Abstract
-
Purpose
This integrative review aimed to examine the application and outcomes of project-based learning (PjBL) in pediatric nursing education and to identify its key characteristics.
-
Methods
Following the integrative review methodology proposed by Whittemore and Knafl, a comprehensive literature search was conducted in May 2025 across PubMed, Embase, CENTRAL, CINAHL, KCI, RISS, ProQuest, and Google Scholar. Studies published in both English and Korean were included. Two reviewers independently screened and selected eligible studies addressing the use of PjBL in pediatric nursing education.
-
Results
Six studies met the inclusion criteria and were included in the final review. Learning outcomes were categorized into 3 domains: cognitive outcomes (improvements in knowledge and critical thinking), affective-attitudinal outcomes (reduced stress and enhanced positive attitudes and self-confidence), and psychomotor outcomes (improvements in performance skills). The role of faculty members as facilitators, supporters, and coordinators emerged as a key determinant of successful PjBL implementation. PjBL may provide beneficial learning outcomes across multiple domains in pediatric nursing education; however, the overall level of evidence ranged from low to moderate, and the findings should therefore be interpreted with caution.
-
Conclusion
For successful implementation, faculty play a critical role in guiding and supporting the learning process. Accordingly, PjBL should be more widely incorporated into nursing curricula, accompanied by adequate faculty development initiatives.
-
Key words: Child health; Learning; Pediatric nursing; Students, nursing
INTRODUCTION
To become competent nurses who can accurately identify and address nursing problems in pediatric patients and their families, nursing students must learn to comprehensively assess children’s health status, recognize potential risks, and implement appropriate interventions [
1]. Because children undergo dynamic growth and developmental changes while remaining physically immature, students must understand age-specific norms and develop refined assessment skills to detect subtle physiological changes that may signal deterioration in a child’s condition [
1,
2].
In addition, nursing students must apply their theoretical knowledge of pediatric nursing within clinical environments to develop into proficient nurses capable of providing autonomous care for pediatric patients [
2]. Consequently, a range of nursing education methodologies has been adopted to enhance students’ ability to apply theoretical nursing knowledge in real-world clinical contexts. In particular, providing students with opportunities to engage in authentic professional settings that allow them to solve problems and develop expertise is strongly recommended [
3]. Project-based learning (PjBL) has emerged as a particularly promising approach for achieving this goal, given its emphasis on active engagement with complex, real-world challenges [
4]. PjBL is an educational method in which learners solve real-world problems and construct knowledge in authentic contexts by working collaboratively to complete projects and produce clearly defined outputs [
5].
As an inquiry-based instructional strategy, PjBL promotes active engagement by organizing learning around meaningful projects that produce tangible, real-world results [
3]. Students must therefore integrate, apply, and expand their existing knowledge as they address authentic problems within a collaborative framework [
5]. Although PjBL shares similarities with problem-based learning (PBL) in its emphasis on real-world problem solving and student-centered team activities, a key distinction is that PjBL culminates in clearly defined and observable outcomes [
3]. These visible outcomes enable learners to recognize that their efforts produce meaningful results, which in turn can enhance engagement and sustained interest in specialized subject areas [
5].
PjBL has been recognized by nursing students as an effective approach for strengthening teamwork and enhancing problem-solving and decision-making abilities, as well as for compensating for limited experience and understanding of real-world clinical situations [
6]. This educational strategy may also help reduce practicum-related stress by alleviating feelings of boredom and powerlessness, particularly in pediatric settings where direct patient access is often restricted due to patient vulnerability, safety concerns, and demanding clinical environments [
7]. In addition, PjBL has demonstrated effectiveness in promoting self-regulated learning. For example, an experimental group of college students who participated in PjBL during a theory-based course exhibited significantly higher levels of self-regulated learning than a control group [
8]. Furthermore, college students engaged in PjBL have consistently reported high levels of satisfaction and enjoyment with the learning process [
9].
Although PjBL can enhance learners’ knowledge and skills by promoting active engagement, it may also impose additional learning demands on students [
5,
10]. Previous studies examining the experiences and effects of PjBL in nursing education have highlighted both its educational benefits and inherent challenges. However, despite the accumulation of quantitative and qualitative evidence, findings remain fragmented, highlighting the need for a comprehensive synthesis of PjBL’s overall impact in the specialized context of pediatric nursing education. Therefore, this study aims to analyze the application and outcomes of PjBL in pediatric nursing education through an integrative review. This methodology was selected because it allows diverse research designs to be included simultaneously, thereby supporting a more nuanced understanding than would be possible through a traditional systematic review alone.
Following the framework proposed by Whittemore and Knafl [
11], this review followed 5 stages: problem identification, literature search, data evaluation, data analysis, and presentation. By integrating disparate evidence, this study sought to provide a foundational evidence base for implementing PjBL to strengthen pediatric nursing competencies. This integrative review therefore examined the application and outcomes of project-based learning in pediatric nursing education and identified its key characteristics. Specifically, it addressed the following research questions: What contextual factors necessitate project-based learning in pediatric nursing education? What are the key characteristics of project-based learning in pediatric nursing education? What learning outcomes are associated with project-based learning in pediatric nursing education? What factors facilitate or hinder the implementation of project-based learning in pediatric nursing education?
METHODS
Ethical statements: This study is a literature review of previously published studies and was therefore exempt from Institutional Review Board approval.
1. Literature Review Method
To obtain a comprehensive understanding of PjBL in pediatric nursing education, an integrative review was conducted to incorporate diverse research perspectives. This approach allowed for the inclusion of studies using various methodological designs. The review strictly followed the methodological framework developed by Whittemore and Knafl [
11].
The aim of this study was to synthesize existing research on PjBL in pediatric nursing education and to evaluate its key characteristics and its impact on nursing students’ learning outcomes.
3. Literature Search
1) Inclusion and exclusion criteria
The inclusion criteria were as follows: (1) Population: studies involving undergraduate nursing students or graduate nursing students; (2) Intervention: educational interventions in the field of pediatric nursing that applied PjBL; and (3) Study design: qualitative, quantitative, or mixed-methods studies, as well as systematic, integrative, scoping, or literature reviews. For this review, PjBL was operationally defined as an educational approach in which learners engaged in a project centered on an authentic pediatric nursing problem or task, participated in a structured inquiry process, and produced project outputs. Additional elements supporting classification as PjBL included student choice, reflection, feedback or revision, and public sharing. The exclusion criteria were as follows: (1) studies aimed at improving medical or nursing care or patient health outcomes rather than learners’ educational outcomes; (2) studies that did not report clear learning outcomes; (3) studies describing simple group assignments, simulation activities, or educational tasks without sufficient evidence of core PjBL elements; and (4) studies published in languages other than English or Korean. No restrictions were applied regarding the year of publication.
