newborn case study for nursing students

Nursing Case Study for Maternal Newborn

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Luisa, 25 years old, is a 37-week pregnant patient who presents to triage with abdominal and back pain. She says she thinks she is in labor because her contractions are regular and about 10 minutes apart. Her electronic health record indicates she is G3 P1 A1 and she is followed by a local obstetrics and gynecology office. She states she thinks she may be in labor but “has not seen any fluid.”

What does G3P1A1 mean in regard to this patient?

• Gravida 3 (number of pregnancies), P 1 (number of live or stillbirths) A 1 (number of abortions [induced] or fetal demises before 20 weeks’ gestation). So, Luisa could have 3 pregnancies and no live children (due to stillbirth) or 1 live child. She may have had an abortion or a miscarriage. Note: if A is 0 it may be omitted.

What does the triage nurse understand labor to be in a pregnant woman?

• Labor is defined as regular and painful uterine contractions that cause progressive dilation and effacement of the cervix. Normal labor results in descent and eventual expulsion of the fetus. Interpreting labor progress depends on the stage and phase:
• First stage: The time from onset of labor (i.e., when contractions started to occur regularly every three to five minutes for more than an hour) to complete cervical dilation (noted when first identified on physical examination)
• Phases: The first stage consists of a latent phase and an active phase. The latent phase is characterized by gradual cervical change, and the active phase is characterized by more rapid cervical change.
• Second stage: The time from complete cervical dilation to fetal expulsion.
• Third stage: The time between fetal expulsion and placental expulsion.
• Lack of fluid indicates that the rupture of the membranes (amniotic sac) has not occurred yet

Vital signs are as follows: BP 150/94 mmHg SpO2 98% on room air HR 91 bpm and regular Pain 2/10 at rest, 8/10 when she reports a contraction RR 12 bpm at rest, 24 bpm when she reports what she thinks is a contraction Temp 36.8°C

Which vital sign is most concerning to the nurse? What should they do regarding this vital sign?

• This blood pressure may indicate pre-eclampsia (“Preeclampsia refers to the new onset of hypertension and proteinuria or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria after 20 weeks of gestation or postpartum in a previously normotensive woman”).
• (Hypertension denotes a rise in systolic blood pressure of 30 mmHg or more and a rise in diastolic blood pressure of 15 mmHg or more from baseline)
• The end-organ dysfunction is evaluated by looking at certain criteria: proteinuria, platelet count, serum creatinine, liver transaminases, pulmonary edema, new-onset and persistent headache unresponsive to analgesics, visual symptoms.”

The nurse decides to take the patient’s blood pressure manually which gives a reading of 130/82. Therefore, the patient is admitted to the labor and delivery unit.

SBAR report is given and Luisa’s admission for labor is started. She is placed in a convertible birthing bed with a fetal monitor attached to her abdomen.

What is the monitor called? What is it for?

•  “Tocodynamometry provides contraction frequency and approximate duration of labor contractions” and measures both fetal heart rate and maternal contractions. It is placed externally to watch both mother and baby as labor progresses.” There are also internal devices that can be placed on the fetus within the mother to monitor fetal heart rate.

Luisa progresses through an uneventful labor with her significant other at the bedside. She does not want any pain control and eventually delivers her newborn son, to be named after his father, Santiago.

At the time of birth, how would staff evaluate Santiago?

• “Staff asks three questions. The answers are used to determine whether the newborn is admitted to the normal nursery (neonatal level of care 1) or requires a higher level of care (neonatal level of care 2, 3, or 4)
• Is the newborn’s GA ≥35 weeks?
• Does the newborn have good muscle tone?
• Is the newborn breathing or crying?”

They determine Santiago is healthy enough to be placed on his mother’s chest to promote bonding and encourage breastfeeding. The staff takes him from his mother after a few minutes and she asks why.

What are staff doing when they remove Santiago at 5 minutes old?

