EXPLORING UNDERGRADUATE NURSING STUDENTS’ PEDIATRIC PRACTICUM
EXPERIENCES
by
Oghenerukevwe Edoja Onororemu
BScN, York University, 2017

THESIS SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE
IN
NURSING SCIENCE

UNIVERSITY OF NORTHERN BRITISH COLUMBIA
June 2022
© Oghenerukevwe Onororemu 2022

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Abstract
Practicum placements are the signature method used in undergraduate nursing programs to
consolidate knowledge in practice. The literature review conducted before this study showed
limited research on pediatric practices in undergraduate nursing education. This qualitative
descriptive study, analyzed within Knowles’ (1977) adult learning theory framework, explored
the practicum experiences of nursing students and the value they ascribed to their learning
experience. The acute and community pediatric practicum experiences of 13 undergraduate
nursing students and two recent graduates in British Columbia were explored using semistructured interviews. Thematic analysis of interview data generated four overarching themes:
relational practice, knowledge consolidation, identity formation, and exposure. Findings from the
study indicated that nursing students valued pediatric placement opportunities that provided a
variety of learning experiences and allowed them to work within their perceived scope.
Information from this study can inform the planning and management of pediatric practicum
experiences for nursing students in undergraduate nursing programs.

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Table of Contents

Abstract .......................................................................................................................................... ii
Table of Contents ......................................................................................................................... iii
List of Tables ................................................................................................................................ vi
List of Figures .............................................................................................................................. vii
Glossary ...................................................................................................................................... viii
Acknowledgements ....................................................................................................................... x
Dedication ..................................................................................................................................... xi
Chapter 1: Introduction ............................................................................................................... 1
1.1 Nursing education in Canada ................................................................................................ 1
1.2 BCCNM framework for nursing education in British Columbia .......................................... 2
1.3 Pediatric practicum as part of undergraduate nursing education programs .......................... 3
1.4 Challenges and opportunities in nursing education programs .............................................. 5
1.5 Research purpose and research question ............................................................................... 6
Chapter 2: Literature Review ...................................................................................................... 8
2.1 Literature review design and search methods ....................................................................... 8
2.1.1 Research question and key search terms ........................................................................ 8
2.1.2 Inclusion and exclusion criteria ...................................................................................... 9
2.1.3 Search methods ............................................................................................................. 10
2.1.4 Selection strategies and search results .......................................................................... 11
2.1.5 Quality appraisal ........................................................................................................... 14
2.1.6 Data extraction and synthesis ....................................................................................... 17
2. 2 Literature review findings .................................................................................................. 17
2.2.1 Study characteristics ..................................................................................................... 18
2.2.2 Pediatric placement types and duration ........................................................................ 19
2.2.3. Role of students ........................................................................................................... 21
2.2.4 Adaptation .................................................................................................................... 23
2.2.5 Assessing Learning ....................................................................................................... 27
2.3 Discussion ........................................................................................................................... 31
2.3.1 The importance of nursing students’ voice................................................................... 33
2.3.2 Gaps in the research ...................................................................................................... 34
2.3.3 Contribution of the current study given existing literature........................................... 35
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Chapter 3: Methods .................................................................................................................... 36
3.1 Research objectives ............................................................................................................. 36
3.2 Research design ................................................................................................................... 37
3.3 Theoretical framework ........................................................................................................ 38
3.4 Sample and recruitment ....................................................................................................... 40
3.4.1 Sample .......................................................................................................................... 40
3.4.2 Recruitment .................................................................................................................. 41
3.5 Data collection..................................................................................................................... 43
3.6 Data analysis ....................................................................................................................... 45
3.6.1 Member checking ......................................................................................................... 47
3.7 Rigor .................................................................................................................................... 48
3.7.1 Reflection and reflexivity ............................................................................................. 50
3.8 Ethical considerations ......................................................................................................... 51
3.9 Knowledge translation......................................................................................................... 54
Chapter 4: Findings .................................................................................................................... 55
4.1 Study participants ................................................................................................................ 55
4.2 Themes development........................................................................................................... 56
4.3 Relational practice ............................................................................................................... 57
4.3.1 Caring interaction with children/adolescents ............................................................... 57
4.3.2 Caring interactions with families .................................................................................. 61
4.4 Knowledge consolidation .................................................................................................... 63
4.4.1 Refining communication skills ..................................................................................... 63
4.4.2 Engaging in Task-based learning ................................................................................. 66
4.5 Identity formation ................................................................................................................ 69
4.5.1 Clarity related to career direction ................................................................................. 70
4.5.2 Role conflict ................................................................................................................. 72
4.6 Exposure .............................................................................................................................. 74
4.6.1 Lived experience........................................................................................................... 74
4.6.2 Caring culture ............................................................................................................... 77
4.6.3 Another side of nursing ................................................................................................ 79
4.7 Summary of findings ........................................................................................................... 81
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Chapter 5: Discussion ................................................................................................................. 82
5.1 An introduction to value ...................................................................................................... 82
5.2 Andragogy and the characteristics of adult learners ........................................................... 83
5.3 The impact of task-centeredness on relationship-building .................................................. 86
5.4 The experience reservoir of knowledge consolidation ........................................................ 89
5.5 The formation of identity irrespective of self-direction ...................................................... 92
5.6 The place of exposure in readiness to learn ........................................................................ 94
5.7 Implications for nursing education and nursing practice .................................................... 96
5.7.1 Nursing education ......................................................................................................... 96
5.7.2. Nursing practice ........................................................................................................... 97
5.7.3 Recommendations for future research .......................................................................... 98
Chapter 6: Conclusion .............................................................................................................. 100
6.1 The pediatric practicum placement experience of undergraduate nursing students .......... 100
6.2 Limitations ........................................................................................................................ 101
6.3 Concluding remarks .......................................................................................................... 102
References .................................................................................................................................. 103
Appendix A ................................................................................................................................ 114
Appendix B ................................................................................................................................ 116
Appendix C ................................................................................................................................ 120
Appendix D ................................................................................................................................ 124
Appendix E ................................................................................................................................ 125
Appendix F ................................................................................................................................ 129
Appendix G ................................................................................................................................ 131
Appendix H ................................................................................................................................ 132

v

List of Tables
Table 1: Evidence Level and Quality Rating of Appraised Articles ...................................... 15
Table 2: Characteristics of Study Participants ........................................................................ 56

vi

List of Figures
Figure 1: Prisma Flow Diagram Depicting Literature Search Strategy Utilized ................. 14
Figure 2: Pediatric Placement Types Featured in the Reviewed literature .......................... 20
Figure 3: Cumulative Practicum Settings that Informed Participants' Narratives ............. 55
Figure 4: The Value of Pediatric Placement for the Nursing Student as Adult Learner ..... 85

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Glossary
Client: “An individual, family, group, population, or entire community who requires
nursing expertise. In some clinical settings, the client may be referred to as a patient or a
resident. In research, the client may be referred to as a participant” (BCCNM, 2021, p. 32).
Holistic: “A system of comprehensive or total patient care that considers the physical,
emotional, social, economic, and spiritual needs of the person; his or her
response to illness; and the effect of the illness on the ability to meet self-care needs” (BCCNM,
2021, p. 35).
Intravenous (IV): “Occurring within or by way of a vein” (Healthwise, 2020, para. 1). When an
IV needle is in place, medication or fluid can be delivered directly to the bloodstream.
Nasogastric (NG) tube: A tube inserted through the nares (nostril), down the oesophagus, and
into the stomach (Sigmon & An, 2021). It is used to decompress the stomach when an intestinal
obstruction is suspected and to administer nutrition or medication to individuals who cannot
tolerate them by mouth (Sigmon & An, 2021).
Pediatrics: “Pediatrics is a discipline that deals with biological, social, and environmental
influences on the developing child [– from birth to young adulthood –] and with the impact of
disease and dysfunction on development” (American Academy of Pediatrics, 2015, p. 780).
PICC: “A peripherally inserted central catheter (PICC) is a long, thin tube that goes into [one’s]
body through a vein in the upper arm”; “its end goes into a large vein near the heart” (Animated
Dissection of Anatomy for Medicine [ADAM] medical encyclopaedia, 2019, para. 1).
Practicum: A clinical practice area in the community or acute care setting where students are
provided practical opportunities to apply classroom-taught skills and knowledge in the care of

viii

actual clients (i.e., knowledge consolidation) as they prepare for their future practice. This study
uses it interchangeably with ‘placement’ (CASN, 2015b).
Psychomotor skills: A principal learning objective in nursing education (CASN, 2015a).
Psychomotor skills are purposeful neuromuscular movements combined with critical thought
reasoning and problem-solving that are developed in practice (Gaberson & Oermann, 2010).
Therapeutic relationship: “A relationship the nurse establishes and maintains with a person or
people, [using] professional knowledge, skills, and attitudes, [to] provide nursing care that is
expected to contribute to the well-being of people” (BCCNM, 2021, p. 38).

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Acknowledgements
First, I would like to acknowledge and express my gratitude to the participants who
volunteered their time and shared their experiences with me for this research study. This
academic endeavour would have been unworkable without their thoughtful reflections. Second, I
would like to thank my research supervisor, Dr. Caroline, who was genuinely Godsent to me.
Her advice and intelligent corrections were second to none throughout this process. Third, I
would like to thank my supervisory committee, Dr. Jonathan and Dr. Janet, whose insightfulness
and guidance shaped and strengthened my thesis from inception to completion. Fourth, I would
like to thank the graduate nursing faculty for the wealth of knowledge imparted to me during my
time there. Finally, I would like to thank several people who were instrumental in different
phases of my research study: Dr. Trina, the health sciences librarian; Becky, a senior colleague;
Kristi, the administrative assistant for graduate nursing programs; and Heidi, an instructor in the
undergraduate nursing program.

x

Dedication
I dedicate this thesis to God for his excellent illumination; my parents, Felix, and Beauty,
for their prayers and encouragement; and my dear friend, Elect, for his unwavering support.

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Chapter 1: Introduction
1.1 Nursing education in Canada
Canadian Association of Schools of Nursing [CASN] (n.d.) is Canada's national voice for
nursing education, research, and scholarship. CASN represents both the baccalaureate and
graduate nursing programs by establishing and promoting national standards of excellence for
nursing education, promoting the advancement of nursing knowledge, facilitating the integration
of theory, research, and practice, and contributing to public policy. CASN (2015a) National
Nursing Education Framework document identifies degree-level core expectations as guiding
principles and essential components for nursing programs and graduate nurses in the following
domain areas: knowledge, research, methodologies, critical inquiry and evidence, nursing
practice, communication and collaboration, professionalism, and leadership (CASN, 2015a).
A key aim of prelicensure nursing degree programs in Canada is to ensure new graduate
nurses have entry-level competencies to safely function as generalists in various health care
settings (CASN, 2015a). Generalist, in this context, refers to nursing education programs and
regulatory bodies' expectation that upon graduation, the registered nurse practice “safely,
competently, and ethically along the continuum of care in situations of health and illness
throughout a client’s lifespan” (CASN, 2015a, p. 19). For the registered nurse, this education-topractice transition may involve caring for individuals and families of all ages in several care
areas, including acute care settings, long-term care facilities, community care, etc. (CASN,
2015b). For nursing education programs, introducing nursing students to practical learning
experiences in pediatric nursing, child and family health, and health promotion in the 0-18 age
range is an essential component of entry-to-practice for new generalist graduate nurses.

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1.2 BCCNM framework for nursing education in British Columbia
In British Columbia (BC), the British Columbia College of Nurses and Midwives
(BCCNM) is mandated as the regulatory body for Registered Nurses. This authority is defined
and constituted by the Health Professions Act (RSBC 1996) Chapter 183, which sets a regulatory
framework from the government to health profession review boards, oversight bodies,
independent discipline panels, and regulatory colleges. As such, the BCCNM must establish
clinical competencies and character requirements for registration, issue licenses to practice, and
establish the standards of professional practice and continuing professional education. The
BCCNM receives and investigates complaints about regulated nurses and takes action to
investigate and resolve these when appropriate (Government of British Columbia, 2020).
In keeping with the duties of a regulatory body to oversee its registrants and establish the
requirement for registration, the BCCNM ensures Schools of Nursing in BC meet the educational
and training standards. Nursing education programs and courses are regularly and systematically
reviewed and evaluated based on the curriculum’s ability to meet the theoretical and practice
learning outcomes necessary for students to achieve the established registered nurse (RN) entrylevel competencies and standards of practice (BCCNM, 2020). Baccalaureate nursing education
programs aim to prepare generalist nurses capable of caring for individuals of all age groups and
across various health and non-healthcare settings. Therefore, practice-based learning in pediatric
or family-centered care becomes necessary to fulfill this entry-level preparation requirement.
Students must have access to sufficient learning resources, including practicum placements, to
gain the competencies and perform their roles according to standards of practice. Schools of
Nursing are expected to provide practice learning experiences and evidence that all students have
had sufficient experiential learning across all patient age groups (BCCNM, 2016). To facilitate

2

this, BCCNM (2015) encourages the use of practice learning experiences across a range of
settings such as schools, daycares, community centers, long-term care facilities, and traditional
acute care settings since all provide opportunities for students to consolidate their learning.
Regardless of practica, BCCNM requires Schools of Nursing to identify the criteria and methods
used to assess the suitability of such placements (e.g., site visits and student evaluation).
1.3 Pediatric practicum as part of undergraduate nursing education programs
Nursing education programs offer practical learning opportunities in pediatrics to
students in various acute (traditional) and community (alternative) placement settings. Acute care
settings are highly valued and sought-after practicum placements for students as they allow
students to care for high-acuity infants, children, and adolescents while developing nursing
psychomotor skills (CASN, 2015; McCarthy & Wyatt, 2014). On the other hand, community
care is the delivery of primary care outside the traditional hospital setting, including schools,
community clinics, and residential homes to help individuals, including children, maintain
optimal health and function. (CIHI, n.d., para. 1; Peters et al., 2015). Pediatric practicums
delivered in the community through alternative placement sites such as childcare centers, schoolbased clinics, head start programs, and school settings have been shown to provide opportunities
for students to consolidate their communication and health teaching skills and address public
health directives in line with health promotion and prevention goals (Carlson, 2012; McCarthy &
Wyatt, 2014).
Additionally, acute and community placements can provide students with opportunities to
work with medically complex infants, children, or adolescents experiencing exacerbations of an
illness or struggling to manage their chronic conditions (Webster et al., 2019). Community
placements allow students to support the health care needs of children and their families in their

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day-to-day lives when a child has a life-limiting condition. And so, a focus on acute clinical
experiences may limit these opportunities for students to engage with children in their local
community, particularly given that in recent years, health care delivery is expanding to
community settings (Lewis et al., 2001).
Providing practice learning experience in pediatrics to undergraduate nursing students is
one way in which student nurses receive training for the uniqueness of caring for children,
adolescents, and their families. The pediatric practicum experience may also be the only
opportunity for some students to connect with the pediatric population and their families.
Evidence from undergraduate nursing programs has highlighted that delivering pediatric care to
pre-verbal children and infants-child-adolescent with chronic or complex needs is stressful
(Oermann & Lukomski, 2001; Darcy-Mahoney et al., 2013). Additionally, practicum placements
in pediatrics may give rise to additional feelings of fear and anxiety for students, as caring for a
sick child can be complex. Consequently, for students with little-to-no exposure to caring for
children and families, a patient and family-centered approach to care may generate some
challenges should they be required to perform in this capacity post-graduation. As such, the
pediatric practicum experience becomes an avenue for nursing students to experience caring for
children, and their families, in a supportive practice learning environment.
The need for pediatric practicum experience within undergraduate nursing education also
has implications for rural practice, especially for students desiring to work in rural or remote
communities. Geographically, rural and remote areas are defined in terms of their accessibility
and population density (Subedi et al., 2020). For example, rural communities are said to have
“isolated populations, limited supplies of goods and services, and long commuting distances”
(Subedi et al., 2020, p. 7). In rural and remote settings, registered nurses need pediatrics as a core

4

aspect of their undergraduate training as in these rural and remote communities, there may not be
dedicated pediatric emergency departments, inpatient pediatric units, or primary care teams with
pediatric specialist knowledge. For example, the registered nurse, as part of the acute health care
team, may be involved in stabilizing an acutely ill pediatric client before transferring to the
nearest hospital to address the case. The provision of practicum opportunities for nursing
students to care for children before graduation and joining the workforce, therefore, benefits both
the community and the nursing profession.
1.4 Challenges and opportunities in nursing education programs
The capacity of pediatric acute care placements alone to bring about learning of essential
pediatric content in undergraduate nursing programs is unclear (Bowling et al., 2018; Carlson,
2012), especially given that well-child care represents about 25% of the overall pediatric office
visit (McCarthy & Wyatt, 2014). Furthermore, nursing undergraduate programs have highlighted
the difficulty of securing clinical practicum opportunities that allow all students to experience
caring for and working with children, adolescents, and their families (McCarthy & Wyatt, 2014;
Schultz et al., 2019). This hurdle is due partly to competition among nursing programs and other
health professions (like medicine, occupational therapy, and physiotherapy) for acute placement
sites (McCarthy & Wyatt, 2014; Smith et al., 2013). A competition that stems from the emerging
disproportion between the availability of programs and accessible practicum opportunities
further complicated by increased student enrollment in nursing school and a decreased number of
acutely unwell children in the pediatric units of general hospitals (Ogenchuk et al., 2014; Smith
et al., 2010). Considering this barrier, researchers have called for the expansion of clinical
learning opportunities in pediatrics to include community and school settings where children
live, study, and play (Harrison et al., 2020; McCarthy & Wyatt, 2014; Schultz et al., 2019).

5

These previously overlooked non-traditional placement sites are gaining traction in
nursing pediatric education as more programs adapt to the changing face of health care delivery
for pediatric patients (Ogenchuk et al., 2014). Despite this growing recognition of the value of
non-traditional placements by nursing education programs, bias against such non-traditional
placement sites persists among students who may struggle to recognize the ‘nursing’ practiced in
these practicum settings (Studnicka & O’Brien, 2016). To better understand students’
perspectives on their pediatric placement experience and how nursing programs may better
prepare students to recognize and optimize practical learning at practicums, this study explored
students’ experiences in pediatric practicum settings within a provincial context – British
Columbia (BC). A literature review of existing non-pediatric placements informed the method
design.
1.5 Research purpose and research question
Professional regulatory bodies set outcomes expected of new graduate registered nurses,
including the ability to apply skills, knowledge, and abilities attained at school to care for
patients across the lifespan (BCCNM, 2015; McCarthy & Wyatt, 2014). To this end, practical
learning experiences in various acute and community health care settings are a vital aspect of
nursing education as they facilitate the acquisition and development of professional competence
through hands-on learning (BCCNM, 2015; Ford et al., 2016). Consequently, the pediatric
practicum experience becomes essential to generalist nursing preparation. Smith et al. (2010)
outlined the growing shortage of clinical placement sites in Canada, especially in maternal/child
health, which has brought about creativity in utilizing practical learning experiences in these
settings. As such, non-traditional practicum settings may remain a dependable means through
which the theoretical concepts taught in the classroom are consolidated in practice. It, therefore,

6

becomes necessary to explore student nurses’ experiences of pediatric practica, including
variations between acute and community, as well as where and how students see value in their
learning. To meet this goal, the study questions are twofold:
1) What are undergraduate nursing students’ experiences of pediatric practicum in BC
baccalaureate nursing programs?
2) How do undergraduate nursing students, as adult learners, determine the ‘value’ in
pediatric practicum?
This study highlights the place of nursing students’ voices in re-imagining practical
learning in pediatrics. Findings may inform students’ learning approaches and practicum
planning in pediatrics. The next chapter delves into this research study's literature review search
component. To explore the pediatric practicum experiences of undergraduate nursing students, it
was necessary to understand the current state of research on how undergraduate nursing
programs brought about practical learning in pediatrics to their students.

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Chapter 2: Literature Review
The following chapter presents a comprehensive literature review, including the
associated search strategies for reliably locating all relevant scholarly literature addressing how
nursing education programs provide meaningful and effective practical pediatric learning
experiences to their students. Findings from the literature review are reported, along with a
discussion of the key themes identified and the current knowledge gaps.
2.1 Literature review design and search methods
The integrative literature review process, as outlined by Lubbe et al. (2020) and in line
with Whittemore and Knafl (2005), was used to guide the search methodology. Steps included
identifying the literature review question, sampling literature, critical appraisal of the sample,
data extraction and synthesis, and findings presentation (Lubbe et al. 2020).
2.1.1 Research question and key search terms
The guiding question for this review was: What are students’ experiences of pediatric
practicum placement in undergraduate nursing programs? In order to focus the literature search,
the PIE (Population, Issue, and Evaluation) question format was utilized, and the literature
review question was separated as follows:
•

P – undergraduate nursing program/nursing students

•

I – pediatrics or child health practice placement or practicum

•

E – nursing education.

A list of relevant keywords was identified from each key concept: undergraduate, nursing
program, nursing student, pediatrics, practicum, placement, and nursing education. Appendix A
provides an exhaustive list of keywords and subject terms used for the literature search.
Additionally, different spellings, tenses, and word variants were considered as well as synonyms
8

and related concepts. Some of these word variants were suggested subject terms and medical
subject headings (MeSH) descriptors. For example, word variants and synonyms for pediatrics
were infants, child, or children.
2.1.2 Inclusion and exclusion criteria
To ensure that only relevant articles that answered the literature review questions were
selected, it was necessary to articulate a list of inclusion and exclusion criteria to guide the
literature search (Lubbe et al., 2020). The following inclusion criteria were applied:
1. Language – only publications in English were included since this was the primary
language used by the researcher.
2. Year of publication – only publications existing after the year 2000 were included.
The rationale for this was prior to the year 2000, nursing schools or programs were
not united when it came to the education of students – some utilized the
apprenticeship model whereby nursing students completed the majority of their
training in hospital settings while others were educated in colleges or universities
(Baker et al., 2012). A complete shift from apprenticeship hospital-based training
models did not happen until later in the 1990s (Baker et al., 2012). Thus, this time
frame was chosen to capture relevant articles that drew on academic institutional
educational approaches to undergraduate nursing programs.
3. Pediatric care – publications must refer to individuals aged 0 – 18 within the context
of an undergraduate pediatric curriculum. This age range reflects the Government of
Canada’s (n.d.) definition of a child as an unmarried individual under the age of 19
years.

9

4. Pediatric practicum experience – publications needed to focus on undergraduate
preceptorship or practicum experiences that involved the care of children within the
context of an undergraduate nursing education program
5. Study participants – publications needed to focus on either undergraduate nursing
students, their instructors, or faculty members as study participants involved in
pediatrics practicum placements; and
6. Publication type – publications must be published as peer-reviewed, full-text journal
articles. This excluded dissertations and opinion pieces since there is a limitation to
which such reports have influenced practice changes.
Based on these inclusion criteria, the exclusion criteria for the literature search were
publications: 1) written in languages other than English, 2) published before the year 2000, and
3) peer-reviewed articles displaying no relevance to pediatric or child health practicum
experience as part of an undergraduate nursing program.
2.1.3 Search methods
According to Lubbe et al. (2020), the next step after composing a review question is to
sample the literature. Databases were selected to search for relevant references. Multiple
databases were used to identify better literature on student nurse pediatric placement experiences
in undergraduate degree programs. The following databases were selected: CINAHL (the
Cumulative Index to Nursing and Allied Health Literature), ERIC (Educational Resources
Information Center), and MEDLINE (Medical Literature Analysis and Retrieval System Online).
This selection was based on the databases' specificity to nursing and the researcher’s qualitative
approach to nursing research (Wright et al., 2015).