2) Search methods and results
The literature search was conducted by one reviewer. The retrieved records were then screened independently by 2 reviewers, who compared and cross-checked their decisions at each stage of the study selection process. Any disagreements were resolved through discussion until consensus was reached. The literature search included 6 academic databases: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Korea Citation Index (KCI), and Research Information Sharing Service (RISS). It also included 2 gray literature sources, ProQuest and RISS; hand searching using Google Scholar; and citation searching through manual screening of the reference lists of the included studies. Detailed search strategies and final search dates for each information source are provided in
Supplement 1. The searches were conducted between May 8 and May 15, 2025, with the final search completed on May 15, 2025. The primary search terms used for the academic database searches included “Project,” “Learning,” and “Pediatrics,” which were combined with relevant Medical Subject Headings (MeSH), Emtree terms, natural language terms, and abbreviations. Boolean operators (AND, OR) and truncation were applied to refine the search strategy, and search terms were adapted for each database according to its indexing system. The initial database search identified a total of 50,048 records. After duplicate records were removed using reference management software, 48,346 records remained for screening. Following title and abstract screening, 29 articles were selected for full-text review, of which 5 met the inclusion criteria.
To identify additional studies not captured through database searches, gray literature searches were conducted using ProQuest and RISS. In addition, hand searching was performed using Google Scholar with the search terms “project based learning” AND “pediatric nursing.” The reference lists of included studies were also manually reviewed. These additional search methods identified 1,135 records. Duplicate records within gray literature sources were removed using EndNote 2025 (Clarivate). Citation searching and hand searching were excluded from duplicate removal, resulting in 4 duplicate records. After title and abstract screening, 2 articles were selected for full-text review, and one additional study was included. Ultimately, a total of 6 studies were included in the final analysis (
Figure 1). The 6 included studies incorporated core PjBL components, including an authentic pediatric nursing problem or task, an inquiry process, and production of project outputs.
Quality appraisal was conducted using design-specific appraisal tools according to the methodological characteristics of each study. The Mixed Methods Appraisal Tool (MMAT) [
12] was applied to descriptive, case study, and mixed-methods studies, and the Joanna Briggs Institute (JBI) critical appraisal tools [
13] were used for quasi-experimental studies. Quality appraisal was performed independently by one reviewer and subsequently verified by a second reviewer. Any disagreements were resolved through discussion until consensus was achieved. The methodological quality of each study was assessed and categorized as low, low–moderate, or moderate according to the number and severity of methodological limitations identified. The quality appraisal results are presented in
Table 1 [
7,
14-
18]. Because the purpose of this review was to examine not only the learning outcomes of PjBL in pediatric nursing education but also its characteristics, all eligible studies were included in the analysis regardless of their level of evidence. Nevertheless, methodological limitations of individual studies were carefully considered during the data synthesis process.
A data extraction sheet was developed to systematically document the information required for reviewing each included study. One reviewer conducted the study-specific review and data extraction, while a second reviewer evaluated the appropriateness of the summarized and condensed content produced during the extraction process. The extracted data were then organized into tables according to the general characteristics of the studies and the specific characteristics of PjBL. During table development, the data were further condensed and summarized (
Tables 2,
3) [
7,
14-
18]. The completed tables were used to compare similarities and differences across the included studies. Through repeated comparison, review, and analysis of the tabulated data, patterns and themes related to the characteristics of PjBL and its associated learning outcomes were identified. Meaningful units were coded and grouped into categories based on similarities and differences. Learning outcomes were then classified into cognitive, affective–attitudinal, and psychomotor domains according to Bloom’s taxonomy [
19]. The final integrated and synthesized findings were subsequently re-examined in conjunction with the original studies to ensure accuracy, and individual studies were cited in the presentation of the conclusions.
Effect sizes, including mean differences (MDs) and 95% confidence intervals (CIs), were calculated using Microsoft Excel (Microsoft Corp.) based on the data reported in the original studies, including sample size, mean, and standard deviation for each group. Effect sizes were calculated to examine the magnitude of effects in individual studies.
RESULTS
1. What Contexts Necessitate the Application of PjBL in Pediatric Nursing Education?
PjBL was implemented in pediatric nursing education to address limited pediatric nursing knowledge and clinical experience, increase learner engagement in restricted clinical environments, and expand learning opportunities across diverse contexts, including community and home settings.
PjBL was used as a pedagogical strategy to support students in integratively understanding the characteristics of pediatric diseases and children’s developmental needs and in applying this understanding to actual nursing practice, particularly in contexts where students possessed limited pediatric nursing knowledge and clinical experience. For instance, Woodley et al. [
15] implemented a project in which students designed developmentally appropriate play activities for hospitalized children during clinical practicums, addressing the contextual limitation that pediatric growth and development concepts are difficult to fully comprehend through theoretical instruction alone. Similarly, Vasset and Sundal [
16] developed a project in which students with limited pediatric nursing experience interviewed nurses caring for children with acute and chronic illnesses and the children’s parents, conducted literature reviews, and produced research reports on pediatric nursing care for acute and chronic conditions, thereby enabling students to explore disease-specific pediatric nursing within an authentic clinical context.
PjBL was also employed as a pedagogical strategy to promote active learner engagement in pediatric clinical practicum settings where opportunities for direct nursing care were constrained. Koo et al. [
7] implemented a project involving the development of educational video clips on high-risk newborn care during neonatal intensive care unit (NICU) practicums, thereby providing students with opportunities to utilize the NICU environment and medical equipment and to interact with practicing nurses.
In addition, PjBL was combined with diverse contexts, including community and home settings, to broaden the scope of pediatric nursing learning. Rossman et al. [
17] addressed a community-level issue (namely, shortages in school health personnel) by engaging nursing students as school nurse extenders in elementary schools, through which students experienced the practical roles of school health nursing. Pohl et al. [
18] implemented a home visit project for children with chronic illnesses, enabling students to assess children’s health status in home environments, communicate with families, and plan and implement family-centered nursing care. Commendador and Flood [
14] linked pediatric health education with community health promotion by engaging nursing students in a blood pressure education project for elementary school students.
Studies applying PjBL in pediatric nursing education were analyzed as having considered learning objectives, design rationales and structures, and evaluation strategies during the implementation of PjBL.
Regarding project topics, Vasset and Sundal [
16] focused on nursing care for children with acute, chronic, and critical illnesses; Koo et al. [
7] addressed high-risk newborn care; and Rossman et al. [
17] emphasized school health nursing. By selecting topics directly aligned with core competencies in pediatric nursing, these studies clearly articulated the instructional focus of PjBL. However, in some studies, the project purpose and learning objectives were presented in a mixed manner, or explicit statements of learning objectives were insufficient [
14,
15].
