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Peer to peer mentoring: Outcomes of third-year midwifery students mentoring first-year students
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Contents lists available at ScienceDirect
Women and Birth journal homepage: www.elsevier.com/locate/wombi
Original Research - Qualitative
Peer to peer mentoring: Outcomes of third-year midwifery students mentoring first-year students Rosemarie Hogan* , Deborah Fox, Georgina Barratt-See Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, P.O. Box 123, Broadway 2007, NSW, Australia
A R T I C L E I N F O
A B S T R A C T
Article history: Received 15 April 2016 Received in revised form 14 December 2016 Accepted 14 March 2017 Available online xxx
Problem: Undergraduate midwifery students commonly experience anxiety in relation to their first clinical placement. Background: A peer mentoring program for midwifery students was implemented in an urban Australian university. The participants were first-year mentee and third-year mentor students studying a three-year Bachelor degree in midwifery. The program offered peer support to first-year midwifery students who had little or no previous exposure to hospital clinical settings. Mentors received the opportunity to develop mentoring and leadership skills. Aim: The aim was to explore the benefits, if any, of a peer mentoring program for midwifery students. Methods: The peer mentoring program was implemented in 2012. Sixty-three peer mentors and 170 mentees participated over three academic years. Surveys were distributed at the end of each academic year. Quantitative survey data were analysed descriptively and qualitative survey data were analysed thematically using NVivo 10 software. Findings: Over 80% of mentors and mentees felt that the program helped mentees adjust to their midwifery clinical placement. At least 75% of mentors benefited, in developing their communication, mentoring and leadership skills. Three themes emerged from the qualitative data, including ‘Receiving start-up advice’; ‘Knowing she was there’ and ‘Wanting more face to face time’. Discussion: There is a paucity of literature on midwifery student peer mentoring. The findings of this program demonstrate the value of peer support for mentees and adds knowledge about the mentor experience for undergraduate midwifery students. Conclusion: The peer mentor program was of benefit to the majority of midwifery students. © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Keywords: Midwifery Education Students Peer mentoring Clinical placements
benefits to mentors such as building mentoring and leadership skills. Statement of significance
Problem or issue Undergraduate midwifery students experience anxiety in relation to their first clinical placement.
What this paper adds This program shows there are benefits to student peer mentors and mentees in the midwifery context. More than 75% of mentors felt that they benefited by developing their communication, mentoring and leadership skills.
What is already known 1. Introduction Student peer mentor programs provide valuable forms of support to mentees that cannot be replicated by staff. The nursing literature has shown that there are additional
* Corresponding author. E-mail address: [email protected] (R. Hogan).
The Bachelor of Midwifery course aims to prepare graduates who will be competent midwives with the skills, knowledge and confidence to practise midwifery according to the International Confederation of Midwives (ICM) definition of the role and scope of practice of the midwife and the Australian National Competency
http://dx.doi.org/10.1016/j.wombi.2017.03.004 1871-5192/© 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: R. Hogan, et al., Peer to peer mentoring: Outcomes of third-year midwifery students mentoring first-year students, Women Birth (2017), http://dx.doi.org/10.1016/j.wombi.2017.03.004
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Standards for the Midwife (Nursing and Midwifery Board of Australia 2006). The problem of varying levels of anxiety experienced by firstyear Bachelor of Midwifery students, prior to their first clinical placement, was a concern among academics. This problem was identified in two ways. Some students self-reported their anxiety verbally to academics during the semester. Others reported it via the university Student Feedback Survey (SFS) process at the end of the first semester in the first year. This peer mentoring program, where third year students mentored first year students, was implemented in order to reduce the anxiety they experienced and to facilitate a smooth transition to clinical practice. In an initial review of the literature, only one paper was found that related to a midwifery student peer mentoring program.3 Due to this, the search was extended to include literature on peer mentoring for nursing students. It was felt this was justified because there were sufficient similarities between the educational pathways of nurses and midwives to warrant adding nursing literature to the search strategy. A database search of the literature was conducted, using the databases OVID Medline, CINAHL, Intermid/Internurse, and PubMed. The search was limited to articles in English from the years 2000 to 2016. The keyword search terms ‘Student nurses’ OR ‘Student midwives’ AND ‘peer mentor’, were used, resulting in 91 hits. After removing duplicates and reviewing abstracts for relevance, eighteen remained, for which full texts were sought. Papers describing student peer mentoring programs that offered academic support only were excluded; as the focus of our program was on supporting students during clinical placement. Seventeen of the eighteen articles retrieved related to nursing student peer mentoring programs. Only one article, which was from Australia, related to a midwifery student peer mentoring program.1 However, only mentees were surveyed in this study about their experiences.3 Our program is, therefore, the first to report a peer mentoring program for midwifery students in which both mentees and mentors were surveyed. Peer mentoring and peer support programs in nursing schools and universities in a number of countries are reported in the literature, including those from the United Kingdom (UK), United States of America (USA), Taiwan, Canada and Australia. The aims and designs of the various programs are diverse. Some have a purely academic focus; some are restricted to the clinical placement experience only; and many integrate social, academic and clinical peer support. Some are specifically time limited to the clinical placement,2 whilst others span a semester or year-long process that include the clinical placement as an important component.3 It is well documented that clinical placements are stressful for new undergraduate students. One of the problems encountered by students is inadequate supervision on placement due to staff shortages in the clinical environment.5,6 Midwifery students face additional challenges of recruiting and following pregnant women for their required continuity of care experiences.1 These challenges include the time-consuming nature of engaging with women in order to recruit them into the program and the pressure of being ‘on call’ to attend their births. The latter is particularly challenging for students with paid work and/or caring responsibilities in addition to academic and clinical placement commitments.24 In order to ameliorate this stress, more support is required for students in the clinical practice environment.2 One solution maybe student peer mentoring programs which enhance the experience of students adapting to the challenges of tertiary level study and university life, across a diverse range of disciplines.4 The aim of several peer mentoring programs reported in the literature3,7,8 was to address and reduce student attrition rates.
Negative experiences on clinical placement were felt to trigger the attrition of first year nursing students.8 There were no quantitative data demonstrating whether peer mentoring does, in fact, reduce attrition. Several surveys revealed, however, that mentees felt motivated to keep going during challenging times due to the peer support they received.6 Most mentees found the support offered by the more senior students to be helpful, encouraging, understanding, reassuring and positive.9,10,11,14 In one study, mentees reported feeling comfortable asking questions of their peer mentors, saying that they felt able to ask them openly for information and advice, especially about clinical placements.17 This is aligned with the views of academics in the same study which found many questions asked by first-year students are best answered by more senior students, rather than staff.7 The grouping of mentors and mentees are structured in a range of ways in the literature. Many of the papers report one mentor working with a group of mentees. The size of the mentee groups vary, from three to eight per mentor,7,9 matching for gender,10 age and/or alphabetically.7 In some programs, however, mentees choose the mentor with whom they most closely identified,1 a process recommended by students in the evaluations elsewhere.9 A number of programs paired a senior student with a more junior student11–13 and another aimed for pairs or trios of students.2 Three used a buddying system, joining a pair of students together with a staff member.5,10,11 A number of benefits from participating in peer mentoring programs were reported in the literature. Students developed their teamwork and collaboration skills,10,11 with increased interaction between students across year levels was noticed by staff.9,10 Mentees felt that their mentors were a protective factor against feeling isolated on clinical placement, which built their confidence and reduced communication barriers.6 Mentors gained confidence from the experience of mentoring a more junior student,10,11,19 finding that they could appreciate how far they had come since beginning their studies.9,12,13 Leadership skills were also enhanced through the experience of being involved in the development of another student.10,12 Mentors reported that the process of organising their role improved their clinical decision making,11 helped them to develop time management skills11,19 and assisted them in gaining a more thorough understanding of the role of clinical educator or preceptor.9,11,19 Whilst evaluations demonstrated positive feedback and showed student peer mentoring programs to be worthwhile, there were some suggestions for improvement. For example time constraints for students were a barrier to maximising the success of peer mentoring relationships.12,14 Suggestions were made by students for academics to provide more structured or timetabled, opportunities for students to meet.9 Where Faculties did provide structured introductory sessions this generally occurred during the orientation or induction period for first-year students2,5,6,14 and/or included a social event a few weeks into the semester.7 A few Faculties had social events at the end of the academic year, at which time surveys and awards could be distributed.2,6 Programs in which these types of events did not occur, received feedback from students that this would have been desirable.11,12 Little is known about the value of peer mentor support for undergraduate midwifery students. To our knowledge, only one such program has been reported in the published literature which was also set in Australia.1 The program involved 55 first year mentees and 21 student peer mentors. However, the views and experiences of the mentors were not surveyed. The 55 mentees who received mentoring responded to surveys that included Likert scale and open questions. Eighty-seven percent responded positively and reported that the program improved their confidence and motivated them to continue their studies during difficult times. Mentors provided reassurance to their mentees by