10

Furthermore, these databases offered a diversity from which to capture the overlap
between nurse-education-healthcare, providing access to a wide range of literature
methodologies. These database choices were discussed with Dr. Fyffe, the Health Sciences
Librarian at the University of Northern BC. In addition, a search using Google scholar was
completed as a general approach to searching the topic area.
2.1.4 Selection strategies and search results
A clear strategy was developed and reviewed with Dr. Fyffe to search each database. The
flowchart in Figure 1 below summarizes included papers, while the following section provides a
brief narrative of the article selection process. Firstly, applying keywords from the research
question in the CINHAL database focused on a range of searches in various combinations using
the ‘advanced search’ feature of the database resulted in subject terms. For example, the keyword
‘undergraduate’ yielded the subject term ‘clinical clerkship’, which was further exploded to
generate ‘preceptorship’ and ‘education’. All of which were deemed appropriate for this
literature review. This process was repeated for the remaining keywords to identify other
relevant subject terms. The words ‘learning’ and ‘experience’ were also included in the subject
terms to capture articles relating to students learning experiences in their respective practicum.
All subject terms were then searched in various combinations under the Abstract (AB) field (see
Appendix A) to yield 884 publications. After limiters were applied, the result was narrowed to
138 journal articles, eight of which were duplicates. All 130 articles were screened by the
researcher for relevance by 1) title – resulting in 80 exclusions since results pertained to a branch
of nursing outside of pediatrics (i.e., gerontology, perioperative, psychiatry, etc.), recruitment
and retention of nursing students, interprofessional education, curriculum planning and
development, substance use, patient safety education, and nursing students’ wellness and

11

wellbeing, 2) title and abstract – resulting in 42 exclusions pertaining to topics outside of
pediatric placement experience of undergraduate students such as models of preceptorship
training for nursing students, method of teaching research to nursing students, creation of a new
masters of nursing program, continuing education in nursing, and community or public health
practicum, and 3) title, abstract and full text – resulting in eight exclusions and the addition of
two articles relevant to the topic of study.
In searching ERIC, the keywords search used with CINAHL was replicated by virtue of
using the EBSCO host system. The same three-level screening process was applied, and while
nine educational papers were noted, zero were found relevant to the study topic.
The final database searched, MEDLINE (Ovid), included keywords of ‘undergraduate’,
‘nursing program’, ‘practicum’, ‘child health’, and ‘pediatric nursing’, which mapped to a wide
range of subheadings. For example, ‘undergraduate’ generated ‘education, nursing,
baccalaureate’ and ‘students, nursing’. These search terms were subsequently searched in
combination using the “OR” feature to produce results that reflected all relevant concepts (see
Appendix A for a detailed search strategy). Applying inclusion criteria, 47 articles underwent
level 1-3 screening. At the first screening level, 20 articles were excluded as these publications
explored the following: simulation, student nurses’ attitudes towards disability, revisions to
pediatric nursing curricula, pediatric palliative care, and pediatric mental health. Second-level
screening excluded a further 20 articles due to one of the following: interprofessional education,
specific skills acquisition of students in the practice setting (e.g., urinary catheterization, IV
insertion), evaluation of a training program or workshop, the creation of a teaching and learning
project. Seven articles following level three screening met the inclusion criteria for the literature

12

search as they described a pediatric practicum experience within an undergraduate nursing
program context.
Google scholar was employed to conduct a general search of the topic area. The
keywords from the research question: ‘pediatric nursing’, nursing education’, and ‘practicum’,
were searched in combination, yielding 1270 results. Following the limiters on year, language,
and publication type, the results were reduced to 63 articles. Applying inclusion criteria, all 63
articles underwent level 1-3 screening. At the first screening level, 40 articles were excluded as
they explored the following: nursing education in general, simulation, student well-being, or
other professional education like counseling, physical therapy, and midwifery. At the second
level of screening, another 19 articles were excluded as they explored topics on one of the
following: cultural safety, palliative care, continuing education, graduate community health
nursing, telehealth, new graduate transition, gerontology, or advanced nursing practice. Four
articles following level three screening met the inclusion criteria for the literature review as they
explored pediatric practicum within the context of undergraduate nursing education. However, of
these four articles, two were duplicates of previous searches.
Finally, using the snowball method, the reference list of included articles that met the
inclusion criteria was screened for relevance by title, resulting in four retrievals that were nonduplicates. These four articles were hand-searched using the University of Northern British
Columbia (UNBC)’s Geoffrey R. Weller library website “general search” box to screen them
further by abstract and full text. Hand searching was focused on identifying publications that
were not linked to databases. All four articles retrieved via the snowball method met the
inclusion criteria for the literature review search. Additionally, using the 11 articles as a starting
point, four more research articles were found by utilizing the snowball method, whereby the

13

reference list of a published article is used to identify other potentially relevant papers. Thus, 15
articles were used to inform the literature review. Figure 1 shows a systematic display of the
search outcomes using a PRISMA flow diagram (Page et al., 2020).
Figure 1
Prisma Flow Diagram Depicting Literature Search Strategy Utilized

2.1.5 Quality appraisal
The next step in the literature review process was critically appraising sampled articles
(Lubbe, 2020). The Critical Appraisal Skills Programme (CASP) tools were used to appraise the
qualitative articles (CASP, 2018), while the Mixed Method Appraisal Tool (MMAT) was used to
14

appraise the mixed-method study (Pluye et al., 2013). Additionally, The John Hopkins hospital
(n.d.) evidence level and quality guide were utilized to assign an appropriate level of evidence
(i.e., Level I, II, or III) and grade (i.e., A, B, or C) to each article included in the review. Most
articles included in the review were descriptive studies of innovative pediatric placement sites or
piloted projects for practical pediatric learning within undergraduate nursing programs. As such,
being non-experimental studies, the evidence level of these articles was categorized as level III.
In all selected papers, there was a clear statement of the research aim. Additionally, congruity
was found between the research purpose and the methods used to collect data. For those six
articles that specified a research methodology, congruity was found between the chosen methods
and the study aims.
All appraised articles were judged to be of satisfactory quality (i.e., high – A or good – B
quality) despite missing some items from the tool checklists. For example, five articles were not
explicit about the sample that informed their study. Notably, most of the articles were written by
authors who doubled as faculty members of the School of Nursing associated with their
participants; this raises the issue of reporting bias in these studies. Thus, articles with limited
data transparency and those with analysis that gave little voice to study participants were graded
as low-quality, or C. Table 1 below provides a summary of each appraised literature review
article, including their type, level of evidence, and assigned grade.
Table 1
Evidence Level and Quality Rating of Appraised Articles
Author/year

Title of Article

Type of
Article

Level of
Evidence

Grade of
Article

Schell et al.
(2001)

First aid and health kamp for kids:
Combining learning with service

Qualitative
study

Level III

B – good
quality

Qualitative

Level III

C – low

Schmidt (2007) Camp nursing: Innovative opportunities

15

Title of Article

Type of
Article

for nursing students to work with children

study

Campbell &
Brown (2008)

The healthy teddy clinic: An innovative
pediatric clinical experience

Qualitative
study

Level III

C – low
quality

Schwartz &
Laughlin
(2008)

Partnering with schools: A win-win
experience

Qualitative
study

Level III

B – good
quality

Harrison &
Unique children in unique places:
Laforest (2011) Innovative pediatric community clinical

Qualitative
study

Level III

C – low
quality

Vogt et al.
(2011)

Baccalaureate nursing students experience
at a camp for children with diabetes: The
impact of a service-learning model

Mixed methods Level III
study

A – high
quality

Rossman et al.
(2012)

Student nurses as school nurse extenders

Qualitative
study

Level III

B – good
quality

Samawi et al.
(2012)

Age-appropriate health promotion
education: Roots firmly established in
baccalaureate nursing pediatric rotation

Qualitative
study

Level III

A – high
quality

Makaroff et al.
(2013)

Let's go to camp! An innovative pediatric
practice placement

Qualitative
study

Level III

B – good
quality

Hensel et al.
(2015)

Implementing a pediatric camp clinical for Qualitative
pre-licensure education
study

Level III

B – good
quality

Author/year

Level of
Evidence

Grade of
Article
quality

Studnicka &
Where is the nursing?: Baccalaureate
O’Brien (2016) nursing students’ perceptions of
nontraditional child health clinical
placements

Qualitative
study

Level III

B – good
quality

Pohl et al.
(2017)

Adapting pediatric clinical experiences to
a changing health care environment

Descriptivecomparative
study

Level III

B – good
quality

Schultz et al.
(2019)

Using elementary schools for pediatric
practicum: An alternative approach

Qualitative
study

Level III

C – low
quality

Quinn &
McAuliffe
(2019)

“There was only one nurse for everyone”:
Student reflections of a school nursing
clinical experience

Qualitative
study

Level III

A – high
quality

Hendrickx et
al. (2020)

Pediatric clinical for nursing students in
rural areas: The camp nursing experience

Qualitative
study

Level III

C – low
quality

16

2.1.6 Data extraction and synthesis
Lubbe (2020) suggests using a data extraction tool to summarize findings obtained from
the appraised articles. To this end, a literature review matrix was employed to aid data
organization. According to Lubbe (2020), the data extracted should include the document’s
context; as such, the column headings chosen for the matrix reflected this. Column headings (see
Appendix B) had the name of the author(s), publication year, study geographical location,
research type or method, study sample, and study results or findings.
Data synthesis in this review involved summarising the outcomes from all individual
articles (using supporting quotes as needed) to discover commonalities that can be clustered and
organized into patterns and themes (Lubbe et al., 2020). This clustering and organizing were
completed based on “salient issues” (p. 390) that arose while reading the text of each included
article (Attride-Stirling, 2001). Given the heterogenous nature of the appraised articles, a
thematic analysis approach was utilized to facilitate the discovery and development of themes
(Lubbe et al., 2020). The identified themes are adaptation (both on the part of Schools of Nursing
and students) and learning (how learning played out across the data). The combination of these
themes addresses the literature review question that served as the blueprint to help inform the
study question and design.
2. 2 Literature review findings
The following sections report key findings from the 15 articles selected after the literature
search. See Appendix B for a summary of the reviewed publications.

17

2.2.1 Study characteristics
Thirteen of the 15 publications included in this review can be classified as qualitative
descriptive studies; the other two were: a mixed-method study (Vogt et al., 2011) and a study
with a descriptive comparative design (Pohl et al., 2017). The qualitative descriptive studies can
be further differentiated by the data collection method utilized. Six of the descriptive studies
reported on the analysis of the journal entries or evaluative reports of participating nursing
students (Campbell & Brown, 2008; Harrison & Laforest, 2011; Makaroff et al., 2013; Schell et
al., 2001; Schmidt, 2007; Quinn & McAuliffe, 2019), one featured a mix of student focus group
discussions and journal entry analysis (Hensel et al., 2015), one utilized a pre- and post- focus
group session (Studnicka & O’Brien, 2016), one used an anonymous questionnaire (Samawi et
al., 2012), while the remaining four revealed no specific data collection method (Hendrickx et
al., 2020; Rossman et al., 2012; Schultz et al., 2019; Schwartz & Laughlin, 2008). Of the 15
studies, only six made use of a framework – two service-learning (Schell et al., 2011; Schwartz
& Laughlin, 2008; Vogt et al., 2011), one Whole School, Whole Community, Whole Child
Model (WSCC) framework (Schultz et al., 2019), one Fink’s significant learning taxonomy
(Samawi et al., 2012), and one the binder-ball continuum of pediatric health care framework
(Harrison & Laforest, 2011).
Ten studies out of the 15 clearly reported a sample size that varied in terms of total
number and level of the student. The study with the largest sample was by Samawi et al. (2012),
with N=85 senior I nursing student participants; this is followed by Pohl et al. (2017) with N=79
senior baccalaureate nursing students participants. The remainder were: N=62 third-year nursing
students (Makaroff et al., 2013), N= 38 undergraduate nursing students (Quinn & McAuliffe,
2019), N= 26 senior-level baccalaureate nursing students (Vogt et al., 2011), N = 24-32 senior

18

nursing students ( Schultz et al., 2019), N= 20 baccalaureate nursing students (Rossman et al.,
2012), N= 14 nursing students enrolled in the accelerated nursing degree program (Schell et al.,
2001), N= 13 second-year baccalaureate nursing students (Studnicka & O'Brien, 2016), and N =
9 junior level baccalaureate nursing students (Hensel et al. 2015). The other five studies offered
the following as samples: junior-level nursing students currently enrolled in the elective camp
nursing theory course of a three-year nursing program (Schmidt, 2007), associate degree nursing
students (Campbell & Brown, 2008), beginning-level nursing students (Schwartz & Laughlin,
2008), nursing students enrolled in the school's nursing program (Harrison & Laforest, 2011),
and students enrolled in the accelerated BSN program (Hendrickx et al., 2020).
Studies were conducted in two different countries – 12 from the United States of America
(Campbell & Brown, 2008; Hendrickx et al., 2020; Hensel et al., 2015; Pohl et al., 2017;
Rossman et al., 2012; Samawi et al., 2012; Schell et al., 2001; Schmidt, 2007; Schultz et al.,
2019; Schwartz & Laughlin, 2008; Quinn & McAuliffe, 2019; Vogt et al., 2011) and three from
Canada – British Columbia (Makaroff et al., 2013); New Brunswick (Harrison & Laforest,
2011), and Ontario (Studnicka & O’Brien, 2016).
2.2.2 Pediatric placement types and duration
The most common pediatric placement type identified from the reviewed articles was
camp settings (i.e., for children with disabilities), followed by school settings (i.e., elementary
schools). Other settings identified were daycares, community centers, and agencies that take care
of children with disabilities (Studnicka & O’Brien, 2016), an ambulatory care clinic as part of a
Health Promotion Teaching Project (HPTP) (Samawi et al., 2012), and a preschool laboratory in
the form of a Healthy Teddy Clinic (Campbell & Brown, 2008). See Figure 2 for a pictorial view
of the different pediatric placement categories.

19

Studies that described using school settings as pediatric placement sites for their students
differed in school type and practicum duration; the same was observed in the studies that utilized
camp settings.
Figure 2
Pediatric Placement Types Featured in the Reviewed literature
Preschool,
elementary
school,
middle, and
high school

Day or
residential
camps

Pediatric
placement
types

Child care
centres,
community
centres

Ambulatory
care clinic

Schools. Schwartz and Laughlin (2008) described a partnership whereby nursing students
served elementary, middle, and secondary school children/adolescents; however, the placement
duration was not stated. Rossman et al. (2012) described a project whereby student nurses
performed the role of school nurses in an elementary school for a cumulative period of 20 hrs
(four hrs per week for five weeks). Pohl et al. (2017) described a community-based venture
termed America's promise school project (APSP) that followed a 96-hour clinical model where
nursing students were placed in elementary and secondary schools as their primary learning sites.
Schultz et al. (2019) described an approach that utilized elementary schools for 28 hours (4hrs
per week for seven weeks). Quinn and McAuliffe (2019) described a pediatric school nursing
placement in public K-12 settings for two days.
20

Camps. Schell et al. (2001) described the development of a day camp experience for
children aged 7 to 12, which took place on the university campus for a duration of 30 hours – 6
hours per day for five days. This camp experience served healthy children; however, the authors
mentioned that reasonable accommodations were made for children with a disability to attend
camp (Schell et al., 2001). Schmidt (2007) described camp nursing placement at a YMCA
residential camp for children and adolescents, where nursing students spent 64 contact hours
with the campers. Harrison and Laforest (2011) described two innovative camp placement
experiences – Camp Rotary and Sensory Motor Instructional Leadership Experience (SMILE) –
for children with developmental or intellectual disabilities. The duration of the former was not
stated, but the duration of the latter was 2 hours weekly for ten weeks.
Vogt et al. (2011) described a one-week residential camp experience at a camp for
children with diabetes. Makaroff et al. (2013) described the placement of nursing students in the
BC Easter Seal camps, a residential camp serving children and adolescents with “physical and/or
mental disabilities” (p. 494) with a placement duration of “a minimum of 380 practice hours over
ten weeks” (p. 493). Hensel et al. (2015) described the creation of a camp clinical in the form of
a weekend Fall retreat where students spent 56 contact hours. Hendrickx et al. (2020) described
using two different children's camps (a visual and performing arts residential camp and a
residential camp for children with Type 1 diabetes) as pediatric placement for nursing students.
The placement duration of the first camp was not stated, but in the second camp, students spent
10 to 12 hours daily for one week.
2.2.3. Role of students
The role of students differed across each study; however, semblance existed across
similar placement types.

21

In the camp placements, students were responsible for health teaching (Schell et al.,
2001; Makaroff et al., 2011; Vogt et al., 2011), planning developmentally appropriate crafts and
games (Schell et al., 2001), ensuring healthy dietary needs were met (Harrison & Laforest, 2011;
Schell et al., 2001), medication administration (Harrison & Laforest, 2020; Hendrickx et al.,
2020; Hensel et al., 2015; Makaroff et al., 2013; Schmidt, 2007; Vogt et al., 2011), direct care
such as urinary catheterization and ostomy management (Harrison & Laforest, 2011; Hensel et
al., 2015; Makaroff et al., 2013), provision of first aid (Hendrickx et al., 2020; Makaroff et al.,
2013), assisting campers with activities of daily living i.e., perineal care for children with urinary
or fecal incontinence (Hensel et al., 2015; Makaroff et al., 2013), blood sugar testing (Harrison &
Laforest, 2011; Hendrickx et al., 2020; Vogt et al., 2011), carbohydrate counting (Hendrickx et
al., 2020), and performing pediatric assessment (Harrison & Laforest, 2011; Hendrickx et al.,
2020). Students also benefitted from developing their communication skills with children
(Harrison & Laforest, 2011; Hendrickx et al., 2020; Hensel et al., 2015; Schmidt, 2007)
In the school placement settings, nursing students performed tasks such as health
screening, e.g., for vision, dental, weight, etc. (Campbell & Brown, 2008; Rossman et al., 2011;
Schwartz & Laughlin, 2008), health education/teaching (Campbell & Brown, 2008; Rossman et
al., 2012; Schultz et al., 2019; Schwartz & Laughlin, 2008), website resource creation (Schwartz
& Laughlin, 2008), one-on-one mentoring/tutoring (Rossman et al., 2011), in-person health
counselling (Rossman et al., 2012), conducting community/classroom need assessments (Pohl et
al., 2017; Schultz et al., 2019), development of a school/family care plan (Pohl et al., 2017), and
caring for children (Pohl et al., 2017; Quinn & McAuliffe, 2019). Students also benefitted from
gaining skills in communicating with children (Campbell & Brown, 2008; Rossman et al., 2011;
Schwartz & Laughlin. 2008).

22

In the other settings (i.e., childcare centers, pediatric ambulatory clinics), students
improved their communication, health teaching, and health promotion skills (Samawi et al.,
2012; Studnicka & O’Brien, 2016).
2.2.4 Adaptation
The themes identified from the thematic analysis of literature review articles were: 1)
adaptation (both on the part of Schools of Nursing and students), and 2) learning (how the
learning was assessed across the data). The theme of adaptation is related to how nursing
programs acclimatised to the changing landscape of the health care system while making the
most of available resources and how students adjusted to placement outside of traditional
hospital settings.
Adaptation of Nursing programs. Shorter stay of patients in the hospital (Campbell &
brown, 2008; Schell et al., 2001), growing demand for clinical practicum sites by other nursing
and medical programs (Hendrickx et al., 2020; Schell et al., 2001), the move to care for children
and adolescents with chronic conditions in the community (Harrison & Laforest, 2011; Schell et
al., 2001), a decline of pediatric patient census in hospital settings (Hendrickx et al., 2020; Pohl
et al., 2017; Schmidt, 2007), increased enrolment of students (Makaroff et al., 2013), inadequate
health assessment and health promotion opportunities (Harrison and Laforest, 2011; Schwartz &
Laughlin, 2008), lack of placement in acute settings (Hensel et al., 2015; Makaroff et al., 2013;
Pohl et al., 2017; Schultz et al., 2017), and shortage of school nurses (Rossman et al., 2012) were
some of the reasons cited that necessitated the creation of diverse clinical sites to provide
valuable pediatric practicum experience for nursing students. Nursing programs in these articles
responded to these challenges by either creating new pediatric placement sites from scratch or
leveraging opportunities in the communities.

23

Schell et al. (2001) described the pilot of an elective (theoretical and practical) well-child
course that doubled as a means to cater to the learning needs of nursing students while also
enabling them to offer a service to the community (Schell et al., 2001). Schmidt (2007) described
a camp nursing theory and clinical elective course that utilized a “student-centered” approach in
its delivery to provide students the opportunity to gain “self-confidence and competencies in
working with children” (p. 246). That is, with guidance from the instructor, nursing students
were encouraged to take part in the design, implementation, and evaluation of their learning and
learning activities both in the classroom course and the clinical course (Schmidt, 2007).
Campbell and Brown (2008) described the initiation of the Healthy Teddy Clinic project in a
preschool learning laboratory that allowed students to work with children and provide health
teachings through teddy bears. Hensel et al. (2015) described the creation and pilot of a camp
clinical during a Fall semester (in the form of a weekend retreat) to meet nursing students'
practical pediatric learning needs. Schultz et al. (2019) described an alternative clinical
placement in elementary schools guided by the Whole School, Whole Community, Whole Child
(WSCC) model – a model in which health services are provided to children in a school
environment to improve their learning and academic achievements. Hendrickx et al. (2021)
described the utilization of children’s camps as alternative placement sites given their capability
of accommodating a maximum number of students and their ability to provide nursing students
the opportunity to care for children in a supervised setting (Hendrickx et al., 2020). Harrison and
Laforest (2011) described the creation of two innovative clinical placement sites – one a camp
setting and the other a psychometric stimulation program – that allowed students to care for
children living with developmental or intellectual challenges while developing health promotion
and maintenance skills.