• Checking an Apgar score (“Apgar score — The Apgar scores at one and five minutes of age provide an accepted, universally used method to assess the status of the newborn infant immediately after birth. Although data from a population-based study reported that lower Apgar scores of 7, 8, and 9 versus 10 were associated with higher neonatal mortality and morbidity, the Apgar score should not be used to predict individual neonatal outcomes as it is not an accurate prognostic tool The following signs are given values of 0, 1, or 2, and added to compute the Apgar score. Scores may be determined using the Apgar score calculator.
• Respiratory effort
• Muscle tone
• Reflex irritability
• Approximately 90 percent of neonates have Apgar scores of 7 to 10 and generally require no further intervention. These neonates usually have all of the following characteristics and can be admitted to the level 1 newborn nursery for routine care:
• Gestational age (GA) ≥35 weeks
• Spontaneous breathing or crying
• Good muscle tone
• Also, they record length, weight, head and chest circumference.

Santiago weighs 3550 grams and is 50.6 cm long. Luisa and Santiago, Sr. ask what that is in pounds and inches so they can tell family and post on social media.

How does the staff respond to this?

• A size chart may be available for staff to convert from metric to English measure and electronic health records may convert these values. But it is key that nursing staff knows how to convert mathematically.
• 50.6 cm/2.54cm per in = 19.9 inches (long)
• 3550 gm x .0022 gm/lb = 7.8 lbs or 7 lbs 12.8 oz. Alternatively, the nurse can convert gm to kg (3550 gm = 3.55 kg) then 3.55 kg x 2.2 lb/kg = 7.8 lbs (the 10th place is multiplied by 16 oz to convert to ounces i.e., 0.8 x 16 = 12.8)

Luisa and Santiago (referred to as a “mother-baby couplet”) are moved from the labor & delivery unit to the postpartum care unit as per protocol. The staff takes the newborn to the nursery for an evaluation. Luisa wants to know what they are looking for and if her son is healthy.

How should the nurse respond?

• Staff frequently (per protocol) assess a postpartum mother for possible complications. A good acronym for this assessment is BUBBLE which is essentially a focused head-to-toe (working from top to bottom) assessment.
• B – breasts (tenderness, size, shape, etc.) U – uterus (is it firm, boggy? This is done by feeling the fundus and massaging if necessary. This is to help assess for a serious postpartum complication – maternal hemorrhage) B – bladder (is mom voiding? Is there distension or difficulty urinating? This is also a good time to discuss self-peri-care) B – bowel (is mom constipated? She may need a stool softener to ease discomfort) L – lochia (quality, quantity of postpartum bleeding). You could also add an “L” for legs to check for swelling, Homan’s sign, etc. E – episiotomy (if this was done, it should be assessed for bleeding or hematoma. Use the REEDA acronym to remember what to look for {Redness, edema, ecchymosis, discharge, approximation)

While the infant is being evaluated in the nursery, postpartum staff come in and assess Luisa. She wants to know why they keep feeling her abdomen and asking her about bleeding. She says, “I thought everything went OK. Why are you always checking on me?”

What is the best answer for Luisa?

• “By pressing on your abdomen, we are assessing your fundus to ensure that the uterine muscle is properly contracting, which prevents bleeding. Similarly, we are evaluating how much you are bleeding to verify that there are no complications after delivering your baby.”

The mother-baby couplet is set to be discharged home after a few days. It turns out that Luisa has no living children as her first pregnancy ended in stillbirth and her second was a miscarriage. She holds Santiago and is tearful as staff prepares to educate her for going home. She says, “I am so afraid I will hurt him or not do stuff right. Why do I keep crying? This is overwhelming.”

Should the nurse address this? What may help the transition from a postpartum unit to home?