Please cite this article in press as: R. Hogan, et al., Peer to peer mentoring: Outcomes of third-year midwifery students mentoring first-year students, Women Birth (2017), http://dx.doi.org/10.1016/j.wombi.2017.03.004
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sharing the stories of their own experiences of early midwifery placements. Our study is the first, to our knowledge, that has sought the views of senior midwifery students about their experiences of mentoring junior midwifery students. 2. The peer mentoring program A peer mentoring program for undergraduate midwifery students was implemented in a large urban university in Australia. The participants were first-year mentee and third-year mentor students studying a three-year Bachelor degree in midwifery. All first and third-year midwifery students were offered the opportunity to participate in the program. The main purpose of the program was to offer peer support to first-year midwifery students who had little or no previous exposure to hospital clinical settings, by assigning them to thirdyear midwifery student peer mentors. The type of support offered to mentees included information on the hospital where they were assigned for their clinical placement such as public transport and directions, finding the toilets and the café, and finding their way to the various clinical areas. An additional purpose of the program was to develop mentoring and leadership skills for the mentors. Mentors were provided with a three-hour face to face training workshop to prepare them for their role. This training was developed based on guidelines developed by the Australian and New Zealand Support Services Association Incorporated.22 It was facilitated by a midwifery academic and the manager of the student peer support service at the university in which the program took place. Topics covered included defining the role and purpose of a mentor, relationship building, communication skills, boundary formation, support services and processes of referral to support services, self-care (health and stress management). Afternoon tea was provided and the mentors were given a 23page booklet accompanying the workshop, intended as a reference guide for the mentors about their role. The booklet summarised the content of the workshop and included information on how to maintain boundaries by giving relevant scenarios as exemplars. Relevant community, online and university support services were listed. 3. Methods The research question that guided the design of this study was ‘What are the benefits, if any, of a peer mentoring program for midwifery students?’ The program was run in 2012, 2014 and 2015. All first and third-year students were offered the opportunity to participate. In 2013 there was a smaller than usual group of final year students and few volunteered to be a mentor, hence, a decision was made not to run the program in that year. A Teaching and Learning Evaluation Declaration was completed and submitted to the university in 2012 in lieu of an ethics committee application, as is required at the university for this type of program. The program was approved as a low-risk teaching and learning activity. Participation from third-year students was voluntary and conducted in their own time. During the threehour mentor training workshop, significant attention was paid to the risks and harms that may arise for them as a result of participating in the peer mentoring program. In particular, time was allocated to teaching and learning about establishing and maintaining boundaries, so that the students were equipped to protect themselves from being over burdened by their mentoring role. Student referral services and contact details were given, so that in the event of a mentee required support beyond the scope of the clinical placement and/or academic life, mentors could refer them immediately to the student support services at the
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university. Support services for which contact details were provided included health counselling, GP clinic, special needs counselling, careers advice, financial counselling, housing, safety, well-being and accident support, discrimination and harassment advisors. Several case scenarios were given to the students during the workshop. One scenario discussed a third-year mentor being approached by a first-year student stating they were suddenly homeless. Another scenario discussed the duty of care for a student in psychological distress. The students were asked to reflect upon how they would manage the situation, followed by a discussion between staff and students. 3.1. Sample and recruitment One-hundred-and-seventy first year students during 2012, 2014 and 2015 were invited to participate in the program as mentees. Their involvement was not compulsory. Sixty-three third year midwifery students were invited to volunteer as peer mentors. A senior midwifery lecturer spoke to the third year students in class and then a follow-up email invitation was sent with further details. Responding to the surveys was entirely voluntary; free and informed consent to participate in the evaluation was assumed to be given when a student completed and returned a written survey. 3.2. Data collection Surveys were distributed to the peer mentors and mentees in their respective classes at the end of the academic years, 2012, 2014 and 2015, asking about their views and experiences of participating in the program. The content of the survey was based on a survey piloted in a similar setting and reported elsewhere.23 Both groups were surveyed about their experiences of the program, via paper-based surveys that comprised both Likert scale and open questions. The content of the peer mentor survey is displayed in Box 1. The content of the peer mentee survey is displayed in Box 2. 3.3. Data analysis Quantitative data were analysed descriptively, by collating the responses to the Likert scale questions contained in the surveys. Qualitative data from the open-ended survey questions were transcribed into NVivo10 software, then coded and analysed using the process of thematic analysis by Roberts and Taylor.14 Similar surveys and methods of analysis were used by a number of other published studies on student peer mentoring in nursing and midwifery.3,6,10,20 4. Findings 4.1. Peer mentoring program—quantitative survey findings from mentors and mentees In total, 63 peer mentors (M) and 170 mentees (m) participated in this program. Fifty-three mentors (84%) responded to the survey seeking their views and experiences of the peer mentoring program. Over 80% felt that they had helped their mentees adjust to being on clinical placement. At least 75% felt that the program benefited them as mentors in developing their communication skills, building self-confidence, and increasing their employability. Table 1 displays their responses to the Likert scale questions. One hundred and seventy mentees participated in the program. One hundred and four mentees (61%) responded to the survey about their views and experiences. Over 80% felt that their allocated peer mentors were at least ‘somewhat helpful’, 38%
Please cite this article in press as: R. Hogan, et al., Peer to peer mentoring: Outcomes of third-year midwifery students mentoring first-year students, Women Birth (2017), http://dx.doi.org/10.1016/j.wombi.2017.03.004
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Box 1. Content of the peer mentor survey. The mentor survey, distributed in class at the end of the year, asked students to respond to five questions, two of which contained several sub-questions requiring Likert scale answers and three of which were open questions. In the Likert scale questions, respondents were asked to rate their responses as follows: 1) being ‘No help at all’, 3) being ‘Somewhat’ and 5) being ‘Very helpful’. The Likert scale questions asked the peer mentors: How useful do you think you have been to your mentees? a) In helping them adjust to the university system? b) In helping them adjust to the clinical placement? c) In helping them make useful contacts? How has being a mentor assisted you with: a) Improving your communication skills? b) Improving your self-confidence? c) Improving your employment skills? The open questions asked the peer mentors: Can you identify ways in which you might have been more helpful to your mentees? If so, why? What problems have you encountered in providing support to your mentees? In what ways do you think the peer mentoring program could be improved?
stated that their allocated peer mentors were ‘very helpful’. Only 6% stated that they met their peer mentors often, which was aligned with the qualitative data reflecting the theme of ‘Wanting more face to face time’. Table 2 displays the mentees’ responses to the Likert scale questions. 4.2. Peer mentoring program—qualitative findings from the mentor and mentee surveys Three themes emerged from the thematic analysis of the openended questions in the program surveys. The themes were ‘Receiving start-up advice’; ‘Knowing she was there’ and ‘Wanting more face to face time’. The first two themes, ‘Receiving start-up advice’ and ‘Knowing she was there’ related to the main benefits from the peer mentoring program as identified by the mentees. The third theme, ‘Wanting more face to face time’ related to feedback from mentors (M) and mentees (m) describing improvements that they felt could be made to the program. These themes are explored below.
4.2.1. ‘Receiving start-up advice’ Receiving ‘good start up advice’ (m) meant that the mentors were able to offer ‘tips on the processes and policies at the specific hospital’ (m). The data suggested that receiving ‘start up advice’ from a peer mentor reduced their anxiety prior to placement and that ‘having the insight of an experienced student’ (m) ‘who has been in our position recently’ (m), was a useful aspect of the program that could not be replicated by staff. Many students remarked that they ‘found it very helpful, as it allowed for an overview of the situation of the hospital before entering’ (m). Prior to placement, mentees enjoyed receiving emails from mentors that contained information about the hospital to which they were allocated, for example: ‘My peer mentor emails me very detailed emails with great advice, tips and even acronyms’ (m). ‘Emailing between mentor and students before our placement started was helpful so she was able to answer all of our questions specific to the hospital’ (m).
Box 2. Content of the peer mentee surveys. The mentees were asked to respond to seven questions, four of which required 5 point Likert scale answers and three of which were open questions. The Likert scale questions asked the mentees: How well do you think you have made the transition to uni? How useful has the peer mentoring program been in helping you adjust to clinical? How often did you meet your mentor(s)? The open questions asked the mentees: In what ways has the peer mentoring program been helpful/unhelpful? What problems have you experienced with the peer mentoring program? What suggestions do you have for improving the peer mentoring program?
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Table 1 Mentor program evaluation (53 respondents). Q1. How useful do you think you have been to your mentees . . . a) . . . in helping them adjust to the University system? b) . . . in helping them adjust to the clinical placement? c) . . . in helping them make useful decisions? Q2. How has being a mentor assisted you with . . . a) . . . improving your communication skills? b) . . . improving your self-confidence? c) . . . improving your employment skills?
