Tutoring experiences of a high-risk newborn care simulation among nurse tutors and nursing student tutees in South Korea: a qualitative study

Article information

Child Health Nurs Res. 2025;31(1):40-51
Publication date (electronic) : 2025 January 31
doi : https://doi.org/10.4094/chnr.2024.038
1Professor, College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, Daegu, Korea
2Assistant Professor, College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, Daegu, Korea
Corresponding author Hyeran An College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel: +82-53-650-3629 Fax: +82-53-650-4392 E-mail: ahr777@cu.ac.kr
Received 2024 October 11; Revised 2024 December 12; Accepted 2025 January 13.

Abstract

Purpose

This study aimed to explore tutoring experiences related to a high-risk newborn care simulation among nurses and nursing students to derive insights into developing effective neonatal nursing practice.

Methods

A qualitative content-analysis study was conducted in March 2023. Data were collected through narrative surveys and focus group interviews with four neonatal intensive care unit nurses and 12 senior nursing students participating in a 1-day high-risk newborn care simulation program. A content analysis was performed on the collected data.

Results

Three categories (“efforts to foster a sense of presence,” “efforts to promote positive awareness of the neonatal intensive care unit,” and “establishing one’s role as an educator”) and six subcategories were derived from the nurses’ responses. Three categories (“growth through a realistic virtual simulation,” “improved learning effects,” and “hope for continued development”) and six subcategories were derived from the nursing students’ responses.

Conclusion

The nursing students experienced realistic practice with their nurse tutors in the high-risk newborn care simulation, which helped them form their professional identity as future nurses. After tutoring, the nurses’ perceptions of nursing students changed positively, which affected their teaching methods.

INTRODUCTION

Nursing students must gain experience in applying their knowledge of nursing to clinical settings if they intend to become qualified nurses. Neonatal nursing practice is essential for students to improve their newborn care competency [1]. Clinical practice allows nursing students to learn about the nursing procedures involved in neonatal health assessment, improvement, and recovery [2]. Nurses also impact nursing students through clinical practice because students engage with them frequently and can learn firsthand how to execute their jobs, communicate with others, and connect with patients [3].

However, clinical nurses reported that nursing students were too passive to approach them and learn nursing care, whereas nursing students have reported being unwilling to approach busy nurses [4]. Due to ethical and legal concerns, such as the protection of patients and nurses’ overwork, the provision of direct nursing care by nursing students has been restricted [5]. Despite the insufficient possibilities in clinical settings for nursing students to actively care for newborns vulnerable to infections and accidents, students desired opportunities for direct nursing practice in the nursery and neonatal intensive care unit (NICU) [4].

To resolve learning issues in clinical practicum, simulation training has been used to help nursing students practice caring for newborns in secure environments [6]. Simulation of neonates with health issues improved nursing students’ clinical practice performance and class satisfaction [7]. Simulation training on caring for high-risk neonates was also favored by NICU nurses [8]. Nurses in clinical practicum fields should understand how to operate simulations to become competent clinical nurse instructors, since simulations allow nursing students to learn crucial nursing skills in a controlled and safe simulated environment [9]. In addition to the principles of how the clinical practicum works, nurses must gain new information and skills in diverse teaching approaches [10]. Facilitating nurses experience and learn new teaching methods can promote nursing competency by allowing nursing students to perform nursing care in a clinical setting [11].

Moreover, nursing students can utilize tutoring, which is a small-group study method composed of a tutor and tutees [12], to extend their learning effects in simulation training [13]. Tutors effectively support tutees’ learning because their encouragement and suggestions act as buffers against the problems that tutees confront [14].

Tutoring is an interactive teaching-learning method that facilitates small-group learning by providing personalized guidance and feedback [12]. It is an effective strategy for promoting critical thinking, practical skills, and collaborative learning, particularly in areas like neonatal nursing care that require precision and adaptability [14,15]. In simulation-based education, tutoring improves learning outcomes by offering structured support and real-time feedback [13]. Tutors play a vital role in bridging the gap between theoretical knowledge and clinical practice, enabling students to develop essential skills in a safe environment [16]. Incorporating NICU nurses as tutors in neonatal nursing simulations is expected to leverage their clinical expertise and facilitate the delivery of high-quality training, thereby contributing to the development of students’ professional identity and confidence [15,17].