24

Makaroff et al. (2013) described the collaboration between the University of Victoria
School of Nursing and the Eastern Seals camps in the province of British Columbia, which led to
the creation of innovative pediatric placement sites in camp settings (Makaroff et al., 2013).
Rossman et al. (2012) described the partnership between a School of Nursing and one
elementary school in the state of Michigan, which led to the creation of the student nurses as
student nurse-extenders project, where participating student nurses took up the role of school
nurses in urban elementary schools in fulfillment of the clinical education portion of their
pediatric curriculum. Schwartz and Laughlin (2008) described the collaboration between private
elementary, middle, and high schools in a county in Nebraska and a School of Nursing situated
in the community to both meet the basic health service needs of enrolled school children while
providing an opportunity for nursing students to develop competence in carrying out a health
assessment and promotion activities. Pohl et al. (2017) described a partnership between the
Mennonite College of Nursing, Illinois, and the school districts, which led to the creation of the
America Promise School Project, whereby “nursing students were assigned to elementary and
secondary schools as their primary learning site” (p. 106) to promote the health of children (and
by extension their families) living with chronic health challenges.
Adaptation of Students. Vogt et al. (2011) described the stages of adapting to a new
immersive camp experience as analyzed from students’ reflective journals. The themes
uncovered were anxiety, fatigue, responsibility, confidence, and empathy, which chronicled the
students’ progress from the beginning to the end of the clinical experience (Vogt et al., 2011).
The nursing students’ initial anxiety about the unknown became fatigue from the fast-paced
camp environment, but as familiarity grew, the overwhelming responsibility began to lessen as
students gained confidence in their ability to care for the children (Vogt et al., 2011). Schultz et

25

al. (2019) also identified the personal learning growth that occurred in nursing students from the
start to the end of their placement. Towards the start of practicum, students were self-absorbed
and more focused on achieving their personal learning goals. However, as the weeks progressed,
their focus shifted to the children, more specifically to meeting the learning and health-related
needs of the children in their assigned classroom (Schultz et al., 2019).
Studnicka and O’Brien (2016) described an instance of negative student adaptation.
Students placed in non-traditional clinical sites could not see the value of the placement.
Although students in the pre-focus group looked forward to developing their communication
skills, most students in the post focus groups considered placements in non-traditional sites as a
waste of time and money because of the lack of opportunity to improve on psychomotor skills
(i.e., assessment skills) that were considered the hallmark of hospital-based nursing.
Additionally, some students described that the roles they took on in their respective settings were
babysitters, which did not improve their practical learning of pediatric content (Studnicka &
O’Brien, 2016). Furthermore, students in both the pre-and-post focus groups struggled to
articulate their roles as student nurses in their respective placements – a confusion made even
more apparent given that they were precepted by individuals who were not practicing nurses, i.e.,
early childhood educators (Studnicka & O’Brien, 2016).
Another instance of negative adaptation was described by Quinn and McAuliffe (2019).
Some nursing students who participated in the school nursing experience for their community
pediatric practicum were disappointed as their expectations did not match their reality (Quinn &
McAuliffe (2019). These students found the pace of school nursing slow and laid back compared
to hospital settings and were dissatisfied with the lack of opportunity to perform “skilled work”
(Quinn & McAuliffe, 2019, p. 74).

26

2.2.5 Assessing Learning
Knowledge tests. In four studies, the knowledge that nursing students gained in pediatric
theory and clinical experience were explicitly tested. Campbell and Brown (2008) utilized
written examination to test students’ pediatric knowledge; although the authors mentioned
improvement in knowledge, objective measures were not provided to justify the claim. Schwartz
and Laughlin (2008) administered quizzes and tests to participating students to ensure they met
course objectives; however, it is unclear if students demonstrated improvement in baseline
knowledge. Vogt et al. (2011) tested the childhood diabetic knowledge of 13 nursing students
before and after completing a service-learning placement at a camp for children with diabetes.
The prescribed diabetic knowledge test was a 23-item multiple-choice instrument developed by
the Michigan Diabetes Research Training Center; it measures knowledge of the disease
(diabetes) process, treatment methods, and side effects of insulin use (Vogt et al., 2011). The
average pre-test scores of students were 78.3%, and the average post-test scores were 82.6%
(Vogt et al., 2011). However, no statistically significant difference (t =1.78, p = 0.055) in test
scores was found in the pre-and post-test comparisons as measured by a t-Test.
Pohl et al. (2017) compared pediatric knowledge and simulation performance scores
across a group of students placed in community and hospital settings. The nursing care of
children assessment test measured pediatric-related health knowledge in areas such as safety and
infection control, while the pediatric simulation performance scored students on four subscales:
communication, assessment, critical thinking, and technical skills (Pohl et al., 2017). Differences
in pediatric knowledge between both groups, as measured by an independent t-test, showed no
statistically significant findings (t163 = 0.852, P = 0.396). However, the mean composite score
of students placed in community settings was “slightly higher” than the hospital-based clinical

27

group (Pohl et al., 2017). Similarly, differences in rated pediatric performance as measured by
the Mann-Whitney u test showed no significant difference in mean scores on all measured
subscales (Pohl et al., 2017).
Assessing against course objectives. In 11 of 15 studies, students were evaluated on
how they met course objectives. However, in some studies (Hensel et al., 2015; Makaroff et al.,
2013; Schell et al., 2001; Schwartz & Laughlin, 2008; Studnicka & O’Brien, 2016), the course
objectives that students needed to meet were not explicitly stated. Schell et al. (2001) evaluated
students based on their self-written critical incident journals, where they documented events that
occurred during the placement and lessons learned during the practicum. Students were also
required to report on how they met prescribed course objectives (which were not stated in the
article) and evaluate the teaching and leadership skills they demonstrated during the camp
experience (Schell et al., 2001).
Schmidt (2007) described a system whereby students established their grading criteria
based on the course objectives provided in the course syllabus and self-analyzed their
performance in the pediatric course's theory and clinical component. Theory course expectations
were that students independently review the literature to identify the knowledge and skills
required to effectively carry out the role of a camp nurse and develop a course syllabus that
reflects this (Schmidt, 2007). The clinical course expectation was that students showed up to
camp and actively participated in the daily activities (Schmidt, 2007).
Campbell and Brown (2008) evaluated students on how they met the Healthy Teddy
Clinic project's objectives: to gain knowledge of children’s growth and development, build
therapeutic communication skills with children, and develop health education skills. Nursing
students’ ability to meet project and course objectives were measured through the clinical

28

evaluation tool, where they gave specific examples of how they met student competencies
(Campbell & Brown, 2008). Despite providing no examples from students' evaluative reports,
Campbell & Brown (2008) maintained that student participants demonstrated “knowledge of
developmental milestones and the ability to teach children [between the ages of two and five]”
(p. 75) post completion of their clinical practicum experience.
Schwartz and Laughlin (2008) provided no specific course objectives but affirmed that
participating students demonstrated the competencies established by the American Association
of College of Nurses and the National Association of Student Nurses at the time based on their
self-evaluation form. These included understanding the concept of health and illness, promoting
children's health, and developing the ability to respond to common health problems in this
population group (Schwartz & Laughlin, 2008).
Harrison and Laforest (2011) described two different placement experiences, each with
different objectives. In Camp Rotary, the objectives were to ensure students: developed caring
relationships with campers and collaborated effectively with the camp counsellors, worked
according to prescribed safety guidelines, gained knowledge on campers presenting
diagnoses/conditions, and were able to transfer knowledge gleaned from the experience into
other practice settings (Harrison & Laforest, 2011). At SMILE, students were required to create
their learning objectives and activities for each program session and make necessary changes
based on the continued evaluation of their assigned child's physical, social, aquatic, and
cognitive skills (Harrison & Laforest, 2011). Aside from evaluative quotes from some parents
and participating students, the findings did not provide an actual method of evaluating how
students met course objectives (Harrison & Laforest, 2011).

29

Rossman et al. (2012) aimed to quantify the activities performed by nursing students
during the duration of their placement in the different school settings and their respective
assigned classrooms. As such, students were required to keep a detailed record of all healthrelated activities they performed in the classrooms, such as home contact made to parents,
counseling provided to children, health education or teaching performed, and health needs
assessment completed (Rossman et al., 2012). These activities performed by student participants
were tied to meeting the learning objectives of “assessment of health needs within the assigned
classroom” (p. 739) and understanding of psychosocial and physical growth and development of
a growing child (Rossman et al., 2012).
Samawi et al. (2012) described the goals of the Health Promotion Teaching Project,
which were to provide participating nursing students the opportunity to deliver health promotion
activities to children in a pediatric clinical setting and gain an understanding of the importance of
factoring a child’s age and development while planning and delivering health care services.
Students were evaluated on how they met these goals using questionnaires that elicited
information about the impact of the teaching project on their learning and the attention they gave
to the age and development level of the users of their teaching activities (Samawi et al., 2012).
Makaroff et al. (2013) did not explicitly list course objectives that participating nursing
students were required to meet; however, students were evaluated based on self-reflective written
narratives and feedback from their preceptors and other camp staff members. Similarly, Hensel
et al. (2015) did not state the course objectives that participating students were required to meet
at the weekend camp experience; however, students were required to submit a reflective account
of ways in which they met prescribed course objectives as well as how the knowledge and skills
they attained fitted with the Quality and Safety for Nursing (QSEN) competencies.

30

Schultz et al. (2019) required students in their practicum setting to learn how to use the
Whole School, Whole Community, Whole Child (WSCC) to guide their assessment of children
and the school community and develop and implement interventions to meet all identified health
need. Students were assigned the following assignments to meet learning objectives: classroom
observation, pick and play activity, development of health lesson plans, the performance of a
school/community assessment, and recommending health activities. Students were also required
to present a reflective letter to the classroom that summarized their accomplishments at clinical
(Schultz et al., 2019).
2.3 Discussion
The purpose of this literature review was to scope and summarize the evidence
concerning where nursing students received practical pediatric education as part of achieving
curriculum learning objectives. Evidence published in the last two decades revealed that most
Schools of Nursing utilized alternative placement sites outside of the traditional hospital settings
(such as camps for children, elementary schools, childcare centers, etc.) to meet the practical
pediatric education need of their enrolled students. The major reasons for this move were: the
lack of available pediatric practicum sites in hospitals due to increased student enrolment; and
low patient census due to more sick children and adolescents being cared for in community
settings.
Alternative practicum sites provided students with the opportunities to care for children,
improve communication and interpersonal skills, and engage in various health promotion and
teaching activities despite the differences in placement duration across studies. These findings
were similarly reported in a national survey of pediatric nursing education in baccalaureate
(BSN) nursing programs (McCarthy & Wyatt, 2014), in which competition and lack of pediatric

31

experiences were listed as the top significant barriers encountered by nursing faculty in the
management and delivery of pediatric nursing education. Augmenting traditional acute carebased pediatric practicum with experiences focused on caring for children in community settings
where they play, live, and learn becomes a valuable shift.
The literature review results indicate that all but two authors (Schultz et al., 2019;
Studnicka & O’Brien, 2016) reported overwhelming positive student evaluations in these
placements. Students in the two studies with less favorable reports cited some dissatisfaction
with being placed in non-acute care settings and a focus on the lack of opportunity for
psychomotor skill development. The Canadian Association for Schools of Nursing (2011)
position statement emphasized the need for clinical education to be based on “real practice
situations” (p. 3), but what is interpreted as “real” may vary between students, educators, and
practicing registered nurses. Students frequently cite hands-on experience and skills as an
essential aspect of nursing education (e.g., Cowen et al., 2018; Quinn & McAuliffe, 2019;
Studnicka & O’Brien, 2014), given their strong focus on psychomotor skill development in the
quest to move from novice students to advanced beginner clinicians post-graduation (Gardner,
2012). As such, clinical experiences that do not lend themselves to developing different aspects
of the entry-to-practice competencies may elicit discontent in students. Providing identical
clinical experiences to all students in a nursing program is an impossibility highlighted by Hensel
et al. (2011). However, most nursing programs explored within the literature review studies
strived to ensure that the clinical learning opportunities provided to students (whether in
traditional or non-traditional settings) brought about similar learning outcomes. It is difficult for
educators to predict or control students' learning experiences in any practicum setting. Individual
student learning styles may also affect student readiness and motivation to learn and,

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consequently, their ability to maximize available learning opportunities (Cowen et al., 2018;
Forber et al., 2016), which could further complicate appreciation for pediatric placement in
community settings.
2.3.1 The importance of nursing students’ voice
This literature review highlighted the importance of the voice of students in education
research. This importance lies in the central role they play as users and consumers of the nursing
education system. Indeed, it has been argued that learners' feedback tends to have a
transformative effect on instructors' teaching practices (Bain, 2010; Seale, 2010). For example,
feedback from the focus group interviews with student participants showed that they cared for
campers with unfamiliar diagnoses and had to perform skills they had no prior training in
(Hensel et al., 2015). This information prompted the nursing faculty to provide a targeted
orientation (including information on potential campers’ diagnoses) to the next cohort of students
placed in camps (Hensel et al., 2015).
Similarly, Hendrickx et al. (2020) described the incorporation of a debriefing session
between the student participants and their instructor at the end of the pediatric clinical
experience. During this time, students were allowed to comment on ways in which the program
could “maximize the [pediatric practical] experience for future clinical groups” (Hendrickx et al.
2020, p. 151). It was further revealed that the feedback from participating students led the
program to increase the instruction on “management of insulin pumps and carbohydrate
counting” to new student cohorts (Hendrickx et al. 2020, p. 152). Therefore, it becomes
important to explore the values and perspectives of students concerning teaching, learning, and
assessment in nursing education so that they do not remain an overlooked treasure.

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2.3.2 Gaps in the research
The reviewed publications had some limitations. First, the literature review search
spanning 20 years produced 15 articles that lent insight to the research question. Of these
articles, only three originated from Canada, thus, revealing a shortage in Canadian-specific
research on practical pediatric education in baccalaureate programs.
Second, the reviewed articles featured mostly descriptive studies written by researchers
who were also instructors of participating students. This authorship introduces the potential for
reporting bias as students' voices in the publications may be overshadowed and marginalized by
their instructors. Moreover, most of these participants could be described as captive participants
because they are involved in a status relationship with the researchers who also acted as their
instructor or professor (Ferguson et al., 2004). Ferguson et al. (2004) also highlighted the double
agency role these authors assume as both instructor and researcher and the experience of
conflicting loyalty that could result from fulfilling two roles.
Third, seven of the fifteen studies included in this review utilized reflective journals/selfevaluation of student participants as a method for data collection; however, only one study
clarified that the journal entries were also graded. An unrecognized shortcoming of reflective
journaling is though a useful tool to elicit the personal thoughts, feelings, and self-reflections of
students, they can be self-limiting for those who have difficulty expressing themselves in writing
(Bashan & Holsblat, 2017). This evaluative method can also influence what students share or
withhold in their journal entries, especially when journals collected for data collection are
graded.

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2.3.3 Contribution of the current study given existing literature
Articles analyzed for this review strongly featured those written by authors based in the
United States of America, with only three articles originating from Canada. Additionally, articles
that met the inclusion criteria for this literature review revealed a limited amount of potential
placement sites for pediatrics, as most were predominantly located in school and camp settings.
This absence of research that focuses on practical pediatric education in baccalaureate programs
warrants a Canadian/Provincial-specific exploration into how Schools of Nursing provide
opportunities for undergraduate nursing students to consolidate their theoretical pediatric
learning and the experiences of nursing students in these placements. This area of research
becomes necessary because pediatric clinical learning is an important component of
undergraduate nursing programs, keeping with the profession’s regulatory body goal of ensuring
new generalist graduate nurses.
Having acknowledged that the voice of students should be an integral part of education
research since they are users of the system, a study that features nursing students as participants
become imperative. Therefore, in line with the gaps identified in the literature review, the current
study aims to explore the placement experiences of nursing students enrolled in (or have recently
completed – within the last 12 months) a pediatric clinical course. However, given the historical
priority nursing students attribute to the acquisition of psychomotor skills, an exploration into the
value that students assign to these different placement settings holds greater merit as it can reveal
biases that they may hold against practicums outside of these settings. This exploration holds
merit for Schools of Nursing and faculty members alike hoping to learn from the experiences
gathered from participating students.

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Chapter 3: Methods
The following chapter describes the research method of the study. This section will begin
with a statement of the research objective and question. Information about the research design,
sample and recruitment, data collection, analysis and storage, ethical considerations, and
knowledge translation activities will also be presented.
3.1 Research objectives
The objectives of this study were:
1) To explore the placement experiences of nursing students who are currently enrolled in or
have recently completed a pediatric clinical course.
2) To describe the value that nursing students ascribe to their respective placement
experiences.
This study answered the following research question:
1) What are undergraduate nursing students’ experiences of pediatric practicum placement
in BC baccalaureate nursing programs?
2) How do undergraduate nursing students, as adult learners, determine the ‘value’ in
pediatric practicum?
Marzilli's (2016) conceptualization of value as an appealing yet subjective benefit deemed
worthy by an individual guided the study’s exploration.
The placement experiences of nursing students were explored through online-facilitated
semi-structured interviews. The knowledge gained from this study can provide insight into what
students appreciated about their placement sites, the values they ascribed to their experiences,
and the extent to which the placement environment nurtured students’ growth and maturation.

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Findings from this study may inform nursing faculty members seeking ways to make practical
education more meaningful for their undergraduate students.
3.2 Research design
The study utilized a qualitative descriptive research design. Qualitative descriptive
research is a method that seeks to: “discover and understand a phenomenon, a process, or the
perspectives and worldviews of the people involved” (Bradshaw et al., 2017, p. 1). Thus, it
involves the direct participation of those experiencing the experiences under investigation. Some
of the philosophical underpinnings of the qualitative descriptive approach are that experience is
recognized as inherently subjective, and the researcher is an active part of the research process
(Bradshaw et al., 2017). Therefore, using a qualitative descriptive research design facilitates the
study's aim of exploring the pediatric practicum experiences of undergraduate nursing students to
aid in the description of values that students identify and see in their respective placement
settings. Additionally, a qualitative descriptive approach offers a flexible yet rigorous and
reliable method of studying an area of interest about which comparatively little is known or
understood (Neergaard et al., 2009), such as in the case of students’ clinical pediatric learning.
Epistemologically speaking, qualitative descriptive research views the experience of
reality as subjective, varying from one person to another, as well as culturally and socially
constructed (Bradshaw et al., 2017; Given, 2008). This view affirms the parallel existence of
multiple experiences of reality and acknowledges the active role that people play in constructing
and ascribing meanings to their experiences (Bradshaw et al., 2017). The qualitative descriptive
research approach posits that “the world does not exist independent of our knowledge of it”
(Bradshaw et al., 2017, p. 2). Essentially, it places the participant’s subjective account as the
“object of research,” with the role of the researcher being that of a co-constructer of meanings

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and understanding rather than an external uninvolved and indifferent observer (Given, 2008, p.
841). Qualitative descriptive research aims to understand the subject being investigated as it is
experienced subjectively while recognizing and articulating the researcher's active role in data
gathering and the analysis process.
In qualitative descriptive studies, the research outcome is a detailed description of the
investigated experience (Neergaard et al., 2009; Willis et al., 2016). Thus, the researcher is
committed to ensuring that the final product is a “description of informants' experiences in a
language similar to the informants' language” (Neergaard et al., 2009, p. 2). These approaches
assure descriptive validity as they enable accurate reporting of events (Sullivan-Bolyai et al.,
2005). Qualitative descriptive methodology stress that avoiding undue inference does not negate
the place of data interpretation as it is an inevitable part of data analysis. When done reliably,
transparently, and reflexively, data interpretation in qualitative studies can help readers
appreciate what is noteworthy in the subjective lived experiences of the study participants. Data
interpretation does not ‘put words into the mouths of participants’ but instead helps showcase
and accentuate what the participants themselves have been saying. Sandelowski (2000)
highlighted the impact of the researcher’s “perceptions, inclinations, sensitivities and
sensibilities” (p.335) on what is recorded and reported. Therefore, to ensure that participants'
voices are not distorted or erased by the researcher, transparency and reflexivity about their
interpretation of the data are necessary.
3.3 Theoretical framework
Knowles’ adult learning theory informs the study, given that the study participants can be
categorized as adult learners. Knowles (1977) adult learning theory (Andragogy) distinguished
the teaching and learning of children from that of adults. According to Knowles (1977, 1978),

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pedagogy differs from andragogy in that the former is teacher-directed, subject-centered, and
authority-oriented, while the latter is student-directed, problem-centered, and a more
participatory form of learning. Adult learning is conceived as a process where “the adult learns to
become aware of and to evaluate his [sic.] experience” (Knowles, 1978, p. 11). The teacher’s
role, therefore, becomes no longer that of an “oracle who speaks from the platform of authority”
(p. 11) but rather that of a guide who is a co-participator in the learning process (Knowles, 1978).
In andragogy, education is a process of self-mastery aided through practical learning
activities and real-life tasks (Decelle, 2016). The core tenets of andragogy hinge on four
assumptions, namely:
1) In adulthood, the learner moves from dependency to self-direction
2) personal experiences are a great source of learning
3) learning readiness directly relates to developmental tasks of social roles
4) adults are competency-based learners who require a practical outlet for learning
(Knowles, 1980, as cited in Decelle, 2016).
Knowles’ adult learning theory fits well with the study as it posits that undergraduate
nursing students are capable of reflecting on their learning experiences. This theory is also
fitting, given that the study is situated within the wider context of practical pediatric nursing
education that strongly advocates the use of practical clinical settings to promote skills
development and the consolidation of theoretical knowledge (CASN, 2015a; 2015b). This
emphasis aligns with andragogy’s position that “experience is the adult learner's living textbook”
(Knowles, 1978, p. 11). Participants in this study were judged to be adults, given that they were
taking charge of their life by persevering in their professional nursing career goals. As such,
Knowles’ (1977) adult learning framework was utilized in the analysis of transcribed interview

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data to understand why participants valued or gave preference to one experience over another in
their respective pediatric practicum settings.
3.4 Sample and recruitment
3.4.1 Sample
The use of purposive sampling was warranted as it aligns with qualitative design and is
especially suited to qualitative descriptive research’s aim of selecting samples that can provide
information pertinent to the study’s goals and objectives (Milne & Oberle, 2005). Purposive
sampling proposes the selection of participants based on availability and how well their
experiences match the purpose of the study (Bradshaw et al., 2017; Mack et al., 2005). In
keeping with the study’s objective of exploring the experiences of undergraduate nursing
students, participants included nursing students who have completed placement (within the past
12 months) in a pediatric setting. For baccalaureate programs with a four-year duration, this
included students in the third or fourth year of nursing school, while for accelerated programs,
this included students in the last three semesters or final year of their education. To fulfill the
study's eligibility criteria, participants from Schools of Nursing who do not offer pediatric
practicum opportunities were excluded. Based on the timing of data collection (May to August
2021), nursing students recruited for this study were starting the final year of their nursing
program or were recent nursing graduates.
This study's target sample range was 10 to 15 third- or fourth-year baccalaureate nursing
students. This sample size for the study was determined after considering the study’s aim and the
sample specificity (Malterud et al., 2015). First, this study was concerned with a specific
experience, that is, the pediatric practical learning experience. Second, the possibility of
variations within the experiences of students was noted. Lastly, given the aim of qualitative

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descriptive research is to generate “a rich descriptive database” (Willis et al., 2016, p. 1194), the
quality and content of the dialogue between the researcher and the participant are of great
importance (Malterud et al., 2015). Therefore, the final sample size decision is also dependent on
the emerging insight gleaned from the interviews, a principle similar to theoretical saturation–the
sample was deemed sufficient once it became evident that further interviews would produce
more of the same rather than new data.
A total of 14 nursing students and two new graduates indicated an interest in
participating; however, only 15 interviews were conducted between May and August 2021, as
one participant did not provide informed consent after the study information was sent to their
email address.
3.4.2 Recruitment
Students in the final year of their nursing program were recruited from different
campuses in BC following research ethics board approval [H21-00463]. Recruitment was done
virtually via email and social media (Facebook). Recruitment sites included six BC nursing
schools from the 22 schools delivering a Bachelor of Science in Nursing program (Nursing
Education Planning Council, 2019) in BC. The schools where recruitment took place are all
network partners of Research Ethics BC – this was done to streamline the ethical approval
process. These schools included the University of Northern BC (UNBC), University of Victoria
(UVic), University of British Columbia (UBC), British Columbia Institute of Technology
(BCIT), and Thomson Rivers University (TRU). The schools are spread across the province
hence providing some representation of the geographic variation in BC. Participants were also
recruited from other collaborative partners affiliated with these schools, such as the College of
New Caledonia (CNC)/UNBC nursing club, the nursing undergraduate Society at UBC, UVIC

