Abstract
-
Purpose
This study aimed to examine the current status and key challenges of pediatric nursing clinical education in South Korea and to provide strategic directions for quality improvement based on competency-based learning outcomes.
-
Methods
A cross-sectional survey was conducted among 89 pediatric nursing faculty members working at various universities nationwide between February and July 2024. Quantitative data were analyzed using descriptive statistics, and qualitative responses were analyzed using inductive content analysis.
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Results
Practicum objectives primarily focused on inpatient care (98.9%) and core nursing skills (83.1%), while communication and problem-solving (22.4%) and ethics (21.3%) were underrepresented. Although high-fidelity simulation use reached 33.7%, interactive tools such as virtual reality (17.9%) and nursing process evaluations (7.8%) remained underutilized. Six themes emerged from the analysis of faculty perspectives on enhancing clinical practicum education: structural barriers in securing sites, inconsistent learning environments, overcrowding, limitations of observation-only learning, regulatory constraints, and excessive faculty burden.
-
Conclusion
This study proposes establishing standardized clinical protocols, expanding hybrid simulation-based models to compensate for shrinking clinical sites, and institutionalizing industry-academic cooperative frameworks to ensure the quality and equity of pediatric nursing education. These approaches are essential to enhancing the quality and equity of pediatric clinical nursing education in Korea.
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Key words: Competency-based education; Nursing education research; Nursing faculty; Pediatric nursing; Simulation training
INTRODUCTION
Recently, the significance of clinical practicums in nursing education has grown substantially in response to evolving healthcare needs, increasing demands for patient safety, and the call for competent and compassionate nurses [
1]. Pediatric nursing plays a critical role in fostering the specialized knowledge and skills required to provide high-quality care for infants, children, and their families [
2].
In South Korea, the pediatric nursing education landscape is currently navigating a critical transitional stage [
3]. Transitioning beyond traditional training models, the field faces an urgent need to adapt to rapid demographic shifts and structural constraints [
2]. The nation’s total fertility rate fell to 0.75 in 2024, the lowest in the Organization for Economic Cooperation and Development [
4], which has resulted in a steep decline in pediatric hospital admissions and, consequently, a reduction in accessible clinical training opportunities. Compounded by stringent infection control policies during the COVID-19 (coronavirus disease) pandemic, nursing students have experienced significantly reduced direct patient interactions, particularly in high-risk units such as the neonatal intensive care unit (NICU) and pediatric intensive care units [
2]. Furthermore, while the number of nursing colleges and graduates continues to rise [
4], clinical site availability and diversity have not kept pace, leading to overcrowded practicum environments and inconsistent educational quality [
5].
These structural limitations are further exacerbated by a lack of standardized clinical learning objectives, evaluation tools, and competency-based teaching frameworks [
5]. Although efforts have been made to integrate simulation-based education and alternative modalities, these have not been systematically embedded into pediatric nursing curricula [
6].
The challenges in pediatric nursing clinical education are particularly acute compared to other nursing specialties due to several unique factors. First, pediatric patients represent a vulnerable population requiring specialized developmental considerations, family-centered care approaches, and age-specific communication skills that cannot be adequately learned through observation alone [
7]. Second, the ethical complexities of pediatric care, including consent processes involving minors and family dynamics, create additional learning challenges that require structured educational approaches [
8]. Third, the emotional intensity and psychological demands of caring for sick children and distressed families necessitate specific competency development in therapeutic communication and coping strategies [
9]. Moreover, the technical skills required in pediatric nursing, such as age-appropriate medication calculations, developmental assessments, and specialized procedures for different age groups, demand hands-on practice opportunities that are increasingly difficult to secure [
5].
If these limitations are not effectively addressed during this transitional period, the consequences may be profound. Educationally, the lack of direct clinical exposure risks widening the gap between theoretical knowledge and practical application, preventing students from internalizing essential clinical reasoning skills [
9,
10]. Practically, this deficiency can lead to significant “reality shock” upon employment, resulting in increased burnout and turnover rates among new nurses [
10]. Most critically, the inability to guarantee clinical competency poses a direct threat to patient safety and the quality of care provided to the vulnerable pediatric population [
11].
Previous research has addressed general trends in clinical nursing education [
12], and some studies have examined specific aspects of pediatric nursing education, including simulation-based learning approaches [
13] and competency assessment tools [
5,
11]. However, few comprehensive studies have systematically examined pediatric-specific practicum challenges or developed evidence-based strategies for improving the structure and outcomes of pediatric nursing clinical education in Korea [
14-
16]. Recent studies have highlighted the need for standardized competency frameworks and innovative educational approaches in pediatric nursing education, but implementation strategies remain limited [
5].
