The significant chronic illness and high acuity of hospitalized children requires nurses to exemplify strong critical thinking skills when caring for this vulnerable population (Berry et al., 2013). An interactive pediatric skills day was designed and implemented to provide nursing students with the foundational knowledge, experience, and practical reasoning through pediatric clinical situations prior to entering pediatric clinical rotations. The goal was to integrate teaching–learning strategies that maximize clinical experiences in the hospital, decrease student anxiety, increase confidence and exposure to pediatric care, promote critical thinking and clinical reasoning skills, and improve student ability to perform safe patient care. The interactive pediatric skills day provides students with the foundational knowledge and multiple practice experiences needed to provide safe care during clinical practice. Using the integrated clinical education theory in the development of the interactive pediatric skills day prompted faculty to introduce students to pediatric content using multiple practice opportunities and provide immediate meaningful feedback to prelicensure nursing students (Jessee, 2018).
The interactive pediatric skills day emphasized high-volume/low-risk skills, pediatric assessment, medication administration, and developmentally appropriate care, as well as use of basic equipment. Students completed preclass assignments about growth and development and assessment differences in children. During the skills day, students completed three unfolding case studies representing different pediatric age groups to facilitate self-guided learning and promote application of knowledge and previous experiences to the pediatric population. Each case study included a bedside instructional guide providing an overview of the case study, a detailed skills checklist, an equipment checklist, and a list of instructor-guided questions. Groups of six students partnered with an assigned instructor and spent 4 hours in low-fidelity simulation for each case study using developmentally appropriate techniques (language, safety, educational needs) to manage the scenario. Concepts and content addressed in each case are as follows:
- General care: measure height, weight, head circumference, and vital signs. Calculate intake and output, maintain intravenous fluids, and practice administering a fluid bolus and an intramuscular injection.
- Respiratory: assess respiratory status and practice selecting and using appropriate oxygen delivery systems, perform suctioning on a pediatric patient, and provide tracheostomy care. Administer oral acetaminophen and intravenous vancomycin.
- Gastrointestinal/genitourinary: insert a nasogastric tube and start continuous feeds. Administer bolus feeding and famotidine through a gastrostomy tube. Provide indwelling urinary catheter care and measure output.
Students calculated safe medication dosages for each case study and administered medications. Faculty ensured that all concepts were addressed and provided immediate feedback on skills, developmentally appropriate care, education, and safe medication administration.
The interactive pediatric skills day decreased student stress and promoted skill competency in a safe learning environment, thus enabling students to successfully transition into the pediatric clinical setting. Students reported a decrease in anxiety prior to entering into the clinical setting. Students also reported an increase in overall confidence and competent implementation of basic pediatric skills. Faculty reported observing students more actively engaged in patient care earlier in the rotation, improvement in clinical reasoning skills, and an increased awareness of patient safety. The interactive pediatric skills day established an environment of continuous purposeful improvement of clinical reasoning skills and encouraged meaningful feedback addressing specific pediatric knowledge and skills.
Angela Weaver, MSN, CPNP-PC, CNE
Mary Melissa Lord, MSN, RN, CPN
Lesley Ann Owen, MSN, RN
Vanderbilt University School of Nursing
- Berry, J.G., Hall, M., Hall, D.E., Kuo, D.Z., Cohen, E., Agrawal, R. & Neff, J. (2013). Inpatient growth and resource use in 28 children's hospitals: A longitudinal, multi-institutional study. JAMA Pediatrics, 167, 170–177. doi:10.1001/jamapediatrics.2013.432 [CrossRef]
- Jessee, M.A. (2018). Pursuing improvement in clinical reasoning: The integrated clinical education theory. Journal of Nursing Education, 57, 7–13. doi:10.3928/01484834-20180102-03 [CrossRef]