Of Lillian Wald, Community Health Nursing Education, and Health Care Reform

Abstract A pilot project is described that was initiated to provide a comprehensive clinical experience for community health nursing (CHN) students despite local cutbacks in field nursing services. The project, entitled the Nursing Elementary Education Outreach Project (NEEOP), is used as a basis for discussion on the CHN role in community-focused health care reform. One-third of the CHN students in one school of nursing during one academic year ( n = 16) participated in the NEEOP. One salaried CHN faculty member assumed primary responsibility, and equipment funding was granted by a local corporation. Collaboration was established with the county's proactive school nurses' association. CHN students developed and conducted health education presentations in elementary schools, worked with school nurses, and participated in other community health activities. Three levels of evaluation were utilized: elementary students to nursing students, nursing students to nursing faculty, and school nurses to nursing faculty. The NEEOP was a success by all evaluation criteria, and plans are currently in progress to expand its focus. Innovative clinical placements such as the one described can promote student understanding of CHN practice with its broad-based emphasis on the promotion of healthier communities.     

The Kids Into Health Careers (KIHC) initiative: innovative approaches to help solve the nursing shortage

In 2001, the Northern Illinois University School of Nursing was awarded a grant from the Division of Nursing of the Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, to enhance the School's advanced practice nursing program. As a recipient of this grant, the School of Nursing was required to incorporate activities to meet the goals of the "Kids Into Health Careers (KIHC) Initiative" to encourage children into health care careers. This article describes the strategies developed by the School of Nursing to meet the KIHC goals and encourage children, especially those from minorities, into health care careers. The School's approach was multifaceted and included collaboration with a variety of community organizations and groups. While there is a tremendous amount of work to be accomplished in encouraging middle and high school students to consider nursing as a career, creative strategies through which nurses take an active role in helping resolve the problem are suggested.     

A program to educate school nurses about mental health interventions.

Concerned with the increasing incidence of mental health problems in children and adolescents and the impact of these problems on students' school success and predisposition to self- and other-directed violence, the Multnomah Education Service District Department of School Health Services determined to become proactive by providing preventive interventions for students experiencing actual or potential mental health problems. An educational program was designed to assist school nurses in the identification of potential mental health problems. In addition, information about appropriate interventions for students at risk for aggression, violence, and other mental health pathology was presented. The program involved education on mental health assessment and intervention, as well as expert psychiatric clinical support for the development of student support groups. School nurses were then challenged to develop practice improvement projects incorporating this knowledge for a group of students in their work setting. This introductory article describes the project's general rationale and implementation process. The four articles following in this issue of The Journal of School Nursing describe the goals, implementation, and outcomes of the practice improvement projects developed for early intervention with students exhibiting attention disorders, school absenteeism, social withdrawal, and depression.     

School nursing in an underserved multiethnic Asian community: experiences and outcomes

Based on an Asian faculty's previous work, University of South Alabama College of Nursing conducted a project targeting the Asian population in Bayou La Batre, Alabama. The Helene Fuld Health Trust, HSBC, Trustee funded the project to demonstrate effective models for involving nursing students and faculty members in community-based practice. This project provided health services and developed educational programs for this underserved population. To facilitate entry into the Asian community, the College established clinical sites at 2 schools in Bayou La Batre that had the highest concentration of Asians in Mobile County's public school system. The purpose of the project was to develop a new curriculum, to involve nursing students in community-based practice, and to provide health care services in the community. The health services, educational programs, and community instructional activities generated substantial outcomes for the targeted population as well as nursing students. Nursing students learned to assess aggregates, plan, and evaluate interventions. The learning outcomes of the nursing students were evaluated using objectives developed in accordance with Bloom's (1956) Taxonomy. The project not only complemented and expanded existing school health services and programs but also filled the void in some health service and program areas. Preliminary evaluation of the project revealed overwhelmingly positive feedback from both the nursing students and Bayou La Batre school teachers. This article also explores the implications of the newly issued "National Standards for Culturally and Linguistically Appropriate Services in Health Care" for nursing education in the contexts of the Census 2000 and the megatrend of globalization.     