Providing practical support as tutors in simulation training furnishes NICU nurses with an opportunity not only to improve their abilities as educators [16] but to reflect on and evaluate their own competencies as nurses. Peer tutoring programs are recognized as effective educational methods for both tutors and tutees. However, dissatisfaction among tutees regarding underqualified tutors is a frequently reported issue [15]. To address this concern, involving NICU nurses—who are currently engaged in clinical practice—as tutors in simulation training is expected to qualitatively enhance the high-risk neonatal care competencies of student tutees. Previous studies on neonatal nursing simulations for nursing students have generally focused on educational needs [6,8] or program outcomes [7]. Studies that applied peer tutoring to neonatal nursing simulations [17] typically involved students in the roles of both tutors and tutees, without incorporating nurses as tutors. Therefore, this study introduced NICU nurses as tutors in a high-risk neonatal nursing simulation program for nursing students. By exploring the experiences of nurse tutors and student tutees, this study aims to contribute to the development of effective educational strategies for neonatal nursing simulation training.

METHODS

Ethical statements: This study was approved by the Institutional Review Board of Daegu Catholic University (CUIRB-2022-0052). Informed consent was obtained from all participants.

1. Study Design

This study adopted qualitative content analysis to explore the tutoring experiences of a high-risk newborn care simulation among nurses and nursing students (Figure 1). This study was based on the methodology of the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines [18].

Figure 1.

Research process of this study.

2. Setting and Sample

Through convenience sampling, four nurses from a university-affiliated hospital and 12 senior nursing students from a university in a South Korean metropolitan city were selected. In March 2023, participants who freely provided written consent to participate in the study were enrolled. The number of participants was determined to be 16 and consisted of four focus groups, with a focus group size of 4 to 12 persons considered ideal [19]. The inclusion criteria comprised nurses who had guided nursing students during a neonatal nursing practicum, worked in the NICU, and taken part in a similar program, as well as senior nursing students who had completed a neonatal nursing practicum the previous semester and taken part in a 1-day high-risk newborn care simulation program. Nurses who had not directed a neonatal nursing practicum were excluded, as were students who chose not to participate in the study or who had not completed a neonatal nursing practicum. All four nurses completed the narrative survey and focus group interview. The nurses were female and ranged in age from 28 to 49 years. Their employment periods ranged from 6 to 27 years, and their preceptorship experience ranged from 1 to 10 times, despite their having no prior simulation or tutoring experience with students. All 12 nursing students completed the narrative survey and focus group interview. The nursing students were between the ages of 21 and 25 years, and three of the 12 were male. Their simulation experience ranged from none to 4 times, and their simulation experience with senior tutors was 0 to 1 time; they had no prior tutoring experience in simulations with nurse tutors (Table 1).

General characteristics of tutors and tutees (N=16)

3. Application of High-Risk Newborn Care Simulation with Tutoring

This simulation focused on nursing care for newborns with respiratory distress syndrome, including respiratory assessments using monitors, invasive airway management, oxygen supply, endotracheal and oropharyngeal suctioning, and reporting to a physician. The simulation comprised six stages. The first stage (30 minutes) included an orientation on simulations with tutoring. The second stage (1 hour) consisted of a verbal test to assess pre-learning. The third stage (30 minutes) included a pre-briefing on the simulation. The fourth stage (2 hours) included a nurse tutor overseeing the tutees in teams of three and facilitating their nursing skills development. Nurse tutors supported the tutees’ learning in their assigned teams, and all tutors performed the same role. The fifth stage (20 minutes) included the teams carrying out the simulation, with one researcher who was not in charge of pediatric practice serving as an evaluator and nurse tutors acting as observers for the debriefing. The sixth stage (40 minutes) included the evaluator, nurse tutors, and student tutees gathering for a debriefing. Before the simulation began, another researcher conducted pre-education for the nurse tutors. Pre-education was divided into two stages. In the initial stage, the researcher gave the tutors simulation learning materials, and they studied independently. The tutors analyzed the simulation scenario in the second stage (30 minutes) and acquired teaching skills. If necessary, the researcher assisted the tutors and the tutees at the same location while the tutors were assisting student tutees.

