P ediatric clinical educationdemands that students movequickly from theoretical learning

of growth and development to the appli-cation of this knowledge in real-lifesituations with sick children. Therefore,it is imperative when teaching growthand development theory to draw onteaching strategies that offer opportuni-ties for the application of theory. Thetendency to deliver lectures laden withtheory only serves to bore students ratherthan stimulate their desire to engage andapply the material.1

BackgroundStudents in a bachelor of science innursing program have been taughtgrowth and development across the lifespan in 1 or more courses in the first yearof the program. When students reachthird year, they have an opportunity for a

month of pediatric theory and practice,with 1 essential component being areview of growth and developmentwithin the context of the various agesand stages of children.

Historically, teaching child growthand development in a 4-week experi-ence had been a challenge in terms ofengaging the students’ interest. Thetraditional teaching approach of interac-tive lecture served well to get the contentdelivered but did not provide the stu-dents with an opportunity to apply theknowledge. Case studies, various typesof group work, and poster presenta-tions were tried in an attempt to incor-porate active learning and to engage thelearner. Typically, the feedback from thestudents resonated with dislike of theapproaches and with the challenges oflearning the content.

Recognizing that the students hadpreviously learned about and completedassignments on growth and develop-ment with theorists such as Piaget,Erickson, Fowler, and Kohlberg, the goalbecame to strive for experiential learn-ing. We wanted to find a creative, ex-periential learning strategy that wouldactively engage students in asking ques-tions, investigating, experimenting, andbeing curious and creative while solvingproblems and constructing meaning.2

The literature reviewed uncoveredseveral novel ideas such as the use ofchildren’s books3 and game playing4 toteach growth and development to stu-dents. Interestingly, game playing didnot prove to be beneficial to studentlearning; students who sat through aninteractive lecture performed higher onfollow-up testing than did the studentswho participated in game playing.4

Bochennek et al5 pointed out that therewas a lack of evidence to support thewidely used practice of using games andboard games to teach medical students.Furthermore, although the creative ideaof using children’s books to illustrategrowth and development conceptsengaged student interest,3 it did notprovide for the application of theory.

One article discussed a learningactivity that was application focused.6

The educator had the students designage-appropriate toys that were safe andwould facilitate the child’s develop-ment. Although toy designing wasclearly application focused and valuedby students, this strategy was not fea-sible given our short timeframe. It isapparent in the literature that a balancebetween interactive lecture and creativeteaching strategies seems to be aneffective approach.3,6 This belief ledus, 2 pediatric nurse educators, to tryan innovative experiential approach toenhance student learning of childgrowth and development.

The Christmas ShoeboxThe Christmas shoebox assignment hasthe third year students working in groupsof 2 or 3. They have 2 weeks to fill acardboard shoebox with items suitablefor a child of a specified age, for example,a 2- to 4-year-old boy or an 11- to 13-year-old girl. The students decorate andthen fill a shoebox with a variety of toys,books, and personal items; selection ofitems is done in consideration of growthand development principles. Studentsare asked to consider the child’s devel-opmental milestones, play preferences,safety concerns, relevant health promo-tion strategies, and parenting issues.

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Teaching Child Growthand DevelopmentThe Christmas Shoebox

Sheila M. Epp, MN, RNJudy E. McAulay, MEd, RN

Teaching growth and development to nursing students can be dry, uninteresting, andlabor-intensive. Engaging students in learning this material was the challenge of ashort, 4-week pediatric experience. Students use growth and development knowledgeto select toys and activities that fit in a shoebox and explain to their classmates therationale for their selection. The Christmas shoebox activity increases their ability totransfer knowledge to both the examination questions and the clinical setting andprovides a charitable service to the community.

Authors’ Affiliation: Instructor (Ms Epp) andAssociate Professor (Ms McAulay), Faculty ofHealth and Social Development, School ofNursing, University of British ColumbiaOkanagan, Kelowna, British Columbia, Canada.Corresponding Author: Ms Epp, Faculty ofHealth and Social Development, School ofNursing, University of British ColumbiaOkanagan, 3333 University Way, Kelowna, BC,Canada, V1V 1V7 (sheila.epp@ubc.ca).

Copyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

The content of each shoebox isthen presented to their classmates,along with a brief summary of theparticular age’s growth and develop-ment highlights. As each item is shared,a rationale for the item selection isprovided. An explanation for why atoy makeup set was included mayinclude the interest of a 4-year-old girlin imitative play, the fine motor skillsneeded to apply lipstick, and theadded sidebar that the composition ofthe lipstick was vegetable based andlabeled safe for human consumption.