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nursing student society, the nursing undergraduate society at TRU, and BCIT nursing student
association.
First, I reached out to the nursing program chair or head of the different Schools of
Nursing, where participants were to be recruited via their email addresses. Emailing lists’
stewards (e.g., chairs and department heads) were sent a letter requesting permission to recruit
nursing students enrolled in their university (See Appendix C). This email also included an
attached letter (see Appendix D) that contained brief information on the study, including the
criteria for eligible participants, goals of the study, the data collection method to be utilized,
compensation for participation, and researcher contact details. Each consenting program chair or
department head was then asked to distribute this letter to the appropriate staff and student
emailing lists. Of the six schools approached, four consented to participate and offered to
distribute the study information to eligible nursing students. However, participants were
successfully recruited from three out of the four consenting Schools of Nursing.
Second, I reached out to the different student nursing associations affiliated with each
School of Nursing through their organization's email or social media page. This was done based
on the notion that nursing students engage with their respective student associations, thus,
making these associations an important avenue through which interested students can be reached.
A letter (See Appendix D) requesting permission to recruit eligible students was sent to nursing
group administrators as a message on their social media (Facebook) page or to the email address
provided on their association’s website. The study’s information letter was also sent to these
nursing associations; each consenting nursing student group was then asked to distribute the
information to their student membership. Of the five groups approached, three associations
consented to share the study’s information letter with their respective student bodies, and one

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consented to post the study’s information directly to their Association’s closed Facebook group.
The researcher’s email address was included in the information letter, so interested students or
recent graduates could contact them about potentially participating in the research study.
Interested students were provided with the study information and consent form (see Appendix E)
via their email addresses, explaining the study in further detail, including its risks and potential
benefits. Appendix F shows a breakdown of the recruitment efforts.
Qualitative descriptive research methodology view of reality as subjective and variable
from person to person necessitates an acknowledgment of the uniqueness of each nursing
student's experience. As such, achieving full data saturation was only partially feasible in this
research. Data saturation is said to occur at the point of data redundancy when “the ability to
obtain additional new information has been attained” (Fusch & Ness, 2015, p. 1408; SullivanBolyai & Bova, 2021). Thus, the notion of saturation signals that all possible data would be
gathered from participating students is unrealistic as experiences of this nature may be
inexhaustible. For this study, data saturation, in line with the goal of qualitative descriptive
research, was determined based on the depth of the data, that is, the richness (quality) and
thickness (quantity) of data obtained from participants’ interviews (Fusch & Ness, 2015).
3.5 Data collection
The method employed for data collection in this study was semi-structured in-depth
interviews, which facilitated understanding and allowed for an explanation of the experience
under investigation (Bradshaw et al., 2017). Semi-structured interviews were completed through
online interviews mediated through the Zoom video-chat platform. Online interviews were
utilized to accommodate the public health and social-distancing measures due to the COVID-19
pandemic. The online data collection method also allowed the researcher to interview students

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from across the province, thereby increasing the breadth of experiences. Although the face-toface interview is considered the gold standard in qualitative research in that it allows for the
observation of more visual – non-verbal – cues that add to the depth and richness of gathered
data, online interviews have been found to produce useful data that is in certain contexts on par
with the in-person approach (Novick, 2008). Archibald et al. (2019) shared that the numerous
advantages of using online data collection methods (e.g., Zoom) during the qualitative interview
process compensate for the occasional technical difficulties.
Interview dates and times were decided mutually between the researcher and participants
to promote receptivity and ensure readiness on the interview day. Participants were informed to
set aside between 30 minutes to one hour for the interview session. Once the interview date was
finalized with each participant, a Zoom meeting invite was sent to their email address close to
the day of the interview to aid their recollection. Due to the virtual nature of the interview, the
informed consent document was sent to participants through their email addresses in advance of
the interview session (between one and seven days) to allow time for the content to be reviewed,
arising questions to be clarified, and for an informed decision to be provided. An electronically
signed copy of the consent form was required on the day of the interview. Additionally, all
participants verbal consent at the time of the interview. The Zoom interviews were recorded (by
clicking the record button at the bottom of the screen).
The interviews were one-on-one between the researcher and the participant. After consent to
proceed with the interview was affirmed, the semi-structured interview session began using
questions from the prepared interview guide (see Appendix G). Participants were invited to
answer four broad, open-ended questions about their pediatric practicum experiences. As the
researcher, I allowed pauses to give the participants time to formulate their answers to direct

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questions and respond when probing or follow-up questions were asked. The semi-structured
nature of the interview allowed for the gathering of rich data on areas that focused on
participants' attitudes, perceptions, and beliefs of their pediatric practicum experiences. All
interviews featured reports about a single event or multiple events that happened at their
respective practicum location. These narratives, packed with personal meanings and lived
realities, provided insight into the values that participants ascribed to their pediatric practicum
experiences.
Data collection lasted for three months, with the first interview on May 21st and the last
on August 13th, 2021. A total of 15 interviews were conducted; each lasted between 11 and 41
minutes, with an average duration of 22 minutes. Opportunities to ask any clarifying questions
were built into the interview schedule. To get the best out of each interview, questions posed to
participants were done neutrally without using leading words so that data was not unintentionally
tainted with the researcher’s preconceived notions (Mack et al., 2005). That is, questions were
asked in a way that did not include or imply the researcher’s desired answers or presuppositions.
Care was also taken to ensure probes and follow-up questions related to the original subject of
interest (Bradshaw et al., 2017).
3.6 Data analysis
The purpose of data analysis in research is to allow for the organization of generated data
in a way that maximizes the drawing of appropriate conclusions and meanings (Sundler et al.,
2019). In qualitative descriptive research, content or thematic analysis is commonly used to
analyze generated data (Bradshaw et al., 2017; Willis et al., 2016). A thematic analysis was most
suitable for this study because of the researcher’s commitment to maintaining participants' voices
while ensuring that any interpretations of the data were made transparent (Bradshaw et al., 2017;

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Sundler et al., 2019). This commitment to giving voice to participants was vital to this research
study's rigor.
The thematic analysis process is inductive and iterative; it begins with data organization
and preparation before coding and sorting (Willis et al., 2016). The audio-recorded interviews
were transcribed verbatim manually by repeatedly listening to the recordings and transcribing
shortly after each interview to ensure that relevant non-verbal communications, such as a long
pause or a deep sigh, were captured (Milne & Oberle, 2005). The interview transcripts were also
double-checked by the researcher, who compared the transcripts against the audio recordings to
ensure accuracy. Additionally, the transcript of each interview, once completed, was again read
from top to bottom on multiple occasions by the researcher to familiarize with the text before
analysis and coding took place (Bradshaw et al., 2017; Willis et al., 2016). Coding involved
reading the transcripts to identify phrases, experiences, and values frequently stated and captured
something relevant to the research objectives (Braun & Clarke, 2006; Willis et al., 2016).
The next stage involved grouping codes into categories - themes - to conceptualize the
data while describing the connections between them (Bradshaw et al., 2017). Throughout this
process, “similar ideas, experiences, or issues that commonly occurred” were identified across
the narratives, which may or may not be interpreted as the essence of students' combined
experiences (Willis et al., 2016). Given that the explored learning experiences featured lived
realities from various settings, searching for patterns of meanings included continually
comparing and contrasting each transcribed text, and identifying codes in a way that enabled
further reorganization into larger overarching themes (Given, 2008). These stages of the analysis
were repeated to ensure that the analysis is a detailed description of the data that best captured
participants’ experiences (Bradshaw et al., 2017).

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Braun and Clarke (2006) cautioned that just because a theme is present across all data
sets does not mean it is the most crucial. Thus, theme classification was judged because of its
relevance to answering the research question and accomplishing the research objectives (Braun
& Clarke, 2006). The goal, however, was always to provide a rich thematic description of the
data in a way that accurately reflected “the content of the entire data set” and maintained a “rich
overall description” (Braun & Clarke, 2006, p. 83). In keeping with the qualitative descriptive
method, searching for patterns and meanings from the transcribed data involved careful
consideration to ensure that the analyzed data was true to the participant’s account despite the
degree of interpretation applied to it (Bradshaw et al., 2017).
A total of 15 semi-structured participant interviews were analyzed.
3.6.1 Member checking
In ensuring that transcribed interview transcripts accurately described participants’
experiences, the researcher was committed to member checking, whereby participants were
asked to verify if written accounts accurately described their experience (Neergaard et al., 2009).
As a result, interviewing and data transcription occurred separately from data analysis – at the
start of the collection and the evaluation stage of the research study. However, member checking
was not feasible due to limited follow-through from participants who indicated an interest in the
member checking process during the initial interview stages. This was because only three out of
the first seven participants reverted with their feedback within the agreed-upon deadline. As
such, a decision was made to stop the respondent validation process altogether to avoid undue
delay in the data analysis process. Consequently, for the last eight interviews, preliminary code
generation occurred during verbatim transcription of data. Furthermore, the search for themes

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began after enough data corpus had been collected to allow for data organization and pattern
visualization; this occurred after the tenth interview.
3.7 Rigor
According to the model of trustworthiness proposed by Lincoln and Guba (1985), rigor in
qualitative research is marked by the following components: 1) credibility, 2) transferability, 3)
dependability, and 4) confirmability (Bradshaw et al., 2017; Sullivan-Bolyai & Bova, 2021;
Thomas & Magilvy, 2011). These components involve intertwined and interrelated strategies as
considering one element increases the possibility of achieving the others (Morse, 2015).
Credibility refers to the trustworthiness and validity of the data, that is, how plausible and
accurate the results are (Thomas & Magilvy, 2011; Tracy, 2010). Credibility also relates to how
well the researcher accurately represents study participants' views (Milne & Oberle, 2005).
Enhancing credibility in this study involved providing an opportunity for member
checking/respondent validation (Thomas & Magilvy, 2011). During member checking, the final
transcription is returned to participants to ensure that the information contained therein is a
correct account (Streubert & Carpenter, 2011). Unfortunately, due to low responsiveness among
participants, member checking was not feasible for this study. Nevertheless, enhancing
credibility involved prolonged engagement by dedicating time to finely combing and recombing
interview transcripts to ensure that all participants’ data are accurately analyzed and represented
in the written report (Milne & Oberle, 2005; Thomas & Magilvy, 2011).
Transferability is the degree to which findings from this study can be transferred to other
participants, settings, or contexts (Thomas & Magilvy, 2011; Morse, 2015). This component of
rigor was limited in this study as, similar to reports from Sullivan-Bolyai and Bova (2021),
findings may only be transferrable to study participants with characteristics and experiences

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similar to those from this study. One strategy to improve transferability is "providing a dense
description of the population studied” (Thomas & Magilvy, 2011, p. 153). Another strategy
suggested is obtaining rich, thick descriptions, which can be made possible by selecting an
appropriate sample for data collection (Morse, 2015). In this study, enhancing transferability
involved carefully describing the characteristics of study participants, such as year of study and
sex. However, to protect the participants' identity, other individual characteristics (such as age or
city of residence) were either not collected at all or were removed from the data in the process of
anonymizing the data. The research design, including the sampling strategy, participant
recruitment efforts, how data was collected and generated, and how meanings were derived from
the text, are all clearly and fully described here. Furthermore, thick descriptions were employed
whereby findings from the entire data set are described as close to participants’ own words as
possible and appropriate. Relaying participants’ pediatric experiences in this way could provide a
database through which other researchers or research users could make transferability judgments
or build their understanding (Lincoln & Guba, 1985).
Dependability refers to the extent to which a research study can be replicated using steps
or decision trails outlined in the project’s data (Bradshaw et al., 2017; Morse, 2015; Thomas &
Magilvy, 2011). This can be achieved by “providing a detailed account of the research method”
(Thomas & Magilvy, 2011, p. 153), as well as accounting for any changes to methodology that
occurred during the study (Bradshaw et al., 2017; Sullivan-Bolyai & Bova, 2021). To enhance
the reliability of this study’s findings, the researcher clearly stated the study goals, explained the
sampling and recruitment strategies, data collection and analysis approach decisions, and how
they fit within the overall research objectives. This provision of transparency may aid in the

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result generalization process by improving the repeatability of this study (Sundler et al., 2019;
Thomas & Magilvy, 2011).
Confirmability occurs when all three components – credibility, transferability, and
dependability – of qualitative rigor have been established (Thomas & Magilvy, 2011). The
confirmability of the research is also aided by the researcher’s self-reflexivity (Sullivan-Bolyai &
Bova, 2021; Thomas & Magilvy, 2011; Tracy, 2010). Self-reflexivity indicates the recognition of
the effects of the researcher (e.g., beliefs, values, biases) on the research process. As an alumnus
of an undergraduate nursing program, reflexivity involved recognizing and acknowledging the
effects that my prior experience of the practice being studied may have on the research process.
An ongoing self-critique and self-analyzing on my part were therefore necessary. My selfreflective account is described below.
3.7.1 Reflection and reflexivity
Informed by the researcher’s prior clinical experience as a student nurse, the researcher
recognized the potential bias that could occur due to having gone through the experience under
exploration. The researcher recognized that they held specific beliefs around expectations for
clinical placements, in that acute care placements would be limited, which inferred that student
nurses might not value their time in non-traditional pediatric practicum sites. The researcher had
to pay attention to confirmation bias during data analysis by considering all the data collected.
Further, the researcher approached analysis by continually re-evaluating their impressions and
responses. Question order bias was limited by starting the interview with general questions
before moving to more specific or probing questions. Following each interview, the researcher
was able to transcribe and listen again to the audio recording. The researcher listened to their

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interviewing style and where they may have applied leading questions or prompted participants
to favor a particular assumption.
Specifically, the first six interviews generated limited data since participants answered
open-ended questions with short narratives. Navigating engagement and applying probing
questions was a skill in which the researcher developed confidence, following discussion with
their supervisor and reflecting on their emerging interviewer skills. Informed by the analysis of
the first few interviews, two new questions focusing on learning desires and the role of the
clinical instructor were added to complement the semi-structured interview. While present in
earlier interviews, asking focused questions about instructors’ ability to facilitate learning in
pediatric contexts enhanced interviews with participants as they indicated having limited
practicum experiences to draw from. As a result, a question about participants’ learning desires
before and after completion of their pediatric practicum experience was introduced during the
seventh interview to generate richer data responses from participants. In the same way, a second
new question was introduced during the fourteenth interview due to the participant’s insight into
the instructor’s role in facilitating learning.
3.8 Ethical considerations
Before data collection, ethical approval was sought and received via a harmonized review
process on RISe [H21-00463] that comprises Research Ethics Boards of potential study sites for
participant recruitment. Consent was also sought from gatekeepers (e.g., nursing heads or
program directors of Schools of Nursing of identified study sites for recruitment). The ethical
principle of autonomy, beneficence, and non-maleficence was upheld for the duration of this
research undertaking. First, informed consent was sought by providing adequate information
about the research study to potential participants as part of the consent form. Participants were

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also required to affirm consent verbally before interviews commenced. Participants were
informed that consent could be withdrawn at any time during the interview with no repercussion
(Bradshaw et al., 2017). Additionally, information about who else outside of the researcher will
have access to the data (i.e., the research supervisor and committee members) were
communicated to participants before obtaining consent.
Second, care was taken to ensure that confidentiality and anonymity were maintained in
the way that data was stored, reported, and shared (Bradshaw et al., 2017). For example, data
was stripped of all identifying participant characteristics at transcription and replaced with alpha
numeric characters (consisting of a letter and a number). Regarding data storage, audio
recordings from the interview and interview transcriptions were stored on my passwordprotected personal computer; the files were encrypted to provide additional security measures.
Each participant file was saved using assigned alphabetic characters. The method of naming was
pre-developed, written down, and stored securely in the researcher’s home office before the start
of data collection. These codes were systematic and consistent throughout the data collection and
analysis phase (Mack et al., 2005). Email addresses collected for honorarium transfer, member
checking, or final results sharing were stored securely in a locked file cabinet. The email
addresses were promptly destroyed after the completion of the study.
Zoom video conferencing allows for the secure recording and storage of interview
sessions “without recourse to third-party software”, which offers a layer of protection for
participants’ sensitive data (Archibald et al., 2019. p. 2). Interviews were stored in an encrypted
folder on the researcher’s password-secured laptop. Data generated from the study will be safely
stored for up to five years after the study’s completion to allow time for research publications,
after which they will be permanently deleted. Also, printed copies of the interview transcriptions

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and hand-written notes or codes will be permanently and securely shredded after this study is
successfully defended. Additionally, any hard copies of data material were stored in a locked file
cabinet when not in use and will not leave the researcher’s home office to centralize data in a
secure location. In so doing, the researcher can give an account of their location at all times
(Mack et al., 2005). The home office, as aforementioned, is inhabited by the researcher alone and
thus not accessible to anyone else.
Nonmaleficence requires that the researcher pays attention to the potential psychological
consequences of participating in a study (Bradshaw et al., 2017). Although no serious
psychological risks were foreseen for this study, the researcher remembered this could change
because of the understanding that interviews have the potential to “evoke emotions and
unexpected feelings” (Bradshaw et al., 2017, p. 4). Additionally, data collection methods utilized
in qualitative studies, i.e., interviews, are unpredictable because one cannot foresee and
adequately prepare for random occurrences (Streubert & Carpenter, 2011). In this study,
interview questions and probes did not appear to evoke strong emotions from study participants.
However, information about seeking help or counselling from the wellness center at their
affiliated schools was provided in the consent form document sent to all participating students.
Additionally, students were provided with the BC Mental health support line for mental health
support.
The virtual nature of the data collection approach (i.e., the Zoom platform) utilized in this
study called for the observance of security measures to ensure the interview sessions are
effective and secure (University of British Columbia (UBC) Research Ethics, 2020). Measures
that were incorporated in this study were: 1) the Zoom meeting link was shared only to
consenting participants and was not be posted on social media or other public spaces to prevent

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random individuals from gaining access; 2) my Zoom Personal Meeting ID was not used to host
any of the interview sessions because this meeting room allows anyone to enter and exit
indiscriminately, and 3) A waiting room was utilized to give the researcher control over which
participants were admitted into the meeting (UBC Research Ethics, 2020). For additional privacy
and confidentiality measures, participants were allowed to turn off their videos during the
interview if preferred (UBC Research Ethics, 2020).
3.9 Knowledge translation
Knowledge translation refers to how research is translated to practice. First, this study,
conducted to fulfill my master’s thesis, will be written as a publishable research manuscript that
will be available through UNBC's Digital Institutional Repository. Second, sections of the
completed thesis will be adapted and submitted as a research article fit for publication in a peerreviewed nursing journal. This way, the study’s findings will be available to download and read
by students, researchers, and nursing education professionals. For example, the literature review
completed for this research study was adapted into an integrative review and submitted to the
International Journal of Nursing Education Scholarship for publication consideration (See
Appendix H). More importantly, given that the primary target audience of this knowledge
translation effort is nursing programs and undergraduate nursing students, especially those
situated in BC, an offer will be made about the possibility of presenting the findings to them
individually and separately. Finally, opportunities to publicly present findings from the
completed study will be sought from various academic, professional, and public settings to create
awareness of the importance of learning about the experiences of undergraduate nursing
students. For example, an abstract was submitted to the 2021 Northern BC Research and Quality
Conference, UNBC 2022 Research Week, and the 2022 Atlantic Regional CASN conference.

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Chapter 4: Findings
The following chapter offers thematic analysis descriptions of interview data collected
for the study’s exploration of nursing students’ pediatric placement experiences within their
undergraduate nursing education. The chapter starts with an overview of the study participants.
The identified four overarching themes – relational practice, knowledge consolidation, identity
formation, and exposure – are also presented.
4.1 Study participants
This chapter presents the findings of semi-structured interviews with 15 participants who
experienced a range of practicums for the pediatric portion of their undergraduate nursing
program. Participants were placed in a community or acute setting, with a few experiencing a
mix of both as some attended multiple practicum sites in the span of one practicum course.
Figure 3 presents the different placement settings that participants in the study were exposed to
in caring for children and/or adolescents.
Figure 3

Placement Types

Cumulative Practicum Settings that Informed Participants' Narratives
YOUTH CORRECTIONAL FACILITY

1

HOME CARE NURSING

1

HIGH SCHOOL/ALTERNATIVE

3

HOME-LIKE FACILITY

9

NICU/POSTPARTUM/MATERNITY

7

PEDIATRICS UNIT/CLINIC

13

DAYCARE/PLAY PROGRAM

4

ELEMENTARY SCHOOL

1
0

2

4

6

8

10

12

14

Number of Participants

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Participants in the study (N=15) were either in their final year of nursing school (n=13) or
recent graduates who completed a pediatric placement in the previous 12 months (n=2) from a
nursing program. The 15 participants came from 1 of 3 schools (see table 2 for details).
Additionally, n=3 of the participants were male, and n=12 were female.
Table 2
Characteristics of Study Participants

Number of participants

Year of study

School

Sex

Final year: 13

A: 10

Male: 3

New grad: 2

B: 4

Female: 12

C: 1

4.2 Themes development
Thematic analysis using an inductive approach, following Braun and Clark (2006),
generated four overarching themes from the data, composed of nine sub-themes. Themes were
determined using an iterative process to report participants' experiences, meanings, and realities
in a way that was relevant to the research objectives (Braun & Clarke, 2006). The overarching
themes identified are: 1) Relational practice; 2) Knowledge consolidation; 3) Identity formation;
and 4) Exposure.
The first theme, Relational Practice, was divided into two sub-themes: 1.1 Caring
interactions with children and adolescents and 1.2 Caring interactions with families, which
captures aspects of client/patient interactions within practicum settings, and the practice of
family-centered care. The second theme, Knowledge Consolidation, was divided into two subthemes: 2.1 Refining communication skills and 2.2. Engaging in task-based learning. This theme
captured how theoretical knowledge was reinforced in practice settings. That is, honing
communication skills and strengthening psychomotor skills through hands-on and observational

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learning. The third theme, Identity Formation, was divided into two sub-themes: 3.1 Clarity
related to career direction; and 3.2 Role conflict. On the one hand, the theme captures career
path decisions and the gaining of confidence in one’s ability to care for patients. On the other
hand, the theme outlines the discontent ensuing from unmet learning desires. The fourth theme,
Exposure, was divided into three sub-themes: 4.1 Lived experiences; 4.2 Caring culture; and 4.3
Another side to nursing. This theme captures the students’ discovery that there was more to
nursing than they encountered in the first three years of nursing school. These are discussed more
broadly in the following sections.
4.3 Relational practice
Relationship, as used within this study, focused on the concept of connection with
patients/clients. Building relationships and getting to know the patients/clients as people rather
than merely people needing care was an important aspect for participants working with children
and families. The reciprocity in such relationships was an aspect of the pediatric practicum
experience that gave meaning to the narratives recounted by participants. While the approach to
building relationships appeared intuitive to individual participants, a common thread drawn from
analysis focused on the child's and family's medical and psychosocial needs – which were
discovered through interactions. The ways in which student/patient interactions were initiated,
nurtured, and maintained was an important sub-theme.
4.3.1 Caring interaction with children/adolescents
A value that all participants attributed to pediatric practicums were the ability to interact
and build relationships with clients/patients within their respective placement settings. They
reflected this in the narrative accounts that alluded to building connections and getting to know
their assigned clients/patients. For example, one participant stated, "I always try and find

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something that we can talk about that just lets us be people before we are the patient and the
nurse” (P14). An example from an acute care context focused on both the time spent with
patients and the type of interactions since both influenced the opportunity for relationship
building between students and patients. This was described at length by one participant who
recognized that being present with the child during “invasive procedures…such as having a
PICC line,…NG tube” and the time needed to “manage [these] meant being in the patient's room
a lot” (P8). P8 reflected further that:
I thought that we were able to develop quite a strong rapport to the point where even
days later when I was working with a different patient, the patient would come out
and talk to me like we created this kind of relationship that was a good working
relationship (P8)
One participant shared a positive interaction where they were closer in age to their adolescent
patient. In this situation, the participant conveyed to the adolescent patient knowledge regarding
appropriate services external to the acute care setting. The participant’s experience is highlighted
below:
[The] adolescent patient liked having me there because I was closer in age to him than all
the middle-aged nurses, so it was easy for him to talk to me about things, especially when
it came to school stuff, given that I am more recently out of high school compared to
some other nurses on the floor. And just kind of building a connection with him and
helping him and [getting] him in contact with some different resources that I knew about
in the community. In that case, I really felt like I had done something to help this kid (P4)
In the same way, another participant spoke at length about the importance of age and common
experience in building rapport with clients while also acknowledging gender as a shared space.