4. Data Collection

On March 18, 2023, narrative surveys and focus group interviews were conducted with four nurses and 12 senior nursing students following a 1-day high-risk newborn care simulation program, which was an optional extracurricular activity, not part of the mandatory curriculum.

In the narrative survey, participants were invited to describe their experiences during tutoring for high-risk newborn care simulations, as well as any positive or negative aspects and any extra comments they might have. The researcher did not intrude while the participants filled out the narrative survey. In the focus group interview, one group of nurses and three groups of senior nursing students, each with four participants, were interviewed once for 60 to 90 minutes by an independent researcher who had not participated in the simulation program. The interviews were held in a seminar room at the institution affiliated with the researchers and students, ensuring a quiet and comfortable environment. A semi-structured interview guide was employed for data collection, and open-ended questions were posed. The main question was, “Please tell us about your tutoring experiences during high-risk newborn care simulations.” For nurse tutors, specific questions such as “How did your experiences as a tutor during the tutoring sessions help you?” and “What challenges did you face as a tutor?” were asked. For student tutees, questions included, “How did your experiences as a tutee during the tutoring sessions help you?” and “What challenges did you face as a tutee?” were posed. Additionally, all participants, both tutors and tutees, were asked, “Please share if you have comments about the tutoring.” These specific questions were designed to elicit more detailed information and clarify participants’ responses.

For ethical consideration, when recruiting participants, the researcher explained the study’s aims, methods, and protocols to ensure participants fully understood the purpose of the research. It was emphasized that participation was entirely voluntary and that anyone could withdraw from the study at any time without consequences. Students were assured that their academic performance would not be affected by their decision to participate. Furthermore, all participants provided written informed consent prior to their involvement.

The researcher ensured that participant data were coded, saved on the chief researcher’s computer, and secured with password protection to maintain confidentiality and anonymity. Additionally, participants were informed that all data collected during the study would be destroyed after its completion to protect their privacy. A modest gift was provided to all participants as a token of appreciation for their time and effort.

All data were audio-recorded and transcribed verbatim. Nonverbal responses observed during the interviews, including facial expressions, mannerisms, and vocal fluctuations, were documented in field notes and analyzed.

5. Data Analysis

In accordance with the inductive methodology of qualitative content analysis [20], data collection and analysis were conducted concurrently. The preparation phase involved researchers studying the data as a whole by reading the transcripts several times. Sentences that described experiences during tutoring for high-risk newborn care simulations were chosen as the unit of analysis, in consideration of the fact that the unit should not be too broad to take the context into account but be large enough to evaluate the entire phenomenon [21]. The organizing phase utilized open coding, during which significant sentences were selected after comprehending participants’ experiences by reading each unit of analysis several times. Important information was noted on the coding sheets as general and abstract statements, and related information was gathered into subcategories that were at a higher abstract level. The subcategories were grouped by similarity to form categories, and each category was then described using terms that best described them. In the reporting phase, the derived categories were presented.

