الفهرس 
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Abstract
Nursing education introduces students to theoretical and clinical training to help them
develop knowledge and skills that are required for them to become nurses. Despite the
importance of clinical practice, it exposes them to various stressors that may, directly or
indirectly, impede their learning and performance, prevent them from adapting to their
environment and cause many psychological problems such as distress, anxiety, depression
and burnout. Therefore, it is important to discover new methods to allow students to have
more positive educational experiences. Peer mentoring can be a very effective approach.
Aside from decreasing stress, it can improve infection control practice. Given the fact that
hospitals are home to a huge network of germs, microbes and viruses, infection prevention
and control practices were put forward to help minimize or even prevent risks of infection
between patients and staff. To increase the nursing students’ obedience when it comes to
infection control practices, they should be well-educated about it, and this can be done
through peer mentoring. This strategy can also increase students’ self-efficacy in relation to
infection control, which can lead to even higher performance due to the feeling of confidence.
Study aims to:
This study aims to determine the effect of peer-mentoring strategy on nursing students‟
infection control practice, self -efficacy and stress.
Research hypotheses:
Nursing students who are instructed by peer mentoring exhibit higher performance
scores in applying infection control standards than those who are not .
Nursing students who are instructed by peer mentoring exhibit higher self-efficacy
scores in applying infection control standards than those who are not .
Nursing students who are instructed by peer mentoring exhibit lower stress level in
clinical setting than those who are not.
Research design:
A quasi experimental research design was used to conduct this study.
Setting:
This study was conducted at the Technical Institute of Nursing in Sharq Elmadena
Hospital in Alexandria and students received clinical training conducted in 6 critical care
units.
Subjects:
The subjects of this study were a convenient sample of 75 students. The minimal sample
size that was estimated based on EPi Info 7.0 statistical program was 74. The study sample
was divided into three groups:
• group 1 (mentors): was composed of 15 mentors who were recruited from the intern
nursing student, and were selected based on their high academic, clinical achievements and
their interest in mentoring. The 15 mentors were randomly assigned to the 30 mentees (one
mentor to two mentees).
• group 2 (mentees): was composed of 30 4th year nursing students who enrolled in the
critical care clinical course at the academic year 2020-2021. They were the mentees in this
study.
• group 3 (control): was composed of 30 4th year nursing students who enrolled in the
critical care clinical course at the academic year 2020-2021.
They were the control group in this study.
Tools of data collection:
Tools: In order to collect the necessary data for the study, three tools were used:
Tool one: “Nursing Students’ Infection Control Performance Observational
Checklist”. This checklist was developed by (Fathy., 2015) and adapted by the researcher to
measure the students‟ performance in applying infection control standards in clinical practice.
The checklist composed of (8) main sections, labeled as follows: Central venous catheters (9
items), urinary catheters (11items), intravenous injection (16 items), intramuscular injection
(10 items), insertion of a line–cannula (10items), suction procedure, Oropharyngeal, Nasotracheal Suction (10items) and Endotracheal Suction (12 items) ,nasogastric tube
insertion(10 items) and nasogastric tube feeding(9 items). Each item was rated on three
responses: done correctly and complete = 2, done correctly but incomplete = 1, done
incorrectly or not done = 0. Scores ≥ 75% are considered unsatisfactory practices and scores ˂
75 to 100% are considered satisfactory.
Tool two: The Perceived Stress Scale (PSS). This scale was developed by (Sheu., et
al, 2002) and modified by the researcher. This tool was a selfreport tool which is used to
identify the nursing students‟ stress level. It consists of 42 items grouped into (7) factors.
Each item was rated on a four point Likert scale in terms of: High=3, Moderate=2, Low=1
and Not present=0. from 1≤ 63 considered low stress score, from 64≤ 88 considered
moderate stress score, while those who scored from 89≤ 126 considered high stress. Higher
scores indicate higher level of stress.
Tool three: Infection Control Practices Self-Efficacy Questionnaire. This tool was
developed by the researcher after extensive review of the literature (Zengin. et al; 2014 and
Abdal, Masoudi., 2015). It was used as a self-report tool to assess students’ self-efficacy
related to infection control practices. It consists of 20 statements with 4points Likert scale
ranged from strongly disagree (1) to strongly agree (4). from 20 > 40 considered low
selfefficacy scores, from 40 > 60 considered moderate self-Efficacy scores, and from 60 ≥ 80
considered high self-Efficacy scores .for the score ranging from 20 - < 40
Methods:
Approval of the Research Ethics Committee of the Faculty of Nursing was obtained. An
official approval was obtained from the Technical Institute of Nursing in Sharq Elmadena
Hospital in Alexandria, Egypt, after providing full explanation of the aim of the study.
Informed consents were obtained from the subjects. The study tools were tested for content
validity by 5 experts from the related fields and the necessary modifications were done
accordingly. A pilot study was carried out on 10% (6 nursing students) who were represented
the study sample, but out of it. The pilot was conducted to test the clarity and applicability of
the research tools. Reliability of the tools was tested using Cronbach’s Alpha test, which
revealed 0.830 for tool one and 0.798 for tool two and 0.850 for tool 3; that denoted acceptable values. Data was collected by the researchers during the period from November
2020 to march 2021.
