Pediatric clinical teaching is becoming more of a challenge as numbers of inpatient pediatric patients decrease and numbers of nursing students increase. Outpatient settings provide one type of clinical experience. But without inpatient pediatric experience, how can nursing students learn about children's reactions to hospitals?
Since education can decrease fear of hospitalization, and young children learn by pretending, the University of Alabama in Hunteville College of Nursing, Huntsville Hospital, Huntsville Hospital Auxiliary and the volunteers from Red Cross decided to set up a make-believe hospital for first grade students. Realistic hospital equipment was set up in a location separate from the hospital. The College of Nursing believed that this would be an excellent learning experience for nursing students. It would provide nursing students with an opportunity to adopt various nursing roles in a realistic hospital setting. Children would be able to see realistic equipment and learn about the hospital experience in a setting with much less anxiety than if they were actually sick or injured and had to be hospitalized. Since client teaching is a major part of our nursing curriculum, nursing students would learn how to communicate with and teach children about hospital and health-related procedures and equipment.
The hospital provides the space, equipment, schedules and the organization of elementary schools participating. The College of Nursing is responsible for preparing the vocabulary list and bibliography list that is sent to teachers of students planning to attend. The College of Nursing is also responsible for preparing the skits used to teach in the various areas of the pretend hospital. Of course, the College of Nursing's major contribution is manpower for role-playing and teaching in the various areas of the hospital.
Generally, each year, approximately 1,000 first graders from 40 elementary schools throughout the city and surrounding county attend. Teachers are sent a vocabulary list and bibliography of children's books related to hospitals about 2 months before the scheduled tours. These are prepared by graduate and undergraduate nursing students as a class activity. This helps students learn to utilize the language of first-graders and helps students learn about lay literature that is available for families who may have children anticipating hospitalization or who have actually been hospitalized. Hospital identification bracelets are made and sent to the schools so first-graders can wear these on the tour. First-graders also draw pictures of hospitals, doctors or nurses. These are used to decorate the walls of the make-believe hospital.
The first-graders and their teachers are greeted by Red Cross volunteers who introduce them to the hospital by showing a brief children's film about hospitals. From here they go to another room to see a health-related skit done by nursing students. Skits emphasize such areas as nutrition and discuss fears of children about hospitals. These skits are written by nursing students as a class activity. In preparing skits designed to teach nutrition, the students must utilize language appropriate for the age group. They must be aware of developmental levels so they can present material in a way that would be appealing to first grade students. Music and many colorful visual aides have been used. One year students actually dressed in costumes that looked like various fruits and vegetables in the nutrition skit. The skit related to fears of hospitals utilized a space bear who had come to earth to learn about hospitals. First-graders are always very excited with the colorful costumes and the catchy music related to health matters.
Then the actual tour of the makebelieve hospital starts. About 20 to 25 children form each group for the tour. Three children in each group are selected and dressed to be the patient and parents for each group.
The first area is the admission office. The children then visit a "pretend" emergency room. All hospital equipment is present- stretcher, cast cutter, needles, and bandages. A teddy bear on a stretcher may have a cast on his leg. Nursing students teach the children some procedures that occur in emergency rooms such as putting on a cast and giving local anesthesia. This again gives the opportunity to utilize knowledge of development so age-appropriate teaching may be done.
After the emergency room, there is a patient room which includes a hospital bed, bedside table, over-bed table, and a real tray with pretend food. Various positions of the bed are demonstrated, and special attention is called to the bedside telephone. From here the group is taken to the x-ray area. X-ray equipment and actual xrays are present. The children are told how the x-ray would be taken and what they would be asked to do if they were having xrays made. The nursing students assisting in this area are dressed as skeletons to emphasize what x-rays show. The costume is a dark T-shirt and pants with white bones drawn to appear as a skeleton.
The next station is the treatment room where starting an intravenous drip and a method of blood sampling are discussed. All equipment is shown. It has been found that this is the most frightening experience for the pretend patient. Nursing students must constantly emphasize that this is only "pretend" in an effort to decrease anxiety. This gives students the opportunity to actually see anxiety in children and to practice various ways to decrease it.
From the treatment room the tour progresses to the operating room and recovery room. Nursing students are dressed in scrub suits. Instruments and an anesthesia cart are present to give a very realistic picture of the operating room. The patient was placed on the stretcher and a mask was used for "pretend" anesthesia. After the surgery, the patient was taken to the recovery room.
Next is a play area similar to those on pediatric units. It contains a table with books, games, and toys. Two nursing students act as the play therapists. This is always a favorite area for the first-graders.
Some years, the last area outside the building has been the Helicopter Ambulance. This has been very exciting for the children. The actual helicopter crew members have been present to answer questions about ambulance transport.
Children are given a take-home bag of goodies. The bag includes a comic book and coloring book on poison prevention, a surgical mask, plastic pill cup, cardboard doctor and nurse cap and safety rules for children in comic form. These materials may then be used to play out their experience later at home or school.
Since the make-believe hospital was developed in 1985, it has changed and developed. It is now held over a 2-week period, rather than the initial 3 days, to accommodate the ever-increasing number of first-graders attending. The participation of nursing students has changed over the years, to provide better coverage of the various stations. Of course, each class of students develops different materials and skits.
Each year over 100 nursing students participate in the event. This is considered a clinical experience for the week. Learning opportunities have been found to be even greater than expected. Students learn how to put material in a format that could be understood by first-graders. They learn about children's reactions to various hospital experiences. They also learn the importance of reassuring the children and decreasing anxiety in stressful situations. They gain a better understanding of children's responses to hospitals and equipment. Even though it is a very demanding part of the course, students enjoy the experience.
Another advantage to this makebelieve hospital has been the good publicity for the hospital as well as the College of Nursing. Each year, it has been well publicized by local newspapers and television stations. Even though it is an expensive proposition for the hospital, it continues to be a beneficial public relations activity for them. It is a high demand project for the school system. During the early years, when there was not adequate space for all schools who desired to participate, those left out were very disappointed. The hospital and the College of Nursing have determined that the participation of nursing students is a large cost saving for the hospital with this project.
Nursing faculty have identified several areas for future development and research. Nursing students' learning is evaluated by pre- and post-testing. Among the areas tested are improvements in the knowledge of teaching children, children's needs regarding hospitalization, communication with children, and the developmental stage of children of this age level.
In summary, this was a joint effort between a College of Nursing and a large teaching hospital to better prepare children for hospitalization. However, it has also functioned as a very good teaching strategy for providing pediatric clinical experience for undergraduate nursing students.