Classroom discussion is encour-aged around the play value of thedifferent selections. Are items reallyappropriate for this age? Does an itemneed a parent to be involved in theactivity? What about the small pieces ofa truck or the eyes of a stuffed toy?What are the challenges of selectingitems for young teens? Should studentscensor their selections and remove

guns and war toys? Is it appropriate toinclude age-appropriate health pam-phlets such as ‘‘Colic and Your Baby’’in an infant box or information onsexual health in a teen box?

In addition, invariably, the issue ofgender-based toys produces a livelydiscussion. Discussion and debatedevelop around play preferences andexploring whether it is innate, arises outof biological differences,7 is unchangingover time,8,9 or is a result of socializa-tion by parents and family who encour-age gendered behaviors by providingand promoting predominately gender-specific toys.9,10

The preparation, presentations, andclassroom discussion (Figure 1) providethe students with knowledge and expe-rience that they are able to transfer totheir work with children and families.The experiential nature of this projectinvites them to consider health promo-tion needs, developmental milestones,

play preferences, and safety in their en-counters with the pediatric population.

Our InspirationWe give credit for the inspiration for thislearning activity to an annual campaignknown as Operation Christmas Child.The organization, Samaritan’s Purse,ships shoeboxes to underprivileged chil-dren in developing countries.11 Initially,the members of the class were askedabout sending their shoeboxes via Sa-maritan’s Purse. The pragmatic issue ofadding $5.00 to each box for shippingwas an additional expense for our budget-conscious students. Other thoughtful stu-dents raised the issue of exporting ourNorth American religious ideals whenthe shoeboxes are handed out withChristian tracks and presentations. Inthe end, members of the class choseto express their caring by givingthese gift boxes to local children. As a

Figure 1. UBC Okanagan School of Nursing Class of 2008 with their Christmas Shoeboxes.

278 Volume 33 & Number 6 & November /December 2008 Nurse Educator

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result, at the end of the semester, stu-dents and teachers collect and deliverthe shoeboxes to agencies that makethese boxes available to marginalizedfamilies in our own community.

The response from the communityhas been gratifying. When more than 30shoeboxes were delivered to a drop-incenter just before Christmas, we learnedthat their annual Santa visit was sadlylacking children’s presents, and the staffcould not have been more appreciativeof the timely donations. The shoeboxesthat were dropped off in the spring havebeen used by parents who came in withworries about birthdays and lack offunds or were given to children waitingfor parents occupied with counsellingsessions. These stories reflect the valueof the Christmas shoeboxes and rewardthe efforts of students and teachers alike.

ChallengesOne potential challenge for the students’learning was the project focus beinglimited to 1 gender and 1 age. A questionwe pondered was ‘‘how much does thisproject require that students delve intothe knowledge and theories of childgrowth and development?’’ Our doubtshave been reduced when we witnessedthe level of students’ understandingduring the presentations and whencourse evaluation data demonstrated areduction in student complaints with theapplication questions on the pediatricexamination. These outcomes are con-sistent with findings of improved testresults when active learning method-ologies are used.12 Furthermore, clinicalinstructors have reported finding stu-dents recognizing growth and develop-ment knowledge as foundational forpediatric nursing and exhibiting animproved ability with approaching andcaring for children in the clinical area.

Another challenge for us was facili-tating a class discussion that maintains abalance of constructive feedback withsensitivity to students’ feelings. The stu-dents are not receiving a grade for thisproject, are donating to the community,and therefore may have increased sensi-tivity to critique.

What Did the StudentsHave to Say?When students were given the opportu-nity to comment on the learning activity,

most found the activity valuable to theirlearning. When asked about the value ofthe shoebox, 23 of the 33 respondentsfound preparing their shoebox to bevaluable. Furthermore, 22 studentsfound presenting their shoebox to theirclassmates valuable. Only 4 studentsfound learning from the presentationsof others not valuable, whereas 23 foundother presentations to be valuable. Onestudents said, ‘‘this project was a fun andcreative way for learning about growthand development.’’

The overwhelming importance ofthe opportunity to participate in a projectthat gives back to their community, withthe shoeboxes going to local, marginal-ized children, was evident, as 30 re-spondents rated this aspect as veryimportant. Comments included the fol-lowing: ‘‘Loved it, it felt nice to dosomething good for someone else’’ and‘‘I spent valuable time to help children inour community.’’ One student who wasneutral in terms of the value of theshoeboxes going to community childrencommented on an awareness of thedifference in value from box to box: ‘‘Itwas a good exercise for us to learngrowth and development, but it can costa lot of money to buy stuff. Afterwardsstill thinking, did I do it well, because Ispent less money on buying gifts thanothers?’’