• Explain that hormonal changes (for mother) are to be expected at this time but reassure her that discharge criteria have been met. Maybe explain, “In the United States, because of concerns that early discharge could adversely affect maternal and infant health outcomes, both state and federal governments passed postpartum discharge laws in the late 1990s (Newborns’ and Mothers’ Health Protection Act [NMHPA]) to prevent extremely short hospital stays. In general, these laws require insurance plans to cover postpartum stays of up to 48 hours for infants born by vaginal deliveries (96 for c-sections). The impact of legislation ensuring insurance coverage for a minimum of 48 hours has increased the LOHS of newborn infants and their mothers and appears to have decreased neonatal readmission rates and emergency department visits.” Also, providing resources for education and follow-up will help ease anxiety. Always be prepared with whatever resources the facility and/or OB/GYN practice provides. There may be support numbers or websites available and those should be provided to the mother as appropriate.

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View the full transcript, nursing case studies.

This nursing case study course is designed to help nursing students build critical thinking.  Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process.  To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy  to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs.  If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding.  In the end, that is what nursing case studies are all about – growing in your clinical judgement.

Nursing Case Studies Introduction

Cardiac nursing case studies.

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Obstetrics Nursing Case Studies

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Mental health nursing case studies.

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Builds on Nextgen Reasoning with twenty open-ended clinical reasoning questions providing a concise, immersive patient care simulation. Students benefit from integrated assessment images and audio files of breath and heart sounds that replicate practice realities. Suitable for all levels.

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Critical-Thinking Questions about Case Studies

• Chart the heart rate as a part of their assessment.
• Call and inform the provider.
• Assess the heart rate a second time by listening for a full minute with the stethoscope.
• Provide stimulation to the newborn and reassess in 3 to 5 minutes.
• A newborn requires oxygen after birth until they are at least 24 hours old.
• A newborn has periods of true apnea, greater than 20 seconds, until they are a month old.
• A newborn uses accessory muscles regularly during breathing, with retractions at the subcostal and supracostal areas.
• A newborn has periodic breathing with short pauses and periods in which they breathe faster.
• Complete the most invasive items first.
• Complete the least invasive items first.
• Complete a head-to-toe exam in the order of top to bottom.
• Complete the assessment of the newborn’s skin followed by the reflexes.

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Access for free at https://openstax.org/books/maternal-newborn-nursing/pages/1-introduction

• Authors: Amy Giles, Regina Prusinski, Laura Wallace
• Publisher/website: OpenStax
• Book title: Maternal Newborn Nursing
• Publication date: Jun 26, 2024
• Location: Houston, Texas
• Book URL: https://openstax.org/books/maternal-newborn-nursing/pages/1-introduction
• Section URL: https://openstax.org/books/maternal-newborn-nursing/pages/25-critical-thinking-questions-about-case-studies

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Quality and Safety Education for Nurses

Strategy submission, unfolding case study to teach assessment and care of the high-risk newborn.

Elizabeth Riley

DNP, RNC-NIC, CNE

Clinical Assistant Professor

Nicole Ward, PhD, APRN, WHNP-BC, RN; Leslie McCormack, MSN, CNM, RN; Natalie Capps, MNSc, RN

Institution:

University of Arkansas for Medical Sciences – College of Nursing

[email protected]

Competency Categories:

Evidence-Based Practice, Patient-Centered Care, Safety

Learner Level(s):

Pre-Licensure ADN/Diploma, Pre-Licensure BSN

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Case Studies

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Development of a Project-Based Learning Program on High-Risk Newborn Care for Nursing Students and Its Effects: A Quasi-Experimental Study

Hyun-young koo.

1 Research Institute of Nursing Science, College of Nursing, Daegu Catholic University, 33 Duryugongwon-ro 17 gil, Nam-gu, Daegu 42472, Korea; rk.ca.uc@ookyh

Young-Eun Gu

2 Incheon Foundation for Arts and Culture, Department of Culture Management, Graduate School, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Korea; rk.ro.cafi@018aicarg

Bo-Ryeong Lee

Associated data.

Please contact the corresponding author for data availability.