6. Rigor

The researchers have extensive experience in qualitative research and have published numerous studies in this field. Since the beginning of the study, they provided simulation training and diligently reviewed the literature on qualitative research to thoroughly investigate and explain participants’ experiences. Strong support for credibility, transferability, dependability, and confirmability, which were the evaluation criteria recommended by Guba and Lincoln [22], was rigorously applied to ensure the rigor of the study outcomes. To ensure credibility, open-ended questions were used to allow participants to convey their experiences in their native language. Additionally, one of the researchers who interviewed the focus groups cross-checked the transcripts to ensure accuracy and minimize any data omission or distortion. To increase transferability, purposeful sampling was employed to choose participants, and data collection was maintained until theoretical saturation was achieved [23]. Two study participants verified that the findings from the data analysis accurately reflected their experiences. For dependability, the study was carried out strictly in accordance with the qualitative content analysis approach [20], and the research process and results were discussed and evaluated by researchers. To ensure confirmability, the researcher sought to explore tutoring experiences objectively, avoiding subjective judgments or pre-existing preconceptions while conducting interviews and evaluating the data.

RESULTS

1. Tutors’ Experiences

Analyzing the experiences of nurses who participated as tutors in the high-risk neonatal nursing simulation yielded six themes and three theme clusters (Table 2).

Categories and subcategories from tutor interview responses

1) Efforts to foster a sense of presence

(1) Describing how nursing is currently practiced in the clinical field

The tutors said that they participated because they thought their knowledge and experience, which arise from their current work in the clinical field, could improve the quality of the simulation. They had set the simulated situation to be as similar as possible to a clinical setting, and they tried to provide a situation rich in realism by adding their own clinical experiences to what the tutees learned through the simulation.

  • “There are many differences between what students learn in school and what nurses actually do in clinical settings, so I was able to talk about that.” (Tutor 1)

  • “Medical devices were operated and items were set up as if they were real, so that students could feel the simulated situation as though it were a real clinical situation.” (Tutor 2)

(2) Providing diverse perspectives

The tutors said that whenever there was a slight difference between what new nurses had learned and a real situation, the new nurses were too nervous to solve problems, as though they did not know anything. The tutors tried to broaden the perspectives of the tutees, who would become new nurses soon, by informing them that even if the situation seemed the same, the solution could be different depending on the patient.

  • “New nurses get nervous and flustered when things don’t go as expected, so I thought it was necessary to expand their perspective on problems while they were students.” (Tutor 1)

  • “I think the students will be less embarrassed later in a clinical context if they know that even if the disease is the same, the solution may be slightly different for each patient. So, I talked to the students about situations that seemed similar but had to be addressed in completely different ways.” (Tutor 2)

2) Efforts to promote positive awareness of the NICU

(1) Explaining the need for the NICU

The tutors were concerned about securing a stable number of nurses in the NICU in the future, since most students wanted to work in wards serving adult patients and few students wanted to work in the NICU. The tutors said that they confirmed to new nurses that the NICU was not only excluded from desired departments but was also considered an avoided department. Therefore, the tutors said that they participated in this simulation to help students, as NICU nurses, become interested in and have a positive perception of neonatal nursing.

  • “I think most students only hope to work in wards with adult patients. And it seems that relatively many students have too much resistance to the NICU. Not long ago, a new nurse who was assigned to the NICU quit before her first day of work because it was a NICU. Through this time, I wanted to let students know how much newborn care is needed.” (Tutor 3)

(2) Conveying rewarding experiences as a NICU nurse

The tutors said that the NICU is a place where, as nurses, they can provide truly holistic nursing care to patients, and that they can immediately see and feel the improvement of the patient due to their care. The tutors hoped that these aspects would be conveyed to the tutees through the high-risk newborn care simulation.

  • “Unlike for adults, I can take care of everything for newborn patients as a nurse, and it is very rewarding to watch them improve right next to me.” (Tutor 4)

3) Establishing one’s role as an educator

(1) Perception of students has changed positively

The tutors said they were disappointed by the tutees’ approach of trying to solve clinical-practice tasks only with patient information obtained through electronic medical records (EMRs) and of practicing without motivation. The nurses participating in this simulation as tutors overcame their existing prejudice against students after seeing that the students who participated as tutees asked questions actively and were eager to learn.

