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Journal of Nursing

Where are the Children? -pediatrics in an integrated format 

Nina Haines, MSN, RN, CPNP-PC Lori Beard, MSN, RN Mary C. Day, MSN, RN, CEN, ACNS-BC Margo Mengel, MSN, RN Cheryl Moody, MSN, RN, CCRN [email protected]


Abstract  


Integrating pediatric content is a challenge to nurse educators.  Limited information exists regarding the most effective method of teaching pediatrics.  Nurse educators disagree on placement of pediatric content. Pediatric concepts are at risk of getting lost or deemed unimportant as other concepts are expanded.  This article will examine the experience of educators in a nursing program that integrated pediatric content.  The benefits and disadvantage of teaching pediatrics in an integrated format will be discussed.   


Methods  


Analysis of objective and subjective data related to the process of integrated pediatric content in the curriculum.  


Implications for Practice/ Objective  


Nurses will expand upon their own knowledge about changes in nursing curriculums. The changes that take place clinically effect the need to provide additional content into nursing education. This requires creative ways to “fit” this information into the curriculum in a timely and effective manner. Many nurses have contact with children of all ages in different areas of healthcare. There is need to ensure that students are obtaining the knowledge to safely care for children.   


Introduction  


The philosophy of the nursing faculty at The Reading Hospital School of Health Sciences, Nursing Program involves educating the nursing student on concepts beginning with normal and simple progressing to abnormal and complex.  Basic under-girding of the philosophy incorporates scientific, technical, and behavioral knowledge to assist individuals across the lifespan to promote, maintain, or restore their health, or experience a dignified death.  The central focus of the philosophy is the individual with physical, emotional, psychological, intellectual, social, and spiritual needs. As a dynamic human being, the individual interacts with the internal and external environment across the lifespan.  The philosophy supports the integration of the pediatric content throughout the curriculum.  


 The purpose of this article is to examine the experience of nurse educators implementing the integration of the pediatric content over the past six years.  Through the lived experience, the educators will discuss both the advantages and challenges of pediatric content integration.  With the integration of pediatric content, educational goals for the nursing students include demonstrating pediatric knowledge needed for entry-level practice, applying theory to meet the healthcare needs of the pediatric population, and assisting the pediatric patient to maintain or achieve wellness through healthcare teaching. 


Literature Review 


The care of the pediatric patient is an essential part of nursing education, because almost one-third of children in the United States have a chronic health disorder (1).  Despite these statistics, nursing programs continue to decrease theoretical and clinical content related to children (2).  In a position statement, The Society of Pediatric Nurses supports the practice of pediatric education as a free standing course (2). There is limited literature to corroborate the merit of a free standing course versus integration of pediatric content into the curriculum.  


Opponents of integration have concerns that pediatric education will be inadequate to prepare nurses for practice and fewer students will choose to work in pediatric fields (3). If integration is to be done, then it should be driven by the pediatric experts who can ensure the concepts of pediatric nursing, along with growth and development, are synthesized into the curriculum (4). Nursing programs have successfully integrated specialty content into curriculums; however, according to Hancock (5), faculty education, and support of faculty through the integration process, has enhanced the success. 


Advantages  


The nurse educators involved in medical-surgical courses, since the integration of the pediatric content, identified advantages and challenges within the curriculum. The most notable advantage for students is their exposure to pediatric content and clinical experiences in a creative, student-centered learning environment throughout the curriculum. 


The integration of pediatric content throughout the curriculum allows the students to assimilate care of a child.  As students learn theory and skills, they are exposed to the norms and special considerations for the pediatric population.  For example, during the oxygen therapy simulation, the students realize the importance of having the correct equipment and are encouraged to apply the various pediatric nasal cannulas and masks to pediatric manikins. 


The students first encounter well children in a school environment while performing health education. Physical and developmental assessment of the well child occurs in both clinical and laboratory experiences as the student progresses.  During the maternal-child health course, the students assess and care for the newborn while providing family-centered care. While in the mental health course, students have the opportunity to care for adolescents in both inpatient and outpatient environments. The medical-surgical courses allow students to care for the acutely ill child while hospitalized.  As the students acquire nursing knowledge, their pediatric clinical experiences expand, thus providing them opportunities to compare and contrast pediatric and adult nursing care. 