Project-based learning (PjBL) allows nursing students to participate in real problem-solving, construct knowledge, and improve their nursing skills in the process of accomplishing meaningful projects. This study was conducted to develop a PjBL program on high-risk newborn care for nursing students and evaluate its effects. A quasi-experimental study using a nonequivalent control group pretest–posttest design was employed between June and December 2021. The participants were 45 nursing students (24 in the experimental group and 21 in the control group). A PjBL program involving the creation of an educational video clip about high-risk newborn care for nursing students was developed, and the experimental group took part in PjBL. The participants’ nursing competency for high-risk newborns, self-leadership, and practicum-related stress were assessed. In the experimental group, nursing competency for high-risk newborns increased and practicum-related stress decreased to a greater extent than in the control group. However, the change in self-leadership was not significantly different between the experimental and control groups. PjBL effectively improved students’ nursing competency for high-risk newborns and decreased their practicum-related stress. PjBL will be utilized to enhance nursing students’ expertise in high-risk newborn care.

1. Introduction

Nurses play an essential role in the recovery of high-risk newborns’ health and in the systematic management of neonatal care units. In order to become a competent nurse in the clinical field, nursing students take part in clinical practice to learn the process of assessing newborns’ conditions, quickly identifying health problems, and solving those problems [ 1 ].

However, as professional intensive management is emphasized due to the recent increase in high-risk newborn birth [ 2 , 3 ], the need for competent performance of nurses is increasing. Simultaneously, due to the work overload of nurses and legal and ethical issues to protect vulnerable patients, direct nursing practice of students is limited in the clinical field [ 4 , 5 ]. In a neonatal intensive care unit (NICU), nursing students experienced anxiety, fear, and stress due to weak infants (e.g., premature infants or very low birth weight infants) and unfamiliar and complicated medical equipment, prompting them to withdraw to avoid disturbing nurses’ work [ 6 ]. In addition, students wanted to be provided with opportunities to hear detailed explanations about nursing and to observe nursing up close in the NICU, while nurses said that it was difficult to guide passive students in a busy situation and wanted students to have more active attitudes [ 7 ].

Therefore, various nursing education methods are being implemented to solve difficulties in the education field [ 8 ]. It is necessary to help nursing students actively participate in high-risk newborn care practicums and self-directed learning, and PjBL can be applied for these purposes. PjBL is an educational method that enables learners to apply knowledge, improve skills, and complete outcomes by participating in solving authentic problems [ 9 ]. PjBL is similar to problem-based learning (PBL) in that it deals with real-world problems and helps students learn by collecting and reconstructing knowledge through student-centered team activities. However, there is a major difference in that PjBL produces clear and visible outcomes [ 10 ]. By producing outcomes through PjBL, learners see that their efforts lead to meaningful outcomes and their interest in specialized fields increases [ 9 ]. College students who participated in PjBL classes showed high satisfaction and felt pleasure in the participation process [ 11 ]. Moreover, the process of achieving goals together allows students to learn proactively to perform their roles and improves their motivations [ 12 ]. The process of collaborating with other students during clinical practice provides students an opportunity to learn from each other, build strong bonds, and maintain relationships, which is a necessary virtue of nurses [ 13 ]. Nursing students recognized PjBL as a way to improve teamwork and enhance problem-solving and decision-making skills, and an opportunity to fill in lacking experience and knowledge about authentic situations [ 14 ].

Thus, this study aimed to develop a PjBL program on high-risk newborn care for nursing students, and to evaluate its effects on nursing competency for high-risk newborns, self-leadership, and practicum-related stress. This study is significant in that it applied PjBL to NICU clinical practice, which is expected to encourage nursing students to engage in active learning during clinical practice while producing meaningful outcomes.

2.1. Study Design

A quasi-experimental study using a nonequivalent control group pretest–posttest design was employed at a university in South Korea ( Figure 1 ). This study report followed the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) reporting guidelines [ 15 ].

Research design.