  • “I was really surprised to see students participating in clinical practice only looking at the EMR to solve their assignments, but today they were actively participating in the simulation.” (Tutor 1)

  • “COVID-19 (coronavirus disease 2019) has limited what students who have been practicing in the clinical field can do, but these days, students are sitting in empty chairs and dozing off after coming to the clinical field and doing all the tasks they have to do that day on the computer. It’s usually seven to eight out of ten students. Most students are not interested in children at all. But when I met the students in the simulation, they weren’t normally like that. I was surprised that all the students actively asked questions and practiced hard.” (Tutor 3)

(2) Opportunity to examine one’s role as an educator

The tutors said that they did not actively teach tutees in the clinical field because the tutees had no interest or enthusiasm for clinical practice. Because the tutees participated actively in the simulation, the tutors thought that the tutees’ lack of motivation in clinical practice may be their problem, not the tutees’ problem. The tutors thought that in the future they should be more active in teaching tutees undergoing clinical training. In addition, the tutors said that as clinical practice instructors, they began to worry about how to guide the tutees when they came to the clinical field so that they could have an active attitude, as they had had in the simulation.

  • “In clinical practice, most students have no focus or motivation. However, when I came here today and looked at the students, I thought that their lack of motivation might be our problem, not their problem, and I began to reflect on myself.” (Tutor 2)

  • “The students really enjoyed trying things out on their own. A new concern arose for me as to whether I should provide standards for the extent to which students can practice nursing directly or indirectly during clinical practice.” (Tutor 3)

2. Tutees’ experiences

As a result of analyzing the experiences of students who participated as tutees in the high-risk newborn nursing simulation, six themes and three theme clusters were identified (Table 3).

Categories and subcategories from tutee interview responses

1) Growth through a realistic virtual simulation

(1) Expanding one’s perspective on the situation

Most tutees said that they were able to learn about actual clinical situations and nursing care through tutors in a virtual simulation situation. In this simulation, the tutees interpreted and learned the scenario not piecemeal, but from a holistic perspective.

  • “Nurses with diverse experiences in clinical fields came and helped us learn about our simulation situations from various perspectives.” (Tutee 2)

  • “Through the tutors, it was great to be able to compare the differences between what I learn at school and actual nursing practice in clinical settings.” (Tutee 9)

(2) Forming identity through the rewards of being a nurse

Most of the tutees said that they had expected only to learn about nursing skills from the tutor, but they also said that they were able to learn the mindset of treating patients as a nurse through the tutor. The tutees learned from their tutors about the aspects that must be considered first in order to provide nursing care that puts the patient first, rather than nursing that solves problems the fastest. Through this simulation, tutees had the opportunity to think about what kind of nurse they should become in the future.

  • “I remember the tutor saying that observing the patient’s condition should be a higher priority than checking the monitor.” (Tutee 3)

  • “As a nurse, I was able to learn and feel how to treat patients through the tutors.” (Tutee 5)

2) Improved learning effects

(1) Learning clearly

Most tutees said that they were able to learn stably while solving problems immediately, thanks to the tutor who was with them during practice time. The tutees finished the practice with confidence that they were doing well because the tutor corrected even the parts they did not think they were doing wrong.

  • “When we practiced by ourselves, we weren’t sure if we were doing it right or not. This time, whenever I had a question, the tutor was right next to me to teach me, so I was able to study clearly without getting confused.” (Tutee 6)

  • “While I was practicing, the tutor was right next to me and gave me specific instructions on how to improve what I was doing. It was great because the tutor saw what I was doing and helped me.” (Tutee 10)

(2) Motivation to learn

The tutees felt that the tutors in clinical settings did not teach them properly and neglected them because of their nursing duties. The tutees said that because the tutor taught them actively in the simulation, they were able to participate actively in learning, and through this, they developed an interest in child nursing. The tutees recognized their shortcomings based on their interactions with the tutor and vowed to study harder in the future.