During the integration of pediatric content, the faculty recognized the need to develop innovative teaching strategies that would enhance student learning.  Pediatric simulations have been developed to allow students to apply the recently taught theory.  A laboratory experience was developed utilizing children of various ages from infancy to adolescence, which enabled students to implement pediatric assessment techniques on a well child. 


Challenges 


The pediatric didactic and clinical laboratory components throughout the curriculum are scattered.  The lack of concentration of content into one course makes it very difficult for the students to have cohesiveness of the material for application in clinical situations.  The content becomes minimized in comparison to the adult content.  The lack of comfort and knowledge of pediatrics by the educators contributes to the minimizing of the content.  The educators noticed decreased student attendance during scheduled pediatric classroom hours.  The time allotted for pediatric content as compared to the adult content is considerably less.


Since there is not a separate pediatric course, clinical experiences are integrated into the curriculum.  Actual pediatric clinical time is very limited. Early pediatric experience is observational and progresses to the assessment of the well child.  The advanced medical surgical courses have very limited pediatric clinical experience on an inpatient nursing department.  The integration of pediatric content does not allow the student to apply their learning in a pediatric setting in a timely fashion.  It is months until the students apply fundamental skills in conjunction with critical thinking skills.  The delay in the application of pediatric theory has resulted in student’s increased anxiety on the clinical unit caring for children in different developmental stages.  This anxiety is reflected by a lack of confidence of the knowledge needed to perform the nursing care required to meet the patient’s needs.  This delay requires re-teaching of content while on the clinical unit.  


Discussion 


The main objective in teaching pediatric content is to provide nursing students with the knowledge and skills to safely and competently care for children.  There are identified issues that need to be addressed to improve the implementation of integrated pediatric content in the curriculum. The percentage of pediatric content, compared to adult content, in each course is much less; thus creating the perception that the content is less important.  


A perception among students exists that there is a lack of continuity between class and clinical.  Student evaluations and comments reflect disconnectedness in the flow of pediatric content throughout the curriculum. Students have expressed a desire for a separate pediatric course that would allow them additional exposure to the pediatric population.  The students struggle with the ability to apply growth and development concepts during the care of the pediatric patient.  A separate course would allow for the integration of growth and development concepts. 


Despite the identified issues with integration of pediatrics into the curriculum, testing results reflect knowledgeable students. The standardized testing results related to pediatrics revealed that the students were average in knowledge of pediatric content over this six year period. The testing results provide evidence that the students were able to critically think and possess ability to apply basic principles of nursing care of children. It has also been noted by some faculty that the pediatric content being integrated has required them to expand their knowledge of pediatrics. 


Conclusion 


The integration of pediatric content was the result of shortening the nursing program and adding other content into the curriculum. This change in curriculum has required tracking of the pediatric content to ensure concepts are not lost.  It also has necessitated implementation of additional teaching strategies.  Clinical application of the pediatric didactic component is necessary for students to ascertain the content to provide safe nursing care to different developmental age levels of children.  Further research and investigation is needed to determine the best approach for teaching pediatric content.  Published research is lacking to provide evidence for successful implementation of integrated pediatric content in a nursing curriculum.  Nursing educators would benefit from evidence-based guidance in the process of integration. 


References 



  1. Guyer B, Wigton A. Child Health: An Evaluation of the Last Century. In: Crosby AG, Greenberg RE, Southward LH, Weitzman M, eds.About Children: An Authoritative resource on the State ofChildhood Today. American Academy of Pediatrics; 2005: 102-105.  

  2. Society of Pediatric Nurses. Position statement on child health in the undergraduate curriculum. Available at:https://www.pedsnurses.org/component/option,com_docman/Itemid,222/task,cat_view/gid,49 . Accessed October 11, 2010.  

  3. Pawlik KM. In defense of pediatric nursing undergraduate education.J Nurs Edu. 1998 Dec; 37(9): 418-21. 

  4. Smith CM, Hamner JB. Bringing pediatric nursing to life in a baccalaureate curriculum. J Nurs Edu. 2008 May; 47(5): 236-39. 

  5. Hancock D, Helfers MJ, Cowen K, Letvak S, Barba B, Herrick C, Wallace D, Rossen E, Bannon M. Integration of gerontology content in nongeriatric undergraduate nursing courses. Geriatr Nurs. 2006 mar-Apr;27(2):103-11. 


 

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