Being cognizant of the expense offilling a Christmas shoebox, the studentshave a choice of 2 assignments, eitherthe Christmas shoebox or a poster pre-sentation on a topic related to growthand development. Despite this alterna-tive assignment, which very few studentshave chosen, the cost factor was 1 themecommented on by 4 participants of theshoebox project. ‘‘It was dollars that wedidn’t have to spend to get the samelearning. I was happy that childrenwould get the boxes though and theywere fun to make’’.

Lessons LearnedThe one student’s comment about spend-ing less money than her peers did raisedour awareness that students who spendless than others do might feel shame or asense of inadequacy. Furthermore, ifstudents were comparing their shoe-boxes, then it was likely that the recipi-ents might also compare their gift boxes.Student feedback and this increasedawareness and led us to believe that there

should be a limit set on the box size andcontents. In the future, the guidelines willinclude the use of a regular shoebox anda restriction of $25.00 on the contents.These guidelines will provide a level ofequity in terms of each box for both thegiver and the recipient.

In the first year, the shoeboxeswent to the families with low incomes,whereas this last year, the shoeboxeswent mainly to homeless families. Wehave come to realize the importance ofthe difference of these 2 groups ofrecipients; consideration of their situa-tion needs to be addressed in terms ofthe content. For example, if the recip-ients are homeless, the contents needto be of a portable nature and inclusionof items such as toothbrushes andcombs becomes salient.

ConclusionTeaching growth and development withthe incorporation of the Christmas shoe-box project proved to be more than just aninteresting and fun teaching strategy, as itserved to provide students with an oppor-tunity to apply knowledge as they choseand defended age-appropriate items for agift box. An increase in knowledge wasevident in the presentation discussions,and students demonstrated reduced anxi-ety with the application questions on theexamination. In addition, clinical educa-tors found students recognizing growthand development as essential to pediatricnursing and better prepared for practice inpediatric settings.

The Christmas shoebox has beenproven to be a successful experientiallearning assignment. Almost 70% ofparticipants found preparing, present-ing, and listening to the presentationsof fellow students valuable to theirlearning. The added bonus, for bothfaculty and students, was awarenessthat the gift boxes provided joy tomarginalized community children.

REFERENCES

1. Kautz DD. Reading children’s book toawe and inspire nursing students. NurseEduc. 2007;32(5):223-226.

2. Association for Experiential Education.What is experiential education? http://www.aee.org/customer/pages.php?pageid=47. Accessed July 2, 2008.

3. Hansen CC, Zambo D. Piaget, meet Lilly:understanding child development throughpicture book characters. Early Child EducJ. 2005;33(1):39-45.

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Copyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

4. Selby G, Walker V, Diwakar V. A com-parison of teaching methods: interactivelecture versus game playing. Med Teach.2007;29:972-974.

5. Bochennek K, Wi t tekindt B,Zimmermann S, Klingebiel T. Morethan mere games: a review of card andboard games for medical education. MedTeach. 2007;29:941-948.

6. Klein EM. The toymakers: an applica-tion activity. Nurse Educ. 1995;20(4):24-25.

7. Hines M, Kaufman FR. Androgen and

the development of human sex-typicalbehaviour: rough-and-tumble playand sex of preferred playmates in chil-dren with congenital adrenal hy-perplasia (CAH). Child Dev. 1994;65:1042-1053.

8. Green VA, Bigler R, Catherwood D. Thevariability and flexibility of gender-typedtoy play: a close look at children’sbehavioural responses to counter stereo-typic models. Sex Roles. 2004;51(7/8):371-387.

9. O’Brien M, Huston AC. Development of

sex-typed play behaviour in toddlers.Dev Psychol. 1985;21(5):866-871.

10. Bradley BS, Gobbart SK. Determinantsof gender-typed play in toddlers. J GenetPsychol. 2001;150(4):453-455.

11. Samaritan’s Purse International Relief.The operation christmas child. http://www.samaritanspurse.org/index.php/OCC/index/. Accessed July 2, 2008.

12. Yoder D, Hochevar CM. Encouraging ac-tive learning can improve students’ per-formance on examinations. Teach Psychol.2005;32(2):91-95.

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