Given the critical role pediatric nurses play in ensuring the health and development of the nation’s children, and considering the unique educational challenges posed by the declining pediatric patient population and evolving healthcare delivery systems, it is imperative to strengthen the clinical education framework. This study seeks to investigate the status of pediatric nursing clinical practicums in South Korea and systematically identify the key challenges encountered in clinical education. Specifically, it analyzes the barriers within the current system and proposes strategic directions to improve its quality and outcomes. By providing empirical insights into the unique difficulties of pediatric nursing education, this study serves as a foundation for future research and policy development. Ultimately, it aims to establish a more effective, equitable, and competency-based nursing education system that prepares nursing graduates to meet the complex needs of pediatric patients and families in contemporary healthcare settings.
METHODS
Ethical statements: This study was approved by the Institutional Review Board (IRB) of Konkuk University (IRB No. 202509-E-119). The requirement for informed consent was waived due to the retrospective nature of the study and the use of de-identified data.
1. Study Design
This is a descriptive study utilizing existing data on child health nursing clinical practicums. The original dataset was compiled from survey responses provided by nursing faculty members for the Conference of the Korean Academy of Child Health Nursing. The reporting of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [
17].
For data search and selection, information presented at the Korean Academy of Child Health Nursing 2024 summer conference regarding the status of pediatric nursing clinical education in South Korea was accessed and reviewed. The data were obtained from materials presented at the conference, which reported the results of a nationwide survey on clinical practice education in pediatric nursing. The original survey was conducted between February and July 2024 and investigated pediatric nursing practicum operations across 200 nursing departments and colleges nationwide. The final sample consisted of 89 institutions that provided complete responses. To ensure data accuracy, the unit of response was limited to one representative pediatric nursing faculty member per institution responsible for the clinical practicum curriculum. The survey instrument, comprising 18 items derived from previous studies [
8,
9] and aligned with national nursing education accreditation outcomes, provided data on practicum goals, credit hours, areas, student numbers, instructional methods, personnel, and evaluation methods, along with responses to open-ended questions regarding improvement needs [
18]. Although the study primarily involved the analysis of official educational information, measures were taken to ensure voluntary participation and data confidentiality. To maintain ethical integrity, all data were accessed and analyzed in an anonymized format, and no personal identifiable information was included in the dataset.
The data were analyzed using IBM SPSS/WIN ver. 26.0 (IBM Corp.). The practicum objectives, program outcome, clinical practicum settings, contractual arrangements, instructor types, pedagogical roles, teaching and evaluation methods, feedback sources, and student assessments were analyzed using frequencies and percentages. Qualitative responses were examined through content analysis. Two researchers independently coded the data, compared themes, and resolved discrepancies through discussion to ensure reliability.
RESULTS
1. Quantitative Analysis
1) Practicum objectives and program outcome alignment
Among the reported practicum domains, the most frequent objectives were inpatient pediatric care (98.9%), core nursing skills (83.1%) and high-risk pediatric care (80.9%), whereas competencies in teamwork & collaboration (28.1%), communication & problem-solving (22.4%), ethical practice (21.3%), and population health & community care (14.6%) were relatively lower.
Alignment with national nursing program outcomes (PO) showed a heavy focus on PO2 (provides nursing care appropriate to the situation through clinical reasoning, 98.9%) and PO1 (apply knowledge from nursing and other disciplines, 73.8%), while PO6 (collaborate with health care teams to promote health and address health issues, 50.0%), PO4 (perform nursing in accordance with law and ethics, 21.3%), PO3 (manage the health of the population within the public health care system, 14.6%) and PO5 (applying the principles of safety and quality improvement, 10.8%) were less emphasized.
2) Clinical practicum settings and contractual arrangements
Practicum institutions were primarily university hospitals (74.2%) and general hospitals (64.0%), while non-traditional community settings showed very low utilization. Regarding cooperation, 74.2% of institutions relied on the “personal requests of professors” to secure sites, and 60% utilized school-attached foundation hospitals (
Table 1).
3) Instructor types and pedagogical roles
Full-time faculty (98.9%), head nurses (84.3%), and visiting instructors (71.9%) were the primary leaders in practicum education. Full-time faculty were most involved in meeting and case studies (93.2%), whereas head nurses focused on orientation (58.0%) and patient assignments (49.4%). A significant number of support staff (44.9% of assistants) had no direct training role (
Table 2).