Understanding cultural diversity through a student exchange program

Nursing curriculum must include multicultural experiences to prepare nurses to work with the nation's ethnically diverse population. To meet this need, a pilot project was instituted between two Bachelor's of Science in Nursing (BSN) programs. It was hypothesized that students could develop new cultural perspectives by experiencing nursing with different ethnic groups. Two senior students from each institution were selected for the experience. The exchange program provided them with opportunities to assess and care for health problems in aggregates and families with whom they might not have had practice. The authors recommend that these types of programs be encouraged to introduce students to practice in settings and with cultures other than their own.     

Doctor of nursing practice program development: reengineering health care

In this article, we describe the developmental process of a Doctor of Nursing Practice (DNP) program that uses interdisciplinary resources to create unique DNP curriculum opportunities. Other schools may benefit from this experience in the development of their own DNP programs. The program delivers an innovative curriculum from post-baccalaureate to doctorate, emphasizing health care engineering and interdisciplinary collaboration among faculty, hospitals, community leaders, and policymakers. This DNP program is uniquely situated to provide leadership in solving complex clinical problems through its partnership with the Regenstrief Center for Healthcare Engineering, the School of Pharmacy, the Homeland Security Institute, and the Center on Aging and the Life Course. Doctoral coursework, interdisciplinary collaboration, health care engineering/systems approaches, and new knowledge result in uniquely qualified providers. Post-baccalaureate students complete the university's Adult Nurse Practitioner program or its developing Pediatric Nurse Practitioner program during the first 2 years of the 4-year curriculum. A total of 83 post-baccalaureate credit hours include 1,526 hours of supervised clinical practice, a health policy residency, and cognate residencies in an area of specialization. The seven core competencies recommended by the American Association of Colleges of Nursing are incorporated into the curriculum.     

Development of a nursing data set for school nursing.

School nurses need to clearly identify how they promote the health and educational achievement of children. School nurses contribute to student health by providing health assessment and nursing interventions, advocating for healthy living, and contributing to prevention of illness and disease management. A Nursing Data Set for School Nursing can identify those data elements that are needed to prove that school nurses have a positive effect on children, families, and the community. The purpose of this project was to develop a Nursing Data Set for School Nursing that would describe and validate school nursing practice. Building on the Nursing Minimum Data Set developed by Werley, Devine, and Zorn, a Nursing Data Set for School Nursing was developed with guidance from experts in the field of school nursing. A Nursing Data Set for School Nursing has the potential to assist school nurses in documentation and validation of their nursing practice. It can validate the complexity of the role of the school nurse, the resources needed, and the effect school nurses have on improving the health and educational outcomes of students.     

Mentoring as a retention strategy in a diverse,multicultural, urban associate degree nursing program

Nursing faculty are expending considerable resources to recruit qualified students. Retention of these valuable students should be a priority to meet the growing need for nurses in a changing health care environment. However, this has been a challenge due to a variety of variables inherent in the nontraditional student and in nursing education. A mentoring program was developed in a diverse, multicultural, urban community college. The significance of this enrichment program in improving retention rate and psychological outcomes for first-semester clinical nursing students was identified.     

One hundred years of excellence in nursing. The University of Cincinnati College of Nursing and Health, 1889-1989

The history of the College of Nursing and Health mirrors the history of the profession. In 1889, students were handmaidens to the doctor; now they are educated to be professionals functioning within the framework of the nursing process. The College of Nursing and Health at the University of Cincinnati has flourished. It began in 1889 as a small private hospital school with five students. There are now 855 students, 54 full-time faculty and 17 part-time faculty. A doctoral program in nursing at the College of Nursing and Health, approved by the National League of Nursing, began in 1989. The College of Nursing and Health has a long history of including occupational health content in its programs, dating back to 1914. The master's program to prepare occupational health nurses was a core program in the first Education Resource Center in the United States.     