1 (No help at all) 2
3 (Somewhat)
4
5 (Very helpful)
No response
9.43% (N = 5/53)
20.75% (N = 11/53) 20.75% (N = 11/53)
35.85% (N = 19/53) 13.21% (N = 7/53)
7.55% (N = 4/53)
7.55% (N = 4/53)
32.08% (N = 17/53)
32.08% (N = 17/53)
13.21% (N = 7/53)
11.32% (N = 6/53)
49.06% (N = 26/53) 16.98% (N = 9/53)
9.43% (N = 5/53)
0% (N = 0/53)
1 (No help at all) 2
3 (Somewhat)
4
5 (Very helpful)
No response
7.55% (N = 4/53) 9.43% (N = 5/53) 13.21% (N = 3/53)
30.19% (N = 16/53) 32.08% (N = 17/53) 33.96% (N = 18/53)
32.08% (N = 17/53) 30.19% (N = 16/53) 32.08% (N = 17/53)
13.21% (N = 7/53) 16.98% (N = 9/53) 11.32% (N = 6/53)
0% (N = 0/53) 0% (N = 0/53) 9.43% (N = 5/53)
16.98% (N = 9/53) 11.32% (N = 6/53) 7.55% (N = 4/53)
0% (N = 0/53)
20.75% (N = 11/53) 0% (N = 0/53)
Table 2 Mentee evaluation of mentor program (104 respondents). 1 (Never)
How often did you meet your mentor(s)?
How useful has the peer mentoring program been in helping you adjust to clinical?
How well do you feel you have made the transition to uni?
How helpful did you find your mentor(s)?
3 (Occasionally) 27.88% (N = 29/ 24.01% (N = 25/ 33.65% (N = 35/ 104) 104) 104) 1 (No help at 2 3 (Somewhat) all) 9.62% (N = 10/ 29.81% (N = 31/ 8.65% (N = 9/ 104) 104) 104) 1 (No help at 2 3 (Somewhat) all) 0% (N = 0/104) 0% (N = 0/104) 9.62% (N = 10/ 104) 1 (No help at 2 3 (Somewhat) all) 8.65% (N = 9/ 7.69% (N = 8/ 17.31% (N = 18/ 104) 104) 104)
Specific details the mentees received included ‘useful information on documentation . . . how to find parking and some tips on communication with the midwives and educators.’ Mentees felt that this start-up advice ‘ . . . bridged the gap between uni and hospital’ because the mentors were ‘ . . . able to relate to clinical and uni . . . making me feel more comfortable’ (m). Many mentees mentioned the value of the assistance they received from their mentors in working out how to use the documentation that was required during placement. Some referred to their ‘portfolio’, others to ‘worksheets’ or ‘sheets’, saying for example that, ‘I needed help negotiating my worksheets’ (m). The benefits of the advice from mentors included, for example: ‘Can ask questions about what to expect and how to fill out sheets’ (m). ‘Excellent practical advice regarding filling out sheets’ (m). ‘Showed examples of portfolio’ (m). ‘Tips on filling out the portfolio’ (m). Seeing how more senior students managed their paperwork on placement was felt to be an important adjunct to being shown in class by academic staff. 4.2.2. ‘Knowing she was there’ The majority of respondents to the surveys were positive about the program and were pleased with the support they received from their mentor. This qualitative finding correlated with the Likert scale results that showed more than 80% of responses were positive. Mentees who had positive experiences used words like ‘supportive’, ‘encouraging’ and ‘positive’ to describe their mentors, as these quotes demonstrate: ‘They provide support and encouragement, as well as clarification of any issues I had’ (m).
2
4
5 (Often)
7.69% (N = 8/ 104) 4
5.77% (N = 6/ 104) 5 (Very helpful) 22.12% (N = 23/ 29.81% (N = 31/ 104) 104) 4 5 (Very well)
34.62% (N = 36/ 52.88% (N = 55/ 104) 104) 4 5 (Very helpful) 25.96% (N = 27/ 38.46% (N = 40/ 104) 104)
No response 0.96% (N = 1/ 104) No response 0% (N = 0/ 104) No response 2.88% (N = 3/ 104) No response 1.92% (N = 2/ 104)
‘Allowing encouragement that 1st year is the hardest, it will get better as placement goes by’ (m). ‘Helped to gear me into a positive mindset, and addressed any concerns and insecurities I had’ (m). ‘[Mentor] was very positive about her experience and instilled enthusiasm and confidence in us’ (m). Being made to feel welcome and receiving reassurance about the hospital environment were among the approaches mentees noticed the mentors using, in order to encourage them: ‘Reassurance that the hospital is a supportive and positive environment’ (m). ‘[Mentor] reassured us that she had a great experience at the hospital’ (m). ‘Helped me feel welcome and adjust to placement’ (m). It was comforting to many of the mentees to ‘know they are there if we need them’ (m) so that they could ask any questions that may arise. ‘Just talking to her, in general, was comforting’ (m) said, one student. Others were reassured by ‘knowing there was help if needed’ (m). Having the mentor ‘help with questions’ (m) was one of the most useful aspects of the program for many of the mentees, as demonstrated in the following quotes: ‘She emailed us at beginning of prac [sic] and answered questions which was helpful’ (m). ‘My mentors were always ready to answer my questions and give me tips’ (m). ‘One student took the time to meet us for an hour and go over all our questions, she also gave us her number and said we could ring at any time which seemed exceptionally kind’ (m). A number of mentees asked questions about clinical placement that they may not have been comfortable asking a staff member. ‘It
Please cite this article in press as: R. Hogan, et al., Peer to peer mentoring: Outcomes of third-year midwifery students mentoring first-year students, Women Birth (2017), http://dx.doi.org/10.1016/j.wombi.2017.03.004
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was nice to talk to people who have been in my position at my hospital. It was nice to have people to ask ‘silly little questions’ (m). ‘Building up a relationship with [mentor] was good as I was able to ask her questions about how things work in the hospital’ (m). Mentees also enjoyed asking their mentors questions about academic work, saying that it was ‘helpful to ask questions about uni and clinical’ (m), to get ‘reassurance that I am on track . . . to chat about uni/prac [sic]’ (m). Having ‘a familiar face on placement’ (m) was reassuring because it helped mentees to ‘feel like you have a more experienced friend in the [clinical student uniform]!’ (m). A familiar face represented ‘someone you could trust when you needed help’ (m). ‘Wonderful to have the support of a fellow [name of university] midwifery student – very helpful in understanding the “quirks” of our particular hospital’ (m). Several mentors were regarded highly for their knowledge and skills and found to be ‘a good role model’ (m) and ‘full of advice’ (m). ‘[My mentor] had a lot of knowledge and skills which were admirable. Very friendly and always willing to lend a hand and answer all questions’ (m). ‘I got to spend some time with my mentor (a whole day) and I found her to be a wealth of knowledge and very good at teaching and demonstrating things to me’ (m). Mentees were grateful when mentors made the effort to check how they were managing their placement and their studies. ‘She asked how my experience is and checked in on me. She is so friendly, really lovely person’ (m). ‘Caring, friendly, helpful, always smiling. Always checking up on us!’ (m). ‘They contacted me lots during the year to ask how I was coping’ (m). A ‘debrief with peer mentors’ (m) was an important process that mentees used to manage the challenges of clinical placement. Some mentees reported that their mentor was ‘always willing to participate in a debriefing session about experiences—both clinical and personal’ (m) and that she was ‘a good person to debrief with and reflect on clinical’ (m). Other students remarked that they would have liked ‘more opportunities to debrief’ (m) and asked that the university ‘establish times when mentors and mentees could meet to debrief/brief’ (m). 4.2.3. ‘Wanting more face to face time’ One mentor commented on enjoying the practical aspect of her role, ‘being a welcoming face on postnatal, encouraging her in her skills’ (M). Both mentors and mentees expressed that they wished they could have spent more time with each other. Comments such as, ‘Difficulty finding time to meet’ (m) and ‘hard to arrange a time to meet them’ (M) were frequent. Although it was ‘hard to build rapport’ (M) without face to face contact, a number of mentees valued email contact for information sharing, saying that it ‘would be nice to meet more regularly but we have frequent contact through email’ (m). There were a number of reasons cited for the lack of sufficient face to face meetings; including that first and third year schedules often clashed, the clinical placement rosters did not coincide, students were allocated to other students at different hospitals, the third year mentors were too busy, and/or that both first and third year students were too busy. Creating student rosters for clinical placements is a complex task, with competing demands from both the university and the hospital. For this reason perhaps, clinical placement rosters were not co-ordinated in a way that prioritised the peer mentor program, as several quotes illustrated: ‘Finding it difficult to meet them very often because we are on different schedules’ (M), and ‘we
have not yet been able to meet as there has been a conflict of our schedules’ (m). Some students felt there was little they could do about the scheduling problem, ‘Would love to see her more around but that comes down to rostering which is out of our control’ (m). Mentors and mentees who were not placed at the same hospital had even more difficulty arranging face to face contact, saying for example, ‘I haven’t had a chance to meet my mentor. She isn’t at my hospital’ (m). ‘They weren't from my hospital, and they were unable to meet up with me so was limited in my ability to support' (M). Lack of familiarity with the mentee’s hospital was problematic, and limited the amount of support that could be offered, ‘I wasn’t at the same hospital . . . which made it hard to answer specific questions’ (M). Several participants made the suggestion that mentor to mentee ratios would be better as one-to-one, or one mentor-totwo mentees, as shown in the following quote: ‘Allocating the students in smaller groups (i.e. 1-2 students only) as that is a more personal experience’ (M). There was a perception by a number of the mentees that the mentors were over committed as third-year students, leaving them little time to manage their mentoring, as these quotes from mentees illustrate: ‘They need more hours in their day! Haven’t had the chance to catch up yet’ (m). ‘Not as much support as I thought . . . because 3rd years are very busy’ (m). A few mentors also made reference to their own time restraints, saying that there was ‘not enough time between uni, prac, work and assignments to dedicate myself to their mentoring’ (M) and ‘we are all very busy’ (M). One mentor made the suggestion to consider getting second year