When designing PjBL, the application of theoretical frameworks helped manage the complexity associated with the learning problem, the instructional process, learner and faculty roles, and the educational environment. Woodley et al. [
15] designed their project based on experiential learning theory [
20], linking theoretical concepts of child growth and development to students’ observational experiences with hospitalized children in pediatric wards. Following a structured reflection phase, the project progressed to active experimentation, during which students designed play activities tailored to the developmental needs of hospitalized children. Vasset and Sundal [
16] applied motivation theory [
21] to ensure that students recognized the significance of the task through a clearly defined problem statement at the initial stage of the project. Their design incorporated diverse learning strategies, including interviews, literature reviews, and discussions, thereby enhancing methodological diversity. In addition, clearly defined outputs were used to strengthen task identity, and although autonomy was emphasized throughout the project, continuous feedback was provided to promote learning motivation and engagement.
PjBL was predominantly designed and implemented within clinical settings, such as pediatric wards, elementary schools, and home environments [
14,
17,
18]. However, several studies adopted hybrid structures that integrated school-based learning with clinical field experiences. For example, Koo et al. [
7] utilized not only the NICU but also on-campus skills laboratories and simulation models to complete an educational video project on high-risk newborn care. Similarly, Vasset and Sundal [
16] conducted interviews in pediatric wards and subsequently returned to academic settings, where students completed literature reviews with librarian support and finalized research reports in collaboration with faculty members.
PjBL interventions in pediatric nursing education were commonly structured in sequential stages, including preparation, implementation, planning, practice, and reflection, with student reflection consistently identified as a core component [
7,
14,
15,
18]. However, only one study employed a cyclical structure in which revised plans were re-applied and re-implemented following reflection [
14]. In contrast, 3 studies were limited to a single cycle of project implementation followed by reflection [
7,
15,
18]. Furthermore, 2 studies did not report a formal student reflection process [
16,
17].
Although project outputs were disseminated to diverse audiences using various methods, formal evaluation of these outputs was reported in only one study. Across the included studies, outputs were shared through presentations [
15,
16], role-playing activities [
15], demonstrations [
7,
15], and publication in local newspapers [
14]. The audiences extended beyond students and faculty to include clinical preceptors [
15], school health teachers [
17,
18], children’s parents [
18], and community members [
14]. However, only one study reported conducting formal evaluations of project outputs [
16], whereas the remaining studies either did not evaluate project outcomes or did not describe their evaluation methods [
7,
14,
15,
17,
18].
Learning outcomes were classified into cognitive, affective–attitudinal, and psychomotor domains based on the taxonomy of educational objectives by Bloom et al. [
19]. Among the included studies, only one quantitatively measured learning outcomes [
7], whereas the remaining studies primarily reported learning outcomes derived from qualitative data.
With respect to cognitive outcomes, PjBL was associated with improvements in pediatric nursing knowledge and critical thinking. Rossman et al. [
17] reported that students, while serving as school nurse extenders, developed an understanding of school health nursing roles, disease pathophysiology appropriate to the elementary school level, and children’s growth, development, and physical assessment. Pohl et al. [
18] found that through home visit experiences, learners gained insights into interactions among family members of children with chronic illnesses, the influence of home environments on children’s health and care, and family strengths in adapting to children’s illnesses, while also developing nursing care plans and engaging in critical thinking. Woodley et al. [
15] reported that PjBL involving the design of age-appropriate play activities was effective in enhancing understanding of child growth and development. They further reported that participants in the project achieved significantly higher scores on growth- and development-related examination items than students who had previously completed the same course. Vasset and Sundal [
16] described improvements in learners’ critical thinking through the process of analyzing nursing problems and identifying solutions for children with acute, chronic, and critical illnesses, and concluded that PjBL was useful for achieving learning outcomes; however, these outcomes were not directly measured.
In terms of affective–attitudinal outcomes, reductions in practicum-related stress, positive attitudes toward PjBL, and increased senses of achievement and self-confidence were reported. Koo et al. [
7] found that following implementation of a PjBL project involving the production of educational video clips on high-risk newborn care, learners’ NICU practicum-related stress significantly decreased. The authors suggested that this reduction may be attributable to the creation of a learning environment that facilitated natural communication and questioning with nurses during the project, as well as the use of a mobile-based video production format that was familiar to students and may have reduced learning burden [
7]. Woodley et al. [
15] reported that most students perceived PjBL as effective for understanding course content, enhancing confidence, and supporting application of learning to practice.
Learning outcomes related to psychomotor domains were reported to a limited extent. Commendador and Flood [
14] reported that nursing students achieved intended performance goals by explaining basic knowledge of blood pressure to elementary school students and demonstrating blood pressure measurement; however, no quantitative analysis was provided regarding the magnitude of improvement in knowledge or skills. Koo et al. [
7] reported improvements in competencies related to high-risk newborn care following PjBL implementation. The authors interpreted these changes as being associated with students’ clearer recognition of their academic level and achievement goals during the process of producing educational videos for peer learning [
7].
Facilitators identified in studies applying PjBL in pediatric nursing education were categorized into learning motivation, appropriate faculty roles, and the availability of sufficient financial and time resources.
First, learning motivation was identified as a key facilitator of PjBL implementation. Learners’ exposure to authentic problem contexts was reported to enhance their motivation for learning. Rossman et al. [
17] reported that students’ learning motivation was strengthened through direct experiences with elementary school students while serving as school nurse extenders. Pohl et al. [
18] stated that through home visits, students encountered children with chronic illnesses and their families and described the experience as learning from children rather than from textbooks. Vasset and Sundal [
16] reported that allowing students to select their own project topics and address issues they perceived as important within pediatric nursing contexts increased learning motivation.
Second, faculty roles as facilitators, supporters, and coordinators were identified as critical factors enabling smooth implementation of PjBL and sustained learner engagement (
Table 4). Koo et al. [
7] provided systematically developed worksheets to guide project implementation and facilitated students’ access to spaces and equipment in both the NICU and on-campus skills laboratories. Woodley et al. [
15] adjusted project scope to allow students to explore diverse aspects of child growth and development and provided orientations prior to project initiation, enabling early immersion in project activities. Vasset and Sundal [
16] used an online platform to deliver feedback and coordinate learning directions throughout the project. The authors emphasized that when online platforms are used, structured support is necessary to ensure predictable access to assistance, including clear guidance on resource locations, question-asking procedures, and pathways to additional information [
16]. In studies where PjBL was implemented outside the nursing school, such as in hospitals, communities, and home environments, collaboration with on-site professionals provided learners with ongoing support and guidance [
7,
17,
18] (
Table 4).
