Nurses integrate principles of growth and development on a daily basis when providing patient- and family-centered nursing care. It is essential, therefore, that nursing students have opportunities to learn and apply principles of growth and development across the life span. We describe an innovative teaching strategy designed to facilitate student application of growth and development in a pediatric undergraduate clinical rotation.
BACKGROUND
A recent revision to our undergraduate nursing curriculum at a large public university included the removal of a separate didactic growth and development course. This change challenged us to rethink how to best integrate growth and development into our existing pediatric nursing course. We believed that an experiential learning activity would meet the needs of our adult learner students, facilitate application of growth and development, and enhance understanding of how hospitalization and illness can impact pediatric patients. A review of the literature uncovered limited information about best teaching practices related to student application of growth and development.
Kolb's experiential learning theory provided the theoretical underpinnings for the Pediatric Play Project (PPP). The experiential learning theory describes a cycle of concrete experience, reflection, conceptualization, and experimentation (Kolb, 2015). In the PPP, students experienced caring for a pediatric patient with unique, diagnosis-specific growth and development needs. They reflected on this experience and then conceptualized a toy or play activity specific to the patient. Experimentation entailed students presenting a description and analysis of their toy or play activity to their clinical faculty and peers and receiving feedback on the same. Students engaged in critical thinking during each phase by analyzing and applying knowledge of growth and development and pediatric nursing care. A meaningful synthesis learning experience resulted, and students successfully achieved course and curricular learning outcomes in an innovative and fun way.
Play projects described in the current nursing literature include filling shoe boxes with age-appropriate toys to donate and selecting toys for a pediatric patient based on age and diagnosis (Epp & McAulay, 2008; Mullen, 2018). Nursing students have critiqued toys on the market and crafted toys for an age group in general (Andrews, 2019; Shutt, 2006). These activities have been described as effective for teaching growth and development and preparing students for clinical settings and nursing examinations. No literature has described students fashioning or modifying a toy or play activity for a hospitalized pediatric patient to address the child's specific needs.
THE PEDIATRIC PLAY PROJECT
The purposes of this pilot project were for students to: 1) apply principles of pediatric growth and development while considering real patient needs related to illness and hospitalization; 2) gain an appreciation for how nurses foster the growth and development of hospitalized pediatric patients; and 3) engage in an experiential learning activity, simultaneously teaching and learning from their peers and their patients. The project received institutional review board exemption.
Students were introduced to the PPP on the first day of class in their undergraduate pediatric nursing course. Discussion centered on the impact of illness and hospitalization on pediatric growth and development, including how this phenomenon is multifactorial. In addition, students read an article describing how play is essential for the development of healthy children (Yogman et al., 2018) and listened to a public podcast on the importance of play for children in general.
During their clinical rotation, students chose an age group to focus their PPP and an inpatient who fit the age criteria. Students considered this patient's unique health and developmental needs and then designed a toy or play activity accordingly. (They were not expected to manufacture the toy.) Students were expected to explain how their play activity would foster the patient's fine and gross motor skills, language, and cognitive and moral growth and development while keeping the patient safe and addressing the patient's unique health needs. Students also learned about and described key developmental milestones pertaining to the patient's age group and observed whether the patient was meeting these milestones or not. Students presented their projects to peers and clinical faculty using a variety of modalities such as role play, demonstration, and PowerPoint presentations. They followed with a short paper addressing main areas of their learning and key takeaways. Within each clinical group, faculty ensured student projects would span a range of pediatric ages and diagnoses to maximize learning.
The PPP was carried out over two semesters during the 2020-2021 academic year. Ten clinical faculty and 206 students participated. Student feedback was collected via a brief, anonymous, optional online survey with three closed-ended questions and narrative remarks. Student performance on exam questions testing understanding and application of growth and development was compared with previous student performance. Clinical faculty feedback was gathered through email and during course meeting discussions.
STUDENTS PROJECTS AND FEEDBACK
Student projects reflected incredible creativity and critical thinking about best ways to foster patients' growth and development. Examples included a Velcro mitt with stuffed animals, rattles, and teething ring for an infant with short bowel syndrome to assist with developmental tasks while keeping medical equipment intact; a Snack Time Mat that would provide positive reinforcement of healthy eating for a toddler with oral aversion through shape and color matching; a game with two-foot-wide dice and activities such as color identification for a preschool patient with Lennox-Gastaut syndrome; a game for a school-aged child with cystic fibrosis, where her chest physiotherapy vest would act as an imaginary jet pack to travel through different galaxies and developmental task completion; and a game called "Are You Smarter Than a Healthcare Provider?" where an adolescent patient with spontaneous pneumothorax would learn about her diagnostic testing, diagnosis, and treatment through play.
Student feedback was extremely positive. A total of 159 students (77 percent) responded to the survey. Almost all (98 percent) found the PPP an effective way to learn about growth and development, and 96 percent believed that designing a play activity or toy for a specific patient promoted their understanding of how illness impacts pediatric growth and development. The vast majority (94 percent) indicated that presenting their own PPP and listening to their peers' presentations enriched their understanding of how pediatric nurses promote patient growth and development. Narrative comments described the project as creative, fun, useful, and valuable to their future career. As one student stated, "I have never had a clinical project that has hit the mark so well[horizontal ellipsis]because we were able to tailor our focus on actual patient interactions, it meant something to us personally. It was a joy to dive deep into how to promote these kids' growth and development and things nurses like me should consider." Some students reported that they found the project time-consuming, and many found writing a follow-up paper redundant. Interestingly, students completing the PPP did equally well on exam questions related to growth and development compared with students in previous semesters. This finding was encouraging because previous students had taken a growth and development course as part of their nursing curriculum, whereas these students had not.
Faculty feedback was very positive. All clinical faculty reported improved student application of growth and development and noted the creativity and breadth of the projects. Faculty observed that because students were aware of the assignment before beginning their clinical rotation, they focused on the growth and development of their patients starting the first clinical day. Compared with previous semesters, faculty found these students demonstrated a remarkable ability and comfort level in speaking to families about the developmental needs of their child. Faculty also reported students tailored nursing interventions to each patient's developmental level at an earlier point in their pediatric clinical rotation compared with previous students.
LIMITATIONS AND RECOMMENDATIONS
Students had limited time in pediatric clinical experiences and faced time constraints. They needed to commence the PPP early, potentially creating a sense of urgency for some. Because the PPP was carried out during the COVID-19 pandemic, some presentations were conducted virtually. A virtual platform appeared to limit student interaction with the game or toy in contrast to presenting on site. Finally, demographic participant data in the online survey were not gathered, nor did every student respond. It is unknown whether the PPP was a more effective learning activity for some groups of students than others. Students were not expected to manufacture the toy or play activity as doing so could have led to resource inequities; therefore, patient responses to the PPPs were not observed.
The PPP shows promise as an effective educational innovation, promoting application of pediatric growth and development through experiential learning. Further consideration of how a written follow-up paper best supports student learning is needed. Finally, more formal research examining differences in student learning using this teaching strategy compared with more traditional assignments could yield important information to determine best teaching practice.
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