The study was conducted in three phases:
Phase I: Preparation Phase:
During this phase, the researcher prepared herself, the content and students (Mentors
and Mentees).
a. Researcher preparation:
- Before data collection, the researcher reviewed the related literature about Peer Mentoring
Strategy and infection control practices in the previously mentioned procedures. The
researcher was trained on the practical part of infection control practices under supervision
of the head of the Infection Control Unit at Sharq Elmadena Hospital. The training was
held for two clinical days at the beginning of the first semester of the academic year 2020-
2021, through demonstration, and re-demonstration.
b. Content preparation:
- The researcher prepared the objectives and the teaching unit in a form of handout and
PowerPoint presentation about Peer Mentoring Strategy which included: the definition of
peer mentoring, benefits for mentors and mentees, roles and responsibilities of the mentors
and mentees, Conduction of Mentoring Strategy, characteristics of successful mentors, and
communication skills and ethical the aspect in mentoring.
c. Students’ preparation:
- The researcher explained the purpose of the study for the mentors, mentees and the control
groups.
- Written consents to participate in the study was signed and collected from all three groups.
- At the beginning of the clinical training, mentors and mentees were given the opportunity
to have an idea about each other‟s personalities and work together, face-to-face.
- The mentors received comprehensive training on infection control practice by using the
“Infection Control Performance Observational Checklist” during critical care lab rotation.
- The mentors’ demonstration and re-demonstration in the skill lab was done under the
supervision of the researcher in order to master the skills.
- The evaluation of mentors’ infection control practices was done to ensure their competent
performance to be mentors in such skills.
- A handout was developed by the researcher about “Peer Mentoring Strategy” to be a
reference for both mentors and mentees.
- The “Infection Control Performance Observational Checklist” was distributed amongst the
mentors after training sessions to be a reference for them.
- At the beginning of clinical training the researcher conducted two orientation sessions
(approximately, two hours for each session) for the mentors and mentees according to their
schedules.
- At the beginning of the clinical training, the researcher assessed students’ clinical
performance by using study tools for both mentees and control groups.
Phase II: implementation phase:
Mentors and mentees:
- Each mentee was assigned a patient in the ICU. Each two mentees were assigned to one
mentor (15 mentors on 30 mentees).
- The mentees were given the information needed about their patients and their diagnoses by
their mentors. Then, the mentees began going through their patients’ medical records and
start to perform the necessary procedures such as cannula insertion, catheterization and
suctioning, following infection control standards.
- Every mentor was the role model for their mentees in taking care of patients and
interacting with clinical teachers and medical staff, following the peer mentoring strategy.
- The mentees were never left without observation from their mentors.
The mentors had to guide, listen to and give feedback to mentees and share their
experiences. They had to support, encourage and motivate them.
- Peer mentoring strategy was implemented in the first semester of the academic year 2020
/2021. It was used for 8 weeks, 3 days per week.
- The researcher were available for 4 hours daily during clinical training to observe and
supervise the mentors and mentees’ performance and correct their mistakes in infection
control practice.
- Several follow-up meetings were held, weekly, for mentors and mentees, separately, to
discuss their development and ideas and up-coming events.
Control group:
- At the beginning of clinical training, the researcher assessed the control groups’ clinical
performance of infection control practice, self-efficacy and stress by using tool (I), tool (II)
and tool (III).
- The control group was trained, on infection control practice, by clinical instructors, using
traditional clinical training schedule and methods (demonstration and re-demonstration).
- Both mentees and control groups were treated equally using the same objectives except for
using of the peer monitoring strategy; it was used only with mentees‟ group.
Phase III: evaluation phase:
- At the end of the clinical training both groups (the mentees and the control) were reevaluated
using tools (I), (II) and (III) and the effectiveness of the peer mentoring strategy was estimated.
Ethical considerations: Written informed consent was obtained from the study subjects
after explaining the aim of the study. They reassured about their right to refuse to participate
in the study or withdraw at any time. Patient’s privacy was respected. Data confidentiality was
ensured during implementation of the study and anonymity of students was ascertained.
The main results obtained were as follows:
Table I shows the distribution of students in both groups in relation to sociodemographic
and personal characteristics. No statistically significant differences were found
between the mentees and the control groups.
Table II reveals that, there was a high statistically significant difference between all
procedures/aspects of infection control practices mean scores among both mentees and control
groups, before and after the conduction of the peer mentoring strategy, in favor of the study
group whereas p ≤ 0.05
Table III illustrates the comparison between the two studied groups (study and
control)according to their self-efficacy levels during infection control practice before and after
the application of peer mentoring strategy. It can be noticed that, all students in the mentees
group (100%) as compared to almost all in control group (93.3%) had low levels of selfefficacy
during infection control practice before the application of peer mentoring strategy.
After the intervention, it was noticed that all (100%) mentees compared to about two thirds of
control group (60%) had high levels of self-efficacy. It is evident that there was a statistically
significant difference between both groups before and after the intervention (p=0.492,
p=0.001), respectively.
Table IV displays the comparison between the two studied groups (study and
control)according to overall perceived stress level before and after the application of the peer
mentoring strategy. It is noticeable that, nearly all students in the mentees‟ group (96.7%) as
compared to all students (100%) in the control group had high stress level before the
application of peer mentoring strategy. But, after the intervention, the stress level of the
mentees group had dropped to zero, while, there was no change in the control group.Table V illustrates the correlation between nursing students’ perceived stress and
infection control performance and self-efficacy among the mentees and control groups before
and after the intervention. For the mentees group, there was a significant negative moderate
correlation between the variables except for infection control performance and its selfefficacy.