Third, the availability of sufficient financial and time resources was identified as a condition enabling practical project implementation and the production of outputs [
7,
15,
17]. Commendador and Flood [
14] notably secured financial support from community organizations by linking PjBL with community-based issues. In the study by Rossman et al. [
17], students were able to perform a wide range of activities—including health screening, preventive health services, routine health care, chronic illness management, emergency response, and documentation—while serving as school nurse extenders over an extended period of 10 weeks. However, when sufficient time was not available, PjBL was still implemented efficiently by integrating projects into clinical practicums [
7,
14,
15].
The barriers reported in studies applying PjBL in pediatric nursing education were categorized into inefficient project design and limitations in faculty guidance, constraints related to ethical procedures, issues in team dynamics, and limitations associated with financial and time resources.
First, inefficient project design and limitations in faculty guidance were identified as barriers to PjBL implementation. Because PjBL involves multiple stages, including problem definition, data collection, and output production, learners experienced confusion and burden when project components were designed inefficiently or were overly complex, or when faculty guidance did not adequately meet learners’ needs. Pohl et al. [
18] reported that students experienced difficulties due to the absence of clear guidelines regarding when to contact families for home visits, how long to wait for responses, and how to address communication-related problems. Commendador and Flood [
14] noted that the complexity of forms used in the project hindered learners’ achievement of learning objectives, and Woodley et al. [
15] reported that redundant or repetitive report-writing requirements during project implementation imposed an additional burden on students. Rossman et al. [
17] pointed out that, given the nature of a 10-week project requiring sustained student participation, it was difficult for students to receive continuous guidance and support from members of participating institutions. Vasset and Sundal [
16] reported as a limitation that students desired substantial guidance from faculty during project implementation and preferred face-to-face guidance over online supervision; however, providing such support sufficiently was challenging.
Second, constraints related to ethical procedures emerged as a significant barrier in projects involving children. Pohl et al. [
18] reported that obtaining parental consent required considerable time and effort, reducing students’ actual activity time when project durations were limited. Delays in the consent process sometimes necessitated changes in participants or reductions in the scope of activities, which in turn affected output production and overall project completeness.
Third, issues related to team dynamics in team-based learning were identified as additional barriers. Pohl et al. [
18] reported that differences in participation levels among team members, imbalances in role allocation, and increased time required for coordinating opinions made project implementation more difficult.
Fourth, constraints related to financial and time resources were reported as barriers to PjBL implementation. Woodley et al. [
15] reported that although producing toys was not mandatory in projects involving the design of developmentally appropriate play activities, some students faced limitations in output production due to financial constraints, highlighting the need for institutional support when monetary costs are incurred. Vasset and Sundal [
16] reported that, given the complexity of tasks involving interviews with nurses and parents caring for children with acute and chronic illnesses, literature reviews, and final report preparation, a 2-week project period was insufficient. However, the authors also noted that securing sufficient time was challenging when taking learners’ overall curricular demands into account [
16].
Several common methodological weaknesses were identified across the studies included in this integrative review. These weaknesses were categorized into limitations related to study design and sampling, insufficient measurement of learning outcomes and limited outcome validity, lack of transparency in qualitative research procedures, and ambiguity in the PjBL concept.
First, limitations related to study design and sampling were observed across multiple studies. Most studies were conducted at a single institution and relied on convenience sampling, which restricted the generalizability of the findings. The study by Rossman et al. [
17] employed a single-case design without a control group, thereby limiting internal validity and precluding verification of changes or effects attributable to PjBL implementation. In the study by Koo et al. [
7], random assignment to groups was not performed, raising the possibility of selection bias.
Second, insufficient measurement of learning outcomes and limited outcome validity were identified. In the studies by Rossman et al. [
17] and Commendador and Flood [
14], project outputs and activity descriptions were reported as performance results; however, no quantitative instruments or analytical strategies were employed to systematically evaluate educational effects. Woodley et al. [
15] reported comparisons of examination scores with those of previous cohorts; however, interpretation of these findings was constrained by the absence of detailed information regarding comparison group characteristics, sample size, statistical analysis methods, and specific statistical values. Vasset and Sundal [
16] identified the achievement of learning outcomes as a primary research focus, but outcome validity was limited because learning outcomes were not operationally defined and no quantitative or qualitative indicators were provided to assess the level of achievement.
Third, deficiencies were identified in strategies used to ensure transparency and trustworthiness in qualitative research procedures. Pohl et al. [
18] and Woodley et al. [
15] provided insufficient methodological descriptions of the coding, categorization, and analytical processes used in qualitative data analysis, making it difficult to assess the rigor of result derivation. In particular, the study by Pohl et al. [
18] relied on voluntary participation for interviews and surveys, which limited sample representativeness. In addition, although Vasset and Sundal [
16] involved researchers who served as both educators and data collectors, reflexivity regarding the researcher–participant relationship was not sufficiently described, and strategies to enhance credibility, such as the use of participant quotations or triangulation, were limited.
DISCUSSION
PjBL was applied in contexts that emphasized the development of complex problem-solving abilities within pediatric nursing settings, rather than focusing solely on the acquisition of discrete knowledge or technical skills [
7,
14-
18]. Because nurses must accurately interpret clinical challenges and resolve them by integrating available resources and situational factors [
2], nursing students are required to develop the capacity to adaptively apply theoretical knowledge and nursing skills to clinical practice [
23]. To strengthen this application capability, effective instructional strategies are essential. In particular, pediatric nursing practicums require educational approaches that address the limitations of direct patient care arising from the heightened vulnerability of neonates and children to infection and injury [
24]. PjBL can function as an effective learning method in this context, as it provides structured opportunities to bridge theory and practice through projects aligned with nursing students’ developmental levels and scopes of practice. In other words, the context necessitating PjBL in pediatric nursing is one in which students must acquire diverse and complex pediatric nursing competencies demanded by clinical settings, despite the temporal, spatial, and practical constraints of the educational environment.