  • “During my child nursing practice, I rarely directly nursed patients. I was interested in child nursing, but I didn’t really feel like I had to study hard. However, through this time, I became interested in child nursing and realized the need to study hard.” (Tutee 10)

  • “I thought that I could do most nursing skills well now, but after watching the tutor do it, I realized that I still lack many things. Now I think I need to study harder from now on.” (Tutee 9)

3) Hope for continued development

(1) Desire for a learning environment similar to the clinical field

The tutees said that when listening to the tutor explain the clinical field, understanding accurately was difficult due to the differences between the simulation environment and the clinical environment. In addition, the tutees said that their understanding of medical devices and medical consumption used in clinical practice was limited when conveyed only through the tutor’s explanation. The tutees expected that they would be able to learn more from tutors if the simulation environment resembled the clinical environment more closely and if medical equipment and medical consumables used in clinical practice were provided at the school.

  • “I did not fully understand the medical devices and supplies currently used in the clinical field because I only heard explanations from the tutor. If there are such medical devices or supplies at school, I think it will be easier to understand them because I can see and use them and learn from a tutor.” (Tutee 7)

  • “The tutor explained the differences between simulation situations and clinical situations, but I was confused because I couldn’t picture the details in my head. When a tutor teaches us in a simulation, I think we will be able to learn more accurately if the environment is as similar to a clinical setting as possible.” (Tutee 2)

(2) Interest in becoming a tutor

All tutees wanted to participate in the simulation to help tutees if they became nurses like the tutors. The tutees said that if they became nurses and participated in the simulation as a tutor, they would be able to teach in a way that the tutees could understand easily. They said that if they became nurses and tutors, they would like to help students by teaching them what they need to learn before becoming nurses.

  • “Since I received help, I want to help students later when I become a nurse. At that time, I think I will be a nurse who understands students and be able to teach in a way easy for students to understand.” (Tutee 2)

  • “When I become a tutor, I want to teach my students about the things they must learn as a nursing student.” (Tutee 11)

DISCUSSION

This study explored the tutoring experiences of high-risk newborn care simulation among nurses and nursing students, identifying the characteristics of tutoring provided by nurse tutors and experienced by student tutees during simulation training.

In the first category identified for nurse tutors, “efforts to foster a sense of presence,” the nurses sought to provide clinical knowledge and experiences that were as realistic as possible. Additionally, they emphasized that patients in similar situations might require different interventions, encouraging students to broaden their perspectives. This aligns with the subcategory identified for student tutees, “expanding one’s perspective on the situation.” The nursing students in this study were able to understand multiple perspectives, moving beyond simply perceiving the simulation scenario, when the nurses offered realistic clinical knowledge and field-based experiences. A thematic synthesis on the mentorship experiences of students and nurses demonstrated that nursing students gained confidence in their practice when guided by a nurse and reported positive learning experiences when nurses exhibited exemplary qualities [24].

In the second category identified for nurse tutors, “efforts to promote positive awareness of the NICU,” the nurses participated in the tutoring of high-risk newborn care simulations to spark nursing students’ interest in neonatal care and conveyed to the students the rewarding experience of being a NICU nurse. This aligns with the subcategory identified for student tutees, “forming identity through the rewards of being a nurse.” The nursing students in this study initially expected to focus solely on learning skilled nursing techniques from nurses, but they also gained a fundamental understanding of how to care for newborns. Furthermore, the nursing students envisioned the type of nurse they aspired to become. The nurses served as essential role models for patient-centered care, significantly enhancing the nursing students’ professional identities [25].

In the third category identified for nurse tutors, “establishing one’s role as an educator,” the nurses developed more favorable perceptions of nursing students and gained opportunities to reflect on their roles as clinical educators. Initially, the nurses felt disappointed by a perceived lack of motivation among nursing students in clinical practicums and held negative stereotypes about the students. However, observing the students’ active participation in the simulation enabled the nurses to overcome these preconceptions. An earlier study highlighted the mutual lack of understanding between nurses and nursing students [4]. Nursing students reported being reluctant to approach busy nurses, while clinical nurses viewed the students as too passive to initiate learning interactions. When nurses are tasked with unmotivated or challenging students, they may feel dissatisfied and disengaged [26]. Nurses cannot provide effective teaching or constructive feedback if they maintain negative perceptions of students or fail to understand their needs. During neonatal practicums, some nurses were described as non-responsive, only addressing students’ questions because they were uncertain about what or how to teach [4]. However, feedback from nurses, plays a critical role in the learning and development of nursing students [24]. The simulation-based tutoring experiences provided a valuable opportunity for nurses to recognize students’ unique characteristics and potential. Nurses’ positive attitudes toward students can empower students to achieve their practice goals and improve their learning outcomes.