A formalized mentoring program for LPN-to-RN students

Nursing programs across the United States are faced with the challenge to admit greater numbers of students and improve retention and progression rates of enrolled students. Associate degree nursing (ADN) programs produce the largest percentage of registered nurse (RN) graduates in comparison with other basic RN programs (National League for Nursing, 2006). Many states and academic institutions have begun to realize that the large pool of licensed practical nurses (LPNs) is a viable source of quality ADN students. LPN students in LPN-to-RN completion programs can often complete degrees and be eligible to take state board RN examinations in half the time of a traditional ADN student. Faculty at Ohio University-Chillicothe (OU-C) examined strategies to enhance the LPN-to-RN transition program on the campus and to promote retention and progression of this unique population of nursing students in the ADN program. The faculty researchers developed the Nursing Success program after a review of the literature and with support from an internal grant from the OU-C Faculty Summer Research Fund. This article describes this formalized, faculty-driven student mentoring program designed for LPN-to-RN students at OU-C and the outcomes of the initial implementation.     

Developing cultural competence in nursing students through their experiences with a refugee population

Nursing students in an urban university in southwestern Pennsylvania began visiting newly relocated Somali refugees as part of their community health nursing (CHN) clinical course-work. The purpose of this qualitative study was to relate the students' experiences in their clinical visits with the refugees to the development of cultural competence. Findings identify the many challenges confronted by students and present strategies for resolution. The level of skills needed for the care of vulnerable populations should be considered when assigning undergraduate students to the clinical setting.     

Transforming nursing curricula for a global community

With nurses and midwives providing the majority of health care globally, nursing education in all countries must prepare students for broader responsibilities to move the agenda forward for equitable care and universal health coverage. Columbia University School of Nursing developed and implemented a vibrant approach to curriculum transformation that included a new didactic course followed by a program of global clinical experiences to expand students' learning environments in global health. Program planning included defining learning objectives, mobilizing support within the school, establishing new sites, recruiting and preparing students, overseeing of students with host institutions, and evaluating the program. A total of twenty-four students were placed over five sites for a six-week credit-bearing global clinical experience. Students had varied clinical experiences with new understandings of the reality of health disparities. Host sites expressed a commitment to have students return in the next year, and all students stated that they would chose a global experience again. This innovation provides a transformative addition to nursing education with a deepened understanding of health disparities and nursing roles in different health systems. It strengthens the school's network of nursing and midwifery educators and opens doors for new exchanges.     

Experiential clinical learning for newly licensed PhD students: Transforming nursing PhD education through academic-practice partnerships

The growing national and international need for nurse scientists to transform health care has encouraged advances in nursing doctoral programs. The Hillman Scholars in Nursing Innovation, a program integrating BSN and PhD education, inspired the creation of the Hillman Clinical Fellowship (“Fellowship”). The Fellowship helps students transitioning from the BSN to PhD gain clinical experiences as newly graduated registered nurses, thus mitigating a common concern that students are naïve about the clinical setting. In collaboration with a practice partner, the Fellowship fosters development of clinical skills consistent with Patricia Benner's Novice to Expert Model. Fellows build clinical skills concurrent with the development of research proficiencies in the PhD program. This Fellowship can be adapted by other schools seeking to introduce curricular innovations that address the needs of early career PhD students, enhance academic-practice partnerships, and meet the growing need for more clinically focused PhD prepared nurses.     

Partnering with schools: a win-win experience

In many states, budget cuts have influenced school systems to question whether school nurses are necessary. Consequently, many schools no longer have a nurse to coordinate school health services. Creighton University School of Nursing saw this situation as an opportunity. Using schools as clinical sites for nursing students has resulted in positive outcomes for all involved. Competencies successfully demonstrated by nursing students have included understanding concepts of health and illness, identification of strategies to promote and protect the school-age population, and the ability to provide population-focused prevention within the community. Faculty think the school population is healthier and school personnel have increased knowledge of health promotion and protection strategies for school-age children as a result of the school health project. The education provided serves to promote the well-being of students, families, and the community and prepares them to make health-related choices. The project has also resulted in health benefits for the community.     

Using expanded individualized health care plans to assist teachers of students with complex health care needs.

As special education teachers have increasing numbers of students requiring health care procedures in their classrooms, school nurses need to help these teachers maintain a safe, healthy environment for their students. Part of this consists of having teachers know the steps to take should certain problems arise. This article examines the receptivity of using an expanded version of an individualized health care plan (IHP) to provide critical information to address health care problems, as well as having individualized education program (IEP) objectives for instructional targets identified in the IHP. The findings of this study indicate that a high percentage of school nurses and special education teachers were in favor of an expanded version of the IHP. There was also support for teaching students to independently or partially participate in performing their own health care procedures and having this instruction formalized as IEP objectives.     