2.2. Participants and Setting

Nursing students at a nursing college in a metropolis of South Korea were recruited through convenience sampling, and third-year students who voluntarily consented in written form to participate in the study were included. The inclusion criteria were students who were in the process of earning 1-credit (45 h) from the NICU practicum. Students who did not consent to participate in the study and did not attend a NICU practicum were excluded. The number of participants was calculated using the G*Power 3.1.9.7 (Düsseldorf, Germany) program by applying repeated-measures analysis of variance (ANOVA) and within–between interactions. Based on previous studies [ 16 ], an effect size of 0.25, significance level of 0.05, power of 80%, correlation coefficient of 0.30, and number of measurements of 2 were set, and the calculated number of participants was 23 in each group [ 17 ]. Considering a dropout rate of 10%, a total of 50 participants (25 in each group) were recruited. As a result of vacancies due to leave of absence, 24 participants in the experimental group and 21 participants in the control group were finally included in the study, without additional dropouts.

In order to prevent the spread of the experimental effect, the students who practiced in the NICU in the first half of the practicum were assigned to the control group and the students in the second half were assigned to the experimental group.

2.3. Development and Evaluation of Project-Based Learning for High-Risk Newborn Care for Nursing Students

The PjBL program on high-risk newborn care for nursing students was developed and evaluated by applying the double-diamond process, a service design method developed by the Design Council [ 18 ], consisting of the discovery, definition, development, and delivery stages.

2.3.1. Discovery

The literature on neonatal nursing practicum education and guidance [ 7 , 19 , 20 , 21 ] was reviewed. From June to September 2021, surveys and interviews of three clinical practice faculty members (CPFs), three clinical nursing instructors (CNIs), three nursing college graduates, and ten senior students who had experienced NICU practice who consented to participate in the study were conducted.

The following problems in high-risk newborn care practicum education were identified: Nursing students felt anxiety due to premature and fragile high-risk newborns and the complicated medical equipment. They also experienced boredom and helplessness since they could not provide direct nursing care or treatment to protect high-risk newborns, and nursing performance and even observations were restricted to prevent spread of infection.

2.3.2. Definition

The problems in practicum education for high-risk newborn care were determined as nursing students lack the opportunity to learn skills through authentic nursing, and face a sense of helplessness and lack of learning motivation as their activities are restricted during clinical practice.

2.3.3. Development

The PjBL program involving the creation of an educational video about high-risk newborn care for nursing students was developed. The educational themes were the NICU environment and developmentally supportive care, incubator neonatal nursing, ventilator nursing care, and phototherapy nursing care.

On the first day of the practicum, a CPF gave teams a project to produce an educational video clip and explained that the purpose of the video clip was to teach high-risk newborn care to peers who have not participated in the practicum. The CPF assigned teams to one of four themes, provided a worksheet for planning the production of the video clip, and guided each individual team to review the literature on the theme. On the second day, teams set specific learning goals for the video clips through discussion and an additional literature review, identified data to collect, and wrote a production plan. Based on the feedback from the CPF and CNI, the teams reviewed and revised the production plan. As teams performed the project, the teams used in-school practice rooms, NICU space, medical equipment, and models in consultation with the CPF and CNI, and were encouraged to ask the CPF and CNI questions or consult them for advice at any time. The teams produced a 10- to 15-min educational video clip using a mobile phone, edited it after the practice, and submitted the final video clip. The video clips will be used as learning materials for next year’s students ( Table 1 ).

Project-based learning for high-risk newborn care for nursing students.

CNI: clinical nursing instructor; CPF: clinical practice faculty; NICU: neonatal intensive care unit.

The validity of the composition and content of the project were verified by two CPFs, two CNIs, and two nursing college graduates, and they all responded that the project was appropriate or very appropriate.

2.3.4. Delivery

The PjBL program period was October to December 2021. The data of the control group were collected in the first half and one researcher applied PjBL to the experimental group for a week in the second half. In both the control and experimental groups, the same practice location, practice time, practice guidance time, and practice guidelines were applied according to regulations for operating clinical practice. The control group was provided individual tasks (reflection report on the practice content) instead of a team project, and participants were not told to which group they were assigned. The participants themselves completed the pretest and posttest, which were administered as self-reported online surveys to ensure blinding.