The nurses participating in this study realized that the students were not inherently passive; instead, they were placed in a passive role by the structure of the clinical practicum. The nurses recognized that the challenges in practicum guidance were not the students’ fault, but rather their own responsibility as educators. The simulation-based tutoring experience provided an opportunity for self-examination and reflection by the nurses. The tutors’ attitudes toward tutees had a greater impact on the tutees’ satisfaction with the educational program and learning outcomes than their knowledge and skills [15]. As clinical nurse instructors, nurses should identify students’ learning needs, facilitate their learning processes, motivate them, and provide constructive feedback [27]. Introspection and reflection enable nurses to mature and develop as effective clinical instructors.

In the first category identified for nursing student tutees, “growth through a realistic virtual simulation,” the nursing students experienced highly realistic simulations guided by nurse tutors actively working in the clinical field and began to form their professional identity as future nurses. Nursing students need the practical skills imparted by nurses to build confidence and competence [24]. As clinical experts, nurses’ participation in practicums substantially facilitates students’ learning. Collaboration between academic education and clinical practicums enhances nursing students’ ability to develop into competent nurses. Additionally, the nursing students in this study gained insights into the nurses’ philosophy and beliefs about neonatal care through natural interactions. Nurses serve as role models for nursing students, teaching them not only technical skills but also attitudes and professional values [24]. Therefore, nurses should be provided with systematic support to improve their teaching abilities during practicums.

In the second category identified for nursing student tutees, “improved learning effects,” the nursing students were able to immediately seek guidance from the nurses to address challenges, which increased their satisfaction with learning. Additionally, the nursing students were motivated to study harder by the active support provided by the nurse tutors, leading to increased interest in neonatal care. In a study of peer tutoring in a neonatal nursing simulation [17], the tutees improved their skills when they received targeted assistance from their tutors and accurately identified problems. Similarly, the nursing students in this study expressed satisfaction with the clinical nurses’ ability to teach nursing skills precisely and clearly. The students were further motivated to learn because the clinical nurses prioritized patient care and guidance despite the demands of a busy clinical setting, and they were actively present in the simulation alongside the students. This aligns with the subcategory identified for nurse tutors, “perception of students has changed positively.” The students’ active learning attitudes positively influenced the nurses’ perceptions of the students, and the reverse was also true. A strong tutor-tutee relationship is essential for effective learning and development [24]. Therefore, nurses and students must understand one another and establish strong relationships in clinical practicums.

In the third category identified for nursing student tutees, “hope for continued development,” the nursing students expressed a desire to participate in more realistic simulations with nurse tutors. In an antecedent study [17], the tutees hoped to continue peer tutoring and sought standardized instruction from their tutors. Similarly, the nursing students in this study aspired to become nurse tutors to support and encourage future students. The nursing students who were tutored by nurses valued the assistance they received and expressed a desire to give back by mentoring younger students after they became nurses. This finding aligns with a prior study [17], which reported that tutees wished to take on the role of tutors. Tutors also benefit from the tutoring process because it improves their teaching abilities and fosters their motivation to study [16]. Therefore, nursing educators should provide students with adequate support and resources to develop their skills and understand the role of tutors.

The use of clinical nurses as tutors in simulations offers a practical approach to improving nursing education. This study showed that nursing students improved their technical skills and gained deeper understanding of neonatal care values, strengthening their professional identity [24,25]. To effectively implement this approach, clinical nurses need systematic support to enhance teaching skills and build strong tutor-student relationships. Collaboration between academic and clinical settings can further boost students’ competence and confidence.