Because PjBL is an educational intervention rather than a simple execution of projects, its successful implementation in pediatric nursing requires clear topic selection, systematic design, and careful evaluation of the project process. The PjBL studies analyzed [
7,
16,
17] addressed topics closely related to pediatric nursing competencies, including care for children with acute and chronic illnesses, high-risk neonatal care, and school health nursing. However, PjBL must clearly define not only the problems students are expected to address or the overarching purpose of the project, but also the specific learning objectives to be achieved [
25]. Because the ultimate goal of PjBL in pediatric nursing is the enhancement of nursing competencies, project topics should be explicitly aligned with core pediatric nursing competencies to ensure attainment of intended educational outcomes. Furthermore, PjBL must be designed in a systematic, efficient, and ethical manner. In projects involving children, it is particularly important to verify ethical procedures, obtain prior parental consent, and ensure that all project activities are conducted ethically. Overly complex designs or project operations lacking clear procedural guidance may impede effective implementation of PjBL. PjBL can be flexibly adapted to different contexts by employing field-based designs that include communities, hospitals, and home settings [
14,
17,
18], as well as hybrid designs that integrate nursing colleges with clinical sites [
7,
16]. Such hybrid designs may serve as effective strategies for preserving educational authenticity while compensating for limitations in clinical accessibility. In addition, for PjBL to be established as a standard teaching method in pediatric nursing, ongoing refinement and improvement through appropriate evaluation are essential. Given that PjBL represents a non-traditional educational approach, deliberate efforts are required to develop diverse and suitable evaluation strategies.
The learning outcomes of PjBL in pediatric nursing can be classified into 3 domains: cognitive, affective-attitudinal, and psychomotor. This study demonstrated that PjBL contributed to the enhancement of pediatric nursing knowledge and critical thinking from a cognitive perspective. Previous research has shown that PjBL supports students’ understanding of knowledge and concepts [
5], improves academic achievement [
26], and promotes critical analysis and problem-solving abilities [
27]. In the present review, students not only expanded their knowledge of child growth, development, and pediatric diseases but also strengthened their critical thinking as they identified, analyzed, and sought solutions to pediatric nursing problems. Because real-world clinical issues served as the starting point for project activities, analytical reasoning and judgment were required at each stage of the learning process, which likely contributed to improvements in critical thinking. In addition, with respect to affective and attitudinal domains, pediatric nursing PjBL yielded positive learning outcomes, including reduced clinical practicum-related stress, more positive attitudes toward learning, and enhanced senses of achievement and self-confidence. Although PjBL shares similarities with PBL in its focus on real-world problems, it enables students to experience a greater sense of achievement and self-confidence through the production and completion of tangible project outcomes. These outcomes included written reports [
16], toys or play activities [
15], educational video clips [
7], and health education materials [
17]. Although students’ performance skills may have improved during the process of producing these outputs, empirical evidence regarding psychomotor learning outcomes remains limited. In particular, only a small number of included studies directly measured psychomotor outcomes, and most inferred performance improvement indirectly. Therefore, conclusions regarding psychomotor outcomes should be interpreted cautiously. Because the ultimate goal of PjBL in pediatric nursing is the development of nursing competencies, future research should more actively measure and analyze learning outcomes related to actual clinical performance.
In this review, the facilitators of PjBL in pediatric nursing included learning motivation, availability of resources, and the role of the instructor. Because solving authentic problems and completing project outputs require competencies that extend beyond students’ existing knowledge and skills, PjBL naturally stimulates motivation for further learning. In the included studies, exposure to problem-based environments—such as direct interactions with children and their families—was reported to enhance students’ learning motivation [
17,
18]. Such meaningful learning experiences are often initiated and sustained through the instructor’s role, underscoring the importance of instructors’ efforts to design strategies that enhance and maintain students’ motivation throughout the PjBL process.
Ultimately, the instructor’s role is pivotal to the success of PjBL, as instructor guidance directly enables students to achieve the intended learning outcomes. Instructors must present clear project topics and encourage learner-led inquiry within a predefined instructional framework [
3]. Whereas the primary activity of PBL involves exploration of problem situations within a flexibly defined structure, PjBL emphasizes project management and the completion of practically applicable outputs [
3]. Accordingly, instructors must facilitate learning by providing clear and explicit guidance throughout the project process. In addition, instructors function as supporters by offering feedback and encouragement that assist students’ learning processes during PjBL [
16], and as coordinators who manage project operations to ensure effective collaboration [
15]. Because PjBL is inherently team-based, team composition and role allocation are critical to successful project execution [
28]. Although team members collaborate toward shared goals [
29], challenges in team dynamics can impede project progress [
18]; therefore, instructors must coordinate roles and perspectives while mediating conflicts among team members. In this context, instructors should serve as providers of instructional “scaffolding” by continuously guiding students to remain aligned with project goals, encouraging the application of existing knowledge and skills, and offering concrete, practical support. Without adequate instructional guidance, learners may experience confusion and unnecessary burden. Future research should examine learning outcomes in relation to specific instructor roles in PjBL and explore strategies to strengthen teaching competencies. In addition, effective programs aimed at enhancing instructors’ PjBL-related capabilities should be developed and implemented to support the sustainable integration of PjBL in nursing education.
While PjBL is a pedagogical approach that enables students to develop the complex competencies required for real-world problem solving, its successful implementation depends on the availability of adequate financial and temporal resources. Because insufficient funding and limited time function as barriers to PjBL, it is essential to allocate sufficient instructional time in consideration of both project complexity and the overall curriculum. In other words, the effective operation of PjBL requires not only pedagogical commitment but also robust administrative and financial support, as well as sustained institutional commitment from educational organizations.
The methodological quality of the included studies ranged from low to moderate. Most studies were limited by single-site designs, small sample sizes, and insufficient use of validated outcome measures. Therefore, the findings of this review should be interpreted with caution. Despite these limitations, the included studies consistently reported positive educational outcomes, suggesting the potential effectiveness of PjBL in pediatric nursing education. However, further well-designed studies with rigorous methodologies are needed to strengthen the evidence base.
This study has several limitations, on the basis of which the following recommendations are proposed. First, methodological vulnerabilities were commonly identified among the studies included in this integrative review. Future PjBL research should incorporate core elements of PjBL more rigorously; specifically, quantitative studies should verify effects through randomized group assignment and validated quantitative outcome measures, while qualitative studies should ensure transparency and credibility in their methodological procedures. Second, as an integrative review, this study did not include a meta-analysis to estimate the effect size of PjBL. It is anticipated that future intervention studies developing and testing diverse PjBL models in nursing education will be conducted, followed by meta-analyses to determine the magnitude of PjBL effects in pediatric nursing. Third, this study did not separately examine the application of PjBL in theoretical versus clinical practice courses. Future research is therefore needed to apply PjBL more extensively across nursing curricula and to provide detailed analyses of PjBL content and learning outcomes according to course-specific characteristics.