The pretest was conducted two days before the NICU practice for both groups. The posttest was conducted within two days after the NICU practice (after the submission of the team project or individual task). In the online survey, if there was an unanswered question, the participants could not proceed to the next page in order to prevent missing values.

2.4. Instruments

All instruments were constructed as self-reported questionnaires and were used after receiving approval from the original authors.

2.4.1. Nursing Competency for High-Risk Newborns

Nursing competency for high-risk newborns was measured using a tool developed by the researcher according to the learning objectives of pediatric nursing [ 19 ]. A total of 7 items were measured on a 5-point Likert scale (1: not at all, 5: strongly agree). A higher score was associated with higher nursing competency for high-risk newborns. The Cronbach’s α of internal reliability was 0.94 in the pretest and 0.90 in the posttest.

2.4.2. Self-Leadership

The Korean version of the Revised Self-Leadership Questionnaire (RSLQ), which was developed by Houghton and Neck [ 22 ] and translated into Korean by Shin et al. [ 23 ], was used for self-leadership. A total of 35 items were measured on a 5-point Likert scale (1: strongly disagree, 5: strongly agree). When four negative items were reverse-coded and summed, the higher score indicated higher self-leadership. The Cronbach’s α was 0.70–0.87 in the study of Shin et al. [ 23 ] and 0.91 both in the pretest and posttest of this study.

2.4.3. Practicum-Related Stress

For practicum-related stress, a tool developed by Park and Kim [ 24 ] was used. A total of 30 items were measured on a 5-point Likert scale (1: not at all, 5: strongly agree). A higher score was associated with higher practicum-related stress. The Cronbach’s α was 0.90 in Park and Kim’s [ 24 ] study, and in this study, it was 0.96 in the pretest and 0.97 in the posttest.

2.5. Data Analysis

The data were analyzed using SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA). The prior homogeneity between the experimental and control groups was tested using the chi-square test and unpaired t -test. Repeated-measures analysis of variance was performed to test differences in outcome variables according to the intervention.

2.6. Ethical Considerations

For the ethical protection of participants, this study was conducted after receiving approval (CUIRB-2021-0005) from the Daegu Catholic University Institutional Review Board. The study purpose, methods, and procedure were explained to potential participants, and they were informed that study participation and survey responses did not affect their evaluation or academic grade. They were also informed that there was no disadvantage if they did not want to participate and that they could discontinue participation at any time. They were also informed that confidentiality and anonymity would be maintained and that the collected data would be deleted after the study. Participants were included in the study only after providing written consent to participate in the study voluntarily.

3.1. Homogeneity Testing of Participants’ General Characteristics

There were no significant differences in general characteristics (age, sex, academic performance, health status, satisfaction with school life, satisfaction with friendship, satisfaction with the lectures on newborn care) between the experimental group and the control group. There were also no significant differences in nursing competency for high-risk newborns, self-leadership, and practicum-related stress between the experimental group and the control group ( Table 2 ).

Homogeneity testing of the general characteristics of the participants and outcome variables of the two groups ( n = 45).

* Fisher’s exact test; Cont.: control group; Exp.: experimental group; p , level of significance; t, unpaired T test.

3.2. The Effects of the Project-Based Learning Program

Although nursing competency for high-risk newborns was not significantly different between groups (F = 0.15, p = 0.703), there were differences between time points (F = 62.24, p < 0.001) and a significant interaction between group and time (F = 8.23, p = 0.006). Therefore, the pattern of change before and after the intervention was significantly different between the experimental group and the control group.

Self-leadership did not differ between groups (F = 1.23, p = 0.273), but there was a difference according to time (F = 25.56, p < 0.001) and no interaction between group and time (F = 0.16, p = 0.688).

