Peer support guidelines for nurse educators during curriculum innovation in Lesotho
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Date
2020-06
Authors
Shawa, Mirriam
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Background: The curriculum for the education of nurses and midwives in Lesotho was transformed through the adoption of competency-based education. Competency-based education promotes the capabilities of the students. Transforming the curriculum challenged educators’ skills, necessitating new sets of facilitation and assessment skills to enable appropriate enactment of the student-centred curriculum. Such major changes imposed by the curriculum innovation required commensurate professional development and ongoing support for the educators. The absence of ongoing supportive strategies during a curriculum innovation naturally led to unstructured support among educators. However, unstructured peer support is threatened by chaotic implementation and a possible curriculum drift. Therefore, there is a need for structured peer support through the provision of practice guidelines. Purpose: This study sought to develop guidelines to enhance peer support among nurse educators during a curriculum innovation in Lesotho. Methods: A qualitative approach with multiple data collection methods was used to develop peer support guidelines according to the World Health Organization’s Handbook for Guideline Development. The research was undertaken in three phases. Phase I described the existing peer support strategies through an integrative review. Phase II described the experiences of nurse educators related to unstructured peer support during the implementation of midwifery curriculum innovation through an exploratory descriptive qualitative study. Phase III integrated the findings from phases I and II to develop guidelines for peer support during a curriculum innovation in Lesotho. An international expert panel validated the guidelines through two iterative Delphi rounds. Results: Phase I of the study described the existing peer support strategies through an integrative review. Six themes emerged, namely types of peer support strategies, characteristics of peer supporters, characteristics of an effective peer support strategy, outcomes of effective peer support strategies, challenges of implementing peer support strategies and lessons learnt from the peer support strategies. Phase II of the study described experiences of educators regarding peer support during midwifery curriculum innovation and revealed five themes, namely motivation for educators to participate in peer support, attributes of educators that influence the extent of interaction and uptake of support, unstructured peer support strategies, consequences of peer support among educators and model performance inspires engagement with the new curriculum. The results from the two phases were triangulated and informed the development of the practice guidelines to enhance peer support among nurse educators during curriculum innovation. Five priority areas and seven recommendations were developed. The priority areas were peer supporters, peer support strategies, content/support needs, outcomes of peer support, and monitoring and evaluation of the peer support strategy. External reviewers validated the developed practice guidelines using AGREE II tool and attained an agreement of between 80 and 100% across the items on the tool. Conclusion: Transforming curricula for nursing and midwifery education is inevitable globally. Curriculum changes challenge the capabilities of the implementers and necessitate planned ongoing professional development and support of the implementers of the new curriculum. Such ongoing support strategies may be costly for low- and middle-income countries, such as Lesotho, and could benefit from structured peer support. The absence of such supportive strategies may compromise the fidelity of the implementation of the curriculum change. This study proposes peer support as an affordable intervention to enhance the implementation of a new curriculum, especially in low- and middle-income countries. The effectiveness of such intervention requires the commitment of institutional leaders, experienced and committed peer support providers, a clear modus operandi, tailor-made activities, appropriate resources, and monitoring and evaluation mechanisms. The proposed guidelines may enhance peer support during curriculum innovation.
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Keywords
Thesis (Ph.D. (Nursing))--University of the Free State, 2020, Curriculum innovation, Peer support, Peer support strategy, Nurse educator, Nursing education, Guidelines, Implementation, Professional development, Enhance, Competency -- Based education, Student-centered curriculum