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For this participant, “finding common ground” with the adolescent client focused on sharing a
mutual love for a sporting activity which allowed them “to connect with” the patient in a way
“no one else in [their] group really had” (P13). When sharing this story, the participant
recollected this as a “memorable” interaction since “for an [adolescent] boy, it probably feels
uncomfortable having a [very young person] as his nurse”; however, “being able to connect”
served to “breakdown the barriers” (P13), which in turn, built relationship.
Furthermore, another participant reflected on the interaction that occurred in their
community practicum experience at an alternative high school for at-risk youth. On this
occasion, they were privileged to “go on a hike” and converse with “the kids about what they
wanted to do when they were done school” (P15). During this encounter, the participant “talked
about nursing and what [nurses] do and kind of showed them [that] nursing isn't just a female
profession because there was a lot of males, and it's a very beneficial program both for the
community and for yourself” (P15). The interaction was mutually enriching because the
participant also learned from the clients about “why they got into the [alternative high school]
program, how much they really enjoyed the program, and how much it's helped them” (P15).
Participants from the study recounted feelings of satisfaction derived from successfully
building rapport with clients who were more reserved or quiet. One participant who was placed
in a daycare setting described feeling excited when they were able to “make a connection” with
those children who “were not so quick to warm up” (P3). Another participant, whose practicum
was at a pediatric clinic, recalled being assigned to a patient who, according to the clinician,
“doesn't like new people” and “doesn't like to talk” (P15). Despite this, the participant found a
way to connect with this patient by conversing about the child’s interests. The patient was
watching a movie on his electronic device, and the participant used this as an opening to

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encourage this child to talk about the characters in the show and other movies the child had seen
in the past. Upon reflection, the participant stated, "it's just funny to learn like you just got to find
those little things that connect you with your patient and not just go in expecting them not to like
you” (P15). This participant saw and embraced an opportunity to engage with a child who
appeared reserved. This reflection endorsed the idea of successful patient interaction as equal
part opportunity and motivation.
Depending on how it was used, interacting and building rapport with patients sometimes
led to them sharing the positive effects that the personal attention and interaction had on them.
For example, one participant narrated an encounter with an adolescent patient newly diagnosed
with an eating disorder in a hospital setting. This participant described providing a safer space
for the patient to be open and vulnerable about the circumstances leading to their disorder. At the
end of the encounter, the participant recalled the client verbalizing that they had “never had
anybody in the past talk to them about body image so openly” (P1), which made the moment
more impactful for the patient and also for the participant.
Client interaction was a valued aspect of the pediatric practicum experience because
participants with fewer opportunities or no opportunity to interact and connect with children or
adolescents in their respective settings expressed their discontent during the interview. One
participant recounted a community pediatric experience at an alternative high school setting
where “the high school kids weren’t even there” (P6). That is, there were no actual students
present. Another participant described a community placement at a center for women and
children that provided families free groceries and meal prep assistance. In this practicum setting,
the participant explained the role of students to be that of “seeing the children interacting”;
however, “there were no children there” (P10). As such, this participant spent their day at the

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practicum site “watching these moms learn how to cook” (P10). These participants believed that
an essential part of their pediatric practicum experience is seeing and interacting with children
and/or adolescents. Unfortunately, practicum settings were unpredictable in that there were
instances when there were no patients/clients for participants to connect with. The next subtheme explored how participants experienced interacting with families as part of their pediatric
placement experience.
4.3.2 Caring interactions with families
A value participants attributed to their pediatric practicums was the opportunity to
establish a trusting relationship with families. Participants recognized parents' important role in
their children's lives. Recognizing this role promotes collaboration whereby families' skills and
expertise are used in decision-making in their child’s healthcare practices. This empowers
families and produces an optimal health experience for all involved. One participant’s reflection
on caring for an individual patient versus caring for a family unit is highlighted below:
With pediatrics, you're dealing a lot more with the families, and I was really looking
forward to the communication. I'm a very personable person, I believe, and I find it easy
to talk to anyone, but knowing those boundaries and knowing what questions are
appropriate and what questions aren't. How do you ask the questions if they're not
appropriately worded? And so, I was most looking forward to dealing with the patient as
a family and not just the patient as an individual. (P7)
Another participant’s reflection on caring for families was “looking at the whole picture, looking
at the whole family and how much that nursing care or what that child is going through is
relating to their entire circle” (P10). The participant also recognized that sometimes going along
with how things were done in the practicum setting was not in the family's best interest. For

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example, new mothers were encouraged to feed their babies independently before discharge,
which sometimes left them exhausted as they were often unable to “get a good night’s sleep”
(P10). Thus, caring for the family in this situation would involve “doing a 3:00 AM feed for a
mom who's exhausted” so that “she can sleep those extra few hours” and “be less tired the next
day” (P10).
One participant linked collaborating with the pediatric client and their family to the
opportunity to engage over some time. For example, this participant described memorable
interactions in their practicum setting at an early years education program as a result of
“multiple” encounters as “it would always be the same children and caregivers coming each
week” (P2). This opportunity over a few weeks allowed the participant to build rapport and
connections as they “[got] to know the parents a little bit and [learn] a little bit about their
stories” (P2).
Despite the consensus that engaging parents and caregivers in the care of the pediatric
client are important, one participant alluded to the complexity of making this practical in the
acute care setting. This participant’s reflection below recognizes that it is an active learning
process.
One of the things that was challenging was learning how to interact with the parents as
well as the pediatric patients, which was unusual, given that normally I just interacted
with the patients themselves, not so much their families. So that was a bit of a learning
curve. (P9)
However, another participant welcomed “the opportunity to practice interacting with some
parents who were not necessarily my patients and keeping them in the loop” (P4). For this

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participant, working with the family was a novel event they had not experienced in previous
practicum settings.
This sub-theme highlighted that making connections and interacting with pediatric
patients/ clients and their families was valuable to participants’ placement experience. Despite
the significance of ‘building relationships’ as a beneficial outcome of pediatric placements,
participants craved the opportunity to care for patients/clients through skills performance.
4.4 Knowledge consolidation
Knowledge consolidation within this study's context refers to applying prior theoretical
learning to a specified task. According to participants’ narratives, this involved either acquiring
new skills or refining previously learned skills within the pediatric practicum settings, which is
positioned with the empirical view of knowledge. The skills, as observed and acquired by the
study participants, were divided into two sub-themes: refining communication skills and
engaging in task-based learning.
4.4.1 Refining communication skills
Participants from the study expressed their excitement about the opportunity their
placements afforded them to acquire and/or improve their communication skills. Participants
recognized that communicating with children in a casual setting may not translate in the same
way in a practice setting. One participant who had always considered themselves “to be good
with kids before” was excited to be placed “in a general hospital” (P1). This opportunity had
proved helpful in that the “communication aspect with children really helped develop [their]
communication with other patients” (P1) both at the time of the practicum and in later clinical
contexts.

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Participants also understood that to communicate effectively with children and
adolescents, an adjustment needed to be made in how information was obtained and conveyed.
One participant who shared an encounter with a school-age child had the following to say about
assessing their client:
This client was so fixated on the TV, so I was trying to do all my assessment, but he
wasn't even making eye contact with me, right? So, I try not to make questions difficult. I
have to use simple words to communicate… I was talking to his mom [who] was really
frustrated and tired. So, just talking to both of them trying to see where they are, and just
asking questions about how he's doing. You know, more like trying to understand, trying
to pull the information from both of them. (P11)
Another participant assigned to an adolescent patient described the challenge of teaching a
patient how to shower with a stapled surgical wound. The participant recognized the need to
“bring it down to [the patient’s] level” and “sometimes reiterate in a different way for them to
understand” (P15). The participant reflected further that:
They want to know everything but to a lesser extent, so you kind of have to bring it back
a little bit. I was teaching a patient that she could shower with staples in, and she looked
at me like I was crazy. Yeah, and so I had to educate her about that, and it took a really
long time, but at the end of it, when she finally understood it, I was like, oh okay, so
that's how you say it. (P15)
This participant described their success in teaching the patient how to shower with a stapled
wound as a learning experience they perceive as useful for future nurse-patient interactions.
The value of applying both ‘foundational’ and ‘new’ communications skills was reported
positively by participants who wanted to improve their communication and interaction with

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children across various ages and stages of development. One participant’s reflection was as
follows:
So, one of my learning objectives I really wanted to achieve this term was
communication with children and I think I did achieve that through this placement … just
learning like how different ages, different stages of development will communicate like a
one-year-old is very different from a 3-year-old… So, if I have an older adult patient, but
if they have, say, a visitor that is a little bit younger, I would be able to communicate with
them. So, I think the communication piece was the biggest learning outcome I took out of
pediatrics. (P12)
Similarly, another participant’s desire “to understand how to better go forward with pediatric
patients” (P15), given that they had never learned about or cared for pediatric clients up to this
point of their education, is expressed below:
So, I was just hoping to understand how to better go forward with pediatric patients and
how to gauge my talking to them to their age and maturity level. Just because a child is
young does not mean that they won't understand what you're saying, and just because a
child is older doesn't mean that they'll understand more. And so, trying to gauge that with
a patient in such a short time with them was my main goal. (P15)
Refining communication skills also occurred through observational learning as one
participant shared their experience shadowing a more advanced nursing student “doing a patient
intake” for a newly admitted adolescent with a parent present. The participant (P7) spoke about
how it was helpful to see the senior student’s ability to read the room, ask appropriate questions,
and redirect the parent out of the room (e.g., to go grab coffee) when it was time to ask the young
patient personal questions.

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While learning communication skills was noted to be important for some participants,
almost all participants preferred learning psychomotor skills as it provided an opportunity to
apply prior learning from the classroom and skills laboratory in a practice setting with real
patients/clients. For example, one participant hoped to come out of the pediatric practicum
rotation “with the most general information that I would need to know so I could be like be able
to assess that population confidently or to know at least who I can contact in case I didn't know
the answer to those things” (P14). For this participant, such learning could only be achieved
“through doing and seeing” (P14). The next sub-theme expands on this sub-theme in further
detail.
4.4.2 Engaging in Task-based learning
Most participants indicated that some of the memorable moments at their placements
involved carrying out a nursing skill or task by themselves. For example, one participant (P4)
recounted getting excited about giving a premature infant their first bath. P4 further described
“getting to practice the whole distraction [approach] with [an infant] while giving them
medications and trying to comfort them at the same time”. Other participants valued carrying out
these nursing tasks or skills for the benefit of their patients at their respective placement settings
because it brought with it not only a sense of personal accomplishment but also a sense of
fulfillment of having “improved someone's wellbeing” (P8). For example, one participant
described elation about successfully completing “a really complicated dressing change on a
patient” where they were “able to take a skill and like make it my own” (P1). P1 further
described that the performance of this skill improved the patient’s comfort as the old dressing
was “pretty uncomfortable”. For another participant, it was being responsible for “a couple week
old baby and then two toddlers” and “helping them all eat at the same time” (P9). Another

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participant recounted caring for an infant who had an oral aversion where they successfully “put
in the NG tube on [their] own” (P10). P10 further described the excitement of watching the
“baby grow and grow” and then get discharged. As such, learning or demonstrating a skill in
practicum occurred in various ways. Additionally, by performing these nursing skills at
placement, participants met learning objectives and practiced within their scopes as student
nurses.
Participants appreciated the novelty of the task-based experiences that their respective
practicums offered. P5 narrated their experience caring for an infant diagnosed with failure to
thrive. This baby was receiving nutrition through a Nasogastric (NG) tube, and they described
finding the planning of the safe care rewarding and exciting because they were utilizing their gift
for mathematics “to do all of the fluid maintenance and looking at the dietary orders” (P5) to
ensure that the client was getting enough calories. This exemplifies not only the honing of a skill
but also how other skills and talents the participant happened to have come into play as they
perform the tasks. P6 described learning new skills in gastrostomy tube feeding and respiratory
management at an overnight home support program for patients. The participant further affirmed
that “I think [it was] the most amount of skills I was able to do because the nurse did it the first
time and then the second time for the feed, I got to do it” (P6). In other words, not only closely
observing how things are done properly but having an actual opportunity to do it themselves. In
the same way, P8 expressed excitement about “the new and novel clinical experiences that”
caring for a patient with both a PICC line and a NG tube provided. Having practiced those skills
in the lab setting, the participant asserted that the opportunity “to create a clinical picture of how
to utilize [them]” and “the opportunities to develop them that this patient presented was very,
very exciting” (P8).

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The value of engaging in hands-on learning becomes obvious as one participant shared their
disappointment from not having opportunities to hone their skills:
When I was working with the children, I guess it was different because I never had to do
a hands-on assessment. I never got to actually like interact with them physically. And
whereas in all the other placements [in acute and community], I've always been hands-on
with the patients, but within the pediatrics, we were not allowed to do anything hands-on
with the children because of safety. (P12)
For one participant, the lack of opportunity to engage in task-based learning was a result of the
acute care nurses' lack of trust in their skills and abilities; the participant lamented that “we
weren’t allowed to do any of those skills that given any other floors, we would have been
allowed to do” (P6). For another participant, it was a result of an occurrence described as
“overstaffing” where “there were not a lot of patients, but quite a few nursing students [and a]
fully staffed unit” (P7). This resulted in students “almost stumbling over each other trying to get
the experience” to do assessments and perform skills on patients (P7).
That said, knowledge application at each respective placement setting did not always
happen through opportunities for hands-on learning. A few participants shared memorable
experiences that involved watching a nursing skill being performed or completing a task. One
participant described this as “being a fly on the wall” (P10). For these participants, having an
opportunity to observe these skills in practice was considered better than doing nothing. For
example, one participant shared, "even if we can't do it, I got to watch a nurse put an NG tube in
a very tiny baby, which was super cool” (P9). One participant (P9) shared an experience “that
struck most with them” where they “had the opportunity to observe a pediatrician do an
assessment on a child” they were assigned to work with. The participant found it “really cool to

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get to watch [the clinician] assess, play, and distract [the child while] talking with the dad all at
the same time”. The participant further stated that “it was a good learning opportunity for me to
kind of see how to balance those skills because that is something that can be hard to learn from
the theory” (P9). The opportunity to just observe, while somewhat disappointing given the
unique advantages of getting hands-on experiences, nevertheless was described by participants as
still a rewarding learning experience. For example, P12 shared that the opportunity to observe
children within the community placement environment helped improve their assessment skills as
they progressed into other care settings. Their reflection is as follows:
I learned how to assess a patient without actually doing a physical assessment. So, just
looking at them and being able to look for things like: do they have a tracheal deviation?
are they presenting with incoherent speech? Things like that I have brought into adult
care as well; I have taken that and applied to adult care. So now, like when I walk into the
room before I put on that BP cuff or start to do these physical assessments, I would look
at my patient and do an overall assessment … and also look at like their skin colour. Are
they alert and oriented? So, these are the things I really learned from pediatrics – looking
at [my patient] and making that assessment. (P12)
The opportunity to learn valuable nursing skills from more senior students and staff at
placements was exciting and memorable for participants. Such peer-to-peer and instructor-tostudent experiences influenced identity formation, which is described in the next theme.
4.5 Identity formation
Identity may be formed by belonging to a group or organization. For participants in this
study, current enrolment in a nursing program validated their identity as nursing students. As
such, participants came into their respective pediatric practicum experiences with preconceived

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ideas of what it means to work as a student in these settings. Feelings of personal fulfillment and
accomplishment occurred in situations where participants' expectations tallied with their reality.
On the other hand, a mismatch between participants’ expectations and reality resulted in feelings
of confusion and dissatisfaction in their respective practice settings. These concepts are
described in the sub-themes below.
4.5.1 Clarity related to career direction
For many participants in the study, the pediatric practicum experience was an opportunity
for them to consider whether working with children and adolescents after graduation was a
plausible career direction to consider. As such, these participants found value in being able to
experience caring for pediatric clients in different care settings. One participant recounted their
experience working on a hospital floor where the maternity and pediatric units were combined.
This participant affirmed that “if I hadn’t gotten my clinical experience there, I don’t know if I
would have known that that’s the kind of nursing I wanted to do” (P9). This participant enjoyed
their pediatric clinical experience in this unit so much that they hoped to work there upon
graduation.
Another participant shared that everybody near them had always said pediatrics nursing
was for them, but they were never sure of it until their pediatric practicum. This participant (P10)
decided they “really liked” the pediatric unit after their “three days” of clinical practicum
experience. They were fortunate to have a longer acute care placement in pediatrics for their final
practicum consolidation, which solidified their interest in the area and motivated them to “learn
as much as [they] possibly could” (P10). The participant went further to share that when they
graduated, they felt they were “able to submit a strong resume and be a strong candidate for one
of the positions [in the hospital’s pediatric unit]” (P10).

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A few participants knew they wanted to work with children long before the
commencement of their pediatric practicum. However, being at placement either confirmed their
decision to work with children and adolescents or, conversely, led them to re-evaluate this idea.
One participant narrated their experience working with a baby that affirmed their decision about
future pediatric nursing. The participant (P13) stated that this was their first time “implementing
play” while assessing a small child and getting their vital signs. This experience was memorable
for this participant because “it opened my eyes to realizing that that's what I am supposed to do”
(P13). The participant stated, “that's kind of what I thought that I always wanted to do… I don't
know what I would have done if I found out that this isn't what I want to do” (P13). For another
participant, their experience in pediatrics discouraged them from wanting to work with children.
This participant (P3) realized that the pediatrics unit “wasn’t what [they] pictured” as they were
“really challenged when it came to working with children with really high needs” (P3). Their
practicum experience helped inform longer-term career choices that perhaps they were “not
really ready for that sort of nursing” (P3).
Furthermore, the value of the pediatric practicum placement in helping students decide on
a future career path became evident when participants lamented that their placement's duration
and/or location were inadequate to expose them to the realities of pediatric nursing. One
participant whose practicum was reduced to three clinical days instead of six because of COVID
stated, “I would have liked to have more time to see if that floor was for me” (P1). As such, this
participant considered “taking one of my extra preceptorships in a pediatrics route … to see if
that is something that I really want to do down the road” (P1). In the same way, another
participant (P11), despite “having a good time with the pediatric rotation” stated it was “not long
enough to see everything” and to know if pediatrics “is a place I want to work in the future”

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(P11). The same sentiment was echoed by a participant who only had a community-based
pediatric placement for their practicum. The participant (P12) stated, “I feel like I probably won't
go into pediatrics because … I don't think the community was a great introduction to pediatrics”.
The participant further stated that “I don't think I saw pediatric care to its full extent, so I don't
know if I like it or not” (P12). For P12, a “proper placement with good experiences would
encourage new nurses [like myself] to go into pediatrics”.
Practicum placements were valued for their capacity to help students decide their career
paths and instill a sense of identity and belonging in students as they work alongside
professionals in roles they aspired to in their future. Consequently, the value of pediatric
placement was reduced when students felt out of place in their respective practicum settings. The
next sub-theme expands on this finding further.
4.5.2 Role conflict
This sub-theme captured participants’ discontent from their inability to work to their full
potential as nursing students. Some participants shared their dissatisfaction with practicing
within a limited scope in their placement settings, feeling confused about what was expected of
them in some placements, and the lack of nursing role models. For example, one participant who
was placed in an early years program noted that “we didn’t have things we were supposed to
specifically do [so] we were just there like interacting with children and their caregivers” (P2).
These feelings were prevalent among participants placed in community settings. P10 discussed
how working with educators in non-nursing roles increased confusion.
I was at a daycare where there were just like lots of children, and we weren't able to do
anything, which is the part that was kind of not satisfying to be there in terms of learning.
The staff there weren't comfortable with the nursing students really doing much, so we

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basically sat there for eight hours, watching the children interact with each other. Most of
the time, there were like early childhood educators who were working there (P10)
This was similar for P11, who spoke about “questioning myself” and wondering if “babysitting
on the chair all the time” during their community placement was helping “to meet my future
learning needs”. This participant believed that they were “missing some nursing perspectives” at
the community placement “because they had no nurses working there, only social workers”
(P11).
On the other hand, participants in acute settings were emphatic about their clinical
instructor's role in guiding and supporting their learning at placement. P15 described how their
instructor kept them “busy and engaged” when things [were] slow” in the unit and helped them
learn about “things that they didn’t get to see in the unit like electrocardiograms” (P15). P10
described an instance where their instructor would provide practical scenarios for them to work
on during periods of downtime such as “making up medication questions … or scenarios”. In the
same way, P14 described how their instructor went above and beyond to ensure they had those
“specific experiences” with pediatric medication maths and syringe pumps at the recognition that
“there's not much going on [in the pediatric ward]”. The presence of a preceptor with a
professional background in pediatrics provided a structure that was valuable for students learning
at placement.
P8 described another instance of discontent. This participant described their community
placement as “childminding” and felt like they “were volunteering [their] time at an institution”
as opposed to “nursing the families” (P8). This participant further stated that in this placement, “I
was there in the capacity of competent adults more than as nurses”, and so tasks they were

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assigned such as “watching babies, feeding babies, day-to-day assistance with things like meal
planning and prepping” was not “nursing as I understood it” (P8).
It is safe to conclude that participants valued working in the capacity of nursing students
and being tasked with responsibilities commensurate to their perceived skills within their
practicum. As such, learning situations where participants perceived their student nursing
practice scope was limited and/or unrecognized and unclear brought about feelings of distrust
both in their abilities as student nurses and identities as future nurses, as well as in their nursing
education program. Another important dimension of the practice learning experience for nursing
students was the opportunity to see a different side of nursing. The next theme provided more
insight on this.
4.6 Exposure
The value that participants derived from their respective placements were not limited to
connecting with clients/patients and their families, skills development, and identity building.
Participants benefited from the opportunity to discover things about the real-life practice setting.
This theme is divided into the following sub-themes: lived experience, work culture, and another
side of nursing.
4.6.1 Lived experience
Participants attributed value to gaining insight into the lived realities of children and their
families in their placement settings. A participant who was placed in a community pediatric
practicum talked about finding joy in listening to the stories of the different families that come
from different cultural backgrounds. The participant went further to state that:
The woman who ran the [program] is from [a country in Asia] and we talked about food a
lot like when it was the kids snack time and so I got to hear about people’s favorite meals

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and like what their special family meal is and different sort of little pieces that go along
with that... So, yeah, I think it was in those moments that I found a lot of value and
interest in that [community] experience …There was also a bit of an emotional
connection as well just thinking about people’s experiences and hearing about them – that
was a lot. The fact that I was learning new things and hearing people’s experiences made
it memorable. (P2)
Another participant spoke about caring for an adolescent who had attempted suicide. The
participant was privileged to sit in on the patient’s counselling session, which led to a reflection
on what it means to be a part of a profession that members of the community trust.
I sat in one of [my patient’s] counselling sessions with the social worker, and we got
pretty deep on his suicide attempt and what he had planned for himself and stuff like that,
and I haven’t sat in on a conversation like that before, even on my mental health clinical
rotation… I think that patient will always just stand out for me because I have never had
somebody so young say such depressing things to me, and it just like really resonated
with me on how instantly people trust a nurse and a health care worker because we were
literally strangers asking [them] about the worst things about [their] life and [they were]
just willing to tell me. (P4)
One participant assigned to care for a client with an eating disorder reflected on how that chance
encounter reoriented their understanding of what it meant to have anorexia. The participants’
reflective account is described below.
I got assigned to a patient [who] had an eating disorder and … that whole process was
really memorable… watching [them] through that and kind of talking to [them] about
[their] relationship with food a bit and assessment wise, seeing how affected [they were]

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by it… It made me go home and think for multiple days like that patient stuck with me
for a long time… That moment was memorable because I think I had an idea of what
someone with an eating disorder would be like. I definitely had a bias going into it, so it
was mostly memorable because it turned my mentality right around. (P5)
Two participants reflected on the resiliency of children living with a life-long condition. The first
participant (P6) narrated an account where they cared for an adolescent patient who was recently
diagnosed with Type 1 diabetes. The patient quickly recovered from the news of the diagnosis
and became very active in their treatment plan. P6 found this moment memorable because they
cared for this patient during the initial diagnosis and were pleased to learn that the child was
“taking charge” by learning how to administer their insulin medication and check their blood
sugar levels. The second participant shared their experience of caring for a child who had been in
and out of the hospital for most of their childhood. The participant reflected on the adaptation
and resiliency children have as follows:
We had a toddler there at the time and she was someone that had come in quite a few
times for management of [their] condition, and [they] were just so funny, and you'd go
into [their] room, and [they] really wanted to play, and [they were] so full of life and just
so funny and it really makes you understand how kids are so resilient. Even in these
conditions, [they are] just so used to being in the hospital, but the fact that [they were]
still in such good spirits, you know, it shows the resilience of kids. (P13)
One participant shared their experience of caring for an acutely unwell baby. The participant
reflected on how memorable it felt being a part of the team caring for the baby and their family
as they recovered.