Although practicum-related stress did not show significant differences between groups (F = 0.60, p = 0.444) or time points (F = 4.05, p = 0.051), there was a significant interaction between group and time (F = 5.84, p = 0.020), and the pattern of change before and after the intervention was significantly different between the experimental group and the control group ( Table 3 ).

Nursing competency for high-risk newborns, self-leadership, and practicum-related stress between two groups ( n = 45).

Cont.: control group; Exp.: experimental group; G: group; p , level of significance; t, unpaired T test; T: time.

4. Discussion

In this study, nursing competency for high-risk newborns among students who participated in the PjBL program, which involved producing an educational video clip on high-risk newborn care, improved to a greater extent than in the control group. Sufficient knowledge is necessary in order to teach others, and nursing knowledge and skills are improved through planning educational content, performing a rehearsal, and reviewing it [ 25 ]. Therefore, it is thought that producing an educational video clip effectively improved students’ nursing competency for high-risk newborns.

As nursing students participated in the PjBL program in teams of 5–7 students, they learned from each other naturally through collecting information together, discussing specific content and methods, and sharing knowledge. Team learning has advantages in improving academic achievement, especially for students with lower academic achievement [ 12 ]. Therefore, it is recommended to use team projects to help all students achieve nursing competency above a certain level.

Since the goal of producing the educational video clips was to teach peers about high-risk newborn care, we believe that the students strived to accurately identify the appropriate academic level and achievement level while constructing the video clip with easily understandable content for peers. In previous studies on nursing students [ 26 ], peers became learning facilitators in pediatric clinical settings, and students worked together with peers to develop practical skills. Furthermore, since nursing students taught peers instead of patients or the general public, they were less nervous and relaxed and could learn in a supportive environment [ 25 ].

Practicum-related stress showed a greater decrease in students who participated in the PjBL program than in the control group in this study. In a clinical setting where the nursing workload has increased and students’ access to patients is restricted, it is becoming difficult for students to receive close guidance from nurses [ 4 , 5 ]. Students restrict their activities or withdraw by themselves so as not to disturb nurses’ work, or passively await nurses’ explanations or guidance [ 6 , 7 ]. This situation increases nursing students’ stress and becomes a factor that makes the practicum education unsatisfactory for them. Since this project producing an education video clip allowed students to use space and medical equipment in the NICU through coordination with the CNI, students were able to talk to nurses naturally and had an opportunity to ask questions on medical equipment. Moreover, the project may have reduced practicum-related stress by decreasing their sense of boredom and helplessness since it provided a task to students who had restricted access to patients in a NICU where medical professionals are busy.

Although PjBL has an advantage of increasing learners’ achievement of knowledge and skills by encouraging learning participation, previous studies also reported burdens for learners, including additional learning [ 9 , 27 ]. Nursing students, who are members of the younger generation, are familiar with media such as YouTube and video clips, are accustomed to shooting video clips using a mobile phone, and have experiences with lectures or clinical skill education utilizing video [ 28 , 29 ]. This may help students feel that producing a video clip was not a substantial source of burden or stress.

However, in this study, the pattern of change in self-leadership did not differ before and after the intervention between the experimental group and the control group. PjBL is characterized as student-centered self-directed learning [ 10 ], and the self-regulated learning ability of the experimental group who participated in PjBL in a theory class improved compared to the control group in a study on college students [ 30 ]. In this study, even though self-leadership of students who participated in the PjBL significantly improved after the intervention, the control group that performed an individual task also showed an increase in self-leadership, and there was no significant difference in the pattern of change between the two groups. This may be because a reflection report, although it was an individual task, also had a positive effect on self-leadership through self-review and evaluation of the practicum content.

Although the effect of PjBL on self-leadership was not different from that of the individual task, this PjBL program was meaningful in that it significantly increased nursing competency for high-risk newborns, a learning goal that is important for nursing students to reach, and reduced practicum stress. The results of this study show that PjBL contributed to achieving learning goals with less stress. Therefore, it can be applied to improve nursing competency in clinical practice, including the NICU as well as in schools.

