Skill competence can deteriorate rapidly (Gonzalez & Kardong-Edgren, 2017; Oermann et al., 2011), leading to skill decay, which can cause nursing students' inability to perform critical skills confidently and competently in the clinical setting. Repetitive practice with feedback, as two of the many components of deliberate practice, can support psychomotor skill learning and, ultimately, proficiency (McGaghie, 2008). Thus, this approach to skill practice is appropriate for nursing education to support motor skill learning and retention (Chee, 2014; Gonzalez & Kardong-Edgren, 2017; Oermann, 2015). Peer mentoring, which pairs experienced students with novice students, offers a method to provide feedback to students during repetitive practice while fostering peer interactions and without increasing faculty workload (Giordana & Wedin, 2010).

There are no available health care studies exploring the use of repetitive practice for psychomotor skill competence and retention. Furthermore, though medical education has suggested that deliberate practice supports mastery and retention of skills (McGaghie, Issenberg, Cohen, Barsuk, & Wayne, 2011), there is a dearth of empirical evidence within the nursing education literature related to deliberate practice and skill competence (Liou, Chang, Tsai, & Cheng, 2013; Oermann et al., 2011). Peer mentoring programs create a positive learning environment while increasing learner confidence and reducing anxiety (Dennison, 2010; Giordana & Wedin, 2010). However, there are no nursing education studies exploring the combination of repetitive practice or deliberate practice with peer mentoring on skill competence and retention.

METHODS

The purposes of this one-group, repeated measures, pretest/posttest study were to determine the effect of repetitive practice with peer mentoring on baccalaureate nursing students' competence in and retention of vital signs assessment and auscultation of breath and heart sounds. Following institutional review board approval, a convenience sample of traditional sophomore nursing students at a mid-sized Catholic university in the mid-Atlantic region was recruited to participate in this study (N = 100). All participants completed a written consent, and data were coded to ensure confidentiality. A total of 69 students completed the study requirements, 4 males and 63 females. Participants ranged in age from 19 to 21 (M = 19.21), with a mode age of 19 (n = 55, 80 percent). Seventy-seven percent of participants (n = 53) indicated they did not have experience practicing vital signs, breath sounds, or heart sounds outside the nursing curriculum.

Instrumentation

The principal investigator created a task-specific checklist for each skill utilizing existing checklists from nursing textbooks. The use of task-specific checklists allows for objective evaluation of psychomotor skill competency (Lammers et al., 2008); most research related to the acquisition of psychomotor skills has used task-specific checklists (Ross, 2012). There were 33 steps in the vital signs checklist, 10 in the auscultation of breath sounds checklist, and 6 in the auscultation of heart sounds checklist. Each step was scored as 1 = yes or 0 = no. Each participant's scores for each skill were computed by totaling the number of points earned on each checklist. Four seasoned nursing fundamentals instructors reviewed the checklists for content validity. All checklists had good scale-level content validity indexes (0.99 to 1). Data were collected by trained research assistants (RAs) who were either doctoral or master's students and licensed RNs. RAs were trained by the principal investigator. To ensure interrater reliability, two RAs rated each pretest. Interrater reliability for all instruments was excellent (0.81 to 0.983).

Procedure

Students were recruited to participate in the study during semester 3 of the eight-semester program. Prior to recruitment, all participants received usual, standard training for vital signs and auscultation of breath and heart sounds, including textbook readings, audiovisuals, didactic lecture, and skills practice in the Simulation and Learning Resource Center (SLRC). Participants were pretested on competency in vital signs and auscultation of breath and heart sounds in the SLRC at the end of semester 3 to provide a baseline measurement of skill competence prior to their participation in the intervention.

In semester 4 of the program, all subjects participated in a program of repetitive practice with peer mentoring in the SLRC. Students self-selected groups of three to work with throughout the semester. Students worked with their groups to practice vital signs and auscultation of breath and heart sounds outside of class a minimum of two times during the semester with upperclassman peer mentors in the SLRC. Peer mentors offered immediate feedback on the students' skill performance during the sessions. In order to work in the peer mentoring role, junior and senior nursing students were required to have references from clinical faculty that addressed their motor skill ability. Peer mentors were trained by the SLRC director (a master's-prepared RN) regarding their role, expectations, and providing feedback to students. The director reviewed the skill checklists and psychomotor skill procedures with peer mentors to ensure their ability level (Ross, Bruderle, & Meakim, 2015).

All participants were posttested on competence in vital signs and auscultation of breath and heart sounds in the SLRC at the end of semester 4 of the program (posttest 1) to determine change in skill competence from baseline based on the repetitive practice with peer mentoring intervention and again four months later on the first day of semester 5 of the program (posttest 2) to assess for skill retention (maintenance of skill competence over time).

RESULTS

There was a statistically significant increase in vital signs competence from pretest to posttest 1, F(2, 62) = 10.353, p = .001. There was no statistically significant difference in auscultation of breath sounds competence, F(2,64) = 2.263, p = .929, or auscultation of heart sounds competence, F(2,62) = 0.541, p = 1, from pretest to posttest 1. There was no statistically significant difference in vital signs, F(2,62) = 10.353, p = .964, auscultation of breath sounds, F(2,64) = 2.263, p = .199, or auscultation of heart sounds competence, F(2,62) = 0.541, p = .975, from posttest 1 to posttest 2.

DISCUSSION

The findings from this study suggest that the use of repetitive practice with peer mentoring within an academic laboratory environment shows promise to foster skill competence in vital signs and skill retention for vital signs and auscultation of breath and heart sounds in baccalaureate nursing students. These findings align with existing literature that deliberate practice enhances skill mastery and retention (Liou et al., 2013; McGaghie et al., 2011; Oermann et al., 2011). The fact that vital signs improved significantly whereas the other skills did not improve significantly may be a result of the curriculum at the study school. Students learned vital signs approximately six to nine months before learning auscultation of breath and heart sounds, which would have potentially allowed students to gain more vital signs practice prior to the repetitive practice intervention. Moreover, the task-specific skill checklist for vital signs had more steps than the auscultation of breath or heart sounds checklists, which may have allowed for greater score variability over time.

The major limitation of this study was the one-group design with lack of a control group for comparison to determine causation. Generalizability is another limitation of this study due to the single site of data collection and homogeneous sample.

Implications

Because of the emphasis on patient safety in today's health care environment, it is imperative that nurse educators prepare competent graduates that can safely provide all aspects of patient care including patient care skills. Thus, it is imperative that nurse educators utilize evidence-based teaching strategies to promote skill competence and retention to support patient safety in the clinical setting through student and graduate nurse competence.

Because of the limited support for repetitive practice, deliberate practice, and peer mentoring in the nursing education literature, more research is needed related to the effect of repetitive practice with peer mentoring on nursing students' skill competence and retention. Specifically, this study should be replicated with a larger sample at multiple sites and with a control group. Moreover, future studies should add additional components of deliberate practice, beyond repetitive practice and feedback, to explore this concept more fully.

REFERENCES