the time to educate peers adequately. Peer nurse learners said that teaching and learning requires proper time. One peer nurse learner stated, “One more thing [peer education] piled up. I’m pushed to my limit! . .the teacher has to miss breaks to teach others.” Another peer nurse learner stated, “I have to read it on my own time and I’m resent-ful of. . .the workload factor. It’s like pushing a rope up a hill.” Participants felt that although managers expect and support peer education in principle, more concrete support (i.e., providing extra staff so that there is time to teach and learn) was needed.

Peer nurse learners did not report any factors that enhanced their experience with peer education. The solutions to hindrances reflect the metatheme of orga-nizational stress, with implications for more resources needed to implement the peer education program. The solutions also focused on interpersonal factors such as the teacher’s ability and the conditions for selecting peer nurse teachers. This finding partly supports the metath-eme of peer role conflict.

Interestingly, the peer nurse learners identified need-ing selection processes that may be in conflict with each other. Peer nurse learners not only wanted knowledge-


able, experienced teachers to be selected, but also wanted a fair and voluntary process, which would not necessarily guarantee these teacher qualities. To better achieve col-lective adoption of a peer education program, it would be worthwhile to explore how selection criteria can be met. It is also questionable whether the peer nurse learn-ers insisted on these criteria as a way of increasing their own odds of being chosen as peer nurse teachers because they spoke in the focus group in a way that suggested peer nurse teachers did not have more teacher qualities than they did.

Peer Nurse Teacher metatheme: Timing of New role integration

The metatheme of time needed for role integration was reflected in the questionnaire responses and focus group. The peer nurse teacher focus group discussed the adjustment time needed for peer nurse learners and peer nurse teachers to integrate the concept of the peer nurse teacher role and the ambivalence peer nurse teachers felt about their roles. These challenges contributed to the negative experiences had at the start of the peer educa-tion program.

Some discussion explored the peer nurse teachers’ previous teaching experience. Although questionnaire data indicated that peer nurse teachers felt well prepared to teach, the focus group indicated they felt they started out with little experience. Peer teaching was something they began with little preparation, but it became a more positive experience once some experience was gained. Peer nurse teachers expressed that both peer nurse learn-ers and peer nurse teachers were generally more accept-ing and comfortable with peer education later in the pro-gram. In the focus group, one peer nurse teacher stated, “[In the beginning,] suddenly the role was given a title. It became scary. I’m more comfortable doing it now. I think more and more people like the informality. It puts them at ease now that they’re used to it.”

It also appears that part of the adaptation process included peer nurse learners and peer nurse teachers coming to terms with the loss of their nurse educators, whose histories and titles perhaps provided clearer roles for the staff. One peer nurse teacher stated, “At first I sensed a lot of ambivalence. Staff was not sure what we were.” Another peer nurse teacher said, “It was a big change, big leap. Up until then we had nurse educators. We had just lost [nurse educators]. . .[so there was] more questioning what the role was. [Nurse educators] were always the authority people up there.” It is possible that staff felt they could share this with the author because these nurse educators were peers of the author.

Peer Nurse Teacher metatheme: organizational stress

Focus group dialogue indicated the need for man-agement’s initial and ongoing support and clarification of expectations when peer nurse teachers encountered performance difficulties in their roles. One peer nurse teacher stated, “I had one incident where I was disap-pointed. For my own comfort I wanted an expert there. I’m supposed to be teaching other people.” Similar to peer nurse learners, the peer nurse teachers also felt that heavy workloads and lack of time hindered the peer edu-cation process. Aside from implicating management’s re-sponsibility to make adjustments, they also put the onus on other nurses to appreciate that new work roles need additional time spent on them aside from the day-to-day tasks they had to complete. One participant said, “Peo-ple are so geared to numbers, I think that’s why time [as a hindrance] keeps popping up.” Peer nurse teachers also suggested nurses learn how to manage time better.

Factors That Enhance Peer EducationThe peer nurse teachers identified willingness to

go with the flow, eagerness, patience, and faith as fac-tors that enhance peer education. These factors reflect their appreciation for the time it takes to adapt to the peer teacher role and peer education as a new concept. They also implied that it is the responsibility of nurses to make peer education work despite other organizational factors.