CONCLUSION
This integrative review examined the implementation and outcomes of PjBL in pediatric nursing education. Synthesis of the 6 included studies suggested that PjBL may yield multifaceted benefits, particularly in cognitive and affective-attitudinal domains, while evidence for psychomotor outcomes was limited. Specifically, PjBL was associated with improvements in pediatric nursing knowledge and critical thinking, reductions in academic stress, and the promotion of positive attitudes toward learning. In addition, although some studies suggested improvements in performance-related skills, empirical evidence for psychomotor outcomes remains insufficient. To maximize the educational impact of PjBL, the role of faculty is critical in guiding students’ learning directions, motivating the integration of knowledge and skills, and providing concrete instructional scaffolding throughout the learning process. Accordingly, the successful integration of PjBL into nursing curricula requires sustained institutional support combined with structured and ongoing faculty guidance. However, although the included studies reported positive outcomes, the overall level of evidence ranged from low to moderate. Future research using more rigorous study designs and validated outcome measures is therefore required to establish stronger evidence for the effectiveness of PjBL in pediatric nursing education.
ARTICLE INFORMATION
Supplementary material
Figure 1.Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. a)Journal articles identified through RISS. b)Gray literature (theses, dissertations, books, and research reports) identified through RISS. c)Citation searching and hand searching: duplicates not removed. CENTRAL, Cochrane Central Register of Controlled Trials; CINAHL, Cumulative Index to Nursing and Allied Health Literature; KCI, Korea Citation Index; RISS, Research Information Sharing Service.
Table 1.Summary of methodological weaknesses in included studies
|
Author |
Study design |
Appraisal tool |
Methodological weaknesses |
Overall quality |
|
Vasset et al. [16] |
Descriptive study |
MMAT (mixed methods) |
• Lack of reflexivity regarding the researcher–participant relationship: potential power dynamics and response bias |
Moderate |
|
• Insufficient procedures to ensure the trustworthiness of qualitative analysis (e.g., use of participant quotations, investigator triangulation, methodological triangulation) |
|
• Single-site study |
|
Woodley et al. [15] |
Case study |
MMAT (mixed methods) |
• Limited rigor and transparency in reporting both qualitative and quantitative analyses |
Moderate |
|
• Inadequate sampling strategy and representativeness, with concerns about bias due to participant attrition |
|
• Single-site study |
|
Koo et al. [7] |
Quasi-experimental |
JBI |
• Absence of random assignment, raising the possibility of selection bias |
Moderate |
|
• Single-site study without longitudinal follow-up |
|
Commendador et al. [14] |
Case study |
MMAT (quantitative descriptive) |
• Limitations in sampling strategy and representativeness |
Low–moderate |
|
• Lack of validated and reliable measurement tools to assess the achievement of educational goals |
|
• Single-site study |
|
Pohl et al. [18] |
Case study |
MMAT (quantitative descriptive) |
• Reliance on voluntary participation, limiting representativeness |
Low–moderate |
|
• Lack of transparency in the qualitative analysis process |
|
• Single-site study |
|
Rossman et al. [17] |
Case study |
MMAT (quantitative descriptive) |
• Single-case study without a control group, limiting internal validity |
Low |
|
• Lack of validated quantitative tools and qualitative methods to evaluate educational effects |
|
• Single-site study |
Table 2.General characteristics of the included studies
|
Author (year) |
Country |
Study design |
Setting |
Participants (undergraduate nursing students) |
Analysis methods |
Key findings and highlights |
|
Level |
Intervention |
Comparison |
|
n (unit of activity) |
n (type) |
|
Vasset and Sundal [16] (2024) |
Norway |
Descriptive study |
University + pediatric ward |
2nd, 3rd |
159 (3–5 students/team) |
None |
• Text analysis [22]: quantitative analysis & content analysis |
• PjBL helped fill the educational gap caused by limited clinical pediatric experience. |
|
• Interviews, literature search, and self-selected topics were key factors in improving learning outcomes. |
|
• Both face-to-face guidance and the digital platform (Canvas) were used, but students expressed a greater need for in-person instruction. |
|
Woodley et al. [15] (2023) |
USA |
Case study |
Pediatric clinical field |
Not stated |
206-159-122a) (individual) |
Not stated (pre-project students) |
• Descriptive statistics |
• The problem source was derived from the illnesses and developmental needs of hospitalized children, and the play and toys designed accordingly by nursing students were noteworthy as creative outcomes. |
|
• Content analysis |
• The Pediatric Play Project, based on Kolb’s experiential learning theory [20], helped nursing students apply growth and development concepts to real clinical situations. |
|
• Some students reported that the project was time-consuming, the reflective report repetitive, and material preparation limited by financial constraints. |
|
Koo et al. [7] (2022) |
Republic of Korea |
Quasi-experimental study |
University + pediatric ward |
3rd |
24 (5–7 students/team) |
21 (usual care) |
• Repeated-measures ANOVA |
• PjBL can be an effective learning method in clinical settings such as the NICU, where student practice is limited. |
|
• Provides a hybrid learning environment by combining the NICU and the school lab. |
|
• Project-produced NICU video was used as a next-year student resource. |
|
Commendador and Flood [14] (2016) |
USA |
Case study |
Elementary school |
Not stated |
4 (4 students/team) |
None |
• Descriptive statistics |
• Nursing students designed, implemented, and evaluated child health education, simulating nurses’ health promotion activities. |
|
• Narrative description |
• Using children as mediators of health education can contribute to community health promotion. |
|
• PjBL served as a community–nursing school partnership model combining clinical training with community health promotion. |
|
• Positive outcomes led to additional funding, expanding PjBL to multiple elementary schools in the community. |
|
Pohl et al. [18] (2014) |
USA |
Case study |
Home visit |
4th |
47–24b) (team, not stated) |
None |
• Descriptive statistics |
• Nursing students received opportunities to learn in the child’s home environment and used a strength-based approach. |
|
• Qualitative content analysis |
• Open communication among students, faculty, and school nurse was essential to secure time for building relationships with new families. |
|
• A unique feature was delivering the student-developed family care plan to families in the form of a letter. |
|
Rossman et al. [17] (2012) |
USA |
Case study |
Elementary school |
3rd |
20 (1–2 students/team) |
None |
• Descriptive qualitative analysis |
• Nursing students gained practical school health experience as school nurse extenders. |
|
• Through PjBL, they produced various outcomes such as nursing care plans, educational materials, and health management reports. |
|
• As a community–university partnership model, the project had positive effects on both student education and school health services. |
Table 3.Characteristics of project-based learning
|
Author |
Project name |
Model or theory |
Learning challenge |
Source of problem |
Output |
Role |
Duration |
Major outcome (tool): MD (95% CI) |
|
Student |
Educator |
|
Vasset et al. [16] |
Project children |
Motivation theory [21] |
Identifying problems related to the nursing care of children with acute, critical, chronic, and complex diseases and seeking solutions to them |
Students |
• Report |
• Selects a pediatric nursing topic |
(Teacher) |
2 weeks |
• Project participation broadened students’ knowledge and understanding of clinical pediatric nursing. |
|
• Oral presentation |
• Formulates a clear problem statement including age range |
• Provides orientation, encourages topic selection, and offers motivation |
