Knowledge and Practice Gaps among Pediatric Nurses at a Tertiary Care Hospital Karachi Pakistan

Table 5

Recommendations to bridge knowledge practice gaps as verbalized by the participants.

Recommendations for:	Recommendations as verbalized by the participants*
Nursing education	(i) Credit hours for both pediatric theory and practice should be increased.; (ii) The faculty should make the students more independent on clinicals.; (iii) The students should be given responsibilities of the patients assigned wholly and solely and they should hand “over” to the upcoming shift staff.; (iv) Written work assignments during the clinical on wards/units should be decreased so that students take more interest in what is going on with the patient and take active part in teaching and procedures.; (v) The clinical hours should be until 3 PM instead of 1 PM, so that the students do not run away without doing/completing their responsibilities.; (vi) The faculty should not discuss the patient in isolation in a room, but at the bedside to double check it with the staff on duty, and also to facilitate more learning about the assigned patients.; (vii) There should be pediatric specialized courses for at least 6 months, which could provide nurses with special skills and knowledge for caring effectively.; (viii) More practice for medication calculation should be encouraged through live scenarios. This could be integrated within each specialized course taught throughout the curriculum and not as a separate course in isolation.; (ix) Crash cart handling should be introduced in nursing education.; (x) Clinicals should also be planned in the evening and night shift at least once a week during the clinical week with the faculty.; (xi) Summer clinicals should be preplanned such that each and every student should get exposure to each specialty in the hospital, during their 3/4 year of formal studies. It should be a trio model and the students should not be handed over to the head nurses for scheduling on their own and using them as nursing assistant.
Nursing services; In-service training programs	(i) The orientation of NES should not be adult focused but it should also cover the pediatric population in all aspects of teaching.; (ii) The medication recertification should also focus on pediatric dosages and scenarios.; (iii) The cannulation should focus on both peads and adults.; (iv) On joining the orientation program the NES instructor should know in which unit the RN will be assigned so that they can focus on the identified areas.; (v) Modules should be prepared for all specialties, whether the person is going to the peads, or critical care, or surgery, and so forth. Thus orientation should be given to subgroups of specialty after need assessment.; (vi) NES instructors should also be available for at least the initial months on shifts so that if the staff nurses are busy they can come to help or guide the novice nurses in the unit.; (vii) The NES should cover the drug dilution file, which contains the drugs and dilution, so that emergency drugs are used during the cardiopulmonary arrest. They should take a quiz on it before sending the nurse to the unit. It should contain both peads and adult scenarios.; (viii) NES library should have enough recent books and journals according to the specialty, the issuing systems should be user friendly, and the book should be issued at least for 3 days.; (ix) During the orientation days, the management should provide a list of options of placements to the NES instructor. The orientees should be given at least three options to select and finally leave it to the group to decide among the available vacancies in the hospital units. This will allow the orientees to make decision and feel important that they have decided their placements according to their previous clinical exposures and eventually feel good throughout their professional life.
Clinical nurse instructors in the hospital settings	(i) The clinical nurse instructor (CNI) should focus on the case studies method, which will enhance critical thinking in the staff, and they will question more and learn more.; (ii) There should be recent materials like books and journals available in the wards so that they could be utilized as references when needed during free time, to clarify some day to day issues.; (iii) The intranet should have enough education materials for ongoing learning.; (iv) The on-the-job training course for 1 week could also serve the purpose, if offered during the first month of joining as a staff nurse.; (v) The CNIs should report to a separate clinical manager who reports to the director. The CNIs should constantly plan continuing education for the nurses on the ward, not only when novice nurses come on the ward. They should not be involved in management work; this should be done only by the head nurse.

*Directly translated to English from Urdu or directly quoted from the participaants.