Peer Nurse Teachers’ insights about ThemselvesPeer nurse teachers reflected positively on their

peer education experiences, which enhanced their self-growth. They identified the increased acquired techni-cal competency they gained through teaching the clinical skills. The experience also further developed their teach-ing skills as part of the general role of the nurse. They identified the continuous process of learning from both the learner and the experience of teaching. One peer nurse teacher stated, “It’s the greatest thing for RNs as a whole. . .[It] fits in with our role with increased emphasis on teaching. I have increased my confidence. . .having the confidence to share has improved a lot.”

imPLicaTioNs For ProFEssioNaL PracTicE aNd EducaTioN

Table 3 outlines some principles for planning a peer education program. Peer nurse learners identified more hindering factors that relate to the interpersonal nature of the peer education relationship and the work environ-ment than did peer nurse teachers. Peer nurse learners re-vealed that conflict can exist between peers when a peer in


the same unit is expected to formally teach them. Conflict arose from feelings of jealousy over not being selected for the prestigious role of peer nurse teacher. A lack of understanding about the intended structure of the peer education relationship created further conflict. Peer nurse learners needed as much explanation and support in their roles as did the peer nurse teachers in theirs. Peer nurse teachers also emphasized the need for ongoing support in their roles once the program was implemented.

Consideration should also be given to how a precep-torship program is effectively implemented because it is similar in concept to peer education. Duff and Kir-sivali-Farmer (1994) supported the need for informa-tion about a preceptorship program to be disseminated to staff at all levels of the organization, particularly during the planning of their program. In addition, Stu-art-Siddall and Haberlin (1983) identified the need for carefully smoothing the ruffled feathers of other staff members who can make an issue of the preceptor’s prestigious assignment.

Nurses are familiar with the traditional preceptorship concept and the formal teacher and learner roles; howev-er, clarification is needed as to how bedside peer teacher roles are intended. Gould and Lomax (1993) cautioned that peer education not be used as a panacea for meeting all education needs; therefore, management personnel need to delineate the roles and responsibilities of peer educators more clearly.

Edelstein and Gonyer (1993) advised that peer edu-cators should be flexible and cope with resistance from others during transition periods. They also advised that a supervision strategy be built into the peer educator’s practice. A peer education program such as this would

benefit from Morrow’s (1984) approach, which enabled peer educators to discuss their experiences, set positive, realistic expectations for themselves, and practice skills for mastery. Benner et al. (1999) stated that clinical lead-ers evolve by having authoritative knowledge. It would be worthwhile to have such a nurse leader facilitate a peer nurse teacher support group to support, develop, and ad-vance the peer nurse teachers’ authoritative knowledge and the peer nurse teacher role.

Both peer nurse learners and peer nurse teachers in this study agreed that a process whereby willing peers volunteered or were elected to be peer nurse teachers by their peers instead of by management alone could possi-bly avert some resistance to the program. Further explo-ration of the meaning behind these suggestions should attempt to discern how the peer nurse learners feel all necessary selection criteria can be met.

Recognition of the time needed for formal peer edu-cation to be accepted and implemented, including mak-ing workload adjustments, is necessary. In addition, peer nurse teachers say that nurses should use time manage-ment skills, see beyond their immediate tasks, and inte-grate change. This is an implication for both time and change management education.

Rogers’ (1983) Diffusion of Innovation Theory sug-gested that early adopters can greatly influence the inte-gration of desired change behaviors. Carefully selected peer nurse teacher candidates who are naturally moti-vated and better prepared to cope with adversity and ambivalence could have significant success in selling the peer education program to their peers and, ideally, peers should participate in this selection. In any case, with little existing time and diminished morale, other incentives are necessary for staff to invest time and commitment to im-

key pointsPeer EducationParkin, V. (2006). Peer Education: The Nursing Experience. The Journal of Continuing Education in Nursing, 37(6), 257-264.

1 Sensitivity about organizational stress, needed resources and

supports, and timing of new peer education role introduction is

necessary when implementing a peer education program.

2 Key stakeholders need to be educated about the peer educa-

tion program, whereas the scope of peer education roles

needs clarification.

3 Peer learners need to feel they can influence the selection of

a peer teacher.

TablE 3

PLaNNiNg sTEPs For a NursiNg PEEr EducaTioN Program

adapt and apply a theoretical framework (e.g., benner)

Delineate roles and responsibilities clearly

Educate peer teachers and peer learners on the scope of the peer teacher role

Collaborate with staff on choice of peer nurse teacher

Provide career and/or financial incentive for the role

Target early adopters who will influence adoption of the program

Consider change management education

Facilitate a support group for peer nurse teachers

adjust peer nurse teacher’s workload to enable new role adoption


plement peer education. Lincoln and McAllister (1993) cautioned that there is the potential for abuse when peer educators are unpaid.