4) Teaching and evaluation methods
Demonstration-based teaching was the most common instructional method (73.0%). Interactive tools like virtual reality (VR) (17.9%) and quizzes (5.6%) remain underutilized. Evaluation relied heavily on reports (100%) and attendance (97.8%), while nursing process evaluation (7.8%) and simulation performance assessment (20.2%) were rare (
Table 3).
Assessments of student performance were mainly conducted through direct faculty feedback (47.1%) and clinical instructor evaluations (44.9%), supplemented by peer appraisals (23.6%) and self-satisfaction (4.5%). Student self-assessment included decision-making skills (38.2%), nursing professional intuition (25.8%), and learning achievement (11.0%), although some institutions reported an absence of formal self-assessment (14.3%).
2. Qualitative Analysis
The qualitative analysis identified six main themes and 12 subcategories that illustrate the structural barriers and pedagogical gaps in pediatric nursing education (
Table 4). To ensure the validity of these findings, representative participant quotations are provided for each subcategory.
1) Structural barriers in securing practicum sites
(1) Reduction of pediatric-specific beds
The continuous decrease in pediatric wards complicates the stability of clinical placements.
“Due to the low birth rate, pediatric wards are closing one after another. We are constantly searching for new hospitals every semester just to maintain the minimum required hours.” (Participant 12)
(2) Restricted practice in integrated care units
Many institutions now operate mixed-age wards, diluting the pediatric focus.
“Pediatric patients are often scattered across integrated internal medicine wards, making it difficult for students to focus solely on developmental-specific nursing care.” (Participant 45)
2) Inconsistency in clinical learning experiences
(1) Gaps in high-risk area exposure
Access to specialized units like the NICU is increasingly restricted.
“Students only get to see the NICU through a window. They graduate without ever assessing a high-risk neonate in person.” (Participant 23)
(2) Regional disparities in training resources
Institutions outside the capital area face a severe lack of specialized pediatric centers.
“In our province, there isn’t a single children’s specialized hospital. Our students have to travel for hours to other cities for a 2-week practicum.” (Participant 67)
3) Overcrowding and inefficient learning environments
(1) Multi-school placement overlaps
Multiple universities competing for the same clinical space leads to overcrowding.
“There are times when students from three different nursing schools are on the same small ward. It’s so crowded that students just end up standing in the corners.” (Participant 8)
(2) Diminished student engagement
Overcrowded environments prevent students from taking an active role.
“When there are more students than patients, the clinical nurses view our students as a hindrance rather than learners, which kills the students’ motivation.” (Participant 31)
4) Limitation of “observational only” learning
(1) Restrictions on direct care
Safety and parental concerns often limit students to passive observation.
“Parents are very sensitive. Students aren’t even allowed to take vital signs for some children, leaving them to only watch from a distance.” (Participant 55)
(2) Competency development gaps
Lack of hands-on experience leads to low confidence in pediatric-specific skills.
“Students spend 80 hours in the hospital but never once perform a physical assessment on a child. This isn’t ‘practice’; it’s ‘watching’.” (Participant 19)
5) Institutional and regulatory constraints
(1) Supply-demand mismatch
The increase in nursing student quotas is not matched by an increase in clinical sites.
“The government increases the number of students, but hospitals are closing pediatric units. Math simply doesn’t work anymore.” (Participant 72)
(2) Passive attitudes from healthcare providers
Hospitals often see student education as an administrative burden.
“Hospitals are reluctant to sign memorandum of understanding (MOU)s because they don’t see any benefit in hosting students, only the risk of complaints from parents.” (Participant 40)
6) Instructor burden and field capacity
(1) Supervisory scope limits
Faculty must manage multiple, distant sites simultaneously.
“I have students at 3–4 different hospitals at once. I spend more time driving between sites than actually teaching students at the bedside.” (Participant 5)
(2) Variability in field leader capacity
The quality of guidance depends heavily on the individual nurse’s willingness to teach.
“Some head nurses are wonderful mentors, but others treat students as ‘invisible’ because they are too busy with their own clinical duties.” (Participant 88)
In summary, the qualitative findings highlight a profound structural crisis in pediatric nursing education, characterized by an acute shortage of clinical sites due to the closure of pediatric wards and a consequent imbalance in practicum opportunities. The learning environment is often inefficient and overcrowded, frequently resulting in passive, observation-only experiences that fail to provide students with essential direct nursing care competencies. Furthermore, the administrative and supervisory burdens are disproportionately concentrated on faculty members who must navigate shrinking institutional cooperation and regional disparities. Ultimately, the quality of clinical education remains highly inconsistent, as student experiences are dictated by the unpredictable autonomy of practice institutions, the varying pedagogical capacity of field leaders, and a significant disconnect between standardized educational goals and the restricted clinical reality.