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We had a baby who came in very sick like truly, if they would have waited another hour,
probably could have died… We had to do 101 different tests and everything, and [the
baby] got flown to [a larger children’s hospital], back to us, stayed with us for months,
and then had a PICC line in. I got to be the one to pull the PICC line off [them] to finally
go home and be off [their] antibiotics. And those moments are so memorable to be there
with the family when their kid is no longer sick, and their baby is okay. (P10)
Thus, participants valued the opportunity to not only know their clients a little better but also to
develop insight into the lived experiences of their illness. Similarly, participants in the study
appreciated the opportunity their placement settings afforded them to observe the working
environment where children and adolescents were cared for. The next sub-theme expounds more
on this.
4.6.2 Caring culture
The pediatric placement experience allowed student participants to see the dispositions of
different team members in a care setting. Participants’ pediatric placement settings also
showcased the rewarding and challenging side of working with children, adolescents, and their
families. Two participants reflected on witnessing the compassion of nursing staff towards their
clients. The first participant spoke about watching one of the pediatric nurses on the unit care for
a patient with a mental health issue in a positive way.
When we had the kid on the floor who had an eating disorder, it was very interesting to
see how they are cared for in a way that is not a psychiatric unit… I don’t think the
person felt like they were there for an eating disorder like there's something seriously
wrong with them. The nurses were really lovely in talking with them, not just about the

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eating disorder, but like, for example, they had crafts there, so we would go in and talk to
them about the craft. (P6)
The second participant spoke about watching nursing staff in a youth correctional facility care
for clients in the judicial system.
I really enjoyed going to the youth jail in town … and seeing how much love the staff has
for them and the opportunities that are there; it is terrible what they've been through to
get there. But I think that this facility is fantastic at helping them progress and not really
hold judgment. (P10)
As described by these participants, this exposure could become a form of positive socialization
whereby students internalize the attitudes displayed by these mentors as they progress in their
future roles as nurses.
One participant reflected on observing the interdisciplinary team in action when a child
was newly diagnosed with a medical condition. The participant found the experience helpful and
reassuring as they looked forward to being a part of an interdisciplinary team someday.
When I was on the pediatric floor and seeing the interdisciplinary like the way kids are
cared for is not just like the nurse and the doctor – there's like the nurse, the pediatrician,
and there's like all of these other people that are involved – and I think that part is really
helpful for when I go into nursing as myself to see that there are all these different areas
that I can rely on, and I can utilize for patient care. (P6)
Therefore, one value of pediatric practicum is the opportunity it offers students to observe how
healthcare team members relate with each other and with the clients they care for. The next subtheme describes the value of the pediatric placement experience in exposing participants to a
different side of nursing.

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4.6.3 Another side of nursing
Participants reflected on the novelty of working with and caring for children for the first
time since starting nursing school. For example, P8 described the first time caring for a pediatric
patient in a health care setting as “so foreign”, so much so that “I had no idea where to start or
where to begin”. One participant stated, “I don’t think I really had to go out of my way on other
wards to look at policies” (P5). In pediatrics, this participant quickly “got really comfortable
having to look things up” (P5) before delivering care as opposed to previous settings caring for
adult patients. That is, although looking up policies was an important care dimension in all care
settings, it was even more so in the pediatric unit because of the unfamiliarity with caring for this
population. Another participant (P3) reflected similarly on the newness of working with children
as follows:
I think that being able to be in a focus that's not just acute medical/surgical like adult
helped me to realize that there is a bit more, and there're like different conditions... So,
you realize that not everything presents the same because kids have [their] own set of
“normal” for them, and so it kind of helped me to realize that there's a lot more to nursing
than what you specifically learned in the first three years because then you're suddenly
introduced to all these new criteria and all this new data and things that you have to
remember that are specific to a different set of people. (P13)
Participants recognized a difference in caring for children and adolescents compared to caring
for adult patients. One participant reflected on the importance and amount of theoretical learning
that had to take place before starting the pediatric practicum.
The pediatric unit was very focused on the nursing process and kind of like following
through with interventions, assessments, and things like that, more so of that empirical

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style of nursing that I find myself more accustomed to… I would say there's a pretty high
threshold for entry into the pediatric unit, and by that, I mean not only do you have to
familiarize yourself with kind of working with the pediatric population (for instance, the
health conditions), but also the developmental age, and the milestones as well…So, it was
a lot more to jump into, [more] than [in my] previous rotations. (P8)
This same participant further commented on their shifting perspective of nursing from one that
was largely empirical-based to one that accommodated an aesthetic view. This participant’s first
two years of nursing introduced the profession as one with a highly scientific position, so there
was a clear emphasis on quantifiable assessment, intervention, and evaluation. This participant’s
pediatric placement “introduced the aesthetic side of nursing” that gives room for creativity,
especially when caring for the patient as a family unit rather than just an individual patient (P8).
One participant also benefited from realizing that pediatric nurses work in various
settings and are not just limited to hospitals or clinics. This participant stated that:
I liked my community placement because it made me realize there's more to nursing than
in the hospital. You can also work in the community; you don't always have to work with
very acutely ill patients in the hospital. There's just a lot of options, so there's public
health, there's like immunizations, there's Tele Health, there are places where they just
need a nurse just to watch like group homes that sort of thing just in case something goes
wrong. (P15)
Thus, participants valued the opportunity to learn new things about the nursing profession that
was previously unknown to them. Additionally, their respective practicum settings allowed them
to experience what it felt to work with and care for children.

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4.7 Summary of findings
This section described the four themes and nine sub-themes generated from the thematic
analysis of participants’ interview data. Bringing these themes together provided a picture of
what participants valued about their respective placement experiences. The pediatric placement
experience was an important aspect of participants’ nursing education because of the following
values ascribed to the opportunity to – 1) build relationships with children and their families, 2)
engage in task-based learning, and hone relevant nursing skills for current and future nursing
practice, 3) build a sense of identity as student nurses and future registered nurses, and 4)
become acquainted with the realities of working in a pediatric setting. The next chapter will
discuss the delineated values within the context of Knowles’ adult learning theory. In this
theory, Knowles outlined key assumptions about the characteristics of adult learners that aided in
understanding why participants in this study ascribed value to these learning opportunities at
practicum.

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Chapter 5: Discussion
This research study focused on exploring the pediatric practicum placements of
undergraduate nursing students in British Columbia (BC) to examine the value that student
participants ascribed to their experiences. This chapter will start with an introduction to the
concept of value, followed by a discussion of the four themes from the study – relational
practice, knowledge consolidation, identity formation, and exposure – through the lens of
Knowles’ (1977) adult learning theory and in relation to current research focused on pediatric
practicum and nursing education in general. The four key sections of the discussion are as
follows: the impact of task-centeredness on relationship building; the experience reservoir of
knowledge consolidation; the formation of identity irrespective of self-direction; the place of
exposure in readiness to learn. The chapter concludes by offering implications as it relates to
nursing education and practice, as well as recommendations for future research.
5.1 An introduction to value
According to Perry (1930), value involves not only a claim on choice or preference but
also a reasonable rationale for making such an assertion. Within this study, all participants
described patient interaction and relational practices with children, adolescents, and their
families as important aspects of their practicum experience as these were linkable to the value of
forging a caring therapeutic relationship with patients/clients in the nursing profession.
Additionally, most participants expressed merit in having a variety of learning opportunities
available to them at their respective placement settings as this could enhance their current
knowledge state, which may, subsequently, increase their experience reservoir as they prepare
for future professional roles. Participants' attribution of value was based on the personal and
professional satisfaction they derived from the learning situation. As such, participants conferred
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value to these actions and situations by taking an interest in and attributing preference to one
thing over another (Hart, 1971). Value, therefore, can be said to be dependent upon the feelings
of individual learners, making the concept of value highly subjective (Marzilli, 2016). Marzilli
(2016) conceptualized value as an appealing yet subjective benefit deemed worthy by an
individual. This subjective nature of value implies that what is considered valuable for the
individual participant is contingent on what they deem important (e.g., in their immediate role as
student nurses and their future role as registered nurses).
In the current study, there were commonalities in what participants attributed value to in
their respective practicum settings by virtue of their status as adult learners. This study favored
the psychological definition of adults as individuals “who have arrived at a self-concept of being
responsible for [their] own lives, [that is], of being self-directing” (Knowles, 2005, p. 64). The
researcher considered participants in this study as adults because of their voluntary contribution
to this study and their capacity for reflection during the interview sessions. Additionally, most of
the students in the study were in the final year of their professional nursing education (with two
already working as registered nurses) at the time of data collection, so they may be described as
taking charge of their lives by persevering with their professional nursing aspirations. To
articulate the value of the pediatric placement experience for nursing students as adult learners,
an overview of andragogy and the characteristic of the adult learner is essential.
5.2 Andragogy and the characteristics of adult learners
Understanding what it is to be an adult learner is important in critiquing how learning
happened for this group of participants in their pediatric practicum. Learning in undergraduate
nursing programs is shaped by entry-level competency requirements established by provincial
regulatory bodies (British Columbia College of Nurses and Midwives [BCCNM] in BC.) and

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interpreted through curriculum by each nursing degree granting institution. Andragogy is rooted
in humanistic and pragmatic philosophy, which promotes the self-actualization of the learner and
places value on knowledge gained from practical experience (Holton et al., 2001). This position
suggests that the adult nursing student can recognize what is important to learn and act (guided
by their interests, desires, and contexts) to meet these goals. The humanistic position of
andragogy, therefore, draws attention to the learning needs of the learner and the feelings
associated with learning, linking the necessity for appreciating the emotions that learners have
about the learning situation. On the other hand, the pragmatic position of andragogy points out
the importance of connecting the theoretical and practical content of learning to the “why” in
learning, as neglecting this can result in negative emotions such as being frustrated, disinterested,
or distressed may affect learning. Such emotions, left unchecked, can impede the hands-on
learning that is noted by Knowles (1977) as core to performance in solving real-life problems.
The Andragogical Model, as theorized by Knowles et al. (2005), outlined noteworthy
assumptions about adult education, focusing on individual learning, growth, and attainment.
Andragogy in practice starts from a position of determining the goals and purpose of learning,
which includes both institutional and societal growth. For participants in this study, these were
reflected in the BCCNM professional standards for registered nurses and the wider social
learning attached to clinical practice. For this study, individual and situational differences
involved paying attention to the learner’s unique experiences, which are reflective of the acute
and community care contexts in which practical pediatric learning took place, as well as the prior
exposure to children they may have had by virtue of their personal experiences. Critical to
Knowles’ (1977) theory are four core principles about adult learners' characteristics that resonate
with this study's findings. These are presented here in alignment with the study rather than

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Knowles et al. (2005) model – 1) task-centric orientation to learning, 2) the learner’s experience,
3) capacity for self-direction, and 4) readiness to learn. Examining these characteristics against
the study findings guides the discussion in the following sections, see Figure 5.
Figure 4
The Value of Pediatric Placement for the Nursing Student as Adult Learner

Looking at the principles in more detail, the first learning consideration for the adult
learner is their task-centered nature, that is, the belief that learning should have some usefulness
in the learner’s immediate future (Forrest & Peterson, 2006; Holton et al., 2001). In the current
study, this drew on attending to problem-centered and contextual factors within the practicum
learning experience. The second consideration is that adult learners draw from their past
experiences in the context of their current learning (Forrest & Peterson, 2006; Holton et al.,

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2001). That is, adult learners take pride in and define themselves by their accumulated
experience in their lives to aid learning (Knowles, 1980). For some participants in this study, this
was demonstrated by the utilization of past experiences (e.g., working in a health care setting) as
it transferred to their pediatric practicum settings. Additionally, there was an acknowledgement
by most participants of the possibility of storing up knowledge and skills – as experience
reservoirs – to be employed in future clinical situations. The third consideration is that adult
learners desire autonomy and self-direction in their learning experience (Forrest & Peterson,
2006; Holton et al., 2001). For many participants in this study, this was demonstrated as
developing a sense of identity as most student nurses found a sense of autonomy in working with
children and their families. However, contrary to the characteristics of self-direction, some
participants could not take the initiative for their learning as some learners relied on direction
and guidance from their clinical instructors to utilize available learning opportunities in their
respective practicum settings. The fourth consideration is adult learners’ readiness to learn,
which is based on the perceived applicability of their learning to their real-life situations (Forrest
& Peterson, 2006; Holton et al., 2001). In the current study, this was demonstrated by how
participants welcomed learning situations that illuminated the realities of the nursing profession
as they envisioned their future nursing roles. The four sections that follow explore the concept of
value in relation to the pediatric placement experiences of participants as adult learners.
5.3 The impact of task-centeredness on relationship-building
The adult learner's orientation to learning is “task-centered or problem-centered”
(Knowles, 2005, p. 67). That is, the learner becomes motivated to learn when new knowledge is
presented “in the context of application to real-life situations” (Knowles et al., 2005, p. 67).
Participants in this study were placed in either community (non-traditional) or acute-based

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settings for the pediatric learning component of their pediatric/child-health course. As such, these
settings made up the practicum experience of participants and provided real-life situations to
help augment their learning. The value of the practicum experience for all participants was the
opportunity, or potential when there were no children or adolescents present in the setting, to
interact with children and their families. All participants described this value as “care”; caring is
a central concept in the nursing profession (Cook & Peden, 2017; Eriksson, 2002; Karlsson &
Pennbrant, 2020). For the motive of caring to be realized in nursing professional practice,
Eriksson (2002) emphasized the place of the relationship between the caregiver (i.e., the nurse)
and the one being cared for. The value of caring, and by extension, relationship building, is
evidenced in the Canadian Nurses Association ([CNA], 2017) Code of Ethics. This document
highlights that the “provision of safe, compassionate, and ethical care” is one of the primary
values and ethical responsibilities of nursing (p. 8). In applying this value to their practice,
participants gave clear accounts of their efforts to find common ground with patients in their
respective practicum settings to build therapeutic relationships. For participants, building
relationships was a two-way interaction that involved actively listening to the needs of children,
adolescents, and their families and therapeutic communication. Such learning opportunities
helped students pay attention to and begin to appraise the concerns and needs of their patients.
Therefore, it is reasonable to conclude that for participants in this study, building relationships
with children through a lens of caring was an interactive experience that facilitated their learning.
According to Eriksson (2002), for a caring relationship to be natural and authentic, it
must come from a genuine desire to alleviate suffering. One of the basic assumptions of
Eriksson’s theory of caritative caring is that “caring implies alleviating suffering in charity, love,
faith, and hope,” which can be naturally expressed through “tending, playing, and teaching in a

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sustained caring relationship” (p. 62). For many participants in this study, alleviating the
suffering of children or adolescents focused on tasks and psychomotor skills that students
equated with making their patients feel better. This involved doing something to bring about an
improvement in the child’s or adolescent’s health or wellbeing, which included the performance
of tasks such as medication administration either through intravenous, oral, or subcutaneous
routes, dressing changes for simple and complex wounds, insertion of NG tube to provide
gastrointestinal decompression or an alternate feeding route, etc. Given that the effect of these
medically-oriented tasks is detectable, seeing the improvement of their patient’s physical
condition could explain why participants regarded the performance of these tasks as the
embodiment of caring. Such a dominant biomedical model of health continues within nursing, as
evidenced within this study and similar work in pediatric practicum experience by Studnicka and
O’Brien (2016).
Nursing, being a caring profession, thrives on the therapeutic relationship built between
the nurse (or, in this case, the student nurse) and the patient or client to facilitate the delivery of
collaborative care, making this skill valuable. Although many participants recognized the
importance of getting to know their patients and building relationships with them, only a few
students could associate those caring actions with enhancing their patients’ overall health. This
finding could be explained by the fact that more than half of the participants in this study cared
for well-children needing no medical-related care. Activities performed with these children, such
as playing (or exercising) and meal preparations, were not considered an expression of caring
with the potential for alleviating suffering. This begs the question of the influence of adult
learner task-centric orientation to learning on nursing students’ ability to understand and
appreciate the therapeutic effect of caring relationships in their practice.

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A study exploring what nursing students understood nursing to be after their first clinical
experience found that some participants recognized there was more to nursing than
“administration of treatment alone” (Teskerecei & Boz, 2019, p. 41). For these students, being a
nurse also involved displaying caring behaviours such as smiling at and listening to their patients
(Teskerecei & Boz, 2019). Be that as it may, based on this current study, it can be argued that the
performance of caring behaviours by nursing students may not translate to an appreciation of
how their actions bring about an improvement in the life and health of their patients. This is
based on learners’ problem-centric focus on fixing their patients, which (to them) can only be
unilaterally achieved by performing a skill, thus minimizing the important place of relational
practice in caring for children and their families.
5.4 The experience reservoir of knowledge consolidation
One of the entry-level competencies for the new graduate registered nurse is that they
function as a clinician in their respective practice (BCCNM, 2021). To be an effective clinician,
the registered nurse must integrate “knowledge, skills, judgment and professional values from
nursing and other diverse sources into their practice” (BCCNM, 2021, p 6). As such, the
education of nursing students is geared towards ensuring that upon graduation, they have the
requisite skills and abilities to safely provide nursing care to a range of clients and communities.
One way nursing programs develop their students' professional knowledge and skill are
through practical learning experiences (Canadian Association of Schools of Nursing [CASN],
2015a, 2015b; Ralph et al., 2009; Stoffels et al., 2019). These practicum settings provide students
with opportunities to apply knowledge learned in classroom and nursing laboratory settings to
the provision of care in real-life situations, that is, a “fluctuating external human environment”
(CASN, 2015b, p.10). Additionally, allowing time to consolidate the knowledge gained from

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practice exposure supported the students to appreciate why they were learning something in the
classroom or the clinical setting. In this current study, many participants were excited to enter
their pediatric clinical placement because of the potential to develop task-based skills. Similarly,
Ironside et al. (2014) reported that both student and faculty participants equated learning nursing
with doing tasks in the clinical setting. Coincidentally, this is a cornerstone in the goals of CASN
(2015b) that the clinical placement experience should ideally offer students the opportunity to
“perform psychomotor/technical skills as part of nursing care in the whole human environment
with individuals across the life span” (p. 10).
For participants in this study, their pediatric placement experience was deemed valuable
based on the learning experiences and opportunities available. These included the opportunity to
attain soft skills such as health teaching and communicating with children and hard skills such as
performing head-to-toe assessments or administering medications. Although all participants in
the study verbalized that some form of learning took place in their respective practicum settings
(either through hands-on or observational means), most of them conferred a greater emphasis on
acquiring skills. This was based on participants’ understanding of what the practicum experience
should ideally provide them. That is, in this study, many participants came into their pediatric
practicum sites with a desire to consolidate their theoretical knowledge base relating to caring for
acutely and chronically ill children and adolescents in practice. Indeed, this was similar to reports
by Cowen et al. (2018) that nursing students enter their clinical rotations expecting to learn
psychomotor skills such as physical assessment, dressing changes, initiating intravenous
infusions, and catheterization. Knowing that adult learners largely define themselves based on
their amassed experiences (Knowles et al., 2015), it is not surprising to expect participants to

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prefer learning situations that further enhance their skills level, thereby developing a reservoir of
nursing-related skills.
Another important dimension in the value of knowledge consolidation for participants
was the potential for transferring attained skills and experiences from one care setting to another
(Aita et al., 2017; Lauder et al., 1999). All of the participants in this study came into their
respective pediatric placement settings with knowledge and skills attained from previous
practicum experiences. For a few of these participants, the goal was to tailor those skills and
knowledge acquired in previous learning situations (i.e., acute medical and surgical rotations) to
a pediatric practicum context. This is in line with the work by Lauder et al. (1999). Here, the
assertion is that the effective transfer of knowledge and skills requires the student to be aware of
the content of their stored reservoir of skills and experiences.
In the same way, participants in this study could convey the potential usefulness of the
knowledge and skills gained in their respective pediatric practicum sites to other care settings.
For example, all of the participants placed in both acute and community pediatric settings
verbalized coming away with an improved ability to communicate with children, adolescents,
and their families. Interestingly, this was expressed more often among participants who spent
most of their time in community settings. Additionally, more than half of the participants placed
in acute care settings verbalized gaining the ability to perform a head-to-toe assessment on
children. These acquired experiences became a part of the students’ knowledge and skills
reservoir that may have utility in future clinical situations, especially for students who desire to
pursue a career in pediatric nursing. This highlights the potential of the practical learning
environment to equip students with the ability to reconstruct new meanings and understand
previously acquired knowledge and skills.