Recognizing the need to reward participation, Flagg and Sparks (2003) introduced continuing education credit hours to boost participation in their night peer education program. If peer teaching responsibilities are not rewarded in some way, the peer education program can be perceived as unimportant, and the quality of what is taught may be compromised. Bedside careers also tend to be short term and hospitals need to find better ways of keeping skilled bedside nurses (Benner, 2001). As a retention strategy, the peer nurse teacher role could be better positioned as a desirable career development goal for nurses who provide direct patient care.

Peer nurse teachers generally viewed the experience of peer education positively. They acquired technical com-petence and developed insights about themselves in their role, a finding that was corroborated by other authors (Gould & Lomax, 1993; Lincoln & McAllister, 1993). More so than the peer nurse learners, the peer nurse teach-ers appreciated the time needed to integrate the new role.

coNcLusioNGiven the small sample size of this study, a bigger

sample size from this hospital and similar organizations could increase the generalizability of our results and bet-ter inform peer education practices. Another limitation to this study is the fact that participants had established interrelationships among themselves and with the author, which could have influenced their responses (particu-larly in the focus groups). One-on-one interviews with an outside, uninformed facilitator might avert researcher bias (DesRosier & Zellers, 1989) and participant bias.

For this study, the written questionnaire provided a starting point for thinking about and discussing the topic. The focus groups generated greater phenomeno-logical depth and richness of discussion; therefore, in a replication of this study, focus groups or one-on-one in-terviews are strongly recommended over questionnaires. It would be interesting to replicate the study once the peer education program is better established (e.g., 1 year

later) to compare program implementation stage suc-cess. The study of different peer groups, such as the ones where peer education is well recognized, could also bring further insight to the practices of peer education, which appears to have been studied with little rigor to date.

rEFErENcEsAtwood, A. H. (1986). Mentoring: A paradigm for nursing. Los Altos,

CA: National Nursing Review Inc.Benner, P. (1984). From novice to expert: Excellence and power in clini-

cal nursing practice. Menlo Park, CA: Addison-Wesley.Benner, P. (2001). From novice to expert: Excellence and power in clini-

cal nursing practice (Commemorative Edition). Upper Saddle Riv-er, NJ: Prentice Hall Inc.

Benner, P., Hooper-Kyriakidis, P., & Stannard, D. (1999). The skilled know-how of clinical leadership and the coaching and mentoring of others. In: Benner, P., Hooper-Kyriakidis, P., & Stannard, D. Clini-cal wisdom and interventions in critical care: A thinking-in-action approach (pp. 489-548). Philadelphia: W. B. Saunders.

Bogdan, R. C., & Biklen, S. K. (1992). Qualitative research for edu-cation: An introduction to theory and methods (2nd ed.). Toronto, Canada: Allyn & Bacon, Inc.

College of Nurses of Ontario. (2005). Fact Sheet: Quality assurance-reflective practice. Accessed October 18, 2006, from http://www.cno.org/docs/qa/44008_fsRefprac.pdf.

DesRosier, M. B., & Zellers, K. C. (1989). Focus groups: A program planning technique. The Journal of Nursing Administration, 19(3), 20-25.

Duff, M. R., & Kirsivali-Farmer, K. R. (1994). The challenge: Develop-ing a preceptorship program in the midst of organizational change. The Journal of Continuing Education in Nursing, 25, 115-119.

Edelstein, M. E., & Gonyer, P. (1993). Planning for the future of peer education. Journal of American College Health, 41, 255-257.

Flagg, R. L., & Sparks, A. (2003). Peer-to-peer education: Nighttime is the right time. Nursing Management, 34(5), 42-43.

Gould, J. M., & Lomax, A. R. (1993). The evolution of peer education: Where do we go from here? Journal of American College Health, 41, 235-240.

Green, J. (2001). Peer education. Promotion & Education, 8, 65-68.Lincoln, M. A., & McAllister, L. L. (1993). Peer learning in clinical

education. Medical Teacher, 15, 17-25.Morrow, K. L. (1984). Preceptorships in nursing staff development.

Rockville, MD: Aspen Publishers, Inc.Rogers, E. M. (1983). Diffusion of innovations (3rd ed.). New York:

The Free Press of Glencoe.Stuart-Siddall, S., & Haberlin, J. M. (1983). Preceptorships in nursing

education. Rockville, MD: Aspen Publishers, Inc.Tesch, R. (1987). Emerging themes: The researcher’s experience. Phe-

nomenology and Pedagogy, 5(1), 230-241.

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