DISCUSSION
This study aims to identify the structural and pedagogical challenges facing clinical practice education in pediatric nursing in Korea and to discuss the way forward based on these findings.
First, practice objectives were skewed toward specific domains. Most practicum learning objectives focused on clinical care and technical proficiency for pediatric inpatients, while also incorporating essential interpersonal skills such as communication, problem-solving skills, and teamwork. This significantly deviates from the holistic nursing competency frameworks emphasized by the World Health Organization [
19] and the International Council of Nurses [
20], suggesting an educational reality biased toward procedural competencies. There is an urgent need to redefine and diversify the educational objectives of pediatric nursing practice to develop a balanced set of core competencies for students as future professional nurses [
1,
2].
Second, simulation-based learning was underutilized. Simulation training can be a highly effective alternative to overcome the limitations of “observational learning” identified in qualitative studies and to prepare students for the high emotional sensitivity and risk involved in pediatric nursing [
21,
22]. As pediatric wards are shrinking due to declining birth rates and tightening infection control, which makes securing training sites increasingly difficult, there is a critical need to actively integrate simulation and VR tools into structured curricula to complement the quality of education [
2,
10]. To this end, it is essential not only to develop and share pediatric nursing simulation scenarios but also to establish a comprehensive support system, including administrative and financial resources, dedicated physical spaces, and specialized personnel, to facilitate simulation-based education in clinical and academic settings.
Third, staffing was overly concentrated on full-time professors. In many schools, clinical nurses participate in practical training, but their roles are limited, and they are unable to utilize diverse teaching methods. The qualitative research also pointed to the physical limitations of professors managing multiple practicum sites (“it’s too much for professors to supervise students”) and the lack of capacity among site leaders. While the leading role of full-time faculty has the positive aspect of strengthening the theory-practice link, it can place an undue burden on the individual faculty member and hinder the diversity of the preceptor workforce [
23,
24]. There is a need to introduce a collaborative leadership team model that includes a competent child nurse practitioner or site preceptor and a clinical leader, benchmarking international models that support continuous feedback and capacity development [
25].
Fourth, structural weaknesses in securing practicum sites and assigning students were revealed. Many practicum sites were secured through the professors’ personal networks (74.2%) rather than through formal agreements, leading to instability and regional imbalances in securing practicum sites [
23]. In the qualitative study, the response “there are no pediatric training sites at all in the provinces” clearly illustrates this problem. There was also concern that some sites were overcrowded, with “more trainees than patients,” which could compromise student engagement and the quality of learning [
26]. Moving forward, there is a need for the standardization of placement criteria, such as institutionalizing formal agreements between institutions and schools and specifying a maximum capacity for each training unit. [
5,
16,
23].
Finally, the evaluation approach is more outcome-oriented and summative than process-oriented and formative. The lack of assessment regarding clinical practice skills, field judgment, and collaboration skills conflicts with the goals of performance-based education [
26,
27]. Multidimensional assessment systems, such as objective structured clinical examinations (OSCEs) and portfolios, should be introduced to comprehensively assess student growth [
13,
28].
In conclusion, this study shows that clinical practice education in pediatric nursing in Korea needs systematic improvement in terms of competency balance, diversification of practice settings, collaborative teaching, and multidimensional assessment. Addressing these challenges is essential not only to improve the quality of education but also to ensure that future generations grow into competent professional nurses capable of providing safe, ethical, and family-centered pediatric care.
Furthermore, as this study analyzed data from 89 out of 200 nursing schools, the potential for non-response bias must be acknowledged, as the perspectives of non-participating faculty members may differ from the results presented. Another limitation is that this study relied solely on faculty responses, omitting the viewpoints of other key stakeholders such as nursing students and clinical preceptors. Additionally, the findings may not fully reflect the inter-institutional variations in pediatric nursing curricula and simulation-based learning resources across different universities. Future studies should adopt a multi-center approach involving diverse participants and standardized assessments of institutional curricula to provide a more comprehensive and validated understanding of pediatric nursing education.