students involved, feeling that they would have more time to spend with mentees than third years, saying, ‘Perhaps second years would have more opportunity to see first years since there is a lot more contact time with them [at] Uni’ (M). Another mentor felt that the preparation for the program could be done in second year, saying, ‘ . . . training is done in second year, so third years would be ready to mentor at start of year’ (M). Many students felt that some of the time constraints could be alleviated if they met each other earlier in the semester, saying that they wanted to have time to make contact and develop relationships before the year got too busy. There were many suggestions for improvement of the program in relation to this issue, for example: ‘Connect students with mentors early on in the semester for more time to meet up’ (m). ‘More warning and time to meet them prior to placement’ (M). A general meet and greet session, which all first and third-year students could attend, was a suggestion that may be easily implemented prior to clinical placements being allocated. Much of the initial information could be shared and questions asked, both about the mentoring program and about clinical placements. An informal social gathering at university was a popular idea, for example: ‘Organise a session for everyone to get together at the beginning of the year to establish [a] relationship’ (M). Others ideas for making initial contact included ‘a welcoming session at the hospital’ (M) and the third years attending first-year lectures. ‘The third year visit to our lecture was very useful . . . having more third-year talks [would be good]' (m) or a ‘class before placement to all pair off and meet for about 1 hour’ (m). Many students called for more structure in the program, or at least a ‘more structured meeting initially’ (M). Some students
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wanted the university to ‘ . . . schedule actual uni time to meet the first years’ (M), asking for ‘allocated mentoring time’ (M) that was ‘set . . . in the timetable for us all’ (M). Mentees made similar suggestions, for example, ‘ . . . facilitate a time through the Uni that we could all meet’ (m). Mentors also made suggestions around allocating time within the clinical placement at the hospital, rather than at university, saying: ‘ . . . times could be arranged by educators during clinical placement . . . allocated time in clinical’ (M). Some mentees admitted that, in hindsight, they could have been more pro-active in seeking information and support from their mentors, for example, ‘I guess I need to take the initiative to contact and meet with them more’ (m) and ‘I really didn’t try so hard to meet her I will admit’ (m). There was a sense, for others, that the mentors should have been more pro-active in following them up, as mentees ‘may feel shy to contact them’ (m). Many mentees felt that their mentors ‘didn’t seem interested in meeting us – maybe because they were busy?’ (m) and would have liked their mentors ‘ . . . to arrange meetings each clinical placement’ (m). Some mentors found it difficult to engage their mentees, however, saying, ‘They [mentees] wouldn’t meet us despite repeated attempts’ (M). Assistance from the university in structuring meetings was seen as a potential solution. 5. Discussion This program is in keeping with the literature from a range of disciplines which demonstrate that student peer mentoring programs have the capacity to enhance the adaptation of students to their tertiary level study and university life.4 Most mentees in this program found that the support offered by their peer mentors was encouraging, understanding, reassuring and positive, reflecting the findings of a number of papers exploring nursing student peer mentoring.10–12,19 The nursing literature shows comprehensive benefits for student peer mentors who participate in mentoring programs, gaining confidence,5,6,11 leadership skills,6,10 clinical decision making11 and time management skills.5,11 This is the first program to evaluate the mentor experience in the midwifery student context. Results show that at least 75% of mentors surveyed felt that the program benefited them at least somewhat, in developing their communication skills, building self-confidence, and increasing their leadership skills. Peer support added value to the help that could be offered by academic and clinical staff. Mentees reported feeling more comfortable asking their mentors questions about clinical placements than they did asking staff members.7 The only other study identified in relation to peer mentoring for midwifery students was also set in Australia.1 Similarly to this study, the mentees in our program responded positively and reported that the program improved their confidence and motivated them to continue their studies during difficult times. The majority of studies on peer mentoring programs for nursing and midwifery students had one mentor assigned to a group of mentees ranging in size from three to eight per mentor.2,3,7,13,18,19 In this study, in 2012, when we first facilitated the program, the ratio of peer mentors to mentees was between four to six mentees to each mentor. Subsequently, in 2012 peer mentors reported experiencing difficulties arranging meetings with large groups of mentees and suggested a more realistic ratio such as one mentor to three mentees at the most would make the program more practicable. In response to this feedback, in 2014 and 2015 no more than three mentees were assigned to one peer mentor and this was evaluated more favourably.
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A number of other changes were made to the program as a result of the feedback received in the 2012 surveys. Constructive feedback given by the first year mentees was incorporated into the training workshops conducted in 2014 and 2015 with the third year mentors. For example, third years were encouraged to meet with the first years at least once or twice in person, ideally initially, and then communicate via email, text or social media. In class, the first years were encouraged to promptly answer emails from their third-year peer mentor and to keep in touch with their peer mentor over their first year. There is ongoing evaluation and development to ensure that the peer mentor program continues to meet the needs of the students. 6. Conclusion Concern amongst academics regarding the varying degrees of anxiety experienced by first-year undergraduate midwifery students prior to their first clinical placement, prompted the implementation of this peer mentoring program. By providing support to first-year midwifery students, it was hoped that the anxiety they experienced would be reduced, enabling a smoother transition to clinical practice. The aim of this program was to find out the benefits, if any, of a peer mentoring program for first-year midwifery students. The program was shown to be of benefit to the majority of students, both mentees and mentors. Over 80% of mentors and mentees felt that the program helped mentees adjust to their midwifery clinical placement. Three themes emerged from the qualitative data, including ‘Receiving start-up advice’; ‘Knowing she was there’ and ‘Wanting more face to face time’. This paper adds to the knowledge about peer mentoring for midwifery students and illustrates the perspective of the mentors for the first time, as this has not previously been studied in the midwifery context. Acknowledgements and disclosures No financial support was provided to the university, for either the conduct of research or the preparation of the manuscript. No conflicts of interest have been identified. Associate Professor Alex Wang, from the Faculty of Health at the University of Technology Sydney, provided guidance to the authors on presentation of the descriptive statistics. References 1. Roberts K, Taylor B. Nursing research processes: an Australian perspective. 2nd ed. Southbank Victoria: Thomson; 2002. 2. Radford SJ. Building a peer mentoring programme. Nurs Stand 2014;28(39):64. 3. McKellar L, Kempster C. We’re all in this together: midwifery student peer mentoring. Nurse Educ Pract 2015. doi:http://dx.doi.org/10.1016/j. nepr.2015.08.014 PubMed PMID: 26422813. 4. Milne L, Keating S, Gabb R. Student peer mentoring at Victoria University. Melbourne: Victoria University; 2007. 5. Deasy C, Coughlan B, Pironom J, Jourdan D, Mannix-McNamara P. Predictors of health of pre-registration nursing and midwifery students: findings from a cross-sectional survey. Nurse Educ Today 2016;36:427–33. doi:http://dx.doi. org/10.1016/j.nedt.2015.09.010 PubMed PMID: 26438968. 6. Brookes N, Moriarty A. Implementation of a peer-support system in the clinical setting. Nurs Stand 2009;23(27):35–9. 7. Mann C. Nursing peer mentors: the student experience of peer mentoring in the school of nursing. University of Nottingham: WordPress.com; 2013 Available from: https://nursingpeermentors.wordpress.com/. 8. Glass N, Walter R. An experience of peer mentoring with student nurses: enhancement of personal and professional growth. J Nurs Educ 2000;39 (4):155–60. 9. Morley DA. Supporting student nurses in practice with additional online communication tools. Nurse Educ Pract 2014;14(1)69–75. doi:http://dx.doi. org/10.1016/j.nepr.2013.06.005 PubMed PMID: 23871299. 10. Sprengel AD, Job L. Reducing student anxiety by using clinical peer mentoring with beginning nursing students. Nurse Educ 2004;29(6):246–50.
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11. Christiansen A, Bell A. Peer learning partnerships: exploring the experience of pre-registration nursing students. J Clin Nurs 2010;19(5–6)803–10. doi:http:// dx.doi.org/10.1111/j.1365-2702.2009.02981.x PubMed PMID: 20500324. 12. Aston L, Molassiotis A. Supervising and supporting student nurses in clinical placements: the peer support initiative. Nurse Educ Today 2003;23(3):202–10. doi:http://dx.doi.org/10.1016/s0260-6917(02)00215-0. 13. Scott ES. Peer to peer mentoring: teaching collegiality. Nurse Educ 2005;30 (2):52–6. 14. Dennison S. Peer mentoring: untapped potential. J Nurs Educ 2010;49(6)340– 2. doi:http://dx.doi.org/10.3928/01484834-20100217-04 PubMed PMID: 20210287. 17. ANMAC. Midwife accreditation standards. . 18. Campbell A. Introducing a buddying scheme for first-year pre-registration students. Br J Nurs 2015;24(20):992–6. 19. Gilmour JA, Kopeikin A, Douche J. Student nurses as peer-mentors: collegiality in practice. Nurse Educ Pract 2007;7(1)36–43. doi:http://dx.doi.org/10.1016/j. nepr.2006.04.004 PubMed PMID: 17689422.