• Students emphasized the particular value of conducting team interviews with nurses and parents. |
|
• Conducts stakeholder interviews and literature review |
• Provides feedback, assists with literature search in collaboration with librarians, and reviews report drafts |
• Allowing self-selected topics enhanced students’ motivation for learning. |
|
• Writes and presents a report |
• Conducts process-oriented evaluation and outcome evaluation |
• Students expressed a need for increased face-to-face guidance from instructors. |
|
|
|
• Students reported difficulty in completing the project within a short period. |
|
Woodley et al. [15] |
Pediatric play project |
Experiential learning theory [20] |
Designing play tailored to the illnesses and developmental needs of hospitalized children |
Hospitalized children |
• Designed a toy or play activity |
• Discusses learning regarding growth and development |
(Clinical faculty) |
Not stated |
• Over 90% of students reported that the project was effective for learning about growth and development. |
|
• Presentation: role play, demonstration, PPT materials |
• Selects children |
• Provides orientation |
• Students stated that it was enjoyable and useful to explore ways of promoting growth and development as nurses. |
|
• Reflective summary report |
• Identifies developmental tasks through milestones |
• Guides students on applying growth and development knowledge to actual children |
• Students with project experience achieved significantly higher scores on growth/development test items than those without. (No detailed statistics reported.) |
|
• Designs and applies tailored play/toy activities |
• Facilitates discussion on the impact of hospitalization on development and the importance of play |
• Clinical faculty evaluated project students as more proficient than former students in developmental nursing interventions and communication. |
|
• Completes a presentation |
• Adjusts the project to include various pediatric diagnoses |
|
|
• Writes and submits a reflective report |
• Provides feedback during student presentations |
|
|
Koo et al. [7] |
Project of producing an educational video clip about high-risk newborn care |
Not specified |
Developing a video clip to teach high-risk newborn care to peers, considering the NICU environment where direct nursing by students is difficult |
CPF |
• Educational video clip |
• Conducts a literature review and sets learning objectives |
(CPF & CNI) |
1 week |
• Nursing competency for high-risk newborns (developed by the authors): MD, 3.75 (95% CI, 1.40 to 6.10) |
|
• Divides roles (script, teaching, filming, editing) |
• Provides project orientation and worksheets |
• Self-leadership (RSLQ): MD, 1.70 (95% CI, –7.28 to 10.68) |
|
• Develops a plan for a product |
• Assigns topics |
• Practicum-related stress: MD, –13.71 (95% CI, –27.11 to –0.31) |
|
• Films and edits a 10–15 min educational video |
• Encourages project progress |
|
|
• Views and reflects on the video |
• Reviews project plans and gives feedback as needed |
|
|
• Coordinates access to skills lab, NICU, equipment, and manikins |
|
|
Commendador et al. [14] |
Blood pressure pilot project |
Not specified |
Enhancing hypertension awareness among sixth-grade students to promote community awareness |
Local organization |
• Teaching materials and tools |
• Sets project goals and evaluation plan |
(Nursing faculty) |
3 weeks |
• Performance goals (nursing students’ knowledge and skills): 100% achieved |
|
• Adult BP data measured by elementary students |
• Develops teaching materials and tools on blood pressure |
• Provides guidance on project goals and evaluation plan |
(90 min/wk) |
• Outcome goals (elementary students’ knowledge and skills): 3 of 4 achieved (75%) |
|
• Newspaper article featuring the project |
• Conducts 2 education sessions (1 hr/session) |
• Adjusts to include the project in clinical practice |
|
• Among 375 adults whose BP was measured by elementary students, 135 (36.0%) had hypertension; about half intended further BP follow-up |
|
• Collects and evaluates data gathered by elementary students |
|
|
|
|
• Evaluates project and suggests improvements |
|
|
|
|
Pohl et al. [18] |
Family outreach project |
Not specified |
Identifying problems and developing/implementing nursing care plans |
Children with chronic conditions and their families |
• Family care plan |
• Prepares for a home visit: Family and Child Health History and Assessment Interview Guide
|
(Clinical faculty, school nurse) |
1 semester |
• Focus group interviews revealed that students found observing the child’s home environment beneficial and experienced improvements in both knowledge and critical thinking. However, they reported difficulties in preparing and conducting home visits and concerns when families were already well adapted with little nursing care needed. |
|
• Conducts role-play practice: initial phone call, history taking |
• Promotes the use of a strength-based approach |
• The family survey (n=10) indicated that students were professional and treated families with respect. |
|
• Carries out a family assessment: rapport building, applying strength-based approach |
• Supports students in preparing for home visits |
|
|
• Develops a care plan |
• Guides role-play |
|
|
• Reflects through focus group interview participation |
• Recruits families and obtains consent |
|
|
• Facilitates smooth student–family interaction |
|
|
• Reviews student-developed care plans |
|
|
Rossman et al. [17] |
Student nurses as school nurse-extenders |
Not specified |
Serving as school nurse extenders to supplement the shortage of elementary school nurses and to manage the health of children |
School children |
• Nursing care plan |
• Conducts daily health office management |
(School nurses & faculty members) |
10 weeks |
• Nursing students learned the role of school nursing and how to provide education to elementary school children. |
|
• Health education material |
• Assesses student health needs |
• Conducts an orientation to school nurse roles |
• Nursing students experienced the impact of chronic diseases on elementary children’s daily lives and learned by implementing appropriate interventions to improve their health. |
|
• Reports on health management outcomes |
• Provides first aid and emergency care |
• Facilitates and guides health needs review and care planning |
• Through the project, detailed child health information was collected, medications for the school were secured, and action plans were established to address children’s chronic health problems. |
|
• Carries out health education and preventive activities |
• Provides feedback on health education and management |
|
|
• Provides administrative support by assisting with paperwork and record management |
• Delegates routine tasks and monitors student activities |
|
|
|
• Coordinates school–university collaboration |
|
Table 4.Instructor roles and functions in pediatric nursing project-based learning
|
Role type |
Primary role |
Specific functions |
Example |
|
Facilitator |
Facilitates learning and provides overall direction for the learning process |
• Guides learning direction |
Koo et al. [7]: Provided project orientation and worksheets to guide project activities |
|
• Explains project purpose and procedures |
|
• Promotes learner immersion and engagement |
|
Supporter |
Provides practical and professional support during project implementation |
• Provides feedback on data collection, interview design, report writing, and presentations |
Vasset and Sundal [16]: Connected students who experienced difficulties in searching recent literature with a librarian |
|
• Connects students with external resources |
|
Coordinator |
Manages and coordinates project operations and collaborative processes |
• Manages schedules and coordinates role allocation |
Woodley et al. [15]: Adjusted project scope to ensure inclusion of diverse pediatric patient groups |
|
• Facilitates communication among students and between students and clinical preceptors |
|
• Mediates conflicts within teams |
REFERENCES
- 1. Kim MY, Kang JS, Kwon YJ, Kwon IS, Kim SH, Kim JS, et al.. Child health promotion care. Soomoonsa; 2018.