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5.5 The formation of identity irrespective of self-direction
One of Knowles’ (1977) core assumptions about the adult learner is that they have a selfconcept of being responsible for their own decisions. As such, they desire self-direction in their
learning experience. Self-directed learning, as proposed by Knowles, is a process whereby
individuals take the initiative in their learning either independently or with the help of others
(Pryce-Miller & Serrant, 2019). This definition presents self-directedness as either a
characteristic of the learner or a goal that the facilitator helps the learner work towards (Van der
Walt, 2019). The capacity of an adult learner to be self-directed is directly related to their ability
to perceive the pre-determined objectives of a learning experience as goals they are striving to
achieve (Van der Walt, 2019). Self-directed learning can therefore be seen as an undertaking
guided by the learner’s self-interest and desire which in some cases can be self-serving. This may
result in students missing out on some learning opportunities at placement by their unwillingness
to work in capacities outside their perceived traditional nursing roles (Reimer-Kirkham et al.,
2005). As such, an effective clinical learning situation is one that either facilitates the
development of – or enables the exercising of – self-direction in learners. The role of nursing
education programs then becomes one of clearly articulating the objectives within the setting to
students and linking these to their future professional practice.
In this current study, a goal that most participants worked towards was developing a
sense of professional identity both as student nurses and as future registered nurses. For some
participants, this entailed working within the scope of a student nurse. Participants came into the
practicum learning environment with preconceived ideas of what nursing should look like, what
their roles should entail, and what new knowledge they should ideally gain from the experience.
As such, there was a limitation in their abilities to be curious. Often, these fixed ideas held by

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students communicated the narrow lens within which they viewed nursing. Few participants
recounted situations at their community pediatric practicum where staff did not fully understand
their expected roles and contributions, which resulted in them fulfilling duties that they perceived
to be unrelated to nursing (such as playing games like hide-and-seek with school-age children).
This sentiment is similarly reported in different literature (Kalyani et al., 2019, Norman et al.,
2005; Sharif & Masoumi, 2005), where student respondents also shared that the roles they took
on in their respective practicum settings were that of a nursing assistant and not valued as a true
nursing experience. This resulted in role conflict and consequently affected participants’ sense of
identity. Accordingly, participants may lack self-direction when their assigned roles at placement
stray from their perceived capability as student nurses. However, when students were tasked with
responsibilities commensurate to their perceived nursing knowledge and skills level, there was a
feeling of personal and professional accomplishment, i.e., a “sense of usefulness” and “becoming
a nurse” (Parchebafieh et al., 2020, p. 5).
In acute practicum settings, participants followed the direction of their clinical instructor
in terms of patient assignments and worked within the pre-determined scope of practice set by
their programs and regulatory body (i.e., in line with BCCNM requirement for entry-level
registered nurses). A few participants in this study highlighted the role that their instructors
played in helping them make the most out of the opportunities available in their placement
settings, a remark contrary to Knowles’ proposed self-directing tendency of adult learners. These
participants described the great length their clinical instructor took to encourage their learning,
especially during periods of downtime. Instructors were said to generate patient scenarios for
students to work through and provide additional training in intravenous medication pumps
(especially when students had no opportunity to use them with patients due to low census on the

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unit). The role of the clinical instructor in socializing students to the practice environment and,
by extension, the nursing profession is similarly documented in works by Browne et al. (2018);
Kalyani et al. (2019); Ogenchuk et al. (2014); and Scully et al. (2010). On the other hand, most
of the participants in community settings described the absence of clinical instructors to role
model expected behaviors and provide structure elements in their respective settings, resulting in
them feeling out of place. Note that nursing students in this study were aware of their learning
preference; however, many thrived best when instructor-directed. As such, participants in this
study were either at the start or in the early stages of recognizing “how” and “when” to be selfdirected in ways that align with the value of becoming a nurse.
5.6 The place of exposure in readiness to learn
Nursing programs in Canada are required to provide students with a “broad knowledge
base in nursing and nursing-related discipline” to bring about a generalist-prepared registered
nurse (CASN, 2015a, p. 10). To accomplish this, the education curriculum for student nurses
should ideally ensure that upon graduation, students will demonstrate knowledge regarding
“healthy work environments including collaborative skills, leadership theories, and effective
team functioning and conflict resolution” (CASN, 2015a, p. 10). One way this can be
accomplished is by exposing nursing students to the realities of professional nursing practice
(Dickson et al., 2006). Knowles (2005) associated readiness to learn for the adult learner in terms
of attaining social and occupational role competencies. This concept was interpreted by
McMillian et al. (2007) to mean the creation of a learning atmosphere that helps learners
“recognize gaps in their knowledge” (p. 90). For participants in the current study, learning took
place in practicum settings. As such, readiness to learn was demonstrated through their ability to
recognize the novelty of caring for children as they envisioned their future reality as registered

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nurses. That is, all of the participants in this study cared for or interacted with children for the
first time in their pediatric acute care or community placement setting, making it a novel
experience for them.
Many of the participants in this study attributed value to the opportunity their practicum
settings afforded them to glimpse the lived experiences of their patients – both children and
adolescents. For example, participants who cared for adolescents with a form of eating disorder
recounted that their previously held misconception about the illness was turned around. This is
comparable to findings from Demir and Ercan (2018), where students described that their
preconception of mental health patients as dangerous shifted after completing their theoretical
and clinical mental health education. Other participants who cared for children living with
chronic illnesses (such as diabetes) came away from their practicum experience with a renewed
appreciation for the child’s resiliency and ability to play and have fun despite their health status.
This finding is similar to Vogt et al. (2011), who reported that students placed at camps for
children with diabetes expressed a renewed appreciation of how exhausting living with diabetes
can be, especially for a growing child. Further, Ranse & Grealish (2006) concluded that students
witnessing care of a health condition clinically (i.e., seeing and assessing a symptom in real time)
was different from reading about the condition in a textbook. Therefore, these learning situations
provided an avenue for participants to discover the meanings children and adolescents attach to
their experience of health and illness, which could aid in their development of a holistic
understanding of health.
For some participants in this study, being immersed in their pediatric placement
experience was an opportunity to socially learn the unit’s or community organization’s caring
culture by observing skilled nurses and multidisciplinary team members. Some participants

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recounted observing certain practices they believed to be unique to pediatric nursing as they had
never experienced these attitudes and skills in their previous placement sites. One of these was
seeing members from different disciplines actively collaborating in caring for a sick child. For
these participants, the practicum experience brought the concept of a multidisciplinary team to
life. Although participants who recounted these experiences did so from their acute care
experience, working in teams is not exclusive to hospital settings. For example, Makaroff et al.
(2013) reported that students placed in camp settings for their community pediatric practicum
were provided the opportunity to engage in collaborative practice with the multidisciplinary
camp staff that comprised of other university students within professional disciplines such as
education, medicine, physiotherapy, and social work. Working effectively with health care team
members is an entry-to-practice requirement for the new graduate nurse as both clinician and
communicator (BCCNM, 2021). CASN (2015a) also highlights the need for nursing programs to
prepare students to adequately collaborate with members of the health care team to provide
quality nursing care. As such, providing opportunities for students to experience first-hand the
realities of the nursing work environment can help them develop positive professional attitudes,
which may positively influence their readiness to learn as students and practice as future nurses
(Tseng et al., 2012). The next section discusses the impact of this study on nursing education and
nursing practice, as well as recommendations for future research.
5.7 Implications for nursing education and nursing practice
5.7.1 Nursing education
The results of this study offer direct implications for nursing education, given the
importance for nursing programs and their faculties alike to know what students see value in
learning at their pediatric clinical placements. Despite the new learning in both community and

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acute pediatric placements, participants described community settings less favorably. Pediatric
placements in community settings are well-positioned to be high-quality practicum experiences;
however, they often lack structure and are unfamiliar to nursing students who may have spent
most of their previous practicum settings in traditional placement sites like hospital in-patient
units. Therefore, nursing programs can highlight the place of community practicum in pediatric
practical learning by adequately preparing their students for the experience. Knowing that adult
learners need to understand why something is important to do or learn, this can involve providing
clear communications to their students about what their community practicum experience would
entail and linking these experiences to their future occupational roles as nurses. In doing so,
nursing students are not only going into their respective practicum knowing what is expected of
them by their program, the professionals in the setting, and the clients they will be caring for or
interacting with but are also able to imagine pediatric nursing outside of the hospital or clinic.
Further to this, this study indicated a disconnect between students' understanding of their
scope of practice and what they are met with in their practicum settings. By virtue of the
knowledge attained in the first few years of their education, nursing students may overestimate
their position and abilities in practicum settings. This is sometimes done to assert themselves as
advanced beginners and a legitimate care team member, as opposed to the novice status they
currently occupy as learners. This speaks to the need for an established and well-defined scope of
practice for nursing students in practicum settings so that students are not short-sighted in their
understanding of the numerous roles they can perform as part of their practicum experience.
5.7.2. Nursing practice
This study offered a direct implication for the practice of nursing students and, by
extension, professional nursing practice. Historically, nursing has a strong task-focused structure

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that is pervasive even in contemporary times (Henderson et al., 2012). As this study highlights,
the priority that nursing students place on psychomotor skill acquisition and tasks in acute
placement settings are, in part, socialized priorities as a predictor of competency in the nursing
profession. As such, for nursing students in practicum settings, the desire for skills attainment
necessary to fulfill the role and responsibility of the profession is often at the forefront.
Consequently, nursing students, at practicum, in their quest to learn about the profession's norms
and fit into their respective work environments, seemed to internalize this task-orientated
approach to care, sometimes at the expense of genuine patient interaction. This speaks to the
need for nurses to be seen as more than task and skill doers so that the holistic nature of nursing
care is not lost in the new generation of nurses.
Further, this study indicated that some students showed a lack of understanding of the
role of pediatric nurses in community settings and what nursing can bring to these settings. This
could be explained by the fact that most students had only been exposed to placement settings in
acute care settings before commencing their pediatric rotation. As such, nursing students may
perceive that nurses typically work in hospital settings. There is, therefore, the need for
practicum experiences utilized in nursing education programs to focus on not just acute but
community settings as well. Additionally, nursing programs could utilize community settings
with a strong nursing presence for practicums. This will provide an avenue for students to engage
with and learn from professional nurses while coming to a better understanding of what it means
to “nurse” in these settings.
5.7.3 Recommendations for future research
The first recommendation relates to the value of learning facilitators in the pediatric
placement experience. Clinical instructors played a pivotal role in relation to directing learning

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for students. Nursing students valued having a clinical instructor with a professional nursing
practice they could aspire to. Indeed, nursing students gain experience in practicum when they
observe and learn from more experienced nurses as they look forward to becoming nurses.
Further research is necessary to understand how clinical instructors contribute to self-direction in
nursing students as well as characteristics of practicum learning environments that promote the
success of clinical instructors as learning facilitators.
The second recommendation relates to the current delivery method of practical learning
in pediatrics. In this study, although readiness to learn was higher for learners in the pediatric
acute care placement setting, most participants in both community and acute settings were
excited to develop their ability to interact and build relationships with children and their families.
This level of interaction is something that students believed could only be achieved through
practical, immersive learning in a health care environment. Additionally, although not a focus of
this study, participants who described virtual learning as one method through which their
programs augmented practical pediatric learning communicated a preference for the in-person,
non-simulated care environment because of the higher realism and personal interaction the latter
afforded. Additionally, the shortage of pediatric practicum sites may result in the utilization of
simulated learning environments by nursing programs determined to provide practical
experiences to their students despite a lack of traditional clinical space. Therefore, future
research should explore the place of virtual learning and face-to-face simulation in the practical
pediatric learning of task-centric nursing students.

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Chapter 6: Conclusion
This chapter summarizes the study’s research exploration into the pediatric placement
experiences of undergraduate nursing students. The section starts with synthesizing the study’s
findings, followed by a discussion of the study’s strengths and limitations. The chapter closes
with concluding remarks on the importance of understanding nursing students' experiences as
users of the nursing education system.
6.1 The pediatric practicum placement experience of undergraduate nursing students
This research study explored the pediatric placement experience of undergraduate nursing
students to understand the value they ascribed to the experience. To meet this goal, it was
necessary to consider the characteristics of nursing students as adult learners, as theorized by
Knowles (1977). Adult learners are said to have a task-centric orientation to learning, crave selfdirection in their learning, consider experience worth accumulating, and learn based on real-life
applicability. In this study, participants valued learning opportunities that they considered useful
and meaningful as they continued their journey to becoming new graduate nurses. All of which
impacted their readiness to learn within their respective placement sites. These learning
opportunities included the opportunities the placement experience provided participants to 1)
interact and build a relationship with children, adolescents, and their families, 2) consolidate
their theoretical knowledge in practice by developing relevant communication skills and
engaging in task-based learning, 3) attain a sense of identity as they socialize into the role of a
student nurse, and 4) become acquainted with the caring culture and practice environment of a
variety of acute and pediatric care settings.
Participants in this study were placed in various community and acute care settings for
their practicum experience. This is contrary to findings from the literature review conducted to
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inform this study that most nursing programs utilized community settings due to a shortage of
placement sites in acute pediatric settings. However, regardless of the settings utilized by their
respective Schools of Nursing, all participants came away from their practicum experience with
new learning in the form of skills, knowledge, or attitude. In this study, it was discovered that in
addition to the learning objectives prescribed by the different nursing programs, nursing students
commenced the practicum setting with personal learning desires they hoped to accomplish–
which may be similar to or separate from the institution’s learning objectives. As such, though
this was not directly explored in this study, nursing students appeared more likely to value a
placement experience and, by extension, perceive it as a positive learning experience when their
expectations and those prescribed by their institution tallied with the reality they are met with at
practicum.
6.2 Limitations
Findings from this study address knowledge gaps in current literature by focusing on the
narrative experiences of students, who are the main users of the education system, and whose
voices are limited in nursing education research. Despite this, there are limitations within the
study that must be acknowledged. First, most participants in the study completed their pediatric
practicum experience during the beginning stage of the COVID-19 pandemic, and they faced
many restrictions and frequent changes to regulation and practicum opportunities. As a result,
participants were in their respective placements for a shorter duration and had fewer experiences
to draw from as they answered the interview questions. The second limitation was the
researcher’s desire for a qualitative research study that spanned multiple jurisdictions was
impeded. The study’s sample comprised participants from only three out of the six nursing
schools where recruitment occurred, resulting in a less diverse sample. Lastly, the member check

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technique implemented to add credibility and trustworthiness to the study’s findings was
discontinued midway through the data collection process due to a lack of participant
engagement. Successfully carrying out the member checking process with all participants could
have added an extra layer of validity to the study’s findings.
6.3 Concluding remarks
This research study aimed to explore the pediatric practicum experience of undergraduate
nursing students in British Columbia. The importance of this study is apparent given the dearth
of research in the area of pediatric practicum settings utilized as a part of the education of student
nurses, as well as the limited representation of students' voices in these publications. As such,
this study endeavoured to incorporate rich narratives in participants’ own words to assert the
importance of nursing students’ contribution to improving teaching and learning in nursing
education. Additionally, by interpreting findings from this study through the lens of Knowles’
adult learning theory (1977) and consequently viewing nursing students as adult learners in their
own right, nursing programs are encouraged to reflect on how the theory’s andragogical
principles can be applied to the practical learning opportunities offered in their respective
programs.

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Appendix A
Search strategy by databases
CIHAHL
Keywords

Suggested subject
terms

Searches

ERIC

MEDLINE (Ovid)

Google Scholar

Undergraduate,
nursing program,
pediatric/child
health, practice
placement,
practicum, nursing
education
Clinical clerkship,
preceptorship,
education, nursing;
education, nursing;
pediatric, child,
health, children,
infant, adolescents;
nursing, practical;
preceptorship;
education, nursing,
baccalaureate

Undergraduate,
nursing program,
pediatric/child
health, practice
placement,
practicum, nursing
education
Clinical clerkship,
preceptorship,
education, nursing;
education, nursing;
pediatric, child,
health, children,
infant, adolescents;
nursing, practical;
preceptorship;
education, nursing,
baccalaureate

Undergraduate,
nursing program,
practicum, child
health, pediatric
nursing

Pediatric nursing,
nursing education,
practicum

Education, nursing
baccalaureate;
students, nursing;
faculty, nursing;
preceptorship; child,
preschool, child
health; child, infant;
pediatric nursing

N/A

S1= clinical
clerkship OR
preceptorship OR
baccalaureate OR
practicum
S2 = education OR
nursing OR school
S3 = (pediatric or
child or children or
infant or adolescent)
OR health
S4 = nursing OR
practical OR
(pediatric or child or
adolescent)
S5 = education OR
nursing OR
baccalaureate
S6 = nursing AND
student
S7 = learning OR
experience
*All within Abstract

S1= clinical
clerkship OR
preceptorship OR
baccalaureate OR
practicum
S2 = education OR
nursing OR school
S3 = (pediatric or
child or children or
infant or adolescent)
OR health
S4 = nursing OR
practical OR
(pediatric or child or
adolescent)
S5 = education OR
nursing OR
baccalaureate
S6 = nursing AND
student
S7 = learning OR
experience
*All within Abstract

S1 = education or
nursing or
baccalaureate AND
students or nursing
S2 = faculty or
nursing
(subheading:
education)
S3 = pediatrics
(subheading:
nursing, education)
S4 = preceptorship
S5 = child or
preschool or child
health AND child or
infant
S6 = pediatric
nursing
(subheading:
education)
S7 = S1 AND S2
AND S3 AND S4
AND S5

“Pediatric nursing”
“nursing education”
“practicum”

114

115
field*
S8 = S1 AND S2
AND S3 AND S4
AND S5 AND S6
AND S7
S1 = 7,864
S2 = 565,609
S3 = 1,279,233
S4 = 721,002
S5 = 416,130
S6 = 35,168
S7 = 125,807
S8 = 884

field*
S8 = S1 AND S2
AND S3 AND S4
AND S5 AND S6
AND S7
S1 = 9,971
S2 = 1,022,159
S3 = 369,389
S4 = 356,804
S5 = 528,755
S6 = 4, 570
S7 = 137, 039
S8 = 76

S8 = S1 AND S3
AND S4
S8 = S1 AND S4
S9 = S1 AND S5
AND S6
S1 = 9,515
S2 = 155
S3 = 7,980
S4 = 1,098
S5 = 2,292,415
S6 = 0
S7 = 0
S8 = 0
S9 = 67

Limiters

Full text, English
language, academic
journal (excluding
report, opinion
pieces and
dissertations), year:
2000 – 2020.

Full text, academic
journals (excluding
report, opinion
pieces and
dissertations), year:
2000 – 2020,
English language

Year: 2000 – 2020;
publication type:
journal article
(excluding reports,
opinion pieces and
dissertation);
language: English

Results after
limiters
Articles included in
review

138

9

47

Year: 2000 – 2020;
publication type:
review articles
(excluding book
chapters, opinion
pieces, reports, and
dissertation);
language: English
63

2

0

7

2

Results

1,270

115

Campbell &
Brown, 2008,
North
Carolina,
U.S.A.

Schwartz &
Laughlin,
2008,
Nebraska,
U.S.A.

Harrison &
Laforest,

3

4

5

2

Schell,
Herrman, &
Plowfield,
2001,
Delaware,
U.S.A.
Schmidt,
2007,
Kansas,
U.S.A.

Author(s),
Year,
Geography

1

#

Described two innovative clinical
placement sites - Camp Rotary &

Described the creation of the health
teddy clinic which is a preschool
setting that provided nursing students
the opportunity to work with children
and provide health teachings through
the use of teddy bears.
Described a merger between Creighton
University School of Nursing and
private schools in Nebraska that
created pediatric placement
opportunities for nursing students in
community settings.

Described the use of a student-centered
approach to delivering a theoretical and
clinical camp nurse course.

Described the development of a
theoretical and clinical elective course
titled "teaching wellness to children" to
meet the service-learning needs of
enrolled nursing students.

Purpose/Aim

The binder-ball
continuum of pediatric

Service-learning
framework; qualitative
descriptive research.

Qualitative descriptive;
analysis of students' self
evaluation

Service-learning
framework; qualitative
descriptive research.
Critical incident journals
of nursing students were
analyzed
Qualitative descriptive;
analysis of student's selfevaluative report

Research type and
methods

N = unknown
Program type

N = unknown
Program type
unknown

N = unknown
Associate
degree
nursing
program

N = unknown
Three-year
nursing
program.

N = 14
Accelerated
degree

Sample

Findings

116

Placement duration unknown. Nursing students
served an average of 30 schools - inclusive of
elementary, middle, and secondary. Learning
outcome of nursing students: engaged in health
screening and health education, created a website
containing useful community resources that can be
assessed by participating schools.
Placement duration at Camp Rotary not stated;
placement at SMILE = 10 weeks (2 hrs/week)

Theory = 25 hrs
Clinical placement = 30 hours (6 hrs x 5 days).
Nursing students learning outcome: critical
thinking, time management, health teaching, team
building, and conflict resolution skills; and the
ability to establish relationship with children.
Theory = 16 hrs
Clinical placement = 64 hrs Themes from students'
evaluations: caring for children, earning children's
trust, critically thinking, communicating with
children and parental collaboration.
Clinical placement = 6 weeks (three days/week).
Nursing students learning outcome: engaged in
health teaching and promotion activities, gained
knowledge of children growth and development
and built therapeutic communication skills.

Summary of studies on pediatric practicum included in the review (N=15, date range 2001-2020)

Appendix B

Vogt, Chavez,
& Schaffner,
2011, Ohio,
U.S.A.

Rossman,
Dood, &
Squires, 2012,
Michigan,
U.S.A.

Samawi,
Haras, &
Miller, 2012,
Illinois,
U.S.A.

Makaroff,
Scobie,
Williams, &
Kidd, 2013,
British
Columbia,

6

7

8

9

2011,
New
Brunswick,
Canada.

Explored nursing students' perception
of planning and delivering health
promotion activity as part of the Health
Promotion Teaching Project (HPTP) in
their pediatric placement at an
ambulatory care clinic.
To describe a partnership between
university of Victoria School of
Nursing and British Columbia (BC)
Easter Seal Camps which led to the
creation of an innovative pediatric
placement for nursing students.

Explored if undergraduate nursing
students could perform the school
nurse role in a way that brings about
quantifiable health benefits to enrolled
children and the elementary school
community.

Examined the impact a service-learning
experience at a diabetic camp for
children had on nursing students'
childhood diabetic knowledge as well
as what their experience were like at
camp.

Sensory Motor Instructional
Leadership Experience (SMILE) - that
afforded nursing students the
opportunity to care for children with
developmental and intellectual
challenges.

Qualitative study using
an anonymous
questionnaire over a
four-semester period.
Fink’s significant
learning taxonomy.
Qualitative descriptive
using written selfreflective narratives of
nursing students.

Mixed method - analysis
of a pre and post
knowledge test
administered to students
as well as their reflective
journal entries. Servicelearning methodology
Qualitative descriptive

health care framework;
qualitative descriptive
study - features
evaluation of students'
journal entries.

N = 62
Baccalaureate
nursing
program

N= 85
Baccalaureate
nursing
program

N = 20
Baccalaureate
nursing
program

N = 26
Baccalaureate
nursing
program

unknown

117

Nursing students learning outcome:
Camp rotary – medication administration,
tracheostomy care, and catheterization skills;
communication and interpersonal skills
SMILE – assessed children's developmental
milestones and planned activities for them;
communication and interpersonal skills.
Clinical placement = one week. 13 out of 26
students completed the knowledge test. No
statistically significant difference was found in
knowledge score before and after the theory and
practicum completion (t=1.78; p=0.055). Themes
from students’ journal analysis = fatigue, anxiety,
responsibility, confidence, and responsibility.
Clinical placement = 20 hrs (4 hrs/week x five
weeks). Nursing students learning outcome:
performed one screening classroom project, one
health education teaching session, and provided
one-on-one education for children with chronic
health concerns; obtained health aids (such as
eyeglasses), dental appointments, and medications
(such as antihistamines) for children in need of
them.
Placement duration unknown. Themes from the
data were: self-discovery in the learning process,
perceived lack of knowledge, receptivity to
learning, learning to communicate, the impact of
health education on health outcome, and
application of theory to practice.
Clinical placement = 10 weeks ( ~380 hrs).
Nursing students learning outcome: providing
client-centered care, health teaching, and working
in teams; an intimate sense of the nurse-client
relationship.