This study has some limitations. First, the participants engaged in tutoring for a high-risk newborn care simulation only once, and this process involved both nurses and nursing students. Nurses and nursing students who participate together in multiple tutoring simulations may have different experiences, leading to varied insights. Future studies should explore the experiences of participants involved in repeated tutoring simulations. Second, the nurse tutors in this study had differences in clinical experience, NICU experience, preceptorship experience, and position. Future studies should examine how these differences in the tutors’ experience and position influence the learning outcomes of the tutees.

CONCLUSION

This study explored the tutoring experiences of a high-risk newborn care simulation among nurses and nursing students. The tutoring experiences of nurses consisted of three categories—“efforts to foster a sense of presence,” “efforts to promote positive awareness of the NICU,” and “establishing one’s role as an educator.” The nurses attempted to extend the students’ perspectives, explained to them the positive experience of being a NICU nurse, and evaluated themselves as clinical educators. The tutoring experiences of the nursing students consisted of three categories—“growth through a realistic virtual simulation,” “improved learning effects,” and “hope for continued development.” The nursing students experienced a realistic simulation with the nurse tutors, built their professional identity as future nurses, and wanted to become nurse tutors in the future to inspire students. The nurses’ evaluations of the nursing students improved after the tutoring event, and the nursing students were motivated to learn neonatal care. Tutoring methodologies for nurses and nursing students will be used to aid nursing students' learning in neonatal nursing practice.

Notes

Authors’ contribution

Conceptualization: HYK, HA; Data collection: BRL, HA; Formal analysis; HYK, HA; Interpretation of data: HA; Writing–original draft: all authors; Writing–review and editing: all authors; Final approval of published version: all authors.

Conflict of interest

No existing or potential conflict of interest relevant to this article was reported.

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2020R1I1 A3052780).

Data availability

Please contact the corresponding author for data availability.

Acknowledgements

None.

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Article information Continued

Figure 1.

Research process of this study.

Table 1.

General characteristics of tutors and tutees (N=16)

Participant Gender Age (yr) No. of simulation participations No. of times participating as a tutee in simulations where a senior was the tutor Clinical/NICU career (mo) Preceptor career (no. of times) Position
Tutee 1 Female 22 3 1
Tutee 2 Female 21 4 1
Tutee 3 Female 22 4 1
Tutee 4 Female 22 2 1
Tutee 5 Female 25 3 None
Tutee 6 Male 23 1 None
Tutee 7 Male 24 3 1
Tutee 8 Female 23 3 1
Tutee 9 Female 21 1 None
Tutee 10 Female 21 2 1
Tutee 11 Female 21 1 1
Tutee 12 Male 25 2 1
Tutor 1 Female 49 <5 324/324 ≤10 Charge nurse
Tutor 2 Female 49 <5 312/288 ≤10 Head nurse
Tutor 3 Female 30 <5 96/96 4 Staff nurse
Tutor 4 Female 28 <5 69/69 1 Staff nurse

NICU, neonatal intensive care unit.

Table 2.

Categories and subcategories from tutor interview responses

Category Subcategory
Efforts to foster a sense of presence • Describing how nursing is currently practiced in the clinical field
• Providing diverse perspectives
Efforts to promote positive awareness of the NICU • Explaining the need for the NICU
• Conveying rewarding experiences as a NICU nurse
Establishing one’s role as an educator • Perception of students has changed positively
• Opportunity to examine one’s role as an educator

NICU, neonatal intensive care unit.

Table 3.

Categories and subcategories from tutee interview responses

Category Subcategory
Growth through a realistic virtual simulation • Expanding one’s perspective on the situation
• Forming identity through the rewards of being a nurse
Improved learning effects • Learning clearly
• Motivation to learn
Hope for continued development • Desire for a learning environment similar to the clinical field
• Interest in becoming a tutor