CONCLUSION
This study highlighted critical gaps in pediatric nursing clinical practicums in South Korea, particularly in the areas of learning objectives, site accessibility, teaching diversity, and competency evaluation. To advance clinical nursing education for pediatric populations, it is essential to develop national guidelines that standardize clinical practicum goals in alignment with core nursing competencies, while also increasing support for simulation-based and blended learning that integrates VR. Strengthening multi-institutional collaborations, including formal partnerships with community health centers and kindergartens, can broaden the scope and accessibility of training opportunities. In addition, promoting team-based instruction involving preceptors, adjunct faculty, and clinical mentors can enrich the learning experience and provide diverse perspectives. Comprehensive evaluation frameworks, incorporating OSCEs, peer assessments, and reflective portfolios, should be implemented to ensure a robust assessment of student competencies. Collectively, these reforms will contribute to building a future-oriented clinical education system that equips nursing graduates to meet the complex needs of pediatric patients and their families in a rapidly changing healthcare landscape.
ARTICLE INFORMATION
Table 1.Characteristics of clinical practicum settings and cooperation methods (N=89)
|
Variable |
Category |
No. (%) |
|
Provider types |
University hospital |
66 (74.2) |
|
General hospital |
57 (64.0) |
|
Specialist hospitals |
47 (52.8) |
|
Health community centers |
10 (11.2) |
|
Kindergarten/child-care center |
6 (6.7) |
|
Cooperation/contract methods |
Personal request by professor |
66 (74.2) |
|
School-attached (foundation) hospital |
53 (60.0) |
|
Department/practice chair led |
26 (29.2) |
|
University headquarters support |
12 (13.5) |
Table 2.Distribution of instructor types and their roles (N=89)
|
Role |
Instructor type |
|
Full-time faculty |
Head nurse |
Preceptor nurse |
Visiting instructor |
Assistant |
|
Instructor presence |
88 (98.9) |
75 (84.3) |
17 (19.1) |
64 (71.9) |
12 (13.5) |
|
Assigning students |
65 (73.0) |
10 (11.2) |
2 (2.2) |
5 (5.6) |
33 (37.0) |
|
Orientation |
41 (46.0) |
52 (58.0) |
20 (22.4) |
13 (14.6) |
1 (1.1) |
|
Meetings/cases studies |
83 (93.2) |
4 (4.5) |
2 (2.2) |
49 (55.0) |
0 (0.0) |
|
Core nursing skill evaluation |
67 (75.2) |
8 (8.9) |
5 (5.6) |
50 (56.1) |
4 (4.5) |
|
Patient assignment |
6 (6.7) |
44 (49.4) |
17 (19.1) |
1 (1.1) |
0 (0.0) |
|
No training |
0 (0.0) |
10 (11.2) |
33 (37.0) |
17 (19.1) |
40 (44.9) |
Table 3.Integration of teaching methods and evaluation metrics (N=89)
|
Variable |
Category |
No. (%) |
|
Teaching methods |
Demonstration |
65 (73.0) |
|
Lecture |
44 (49.4) |
|
Media usage |
36 (40.4) |
|
High-fidelity simulation |
30 (33.7) |
|
Low-fidelity simulation |
19 (21.3) |
|
VR simulation |
16 (17.9) |
|
Role-play |
8 (9.0) |
|
Quizzes/medical term |
5 (5.6) |
|
Evaluation metrics |
Written reports |
89 (100.0) |
|
Attendance |
87 (97.8) |
|
Attitude |
84 (94.4) |
|
Core nursing skills |
83 (93.3) |
|
Knowledge (quizzes) |
81 (91.0) |
|
Reflective diary |
66 (74.1) |
|
Simulation performance |
18 (20.2) |
|
Nursing process |
7 (7.8) |
Table 4.Qualitative analysis of improvement need in pediatric nursing education
|
Themes |
Sub-category |
|
Structural barriers in securing practicum sites |
• Reduction of pediatric-specific beds |
|
• Restricted practice in integrated care units |
|
Inconsistency in clinical learning experiences |
• Gaps in high-risk area exposure |
|
• Regional disparities in training resources |
|
Overcrowding and inefficient learning environments |
• Multi-school placement overlaps |
|
• Diminished student engagement |
|
Limitation of “observational only” learning |
• Restrictions on direct care |
|
• Competency development gaps |
|
Institutional and regulatory constraints |
• Supply-demand mismatch |
|
• Passive attitudes from healthcare providers |
|
Instructor burden and field capacity |
• Supervisory scope limits |
|
• Variability in field leader capacity |
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