117

Schultz,
Krassa, &
Doran, 2019,
Illinois,
U.S.A.

Quinn &
McAuliffe,
2019,
Massachusetts,
U.S.A.
Hendrickx,
Pelzel,

13

14

15

Pohl, Jarvill,
Akman, &
Clark, 2017,
Illinois,
U.S.A.

12

11

10

Canada.
Hensel,
Malinowski,
& Watts,
2015, Indiana,
U.S.A.
Studnicka &
O'Brien, 2016,
Ontario,
Canada.

Described the use of two different
children camps (visual and performing

Described “a pedagogical approach”
guided by the Whole School, Whole
Community, Whole Child Model
(WSCC) where elementary schools
were used as practicum sites to bring
about a dual benefit – for children and
nursing students.
Described the benefits and barriers of
pediatric placements in a public K-12
school setting.

Compared the pediatric knowledge and
clinical simulation performance of
students placed in community settings
via the America's promise school
project (APSP) versus those placed in
traditional hospital settings for their
pediatric practicum.

Described the creation of a camp
clinical during the fall/spring semester
that catered to the pediatric placement
needs of nursing students enrolled in a
baccalaureate (BSN) program.
Explored nursing student’s perception
of Non-traditional Clinical Placement
(NTCP) in child health prior to and
after commencing their practicum.

Qualitative descriptive

Qualitative, descriptive;
analysis of students'
reflective journal.

Qualitative; the WSCC
framework.

Descriptive comparative
design. Evaluative
instruments: a 60 item
multiple-choice
examination and a 22item Creighton
Simulation Evaluation
Instrument

Qualitative study using
analysis of students'
online reflective entry
and focus group
discussion
Qualitative with pre and
post semi-structured
focus groups

N = unknown
Accelerated

N = 38
Baccalaureate
nursing
program

N range = 2432
Baccalaureate
nursing
program.

N = 79 (32
traditional, 42
community)
Baccalaureate
nursing
program

N = 13
Collaborative
nursing
program

N=9
Baccalaureate
nursing
program

Clinical placement:
Camp 1 = duration unknown

118

Clinical placement = 6 weeks. Placement settings
included childcare and community centers,
schools, and agencies for children with disabilities.
The central theme from the interviews was "where
is the nursing?" which was further divided into
placement value and role of the nurse.
Clinical placement: Traditional model = 48 hrs
Community model = 96 hrs Difference in pediatric
knowledge between the hospital- and communitybased groups measured using an independent t-test
- result showed no statistically significant finding
(CP = 0.396). The rated pediatric performance as
measured by the Mann-Whitney u test showed no
significant difference in mean score in all
measured subscales.
Clinical placement = 6 weeks (4 hrs/week).
Nursing students learning objectives: classroom
observation and assessment; development, and
presentation of four health lessons; evaluation of
the effectiveness of organised pick-and play
activity; and assessment of the school and
community environment.
Clinical placement = 2 days.
Themes from data analysis: benefits of the clinical
experience, suggestions for improvement, and an
appreciation for the school nurse role.

Clinical placement = 56 hrs. Nursing students
learning outcome: providing patient-centered care,
attainment of Quality and Safety for Nursing
(QESN) competencies.

118

Burdette, &
Hartung, 2020,
South Dakota,
U.S.A.

arts residential camp; residential camp
for children with diabetes) as
alternative pediatric placement sites for
nursing students.

BSN program

119

Camp 2 = 10 – 12 hrs/day x 1 week.
Nursing students learning outcome:
Camp 1 - Medication administration and treatment
of minor acute injuries.
Camp 2 –carbohydrate count, medication
administration, and blood sugar testing.

119

Appendix C
Organization Permission Form attached to email requesting permission from different Schools of
Nursing

Organization Permission Form
We have read the information presented in the information letter about a study being conducted
by Oghenerukevwe Onororemu, a Master of Nursing Science Student at the university of
Northern British Columbia under the supervision of Dr. Caroline Sanders. We have had the
opportunity to ask any questions related to this study, to receive satisfactory answers to our
questions, and any additional details we wanted.
We are aware that the name of our organization will only be used in the thesis or any
publications that comes from the research with our permission. We were informed that study
participants may withdraw from participation at any time without penalty by advising the
researcher.
We have been informed this project has been reviewed by and received ethics approval through a
harmonized review process (H21-00463) and that questions we have about the study may be
directed to Oghenerukevwe Onororemu at 647-716-1019 or by email onororemu@unbc.ca and
Dr. Caroline Sanders at 250-960-5848 or by email caroline.sanders@unbc.ca
We were informed that if we have any comments or concerns with this study, we may also
contact the UNBC Office of Research at 250 960 6735 or by e-mail at reb@unbc.ca
Oghenerukevwe, Onororemu, Master’s Candidate
Department of Nursing, University of Northern British Columbia
Dr, Caroline Sanders, Associate Professor
Department of Nursing, University of Northern British Columbia
We agree to help the researchers recruit participants for this study from among our enrolled
nursing students (in year 4) who have completed practicum in child health or pediatrics
YES or NO
Program Chair/Dean Name: __________________________________ (Please print)
Program Chair/Dean Signature: ____________________ Date: ___________________
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Letter Requesting Permission from Student Nursing Association

Permission to Recruit Students through [insert institution] Student Nursing Association
Date: x
To whom it may concern:
RE: Permission to Conduct Masters Thesis Research Study (H21-00463)
My name is Oghenerukevwe Onororemu; I am a Registered Nurse and am currently enrolled in
the Master of Nursing Science program at University of Northern British Columbia (UNBC)
under the supervision of Dr. Caroline Sanders. I am writing to request [insert association’s name]
assistance with a research project I am conducting as part of my master’s thesis. This harmonized
research study has received ethical approval [H21-00463] from the Research Ethics Boards of
five different Schools of Nursing, yours inclusive. My study is titled: Exploring the Practical
Pediatric Learning Experiences of Undergraduate Nursing Students.
The study is inspired by the dearth of research that focuses on practical pediatric education in
baccalaureate programs. The study aims to: 1) Explore the placement experiences of nursing
students who are currently enrolled in or have completed a clinical pediatric course, and 2)
Describe the value that nursing students ascribe to their respective placement sites. Nursing
students from five different School of Nursing in British Columbia will be invited to participate
in this study. The knowledge gained from this study has the potential to provide insight focused
on students appreciation of their placement sites, and the extent to which the placement
environment stimulated students’ growth and maturation. Knowledge and information generated
from this study may provide nursing programs and faculty members with a rich insight into the
value of pediatric placements. The study’s finding will be communicated in my masters
dissertation and in some nursing academic journals while maintaining the privacy of all
participating students. At the point of research publication, data from this study may be made
available at the discretion of journals and granting agencies.
It is my hope to connect with three to four students from your nursing student group who have
completed a child health/pediatric placement experience (particularly those in their third and/or
fourth year). I believe students, as primary users, and consumers of the nursing education system,
come with unique understanding and insights relating to their learning which my study hopes to
explore. The research study will entail a one-hour, audio-recorded, semi-structured interview
with consenting student participants via Zoom. To appreciate participating students for their
time, they will be emailed a $10 digital Tim Hortons gift card. There are no foreseeable risks in
participating in this study. However, due to the unpredictable nature of interviews, students will

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be provided with the BC mental health support line should questions from the interview create
overwhelming feelings for them.
Students will be asked to give their written or verbal consent before the research begins. They
will be reassured that they can withdraw their permission at any time during the interview up
until the point of data analysis without any penalty; during which their data will be permanently
destroyed and will not be included in the final manuscript. Their responses will be treated
confidentially, and identities (their names and the name of the school) will be anonymous - at
transcription, data will be stripped of any identifying participant characteristics and will be
replaced with pseudonyms. The original audio recording and transcription will be kept for five
years post completion of the masters’ thesis, after which it will be permanently deleted. Audio
recordings will be stored safely in an encrypted file in the researcher’s password-protected
computer. Paper copies of interview materials will be stored in a locked cupboard when not
actively in use; they will be securely shredded after the successful masters’ thesis defense.
Recruitment for this study will be done virtually, and as such, I would appreciate your assistance
in sharing the letter of initial contact for my study (which is also attached) to student members
via your social media group page or your student email list. The letter contains a study overview,
including: the criteria for eligible participants, goals of the study, the data collection method to
be utilized, compensation for participation, and researcher contact details. If a student is
interested in participating, they will be invited to contact me and will be provided with an
information letter that explains the study in further details.
If you have any questions regarding this study, please contact me using the contact information
provided at the bottom of this letter. You may also contact my supervisor as well. Any comments
or concerns you may have with this study can also be addressed to UNBC Office of Research at
250 960 6735 or by e-mail at reb@unbc.ca
As a knowledge translation output, I will share a summative of the findings in a short report
and/or discussion with each School of Nursing involved in recruitment
Please complete the next page of this form and revert via email to indicate your consent. I look
forward to a favorable response and I thank you in advance for your assistance with this project.
Yours sincerely,
Oghenerukevwe Onororemu, MScN (candidate)
Email : onororemu@unbc.ca Cell : 647-716-1019
Dr. Caroline Sanders, Graduate research Supervisor
Email: Caroline.Sanders@unbc.ca Office: 250-960-584
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123
Student Nursing Association Permission Form
We have read the information presented in the information letter about a study being conducted
by Oghenerukevwe Onororemu, a Master of Nursing Science Student at the university of
Northern British Columbia under the supervision of Dr. Caroline Sanders. We have had the
opportunity to ask any questions related to this study, to receive satisfactory answers to our
questions, and any additional details we wanted.
We are aware that the name of our institution will only be used in the thesis or any publications
that comes from the research with our permission. We were informed that study participants may
withdraw from participation at any time without penalty by advising the researcher.
We have been informed this project has been reviewed by and received ethics clearance through
a harmonized review by UBC Behavioural Research Ethics Board and that questions we have
about the study may be directed to Oghenerukevwe Onororemu at 647-716-1019 or by email
onororemu@unbc.ca and Dr. Caroline Sanders at 250-960-5848 or caroline.sanders@unbc.ca
We were informed that if we have any comments or concerns with this study, we may also
contact the UNBC Office of Research at 250 960 6735 or by e-mail at reb@unbc.ca
Oghenerukevwe, Onororemu, Master’s Candidate
Department of Nursing, University of Northern British Columbia
Dr, Caroline Sanders, Associate Professor
Department of Nursing, University of Northern British Columbia
We agree to help the researchers recruit participants for this study among our network of nursing
students
YES or NO

Group Admin/President Name: _________________________________________ (Please print)
Group Admin/President Signature: ______________________________________
Date: ___________________________________________________

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Appendix D
Information Letter
Dear Student,
Re: Research Study: [Exploring the Practical Pediatric Learning Experiences of Undergraduate
Nursing Students]
I am writing to inform you of a thesis study that aims to explore the learning experience of
students who have undergone the practical portion of their pediatric course/curriculum.
The principal researcher name, Rukevwe Onororemu is a Master of Nursing Science Student at
the University of Northern British Columbia (UNBC). This study, a masters thesis project, is
being undertaken under the supervision of Dr. Caroline Sanders, an Associate Professor in the
School of Nursing.
The research team is trying to determine what students like yourself valued about your practical
placement in pediatric and the experiences that challenged your view of nursing. Data collection
for the study will be in form of a semi-structured interview that takes place virtually (through
Zoom) Each interview will last approximately one hour, and you will be offered a $10 digital
Tim Hortons gift card as a thank you for your time.
I am asking you to participate in this research because you meet the inclusion criteria of being
enrolled in a nursing program within British Columbia and have completed the practicum aspect
of a child health/pediatric course within the past 12 months.
Taking part in this study is entirely up to you. You have the right to refuse to participate in this
study. If you decide to take part, you may choose to pull out of the study at any time without
consequence.
For more information about the study or to arrange for your participation, contact Rukevwe
Onororemu at onororemu@unbc.ca or 647-716-1019.
Sincerely,
Rukevwe Onororemu
BScN, MScN candidate, UNBC.

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125
Appendix E
Consent Form
Project Title: Exploring the Practical Pediatric Learning Experiences of Undergraduate Nursing
students [H21-00463]
Who is conducting the study?
Principal researcher name: Oghenerukevwe Onororemu, BScN, MScN candidate
Program/Department/School: School of Nursing, University of Northern British Columbia
(UNBC), Prince George, BC V2N 4Z9
Email address: onororemu@unbc.ca
Cell / office phone number: 647-716 1019
Supervisor’s name and position: Dr. Caroline Sanders, Associate Professor, School of Nursing
Office phone number: 250-960-5848
Email address: caroline.sanders@unbc.ca
Why are we doing this study?
The growing shortage of clinical placement sites, especially in areas like pediatrics, have led to
the usage of non-traditional placement sites like schools and camps in nursing schools struggling
to secure sought-after hospital placements for their students. We are interested in discovering the
learning experience of students who have undergone the practical portion of their pediatric
course/curriculum. We are asking you to participate in this research because you meet the
inclusion criteria of being enrolled in a nursing program within British Columbia and have
completed the theoretical and practical aspect of the child health/pediatric course within the past
12 months. The research is being conducted as a master’s thesis project at UNBC and
participation is completely voluntary. You are free to withdraw from this study at any point
during the interview and before data analysis takes place. You are also free not to answer any
questions that make you feel uncomfortable during the interview. Also, note that some of the
information (albeit de-identified) that will be learnt from you in the duration of this interview
will be shared with the supervisory committee members. Additionally, at the point of research
publication, data from this study may be made available at the discretion of journals and granting
agencies. Please take the time to read this carefully and do not hesitate to ask for clarification on
any aspect of this information piece.
How will the study be conducted?
If you choose to take part in this study, you will be asked to participate in a semi-structured
interview (online through Zoom) where we will ask you questions about your pediatric practical
learning experiences. The interview sessions will take about 60 minutes of your time. The
interview will be recorded via the Zoom platform (and with an audio recorder as a backup
measure), and a transcript will be produced. If interested, you will be sent your transcribed data
and given the opportunity to check its accuracy. The research study is independent of your
School of Nursing so any information shared will not affect your academic status
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126
Is there any way that participating in this study would harm you?
There are no known risks to you for taking part in this study. However, some of the questions we
ask might upset you, for example, if you had to speak about a negative placement experience.
Please speak up at any point during the interview should this happen. For mental health support,
please call the BC crisis line at 310-6789. This service is toll-free and available 24 hours a day, 7
days a week anywhere in BC.
What are the benefits of participating?
Taking part in this study will not help you directly, however, information gathered might prove
useful for Schools of Nursing looking improve the pediatric placement experience of incoming
students. The information you share will help the researcher in planning future work which
includes dissemination to nursing programs.
How will your privacy be protected?
All the information provided for this study will be treated confidentially – only authorized
personnel will have access to the interview transcripts. Your anonymity will be respected – no
information obtained during the study will be discussed with anyone outside of the research
team. All interview data shared with the research team will be de-identified and devoid of any
personal information. Any narrative content, or direct quotations from the interview that are
made available through academic publication or other academic outlets will be kept anonymous
(using pseudonyms) so that you cannot be identified. However, please note that I may be legally
and/or morally obligated to share freely disclosed information that identifies risk to safety of self
or others (i.e., reports of professional misconduct or abuse within clinical settings) to the
appropriate authority – namely the program head or Chair of the corresponding institution –
under the Health Professions Act. All documents and audio recording will be identified by code
number, encrypted, and stored in a password-protected laptop. The master list containing the
codes, pseudonyms and email addresses of participants will be saved in a separate encrypted
folder in my password-protected computer and any hard copies will be stored securely in a
locked cabinet accessible only to the researcher. The original audio recording and transcription
will be kept for 5 years post completion of the masters’ thesis, after which it will be permanently
deleted. Paper copies of interview materials will be stored in a locked cabinet located in the
researcher’s home office when not actively in use; they will be securely shredded after the
successful masters’ thesis defense.
Will you be paid for taking part in this study?
We will offer you a $10 digital Tim Hortons gift card for the time you take to be in this study. It
will be emailed to you (using the email address you provide to us) at the end of the interview
session.
Study Results
The results of this study will be reported in my graduate thesis and may also be published as
articles in academic journals. If you wish to participate in a member check where interview
transcripts will be sent back to you for a chance to check for accuracy, please indicate on the
consent page by providing your email address. If you choose to do this, a confidential email will
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be sent to you through the sync.com platform containing your interview data; you will be
required to return the corrected piece of document to me in one week. If you wish to receive a
copy of (or a link to) the final publication, please indicate so on the signature page by providing
your email address. During publication, I may be required by granting agencies and journals to
make findings and/or data from your interview available as a show of trustworthiness.
Contact for Information about the Study
Please contact the principal researcher, Rukevwe Onororemu (phone: 647-716-1019
email: onororemu@unbc.ca) if you have any questions and/or require any further information
about aspects of this study.
Contact for Concerns or Complaints
If you have any concerns or complaints about your rights as a research participant and/or your
experiences while participating in this study, contact the UNBC Office of Research at 250 960
6735 or by e-mail at reb@unbc.ca
Participant Consent and Withdrawal
Taking part in this study is entirely up to you. You have the right to refuse to participate in this
study. If you decide to take part, you may choose to pull out of the study at any time up until the
point of data analysis without giving a reason and without any negative impact on your class
standing. If this happens, your information and data will be permanently deleted. However, once
the data have been analyzed and results made available, it will become impossible to withdraw
your data.
CONSENT
I have read or been described the information presented in the information letter about the
project:
YES
NO
I have had the opportunity to ask questions about my involvement in this project and to receive
additional details I requested.
YES
NO
I understand that if I agree to participate in this project, I can withdraw my contributions at any
time up to the point of data analysis, during which my data will be permanently destroyed
YES
NO
I understand that participating in this interview means that quotes from my data may be used in
research publications relating to this study and made available to granting agencies and journals.
YES
NO
I have been given a copy of this form.
YES
NO
I agree to be audio recorded
YES
NO

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128
I agree to be emailed a digital Tim Hortons gift card as a “thank you” for my time. If yes, please
provide email address here: ___________________
YES
NO
Follow-up information (e.g., to review interview transcription) can be sent to me at the following
email address ___________________________
YES
NO
Findings from this study can be sent to me at the following email address:_________________
YES
NO
Signature (or note of verbal consent):
Name of Participant (Printed):
Date:

128

Appendix F
Participant Recruitment Table
Date
Contacted

Gatekeeper
position

Outcome/Response

May 17, 2021

School/Nursing
Student Association
(NSA)
School A

Chair

May 17, 2021

School B

Team Lead

May 17, 2021

School C

May 17, 2021
May 17, 2021
May 17, 2021
May 17, 2021

School D
School E
School F
NSA A via email

Director and
Associate
Director
Associate Dean
Acting Director
Chairperson
Club president

May 17, 2021
May 17, 2021
May 17, 2021
May 18, 2021

NSA D via email
NSA E via email
NSA F via email
NSA C via email

N/A
N/A
N/A
Club president

May 20, 2021

School C

Director

May 21, 2021

N/A

May 26, 2021

NSA F via FB
group/messenger
NSA D via FB
group/messenger
School F

Request handed over to next acting chair
which was later approved by program
Dean.
Forwarded email to Program Director
who gave approval.
Asked that minor adjustments be made
to the wording of the study’s
information letter.
No response.
Forwarded to acting Associate Director.
No response.
Agreed to share the study’s information
letter through the school’s program
advisor.
No response.
No response.
No response.
Agreed to share the study's information
letter.
Follow-up email sent. Agreed to post on
the undergraduate student blog.
Read but received no response.

May 26, 2021

School D

Associate Dean

May 30, 2021

NSA A via FB

Page Admin

May 31, 2021

School E

Associate
Director (acting)

May 21, 2021

N/A
Dean

Stated information letter was posted on
the group’s Facebook feed.
Agreed to send the study’s information
letter to applicable students.
Mentioned that not many students would
meet the study’s inclusion criteria. I
replied that I would love to connect with
students regardless but received no
response.
Permission was received for me to post
research information on the group feed.
No response.

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June 07, 2021
June 09, 2021

School B FB page
School A

June 09, 2021

School B

June 14, 2021

School E

July 18, 2021
July 18, 2021

NSA C
NSA A via FB

July 19, 2021

School F

July 19, 2021

School D

July 19, 2021

School E

July 19, 2021

School C

N/A
Nursing
program advisor
Director
Associate
Director (acting)
Club President
Page Admin
Dean; cc’d
administrative
assistant
Associate Dean

Associate
Director (acting)
Director; cc’d
Associate
Director

Redirected me to SoN Director.
Agreed to send the study’s Information
letter to incoming year four students.
Agreed to repost the study’s information
letter to students for a second time.
No response.
No response.
Posted study information on the group
feed.
Admin assistant emailed back stating
that the year four students have been
sent the study’s information letter.
Mentioned that students do not return to
classes until September and may not
check their email. The researcher
responded that the information letter
could be sent anyway, but no
confirmation was received.
No response.
Agreed to repost the study’s information
letter to applicable students.

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Appendix G
Semi-structured Interview Guide
1. In your nursing education so far, which clinical placements have you worked with
infants, children and/or adolescents? Please speak briefly about each practicum – what
was your experience like?
2. Thinking back to your pediatric practicum, describe some of the experiences that
challenged the way you view nursing? A two-fold question: What is your view of nursing
(experience that challenged the view you have of what nursing is about)
Update to question: Describe some of the experiences during your different pediatric
placement experiences that broadened your understanding of what nursing means to you?
3. Describe a time when you were excited because of a learning experience during your
pediatric practicum. What were the circumstances, and why was it exciting?
4. Please tell me about the most (update: some) memorable events that happened during
your time in the placement location. (i.e., something that shocked or excited you – an
experience that stands out the most)
5. What did you hope to achieve as you began your pediatric placement? How was your
learning desire met/or not met? [New question added during Interview 7]
6. How did your instructor impact your learning at clinical? [added after interview 14]
7. Based on your pediatric practicum experience as part of your undergraduate nursing
education, describe what you believe will prove very relevant or beneficial to your future
role as a nurse?

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Appendix H

July 8, 2021
Dear Editor(s),
To whom it may concern:
I would like to submit the manuscript entitled “Pediatric practicums in undergraduate nursing
programs: An integrative review” authored by Ms. Oghenerukevwe Onororemu, Dr. Caroline
Sanders, Dr. Jonathan Alschech, and Dr. Janet McCabe to be considered for publication as a
Literature Review in the International Journal of Nursing Education Scholarship (IJNES).
In this paper, we report on existing literatures describing experiential learning in baccalaureate
nursing education with respect to the pediatric or child health curriculum. Articles analyzed for
this literature review revealed a limited amount of potential placement sites for pediatrics (that
were predominantly located in school and camp settings). Recognizing that pediatric placements
within undergraduate nursing programs are a requirement for generalist practice, we call for
creativity in identifying innovative placements as well as re-thinking and re-defining
traditionally taken-for-granted placements (i.e., practicums outside of acute settings). We believe
these findings will be of interest to the readers of your journal.
We declare that this manuscript is original, has not been published before and is not currently
being considered for publication elsewhere.
We know of no conflicts of interest associated with this publication, and there has been no
significant financial support for this work that could have influenced its outcome. As
Corresponding Author, I confirm that the manuscript has been read and approved for submission
by all the named authors.
We hope you find our manuscript suitable for publication and look forward to hearing from you
in due course.
Sincerely,
Oghenerukevwe Onororemu
MScN (candidate), School of Nursing, University of Northern British Columbia
onororemu@unbc.ca

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