20. Harmer BM, Huffman J, Johnson B. Clinical peer mentoring: partnering BSN seniors and sophomores on a dedicated education unit. Nurse Educ 2011;36(5) 197–202. doi:http://dx.doi.org/10.1097/NNE.0b013e3182297d17 PubMed PMID: 21857338. 22. Australian and New Zealand Students Support Services Incorporated (ANZSSA). Guidelines for best practice in peer mentoring. updated in 2014. http://anzssa.squarespace.com/fye-peer-mentoring/. [Accessed 6 April 2014]. 23. Glaser N, Hall R, Halperin S. Students supporting students: the effects of peer mentoring on the experiences of first-year university students. J Aust N Z Stud Serv Assoc 2006;27:4–19. 24. Gray J, Taylor J, Newton M. Embedding continuity of care experiences: an innovation in midwifery education. Midwifery 2016;33:40–4.
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Contents lists available at ScienceDirect
Women and Birth journal homepage: www.elsevier.com/locate/wombi
Original Research - Qualitative
Peer to peer mentoring: Outcomes of third-year midwifery students mentoring first-year students Rosemarie Hogan* , Deborah Fox, Georgina Barratt-See Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, P.O. Box 123, Broadway 2007, NSW, Australia
A R T I C L E I N F O
A B S T R A C T
Article history: Received 15 April 2016 Received in revised form 14 December 2016 Accepted 14 March 2017 Available online xxx
Problem: Undergraduate midwifery students commonly experience anxiety in relation to their first clinical placement. Background: A peer mentoring program for midwifery students was implemented in an urban Australian university. The participants were first-year mentee and third-year mentor students studying a three-year Bachelor degree in midwifery. The program offered peer support to first-year midwifery students who had little or no previous exposure to hospital clinical settings. Mentors received the opportunity to develop mentoring and leadership skills. Aim: The aim was to explore the benefits, if any, of a peer mentoring program for midwifery students. Methods: The peer mentoring program was implemented in 2012. Sixty-three peer mentors and 170 mentees participated over three academic years. Surveys were distributed at the end of each academic year. Quantitative survey data were analysed descriptively and qualitative survey data were analysed thematically using NVivo 10 software. Findings: Over 80% of mentors and mentees felt that the program helped mentees adjust to their midwifery clinical placement. At least 75% of mentors benefited, in developing their communication, mentoring and leadership skills. Three themes emerged from the qualitative data, including ‘Receiving start-up advice’; ‘Knowing she was there’ and ‘Wanting more face to face time’. Discussion: There is a paucity of literature on midwifery student peer mentoring. The findings of this program demonstrate the value of peer support for mentees and adds knowledge about the mentor experience for undergraduate midwifery students. Conclusion: The peer mentor program was of benefit to the majority of midwifery students. © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Keywords: Midwifery Education Students Peer mentoring Clinical placements
benefits to mentors such as building mentoring and leadership skills. Statement of significance
Problem or issue Undergraduate midwifery students experience anxiety in relation to their first clinical placement.
What this paper adds This program shows there are benefits to student peer mentors and mentees in the midwifery context. More than 75% of mentors felt that they benefited by developing their communication, mentoring and leadership skills.
What is already known 1. Introduction Student peer mentor programs provide valuable forms of support to mentees that cannot be replicated by staff. The nursing literature has shown that there are additional
* Corresponding author. E-mail address: [email protected] (R. Hogan).
The Bachelor of Midwifery course aims to prepare graduates who will be competent midwives with the skills, knowledge and confidence to practise midwifery according to the International Confederation of Midwives (ICM) definition of the role and scope of practice of the midwife and the Australian National Competency
http://dx.doi.org/10.1016/j.wombi.2017.03.004 1871-5192/© 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
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Standards for the Midwife (Nursing and Midwifery Board of Australia 2006). The problem of varying levels of anxiety experienced by firstyear Bachelor of Midwifery students, prior to their first clinical placement, was a concern among academics. This problem was identified in two ways. Some students self-reported their anxiety verbally to academics during the semester. Others reported it via the university Student Feedback Survey (SFS) process at the end of the first semester in the first year. This peer mentoring program, where third year students mentored first year students, was implemented in order to reduce the anxiety they experienced and to facilitate a smooth transition to clinical practice. In an initial review of the literature, only one paper was found that related to a midwifery student peer mentoring program.3 Due to this, the search was extended to include literature on peer mentoring for nursing students. It was felt this was justified because there were sufficient similarities between the educational pathways of nurses and midwives to warrant adding nursing literature to the search strategy. A database search of the literature was conducted, using the databases OVID Medline, CINAHL, Intermid/Internurse, and PubMed. The search was limited to articles in English from the years 2000 to 2016. The keyword search terms ‘Student nurses’ OR ‘Student midwives’ AND ‘peer mentor’, were used, resulting in 91 hits. After removing duplicates and reviewing abstracts for relevance, eighteen remained, for which full texts were sought. Papers describing student peer mentoring programs that offered academic support only were excluded; as the focus of our program was on supporting students during clinical placement. Seventeen of the eighteen articles retrieved related to nursing student peer mentoring programs. Only one article, which was from Australia, related to a midwifery student peer mentoring program.1 However, only mentees were surveyed in this study about their experiences.3 Our program is, therefore, the first to report a peer mentoring program for midwifery students in which both mentees and mentors were surveyed. Peer mentoring and peer support programs in nursing schools and universities in a number of countries are reported in the literature, including those from the United Kingdom (UK), United States of America (USA), Taiwan, Canada and Australia. The aims and designs of the various programs are diverse. Some have a purely academic focus; some are restricted to the clinical placement experience only; and many integrate social, academic and clinical peer support. Some are specifically time limited to the clinical placement,2 whilst others span a semester or year-long process that include the clinical placement as an important component.3 It is well documented that clinical placements are stressful for new undergraduate students. One of the problems encountered by students is inadequate supervision on placement due to staff shortages in the clinical environment.5,6 Midwifery students face additional challenges of recruiting and following pregnant women for their required continuity of care experiences.1 These challenges include the time-consuming nature of engaging with women in order to recruit them into the program and the pressure of being ‘on call’ to attend their births. The latter is particularly challenging for students with paid work and/or caring responsibilities in addition to academic and clinical placement commitments.24 In order to ameliorate this stress, more support is required for students in the clinical practice environment.2 One solution maybe student peer mentoring programs which enhance the experience of students adapting to the challenges of tertiary level study and university life, across a diverse range of disciplines.4 The aim of several peer mentoring programs reported in the literature3,7,8 was to address and reduce student attrition rates.