A limitation of this study is that it was conducted among nursing students at a single nursing college by convenience sampling, and its results should be generalized with caution. In addition, only one posttest was conducted after the intervention in this study, and a follow-up test was not conducted to verify the long-term effect of PjBL. In the future, it will be necessary to conduct a study to verify the long-term effect of PjBL on characteristics such as students’ learning attitudes and communication methods, as well as nursing competency.

5. Conclusions

This study was conducted to develop a PjBL program on high-risk newborn care for nursing students and examine its effects. In this study, a PjBL program, which involved producing an educational video clip about high-risk newborn care for nursing students, was developed. The results revealed that the PjBL program was effective for improving students’ nursing competency for high-risk newborns and decreasing their practicum-related stress. The application of PjBL to clinical practice education contributes to the improvement of nursing competency by encouraging nursing students to engage in active learning while producing meaningful outcomes. Therefore, the application of PjBL can be considered at various clinical practice sites.

Author Contributions

Conceptualization, H.-Y.K. and Y.-E.G.; Methodology, H.-Y.K., Y.-E.G. and B.-R.L.; Formal Analysis, H.-Y.K., Y.-E.G. and B.-R.L.; Investigation, B.-R.L.; Writing—Original Draft Preparation, H.-Y.K.; Writing—Review and Editing, H.-Y.K., Y.-E.G. and B.-R.L.; Supervision, H.-Y.K.; Funding Acquisition, H.-Y.K. All authors have read and agreed to the published version of the manuscript.

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2020R1I1A3052780).

Institutional Review Board Statement

This study was conducted after obtaining approval from the Institutional Review Board of Daegu Catholic University (CUIRB-2021-0005).

Informed Consent Statement

The informed consent forms of all patients were collected at the beginning of the pretest.

Data Availability Statement

Conflicts of interest.

The authors declare that they have no competing interests regarding the publication of this paper.

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Management and treatment outcomes of hemolytic disease of the fetus and newborn (hdfn)—a retrospective cohort study.

1. Introduction

2. materials and methods, 3.1. characteristics of the study group, 3.2. laboratory test results and management of newborns with hdfn, 3.3. comparison of children with and without intrauterine fetal transfusions (iut), 4. discussion, 5. study limitations.

• We obtained the data retrospectively, so there was no previously established HDFN management protocol; therapeutic decisions were made based on the doctor’s knowledge and individual experience, and not on previously established guidelines. This also applies to the doctor’s preferences regarding the first Hgb concentration measurement in the umbilical cord or peripheral blood sample.
• Furthermore, the patients’ highest ferritin concentrations remained unknown due to laboratory limitations, as the test’s detection range did not exceed >1650 ng/mL.
• In some neonates, the diagnosis of HDFN (especially in the case of AB0-alloimmunization) was made a few days after birth. Therefore, there is no complete data on the hemoglobin and bilirubin concentrations measured in cord or peripheral blood samples right after birth.

6. Conclusions

Author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Share and Cite

Drozdowska-Szymczak, A.; Łukawska, S.; Mazanowska, N.; Ludwin, A.; Krajewski, P. Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)—A Retrospective Cohort Study. J. Clin. Med. 2024 , 13 , 4785. https://doi.org/10.3390/jcm13164785

Drozdowska-Szymczak A, Łukawska S, Mazanowska N, Ludwin A, Krajewski P. Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)—A Retrospective Cohort Study. Journal of Clinical Medicine . 2024; 13(16):4785. https://doi.org/10.3390/jcm13164785

Drozdowska-Szymczak, Agnieszka, Sabina Łukawska, Natalia Mazanowska, Artur Ludwin, and Paweł Krajewski. 2024. "Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)—A Retrospective Cohort Study" Journal of Clinical Medicine 13, no. 16: 4785. https://doi.org/10.3390/jcm13164785

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