Methods to Learn Clinical Pediatric Nursing for Nurse Students

Abstract

It is useful to learn about somatically ill children when implementing project-based learning. The students interview children’s nurses/parents with sick children and this enables/strengthens the students’ learning. Students learned pediatric nursing after completing the pediatric project, which is part of the nursing program. Some students learned in an international clinical placement in a pediatric ward. Combined learning from inside and outside educational institutions is useful. How can nursing students learn pediatric nursing in nursing education in the future, with large cohorts of nurses and few internships? This chapter is composed of several studies, both quantitative studies with questionnaires from 159 nursing students and qualitative studies with individual interviews of 18 nursing students after international clinical placement in a pediatric ward and eight nurses who had an international clinical placement in a pediatric ward as nurse students. And some studies about simulation in nursing studies and studies about clinical practice in other countries.

1. Introduction

Why and how should nursing students learn pediatric nursing?

EU directive (European Communities) states that pediatric nursing must be included in nurse education.

Increased global competence and intercultural society can indicate that part of practice, such as children’s nursing, can also be learned in other countries/parts of the world.

New subject areas, as technology and innovation etc., in nursing education compete for time and resources. It can lead to less time for pediatrics.

The European Communities (EU) developed the Bologna Agreement [1, 2] to safeguard common standards in higher education in Europe. The regulations in each country’s nursing education regulate learning outcomes through knowledge of the normal development and special needs of children and young people. Nursing students must have practical studies, and according to the EU, it must be 50% of the study, but there is no mention of how much of this time should be pediatric nursing. In Norway, the standards were introduced in 2003/2004 [3]. Regulation on common framework plan for health and social education regulates Norwegian bachelor’s education in nursing in compliance with the Bologna Agreement.

Nursing students must have clinical experiences with patients throughout their lifetime to be in line with the European Union (EU) directive. Included is knowledge of pediatric nursing and experiences with children as patients. The bachelor program in nursing must ensure that the students acquire knowledge of pediatric nursing, according to Anon [4, 5, 6]. Further, it means that nurse students should learn pediatrics through internships in pediatric wards [7]. However, the lack of such internships makes it challenging to meet the quality requirements for providing adequate clinical care for pediatric patients [8, 9]. In addition, the level of documentation of learning clinical pediatric nursing in a bachelor’s degree in nursing is inadequate [8].

To solve the problem of lack of internship, alternative work requirements have been developed. It can be useful for nursing students to learn about somatically ill children by implementing project-based learning in nursing programs, simulation, and/or international clinical placements, or all.

In summary, there is a need for nursing expertise and practice for pediatric nursing (children under 18 years), but we can also see that there is a shortage of internships in pediatrics for nursing students, especially in the specialist health service.

This chapter emphasizes different models for clinical pediatric nursing for nursing students. The theoretical part of pediatric nursing is not emphasized because it is not a special challenge. There are several good textbooks.

2. Pediatric nursing

International studies show that nursing students’ learning through clinical practice was central and important in the practice of nursing in the subject [10, 11, 12], and Norwegian nursing students had clear learning benefits from clinical practical experience [13, 14]. Learning through clinical practice in a pediatric practice setting underlined the importance of learning in that type of practice [7]. American study shows that the Society of Pediatric Nursing recommended a minimum of 61 to 80 hours of pediatric clinical experience for Registered Nurses [8].

How learn nurse students pediatric nursing

• Project-based learning at universities.

• Simulation.

• Placement for pediatric nursing.

In case of lack of clinical practice experience is, project-based learning an alternative way for nursing students and an important contribution to achieve learning outcomes about children as somatic sick patients. Project-based learning (PjBL) is a pedagogical method in which the students manage the learning process to a greater extent himself, while the teacher functions more as a facilitator [15]. The method involves a problem analysis of the topic to be studied and preparing a solution to the problem [16], as well as it is suitable when students must learn new topics [17]. PjBL contributes to students becoming more independent in their work [17]. The method supports students’ autonomy in the learning process and contributes to self-regulated learning [18, 19].

Key features of the project are the nursing students choose the composition of the group (three to five students), choose a topic and prepare a problem under supervision, which includes a delimitation of the child’s age. They interview relevant healthcare personnel, pediatric nurses, or people/parents they know who have experience that can answer the problem. They write a report and submit it to the student portal. Then, they make an oral presentation (30 min) for supervisors, examiners, and fellow students. The students must have the supervisor’s approval of the issue, interview guide, and information letter, which emphasizes ethical considerations regarding voluntary participation and safeguarding the confidentiality of the interviewees and that important information in the interview situation is noted in an anonymized manner [20].