Negative experiences on clinical placement were felt to trigger the attrition of first year nursing students.8 There were no quantitative data demonstrating whether peer mentoring does, in fact, reduce attrition. Several surveys revealed, however, that mentees felt motivated to keep going during challenging times due to the peer support they received.6 Most mentees found the support offered by the more senior students to be helpful, encouraging, understanding, reassuring and positive.9,10,11,14 In one study, mentees reported feeling comfortable asking questions of their peer mentors, saying that they felt able to ask them openly for information and advice, especially about clinical placements.17 This is aligned with the views of academics in the same study which found many questions asked by first-year students are best answered by more senior students, rather than staff.7 The grouping of mentors and mentees are structured in a range of ways in the literature. Many of the papers report one mentor working with a group of mentees. The size of the mentee groups vary, from three to eight per mentor,7,9 matching for gender,10 age and/or alphabetically.7 In some programs, however, mentees choose the mentor with whom they most closely identified,1 a process recommended by students in the evaluations elsewhere.9 A number of programs paired a senior student with a more junior student11–13 and another aimed for pairs or trios of students.2 Three used a buddying system, joining a pair of students together with a staff member.5,10,11 A number of benefits from participating in peer mentoring programs were reported in the literature. Students developed their teamwork and collaboration skills,10,11 with increased interaction between students across year levels was noticed by staff.9,10 Mentees felt that their mentors were a protective factor against feeling isolated on clinical placement, which built their confidence and reduced communication barriers.6 Mentors gained confidence from the experience of mentoring a more junior student,10,11,19 finding that they could appreciate how far they had come since beginning their studies.9,12,13 Leadership skills were also enhanced through the experience of being involved in the development of another student.10,12 Mentors reported that the process of organising their role improved their clinical decision making,11 helped them to develop time management skills11,19 and assisted them in gaining a more thorough understanding of the role of clinical educator or preceptor.9,11,19 Whilst evaluations demonstrated positive feedback and showed student peer mentoring programs to be worthwhile, there were some suggestions for improvement. For example time constraints for students were a barrier to maximising the success of peer mentoring relationships.12,14 Suggestions were made by students for academics to provide more structured or timetabled, opportunities for students to meet.9 Where Faculties did provide structured introductory sessions this generally occurred during the orientation or induction period for first-year students2,5,6,14 and/or included a social event a few weeks into the semester.7 A few Faculties had social events at the end of the academic year, at which time surveys and awards could be distributed.2,6 Programs in which these types of events did not occur, received feedback from students that this would have been desirable.11,12 Little is known about the value of peer mentor support for undergraduate midwifery students. To our knowledge, only one such program has been reported in the published literature which was also set in Australia.1 The program involved 55 first year mentees and 21 student peer mentors. However, the views and experiences of the mentors were not surveyed. The 55 mentees who received mentoring responded to surveys that included Likert scale and open questions. Eighty-seven percent responded positively and reported that the program improved their confidence and motivated them to continue their studies during difficult times. Mentors provided reassurance to their mentees by
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sharing the stories of their own experiences of early midwifery placements. Our study is the first, to our knowledge, that has sought the views of senior midwifery students about their experiences of mentoring junior midwifery students. 2. The peer mentoring program A peer mentoring program for undergraduate midwifery students was implemented in a large urban university in Australia. The participants were first-year mentee and third-year mentor students studying a three-year Bachelor degree in midwifery. All first and third-year midwifery students were offered the opportunity to participate in the program. The main purpose of the program was to offer peer support to first-year midwifery students who had little or no previous exposure to hospital clinical settings, by assigning them to thirdyear midwifery student peer mentors. The type of support offered to mentees included information on the hospital where they were assigned for their clinical placement such as public transport and directions, finding the toilets and the café, and finding their way to the various clinical areas. An additional purpose of the program was to develop mentoring and leadership skills for the mentors. Mentors were provided with a three-hour face to face training workshop to prepare them for their role. This training was developed based on guidelines developed by the Australian and New Zealand Support Services Association Incorporated.22 It was facilitated by a midwifery academic and the manager of the student peer support service at the university in which the program took place. Topics covered included defining the role and purpose of a mentor, relationship building, communication skills, boundary formation, support services and processes of referral to support services, self-care (health and stress management). Afternoon tea was provided and the mentors were given a 23page booklet accompanying the workshop, intended as a reference guide for the mentors about their role. The booklet summarised the content of the workshop and included information on how to maintain boundaries by giving relevant scenarios as exemplars. Relevant community, online and university support services were listed. 3. Methods The research question that guided the design of this study was ‘What are the benefits, if any, of a peer mentoring program for midwifery students?’ The program was run in 2012, 2014 and 2015. All first and third-year students were offered the opportunity to participate. In 2013 there was a smaller than usual group of final year students and few volunteered to be a mentor, hence, a decision was made not to run the program in that year. A Teaching and Learning Evaluation Declaration was completed and submitted to the university in 2012 in lieu of an ethics committee application, as is required at the university for this type of program. The program was approved as a low-risk teaching and learning activity. Participation from third-year students was voluntary and conducted in their own time. During the threehour mentor training workshop, significant attention was paid to the risks and harms that may arise for them as a result of participating in the peer mentoring program. In particular, time was allocated to teaching and learning about establishing and maintaining boundaries, so that the students were equipped to protect themselves from being over burdened by their mentoring role. Student referral services and contact details were given, so that in the event of a mentee required support beyond the scope of the clinical placement and/or academic life, mentors could refer them immediately to the student support services at the
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university. Support services for which contact details were provided included health counselling, GP clinic, special needs counselling, careers advice, financial counselling, housing, safety, well-being and accident support, discrimination and harassment advisors. Several case scenarios were given to the students during the workshop. One scenario discussed a third-year mentor being approached by a first-year student stating they were suddenly homeless. Another scenario discussed the duty of care for a student in psychological distress. The students were asked to reflect upon how they would manage the situation, followed by a discussion between staff and students. 3.1. Sample and recruitment One-hundred-and-seventy first year students during 2012, 2014 and 2015 were invited to participate in the program as mentees. Their involvement was not compulsory. Sixty-three third year midwifery students were invited to volunteer as peer mentors. A senior midwifery lecturer spoke to the third year students in class and then a follow-up email invitation was sent with further details. Responding to the surveys was entirely voluntary; free and informed consent to participate in the evaluation was assumed to be given when a student completed and returned a written survey. 3.2. Data collection Surveys were distributed to the peer mentors and mentees in their respective classes at the end of the academic years, 2012, 2014 and 2015, asking about their views and experiences of participating in the program. The content of the survey was based on a survey piloted in a similar setting and reported elsewhere.23 Both groups were surveyed about their experiences of the program, via paper-based surveys that comprised both Likert scale and open questions. The content of the peer mentor survey is displayed in Box 1. The content of the peer mentee survey is displayed in Box 2. 3.3. Data analysis Quantitative data were analysed descriptively, by collating the responses to the Likert scale questions contained in the surveys. Qualitative data from the open-ended survey questions were transcribed into NVivo10 software, then coded and analysed using the process of thematic analysis by Roberts and Taylor.14 Similar surveys and methods of analysis were used by a number of other published studies on student peer mentoring in nursing and midwifery.3,6,10,20 4. Findings 4.1. Peer mentoring program—quantitative survey findings from mentors and mentees In total, 63 peer mentors (M) and 170 mentees (m) participated in this program. Fifty-three mentors (84%) responded to the survey seeking their views and experiences of the peer mentoring program. Over 80% felt that they had helped their mentees adjust to being on clinical placement. At least 75% felt that the program benefited them as mentors in developing their communication skills, building self-confidence, and increasing their employability. Table 1 displays their responses to the Likert scale questions. One hundred and seventy mentees participated in the program. One hundred and four mentees (61%) responded to the survey about their views and experiences. Over 80% felt that their allocated peer mentors were at least ‘somewhat helpful’, 38%
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Box 1. Content of the peer mentor survey. The mentor survey, distributed in class at the end of the year, asked students to respond to five questions, two of which contained several sub-questions requiring Likert scale answers and three of which were open questions. In the Likert scale questions, respondents were asked to rate their responses as follows: 1) being ‘No help at all’, 3) being ‘Somewhat’ and 5) being ‘Very helpful’. The Likert scale questions asked the peer mentors: How useful do you think you have been to your mentees? a) In helping them adjust to the university system? b) In helping them adjust to the clinical placement? c) In helping them make useful contacts? How has being a mentor assisted you with: a) Improving your communication skills? b) Improving your self-confidence? c) Improving your employment skills? The open questions asked the peer mentors: Can you identify ways in which you might have been more helpful to your mentees? If so, why? What problems have you encountered in providing support to your mentees? In what ways do you think the peer mentoring program could be improved?
stated that their allocated peer mentors were ‘very helpful’. Only 6% stated that they met their peer mentors often, which was aligned with the qualitative data reflecting the theme of ‘Wanting more face to face time’. Table 2 displays the mentees’ responses to the Likert scale questions. 4.2. Peer mentoring program—qualitative findings from the mentor and mentee surveys Three themes emerged from the thematic analysis of the openended questions in the program surveys. The themes were ‘Receiving start-up advice’; ‘Knowing she was there’ and ‘Wanting more face to face time’. The first two themes, ‘Receiving start-up advice’ and ‘Knowing she was there’ related to the main benefits from the peer mentoring program as identified by the mentees. The third theme, ‘Wanting more face to face time’ related to feedback from mentors (M) and mentees (m) describing improvements that they felt could be made to the program. These themes are explored below.
4.2.1. ‘Receiving start-up advice’ Receiving ‘good start up advice’ (m) meant that the mentors were able to offer ‘tips on the processes and policies at the specific hospital’ (m). The data suggested that receiving ‘start up advice’ from a peer mentor reduced their anxiety prior to placement and that ‘having the insight of an experienced student’ (m) ‘who has been in our position recently’ (m), was a useful aspect of the program that could not be replicated by staff. Many students remarked that they ‘found it very helpful, as it allowed for an overview of the situation of the hospital before entering’ (m). Prior to placement, mentees enjoyed receiving emails from mentors that contained information about the hospital to which they were allocated, for example: ‘My peer mentor emails me very detailed emails with great advice, tips and even acronyms’ (m). ‘Emailing between mentor and students before our placement started was helpful so she was able to answer all of our questions specific to the hospital’ (m).
Box 2. Content of the peer mentee surveys. The mentees were asked to respond to seven questions, four of which required 5 point Likert scale answers and three of which were open questions. The Likert scale questions asked the mentees: How well do you think you have made the transition to uni? How useful has the peer mentoring program been in helping you adjust to clinical? How often did you meet your mentor(s)? The open questions asked the mentees: In what ways has the peer mentoring program been helpful/unhelpful? What problems have you experienced with the peer mentoring program? What suggestions do you have for improving the peer mentoring program?
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Table 1 Mentor program evaluation (53 respondents). Q1. How useful do you think you have been to your mentees . . . a) . . . in helping them adjust to the University system? b) . . . in helping them adjust to the clinical placement? c) . . . in helping them make useful decisions? Q2. How has being a mentor assisted you with . . . a) . . . improving your communication skills? b) . . . improving your self-confidence? c) . . . improving your employment skills?