- 2. Korean Society of Nursing Science. Learning objectives of subjects for nursing students. Korean Society of Nursing Science; 2017.
- 3. Brundiers K, Wiek A. Do we teach what we preach?: an international comparison of problem-and project-based learning courses in sustainability. Sustainability. 2013;5(4):1725-1746. https://doi.org/10.3390/su5041725
- 4. Parra-Anguita L, López-Franco MD, Martínez-Galiano JM, González-Cabrera M, Moreno-Cámara S, Granero-Moya N. Evaluation of the use of project-based learning in the nursing degree. Nurs Rep. 2023;13(4):1648-1657. https://doi.org/10.3390/nursrep13040136
- 5. Guo P, Saab N, Post LS, Admiraal W. A review of project-based learning in higher education: student outcomes and measures. Int J Educ Res. 2020;102:101586. https://doi.org/10.1016/j.ijer.2020.101586
- 6. Kaya H, Şenyuva E, Işık B, Bodur G. Nursing students’ opinions regarding project based learning. Procedia Soc Behav Sci. 2014;152:379-385. https://doi.org/10.1016/j.sbspro.2014.09.216
- 7. Koo HY, Gu YE, Lee BR. Development of a project-based learning program on high-risk newborn care for nursing students and its effects: a quasi-experimental study. Int J Environ Res Public Health. 2022;19(9):5249. https://doi.org/10.3390/ijerph19095249
- 8. Park HY. The effects of team-based project learning on creativity and self-regulated learning ability of university students. J Educ Cult. 2019;25(4):283-297. https://doi.org/10.24159/joec.2019.25.4.283
- 9. Shin YH, Ryu KS. The study on instructional effect and satisfaction of project-based learning. J Korea Contents Assoc. 2020;20(12):1-12. https://doi.org/10.5392/JKCA.2020.20.12.001
- 10. Wu TT, Huang YM, Su CY, Chang L, Lu YC. Application and analysis of a mobile e-book system based on project-based learning in community health nursing practice courses. J Educ Technol Soc. 2018;21(4):143-156.
- 11. Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-553. https://doi.org/10.1111/j.1365-2648.2005.03621.x
- 12. Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M. Mixed Methods Appraisal Tool (MMAT), version 2018: user guide [Internet]. Canadian Intellectual Property Office, Industry Canada; 2018 [cited 2025 Aug 20]. Available from: http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf
- 13. Joanna Briggs Institute. Critical appraisal tools for use in JBI systematic reviews: checklist for case reports, cohort studies, case control studies, randomized controlled trials, and quasi-experimental studies [Internet]. The Joanna Briggs Institute; 2017 [cited 2025 Aug 18]. Available from: https://jbi.global/critical-appraisal-tools
- 14. Commendador K, Flood J. Teaching children to be health educators. Am J Nurs. 2016;116(10):64-67. https://doi.org/10.1097/01.NAJ.0000503310.83251.32
- 15. Woodley LK, Cosgrove B, Stone E, Stanley E, Nance J, De La Grana A. Experiential learning of childhood growth and development through a pediatric play project. Nurs Educ Perspect. 2023;44(4):257-258. https://doi.org/10.1097/01.NEP.0000000000001037
- 16. Vasset FP, Sundal H. Paediatric nursing: implementation and evaluation of project-based learning in nursing studies. Soc Sci Humanit Open. 2024;10:101022. https://doi.org/10.1016/j.ssaho.2024.101022
- 17. Rossman CL, Dood FV, Squires DA. Student nurses as school nurse extenders. J Pediatr Nurs. 2012;27(6):734-741. https://doi.org/10.1016/j.pedn.2012.02.005
- 18. Pohl CJ, Malin S, Kennell L. Reinventing the home visit for undergraduate nursing students. J Nurs Educ. 2014;53(12):696-698. https://doi.org/10.3928/01484834-20141120-05
- 19. Bloom BS, Engelhart MD, Furst EJ, Hill WH, Krathwohl DR. Taxonomy of educational objectives: the classification of educational goals. Longman; 1956.
- 20. Kolb DA. Experiential learning: experience as the source of learning and development. 2nd ed. Pearson Education; 2015.
- 21. Hackman JR, Oldham GR. The job diagnostic survey: an instrument for the diagnosis of jobs and the evaluation of job redesign projects. Yale University, Department of Administrative Sciences; 1974.
- 22. Newman IB. Meaning, materiality, and power: an introduction to discourse analysis. Studentlitteratur; 2003.
- 23. Korean Accreditation Board of Nursing Education (KABONE). The manual of nursing education accreditation for university. KABONE; 2021.
- 24. Koo HY, Lee BR. Educational needs for practicing neonatal intensive care among Korean nursing students. Child Health Nurs Res. 2021;27(4):339-353. https://doi.org/10.4094/chnr.2021.27.4.339
- 25. PBLWorks. Gold standard PBL: essential project design elements [Internet]. Buck Institute for Education; 2015 [cited 2025 Aug 18]. Available from: https://www.pblworks.org/what-is-pbl/gold-standard-project-design
- 26. Chen CH, Yang YC. Revisiting the effects of project-based learning on students’ academic achievement: a meta-analysis investigating moderators. Educ Res Rev. 2019;26:71-81. https://doi.org/10.1016/j.edurev.2018.11.001
- 27. Aley M, Lee R, Wang J, Wang J, Zheng S. Project-based learning and student outcomes in health professions education: a literature review. Health Prof Educ. 2024;10(3):11. https://doi.org/10.55890/2452-3011.1292
- 28. Aranzabal A, Epelde E, Artetxe M. Team formation on the basis of Belbin’s roles to enhance students’ performance in project based learning. Educ Chem Eng. 2021;38:22-37. https://doi.org/10.1016/j.ece.2021.09.001
- 29. Dearnley C, Rhodes C, Roberts P, Williams P, Prenton S. Team based learning in nursing and midwifery higher education; a systematic review of the evidence for change. Nurse Educ Today. 2018;60:75-83. https://doi.org/10.1016/j.nedt.2017.09.012