The study is designed as a quantitative study with anonymized data obtained through a structured questionnaire of 159 nursing students. The questionnaire [21] has been prepared to gain insight into the learning outcome nursing students achieve about somatically ill children and their relatives and about nursing practice in that connection through the group examination project “Project Child” in the bachelor’s program [20].

The nursing students experienced the 2 weeks with PjBl as useful learning outcomes about somatically ill children when completing PjBL (76,8% positive response). This even though they answered they were less motivated to perform the project (69.2 positive response). They underlined that at future meetings with somatically ill children as students, the learning outcomes were very useful (80,5 positive responses). The learning outcomes from the project were considered important for the students as a future nurses in dealing with somatically ill children (0–18 years) in hospital (70,0 positive response) [20].

In the PjBl, the students’ emphasis is placed on creating themes and problem formulation themselves as important (90,6% positive response) and on interviewing people with experience in pediatric nursing as motivating and useful. Their learning outcomes of interviewing are high (92,2% positive response). The students experience learning outcomes from having written a project report in the group as important (81,1% positive response). The students are less positive that they learned from their own oral presentation (39.5 positive response), and they learned more from their fellow students’ oral presentation (69.2 positive response) and giving fellow student’s responses to another group’s presentation and report learned they even more of (74.9 positive response). They rated searching, finding, evaluating, and including research articles in the project slightly less positively (57.9 positive response), as well as the learning outcomes of the guidance from the teacher (59.7 positive response). Having been prepared for the project through information, study plan, and teaching, slightly less than half experienced it positively (49.0 positive response) [20].

The student thinks it is important to gain practical experience with somatically ill children (0–18 years) in a hospital during the education (90,5% positive response), and they think that nursing education emphasizes somatically ill children (0–18 years) in hospital in a small degree (8,6% positive response) [20]. Sundal & Vasset’s [20] study also shows that if students do not get clinical practice in the pediatric ward, interviewing and discussing pediatric nursing with a knowledgeable pediatric nurse can also provide learning.

Discussion and conclusion: PjBL, especially the students’ interviews of people with experience, enables students’ learning outcomes, which contributes to nursing students’ learning outcomes requirements in pediatric nursing [20].

3. Pediatric learning in simulation laboratory

Simulation has been implemented as a pedagogical method in the curriculum for bachelor’s degrees in several educational institutions. Simulation is especially suitable for training communication and interaction in acute situations in pediatrics. To equip nursing students for practice studies, there has been a tradition of practical training in procedures at training departments. To improve this, simulation laboratories have set up one or more simulator machines, such as SimMan and SimPad [22, 23]. Simulation-based training is one of the most important measures to improve patient safety in pediatrics and reduce the number of adverse events in hospital departments [22, 23, 24]. Simulation can be conducted in the field of practice or through school-based education [24, 25]. A study indicated that simulation in the laboratory was a useful instrument in learning pediatric nursing. They believed it was mostly used in cardiopulmonary resuscitation and could have been used more [26]. Using a SimMan that could receive a venflon can facilitate this performance of care for children. The students could learn more about how they use such dolls in hospitals. To divert children’s attention, or are there other purposes? A study [27] noted that intravenous-access procedures in children are one of the most stressful because it is invasive, and using needles generates anxiety, insecurity, and fear. Playful strategies using SimMan and even the materials used for venipuncture can assist children in understanding, accepting, and coping with the procedure.

Studies underlined that students expressed the view that making mistakes was uncomfortable, even though this was just a simulation situation [22, 23, 28, 29]. This was especially related to an occurrence in a scenario in another study where a child needed a blood transfusion. Here, the informants reported that during the simulation, several teams had given the wrong blood because the patient’s identity was not managed properly [22, 23]. Simulation is considered one of the most practice-oriented methods to learn practical competencies, and these findings correspond with other research in the field [30, 31, 32, 33] that underlines simulation-based training as one of the most important measures to improve patient safety [29, 30, 31, 33, 34].