1 (No help at all) 2
3 (Somewhat)
4
5 (Very helpful)
No response
9.43% (N = 5/53)
20.75% (N = 11/53) 20.75% (N = 11/53)
35.85% (N = 19/53) 13.21% (N = 7/53)
7.55% (N = 4/53)
7.55% (N = 4/53)
32.08% (N = 17/53)
32.08% (N = 17/53)
13.21% (N = 7/53)
11.32% (N = 6/53)
49.06% (N = 26/53) 16.98% (N = 9/53)
9.43% (N = 5/53)
0% (N = 0/53)
1 (No help at all) 2
3 (Somewhat)
4
5 (Very helpful)
No response
7.55% (N = 4/53) 9.43% (N = 5/53) 13.21% (N = 3/53)
30.19% (N = 16/53) 32.08% (N = 17/53) 33.96% (N = 18/53)
32.08% (N = 17/53) 30.19% (N = 16/53) 32.08% (N = 17/53)
13.21% (N = 7/53) 16.98% (N = 9/53) 11.32% (N = 6/53)
0% (N = 0/53) 0% (N = 0/53) 9.43% (N = 5/53)
16.98% (N = 9/53) 11.32% (N = 6/53) 7.55% (N = 4/53)
0% (N = 0/53)
20.75% (N = 11/53) 0% (N = 0/53)
Table 2 Mentee evaluation of mentor program (104 respondents). 1 (Never)
How often did you meet your mentor(s)?
How useful has the peer mentoring program been in helping you adjust to clinical?
How well do you feel you have made the transition to uni?
How helpful did you find your mentor(s)?
3 (Occasionally) 27.88% (N = 29/ 24.01% (N = 25/ 33.65% (N = 35/ 104) 104) 104) 1 (No help at 2 3 (Somewhat) all) 9.62% (N = 10/ 29.81% (N = 31/ 8.65% (N = 9/ 104) 104) 104) 1 (No help at 2 3 (Somewhat) all) 0% (N = 0/104) 0% (N = 0/104) 9.62% (N = 10/ 104) 1 (No help at 2 3 (Somewhat) all) 8.65% (N = 9/ 7.69% (N = 8/ 17.31% (N = 18/ 104) 104) 104)
Specific details the mentees received included ‘useful information on documentation . . . how to find parking and some tips on communication with the midwives and educators.’ Mentees felt that this start-up advice ‘ . . . bridged the gap between uni and hospital’ because the mentors were ‘ . . . able to relate to clinical and uni . . . making me feel more comfortable’ (m). Many mentees mentioned the value of the assistance they received from their mentors in working out how to use the documentation that was required during placement. Some referred to their ‘portfolio’, others to ‘worksheets’ or ‘sheets’, saying for example that, ‘I needed help negotiating my worksheets’ (m). The benefits of the advice from mentors included, for example: ‘Can ask questions about what to expect and how to fill out sheets’ (m). ‘Excellent practical advice regarding filling out sheets’ (m). ‘Showed examples of portfolio’ (m). ‘Tips on filling out the portfolio’ (m). Seeing how more senior students managed their paperwork on placement was felt to be an important adjunct to being shown in class by academic staff. 4.2.2. ‘Knowing she was there’ The majority of respondents to the surveys were positive about the program and were pleased with the support they received from their mentor. This qualitative finding correlated with the Likert scale results that showed more than 80% of responses were positive. Mentees who had positive experiences used words like ‘supportive’, ‘encouraging’ and ‘positive’ to describe their mentors, as these quotes demonstrate: ‘They provide support and encouragement, as well as clarification of any issues I had’ (m).
2
4
5 (Often)
7.69% (N = 8/ 104) 4
5.77% (N = 6/ 104) 5 (Very helpful) 22.12% (N = 23/ 29.81% (N = 31/ 104) 104) 4 5 (Very well)
34.62% (N = 36/ 52.88% (N = 55/ 104) 104) 4 5 (Very helpful) 25.96% (N = 27/ 38.46% (N = 40/ 104) 104)
No response 0.96% (N = 1/ 104) No response 0% (N = 0/ 104) No response 2.88% (N = 3/ 104) No response 1.92% (N = 2/ 104)
‘Allowing encouragement that 1st year is the hardest, it will get better as placement goes by’ (m). ‘Helped to gear me into a positive mindset, and addressed any concerns and insecurities I had’ (m). ‘[Mentor] was very positive about her experience and instilled enthusiasm and confidence in us’ (m). Being made to feel welcome and receiving reassurance about the hospital environment were among the approaches mentees noticed the mentors using, in order to encourage them: ‘Reassurance that the hospital is a supportive and positive environment’ (m). ‘[Mentor] reassured us that she had a great experience at the hospital’ (m). ‘Helped me feel welcome and adjust to placement’ (m). It was comforting to many of the mentees to ‘know they are there if we need them’ (m) so that they could ask any questions that may arise. ‘Just talking to her, in general, was comforting’ (m) said, one student. Others were reassured by ‘knowing there was help if needed’ (m). Having the mentor ‘help with questions’ (m) was one of the most useful aspects of the program for many of the mentees, as demonstrated in the following quotes: ‘She emailed us at beginning of prac [sic] and answered questions which was helpful’ (m). ‘My mentors were always ready to answer my questions and give me tips’ (m). ‘One student took the time to meet us for an hour and go over all our questions, she also gave us her number and said we could ring at any time which seemed exceptionally kind’ (m). A number of mentees asked questions about clinical placement that they may not have been comfortable asking a staff member. ‘It
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was nice to talk to people who have been in my position at my hospital. It was nice to have people to ask ‘silly little questions’ (m). ‘Building up a relationship with [mentor] was good as I was able to ask her questions about how things work in the hospital’ (m). Mentees also enjoyed asking their mentors questions about academic work, saying that it was ‘helpful to ask questions about uni and clinical’ (m), to get ‘reassurance that I am on track . . . to chat about uni/prac [sic]’ (m). Having ‘a familiar face on placement’ (m) was reassuring because it helped mentees to ‘feel like you have a more experienced friend in the [clinical student uniform]!’ (m). A familiar face represented ‘someone you could trust when you needed help’ (m). ‘Wonderful to have the support of a fellow [name of university] midwifery student – very helpful in understanding the “quirks” of our particular hospital’ (m). Several mentors were regarded highly for their knowledge and skills and found to be ‘a good role model’ (m) and ‘full of advice’ (m). ‘[My mentor] had a lot of knowledge and skills which were admirable. Very friendly and always willing to lend a hand and answer all questions’ (m). ‘I got to spend some time with my mentor (a whole day) and I found her to be a wealth of knowledge and very good at teaching and demonstrating things to me’ (m). Mentees were grateful when mentors made the effort to check how they were managing their placement and their studies. ‘She asked how my experience is and checked in on me. She is so friendly, really lovely person’ (m). ‘Caring, friendly, helpful, always smiling. Always checking up on us!’ (m). ‘They contacted me lots during the year to ask how I was coping’ (m). A ‘debrief with peer mentors’ (m) was an important process that mentees used to manage the challenges of clinical placement. Some mentees reported that their mentor was ‘always willing to participate in a debriefing session about experiences—both clinical and personal’ (m) and that she was ‘a good person to debrief with and reflect on clinical’ (m). Other students remarked that they would have liked ‘more opportunities to debrief’ (m) and asked that the university ‘establish times when mentors and mentees could meet to debrief/brief’ (m). 4.2.3. ‘Wanting more face to face time’ One mentor commented on enjoying the practical aspect of her role, ‘being a welcoming face on postnatal, encouraging her in her skills’ (M). Both mentors and mentees expressed that they wished they could have spent more time with each other. Comments such as, ‘Difficulty finding time to meet’ (m) and ‘hard to arrange a time to meet them’ (M) were frequent. Although it was ‘hard to build rapport’ (M) without face to face contact, a number of mentees valued email contact for information sharing, saying that it ‘would be nice to meet more regularly but we have frequent contact through email’ (m). There were a number of reasons cited for the lack of sufficient face to face meetings; including that first and third year schedules often clashed, the clinical placement rosters did not coincide, students were allocated to other students at different hospitals, the third year mentors were too busy, and/or that both first and third year students were too busy. Creating student rosters for clinical placements is a complex task, with competing demands from both the university and the hospital. For this reason perhaps, clinical placement rosters were not co-ordinated in a way that prioritised the peer mentor program, as several quotes illustrated: ‘Finding it difficult to meet them very often because we are on different schedules’ (M), and ‘we
have not yet been able to meet as there has been a conflict of our schedules’ (m). Some students felt there was little they could do about the scheduling problem, ‘Would love to see her more around but that comes down to rostering which is out of our control’ (m). Mentors and mentees who were not placed at the same hospital had even more difficulty arranging face to face contact, saying for example, ‘I haven’t had a chance to meet my mentor. She isn’t at my hospital’ (m). ‘They weren't from my hospital, and they were unable to meet up with me so was limited in my ability to support' (M). Lack of familiarity with the mentee’s hospital was problematic, and limited the amount of support that could be offered, ‘I wasn’t at the same hospital . . . which made it hard to answer specific questions’ (M). Several participants made the suggestion that mentor to mentee ratios would be better as one-to-one, or one mentor-totwo mentees, as shown in the following quote: ‘Allocating the students in smaller groups (i.e. 1-2 students only) as that is a more personal experience’ (M). There was a perception by a number of the mentees that the mentors were over committed as third-year students, leaving them little time to manage their mentoring, as these quotes from mentees illustrate: ‘They need more hours in their day! Haven’t had the chance to catch up yet’ (m). ‘Not as much support as I thought . . . because 3rd years are very busy’ (m). A few mentors also made reference to their own time restraints, saying that there was ‘not enough time between uni, prac, work and assignments to dedicate myself to their mentoring’ (M) and ‘we are all very busy’ (M). One mentor made the suggestion to consider getting second year