The Effect of Simulation and Peer Teaching Methods on Nursing Students

Deficiencies in basic skills pose a significant threat to patient safety. Therefore, the training, practice, and evaluation components of basic skills such as blood pressure measurement should be renewed as needed. Simulation is a teaching method that allows students to practice in a realistic and safe environment, enabling repetition without the risk of causing harm. Simulation is particularly important in nursing education due to the increasing number of students, the insufficient number of educators, its accessibility and repeatability in learning opportunities, and its role in ensuring patient safety. Another effective method frequently used in teaching blood pressure measurement in nursing education is peer teaching. It defines a collaborative teaching and learning strategy. Peer teaching is a relational process in which a more experienced individual contributes to the professional and personal development of a less experienced individual. In peer teaching, students can ask their peers questions without hesitation, benefit from a stress-free learning environment, and experience increased academic success through mutual support. As a result, it can improve nursing students' academic performance and enhance the retention rates of nursing courses.

The aim of this study is to determine the effect of simulation and peer teaching methods on nursing students' ability to assess blood pressure. The study population will consist of first-year nursing students who will enroll in the Fundamentals of Nursing course at Gazi University Faculty of Nursing during the spring semester of the 2024-2025 academic year. Based on a power analysis conducted using the GPower 3.1.9.7 program, the sample size was determined to be 28 participants per group, with a total of 84 participants, considering a Type 1 error of 0.05, a Type 2 error of 0.20, and an effect size of f = 0.35 for detecting differences in measurements between groups. Considering possible dropouts, the sample size was increased by 10%, and a total of 93 participants (31 per group) will be included in the study.

Data collection tools will include the "Demographic Characteristics Form," "Blood Pressure Knowledge Test," "Blood Pressure Measurement Checklist," and "Visual Analog Scale (VAS)." During the spring semester of the 2024-2025 academic year, theoretical lectures on blood pressure measurement will be conducted within the Fundamentals of Nursing course. Researchers will demonstrate blood pressure measurement techniques and show a video illustrating the skill steps. All students will complete the "Demographic Characteristics Form" and the "Blood Pressure Knowledge Test" (pre-test). Then, students who voluntarily agree to participate will be selected based on inclusion criteria. Students will be randomized according to their average scores, and three groups will be formed. Each group will be taught blood pressure psychomotor skills using different instructional methods. The training for each group will be conducted in different laboratories simultaneously.

• Experimental Group 1 (Peer Teaching): Students will practice the psychomotor steps of blood pressure measurement through peer teaching. Third- and fourth-year nursing students will serve as peer educators. Students will apply the skill steps under the guidance of an upper-class peer instructor.
• Experimental Group 2 (Simulation): Students will practice the psychomotor steps of blood pressure measurement using a simulator.
• Control Group (Traditional Laboratory Training): Students will practice the psychomotor steps of blood pressure measurement through traditional laboratory training, which is instructor-centered. They will practice blood pressure measurement steps on low-fidelity mannequins and on each other.

After completing the two-session psychomotor skills training, all students will be assessed using the "VAS" (first measurement) to determine their confidence and anxiety levels.

One week after the training, all students will measure the blood pressure of a healthy adult in the skills laboratory. Each student will perform the procedure individually. During the measurement, the researcher will evaluate the students using the "Blood Pressure Measurement Checklist." The observing instructor will mark each checklist item as "observed," "incorrect/incomplete," or "not observed." After the procedure, the students will complete the "Blood Pressure Knowledge Test" (post-test) and the "VAS" (second measurement) to assess their confidence and anxiety levels.

Four to six weeks after the training, all students will measure the blood pressure of a hospitalized adult patient in a clinical setting. Each student will perform the procedure individually. The researcher will evaluate the students using the "Blood Pressure Measurement Checklist," while the observing instructor will mark each item on the checklist as "observed," "incorrect/incomplete," or "not observed." Following the procedure, students will complete the "Blood Pressure Knowledge Test" (retention test) and the "VAS" (third measurement) to assess their confidence and anxiety levels.