3.1 Reflection as a pedagogical method in simulation laboratory

Students construct their own learning within social frameworks. According to David Kolb’s theory, learning is a process in which knowledge is formed through the transformation of experience in four stages [35]. First, students experience a given situation (in pediatrics). Next, students reflect on their experiences and what they think and mean. Based on reflective observation, students’ structure and generalize or formalize the learning outcomes of their experiences. Later, this knowledge will be tested in new pediatric contexts. Then, it will be clear whether the student has learned and reflected on pediatric nursing challenges.

Philosopher Donald Schön’s [36] theory of the reflective practitioner can provide an understanding of learning and performing tasks in practice, including examining the processes of thinking, talking, and interacting through a series of cases in practice. His theory addresses knowledge-in-action and reflection-in-action. According to Schön [36], teachers or managers must guide the reflection process. Knowledge-in-action and reflection-in-action. Reflection afterward a simulations section is particularly useful in the simulation work for increasing knowledge. Debriefing after the simulation work is fundamental for students’ learning, according to Hammer and Vasset; Vasset, Helberget, and Almås [22, 29].

One study [22] shows that scenario-based simulation experiences in themselves are no guarantee of learning; they need to be part of a systematic process that incorporates reflection on the action. Without reflection, simulation experiences result in limited learning. Several other studies show that debriefing with an emphasis on reflection helps ensure learning in the simulation situation [22, 29].

Where learn nursing students in pediatric nursing?

• In their own country

• International clinical internships (ICI)

4. Learning outcome in national versus international clinical internships

Nursing education in European countries must be 50% of the education [1, 2, 3, 4, 5, 6]. With increasing numbers of nurse students, there is often a problem when it comes to hospital practice in pediatric nursing [20].

One method of offering nursing students experience in pediatric nursing is to integrate clinical placement in a pediatric ward or in health centers in exchange studies (ICI). There are several advantages to this. From a different context, in which they study nursing, they can bring home new perspectives on pediatric nursing related to health prevention and health promotion, as well as care for sick children and their next-of-kind. The challenges regarding public health work aimed at children and young people, the prevalence of disease, and the treatment offered will include similarities and differences. Students learn through comparison between contexts. In some contexts, students will encounter diseases they would not get experience with at home, and thus, they gain a wider range of experience than if they stayed home. In addition, the students get insight into some migrants’ acquired understanding of health, illness, and treatment according to children. Moreover, their cultural competence increases [36, 37].

Several bachelors’s programs in nursing offer international clinical placement in both low- and high-income countries [38, 39]. Another focus in international placement is an increased focus on developing a global perspective in children’s nursing.

A program for practice in the pediatric department in the ICI

• Context for the pediatric department

• Organization of the pediatric service

• Organization of students’ practice

• Learning theory

• Nurse students’ learning outcomes after homecoming

• Nurses’ experience after attending ICI as a student retrospectively.

Learning outcomes will be discussed – using teaching—theory, and development of cultural competence and personal and professional development. In Ulvund and colleagues’ [36] study, when Norwegian nurse students had internships in a hospital in Ethiopia, they compared similarities and differences, which can lead to increased cultural awareness. Parents had to pay for parts of or all treatment, such as for the painkillers and antibiotics. As a result, many children develop some complications after fractures, such as osteomyelitis, because they did not receive antibiotics. Many children also received no painkiller either after surgery or when a nurse performed a painful procedure [40].

In North Europe, the treatment and medicine are free for children. The students gained experience with and insights into more unknown medical conditions—for example, meningitis, tetanus, malaria, tuberculosis, and other infectious diseases. There are few such diseases in Norway, but they exist mostly because of increasing immigration. The students learn that children may die from diseases because their parents cannot pay for their treatment [40]. The students gain more knowledge on pediatric patients, the roles of parents and nurses, and the treatment methods and various diseases that are relevant to pediatric nursing. This placement helps them provide some level of cultural knowledge, awareness, and sensitivity because of the contrasting conditions in their home country.

5. Summary

This chapter of the book emphasizes nursing students’ clinical practice in pediatric nursing. It can be implemented in various ways, such as project-based learning with interviews of professionals in pediatrics. Then, simulation learning will take place in simulation laboratory. Clinical placement in hospitals is discussed both as a part of the program in exchanges studies and as internships in hospitals nearby campus. The chapter is built on our own research on these topics. In addition, we have used some research from other researchers.

Acronyms and abbreviation

EU	European communities
Anon	the European parliament and the council of the european union
PjBL	project-based learning
SimMan	well-known patient simulators in healthcare simulation
SimPad	used to operate device used to control leardal simulations.
ICI	international clinical internships.