students involved, feeling that they would have more time to spend with mentees than third years, saying, ‘Perhaps second years would have more opportunity to see first years since there is a lot more contact time with them [at] Uni’ (M). Another mentor felt that the preparation for the program could be done in second year, saying, ‘ . . . training is done in second year, so third years would be ready to mentor at start of year’ (M). Many students felt that some of the time constraints could be alleviated if they met each other earlier in the semester, saying that they wanted to have time to make contact and develop relationships before the year got too busy. There were many suggestions for improvement of the program in relation to this issue, for example: ‘Connect students with mentors early on in the semester for more time to meet up’ (m). ‘More warning and time to meet them prior to placement’ (M). A general meet and greet session, which all first and third-year students could attend, was a suggestion that may be easily implemented prior to clinical placements being allocated. Much of the initial information could be shared and questions asked, both about the mentoring program and about clinical placements. An informal social gathering at university was a popular idea, for example: ‘Organise a session for everyone to get together at the beginning of the year to establish [a] relationship’ (M). Others ideas for making initial contact included ‘a welcoming session at the hospital’ (M) and the third years attending first-year lectures. ‘The third year visit to our lecture was very useful . . . having more third-year talks [would be good]' (m) or a ‘class before placement to all pair off and meet for about 1 hour’ (m). Many students called for more structure in the program, or at least a ‘more structured meeting initially’ (M). Some students
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wanted the university to ‘ . . . schedule actual uni time to meet the first years’ (M), asking for ‘allocated mentoring time’ (M) that was ‘set . . . in the timetable for us all’ (M). Mentees made similar suggestions, for example, ‘ . . . facilitate a time through the Uni that we could all meet’ (m). Mentors also made suggestions around allocating time within the clinical placement at the hospital, rather than at university, saying: ‘ . . . times could be arranged by educators during clinical placement . . . allocated time in clinical’ (M). Some mentees admitted that, in hindsight, they could have been more pro-active in seeking information and support from their mentors, for example, ‘I guess I need to take the initiative to contact and meet with them more’ (m) and ‘I really didn’t try so hard to meet her I will admit’ (m). There was a sense, for others, that the mentors should have been more pro-active in following them up, as mentees ‘may feel shy to contact them’ (m). Many mentees felt that their mentors ‘didn’t seem interested in meeting us – maybe because they were busy?’ (m) and would have liked their mentors ‘ . . . to arrange meetings each clinical placement’ (m). Some mentors found it difficult to engage their mentees, however, saying, ‘They [mentees] wouldn’t meet us despite repeated attempts’ (M). Assistance from the university in structuring meetings was seen as a potential solution. 5. Discussion This program is in keeping with the literature from a range of disciplines which demonstrate that student peer mentoring programs have the capacity to enhance the adaptation of students to their tertiary level study and university life.4 Most mentees in this program found that the support offered by their peer mentors was encouraging, understanding, reassuring and positive, reflecting the findings of a number of papers exploring nursing student peer mentoring.10–12,19 The nursing literature shows comprehensive benefits for student peer mentors who participate in mentoring programs, gaining confidence,5,6,11 leadership skills,6,10 clinical decision making11 and time management skills.5,11 This is the first program to evaluate the mentor experience in the midwifery student context. Results show that at least 75% of mentors surveyed felt that the program benefited them at least somewhat, in developing their communication skills, building self-confidence, and increasing their leadership skills. Peer support added value to the help that could be offered by academic and clinical staff. Mentees reported feeling more comfortable asking their mentors questions about clinical placements than they did asking staff members.7 The only other study identified in relation to peer mentoring for midwifery students was also set in Australia.1 Similarly to this study, the mentees in our program responded positively and reported that the program improved their confidence and motivated them to continue their studies during difficult times. The majority of studies on peer mentoring programs for nursing and midwifery students had one mentor assigned to a group of mentees ranging in size from three to eight per mentor.2,3,7,13,18,19 In this study, in 2012, when we first facilitated the program, the ratio of peer mentors to mentees was between four to six mentees to each mentor. Subsequently, in 2012 peer mentors reported experiencing difficulties arranging meetings with large groups of mentees and suggested a more realistic ratio such as one mentor to three mentees at the most would make the program more practicable. In response to this feedback, in 2014 and 2015 no more than three mentees were assigned to one peer mentor and this was evaluated more favourably.
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A number of other changes were made to the program as a result of the feedback received in the 2012 surveys. Constructive feedback given by the first year mentees was incorporated into the training workshops conducted in 2014 and 2015 with the third year mentors. For example, third years were encouraged to meet with the first years at least once or twice in person, ideally initially, and then communicate via email, text or social media. In class, the first years were encouraged to promptly answer emails from their third-year peer mentor and to keep in touch with their peer mentor over their first year. There is ongoing evaluation and development to ensure that the peer mentor program continues to meet the needs of the students. 6. Conclusion Concern amongst academics regarding the varying degrees of anxiety experienced by first-year undergraduate midwifery students prior to their first clinical placement, prompted the implementation of this peer mentoring program. By providing support to first-year midwifery students, it was hoped that the anxiety they experienced would be reduced, enabling a smoother transition to clinical practice. The aim of this program was to find out the benefits, if any, of a peer mentoring program for first-year midwifery students. The program was shown to be of benefit to the majority of students, both mentees and mentors. Over 80% of mentors and mentees felt that the program helped mentees adjust to their midwifery clinical placement. Three themes emerged from the qualitative data, including ‘Receiving start-up advice’; ‘Knowing she was there’ and ‘Wanting more face to face time’. This paper adds to the knowledge about peer mentoring for midwifery students and illustrates the perspective of the mentors for the first time, as this has not previously been studied in the midwifery context. Acknowledgements and disclosures No financial support was provided to the university, for either the conduct of research or the preparation of the manuscript. No conflicts of interest have been identified. Associate Professor Alex Wang, from the Faculty of Health at the University of Technology Sydney, provided guidance to the authors on presentation of the descriptive statistics. References 1. Roberts K, Taylor B. Nursing research processes: an Australian perspective. 2nd ed. Southbank Victoria: Thomson; 2002. 2. Radford SJ. Building a peer mentoring programme. Nurs Stand 2014;28(39):64. 3. McKellar L, Kempster C. We’re all in this together: midwifery student peer mentoring. Nurse Educ Pract 2015. doi:http://dx.doi.org/10.1016/j. nepr.2015.08.014 PubMed PMID: 26422813. 4. Milne L, Keating S, Gabb R. Student peer mentoring at Victoria University. Melbourne: Victoria University; 2007. 5. Deasy C, Coughlan B, Pironom J, Jourdan D, Mannix-McNamara P. Predictors of health of pre-registration nursing and midwifery students: findings from a cross-sectional survey. Nurse Educ Today 2016;36:427–33. doi:http://dx.doi. org/10.1016/j.nedt.2015.09.010 PubMed PMID: 26438968. 6. Brookes N, Moriarty A. Implementation of a peer-support system in the clinical setting. Nurs Stand 2009;23(27):35–9. 7. Mann C. Nursing peer mentors: the student experience of peer mentoring in the school of nursing. University of Nottingham: WordPress.com; 2013 Available from: https://nursingpeermentors.wordpress.com/. 8. Glass N, Walter R. An experience of peer mentoring with student nurses: enhancement of personal and professional growth. J Nurs Educ 2000;39 (4):155–60. 9. Morley DA. Supporting student nurses in practice with additional online communication tools. Nurse Educ Pract 2014;14(1)69–75. doi:http://dx.doi. org/10.1016/j.nepr.2013.06.005 PubMed PMID: 23871299. 10. Sprengel AD, Job L. Reducing student anxiety by using clinical peer mentoring with beginning nursing students. Nurse Educ 2004;29(6):246–50.
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20. Harmer BM, Huffman J, Johnson B. Clinical peer mentoring: partnering BSN seniors and sophomores on a dedicated education unit. Nurse Educ 2011;36(5) 197–202. doi:http://dx.doi.org/10.1097/NNE.0b013e3182297d17 PubMed PMID: 21857338. 22. Australian and New Zealand Students Support Services Incorporated (ANZSSA). Guidelines for best practice in peer mentoring. updated in 2014. http://anzssa.squarespace.com/fye-peer-mentoring/. [Accessed 6 April 2014]. 23. Glaser N, Hall R, Halperin S. Students supporting students: the effects of peer mentoring on the experiences of first-year university students. J Aust N Z Stud Serv Assoc 2006;27:4–19. 24. Gray J, Taylor J, Newton M. Embedding continuity of care experiences: an innovation in midwifery education. Midwifery 2016;33:40–4.
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