Integrating gerontology competencies into graduate nursing programs.

Current demographic and health care utilization trends strongly indicate a rapidly increasing demand for nurses who are well qualified to care for older adults. Advanced practice nurses are positioned to assume leadership roles in geriatric nursing care; however, they must first acquire adequate preparatory education. This article describes two graduate nursing schools' curricular innovations that were funded by The John A. Hartford Foundation, in collaboration with the American Association of Colleges of Nursing (AACN), through the Geriatric Nursing Education Project: Enhancing Gerontological/Geriatric Nursing for Advanced Practice Nursing. These programs at University of North Carolina at Greensboro and Pennsylvania State University incorporated techniques to translate the Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care [American Association of Colleges of Nursing. (2004). Nurse practitioner and clinical nurse specialist competencies for older adult care. Washington, DC: AACN] into an advanced practice curriculum and developed strategies to sustain curricular innovations. Finally, lessons learned from these two projects are discussed and recommendations are made for integrating geriatric nursing competencies into graduate programs.     

Empowering students on medication for asthma to be active participants in their care: an exploratory study.

This article is part of a larger study of young students with asthma. It focuses on the observations of school nurses and comments from parents and students pertinent to school nursing practice. The study shed light on the educational needs of 9- to 11-year-old students with asthma and identified some areas where the school nurse could easily enhance the health management of these students. Responses from students and parents about asthma provided insight into the daily challenges faced by students with asthma. Students with asthma may or may not fully understand the seriousness of their chronic condition or how to recognize and treat symptoms. The purpose of this pilot study was to identify strategies school nurses might use to determine the knowledge level of students and to determine the effects of asthma education programs. School nurses who participated in the study were provided with a comprehensive package containing current asthma information and an education program to update knowledge and skills. These school nurses also received Open Airways for Schools, an American Lung Association education program for students in grades three to five. The study was a two-group exploratory, quasi-experimental design. Questionnaires were prepared for students, school nurses, and parents to collect information on knowledge and perceptions about asthma. Students who participated in the educational program were reported by their school nurses to have increased knowledge and management skills related to their disease.     

Undergraduate registered nursing students working as assistants in nursing within the acute care environment: Program development and discussion

BackgroundMost pre-registration nursing students require employment during their studies which may entail undertaking another qualification.This paper describes how one university developed a program whereby undergraduate nursing students complete the national vocational education – HLT33115 Assistant in Nursing qualification through recognition of prior learning, a self-directed education package and completion of an objective structured clinical examination.ObjectiveTo discuss the development of an ‘Assistant in Nursing’ in the acute care environment program for pre-registration undergraduate nursing degree students using the national vocational education framework.DesignThis program maps the national ‘Assistant in Nursing- Acute Care’ vocational qualification to the pre-registration registered nurse degree. Upon successful completion of this program students can work as Assistants in Nursing within the acute care environment.ConclusionsThis program enables student nurses to work as Assistants in Nursing within the acute care environment. This provides employment in a health facility and opportunities for students to immerse themselves in the clinical environment whilst continuing their studies. This may assist students to gain a deeper insight into their future role as a nurse, build networks within the nursing community and assimilate into the clinical environment. This program design may prove useful as a template for other nursing faculties wishing to implement a similar program.     

Developing community partnerships in nursing education for children's health

Community partnerships are central to educating nurses and providing much-needed services to underserved children in Baltimore City. Johns Hopkins University School of Nursing (JHUSON) collaborates with Head Start programs and a local elementary school for faculty practice and child-health clinical Service Learning experiences. At local Head Start programs, undergraduate nursing students annually screen > 1000 children for height, weight, hearing, vision, and blood pressure. Results are sent to parents with referral information if indicated. In addition, graduate and baccalaureate nursing students implement skills and knowledge learned in the classroom in a nurse-run clinic in a local elementary school, a faculty practice site. The Service Learning community partnerships benefit nursing students because they can apply principles of growth and development while providing important health screening to children in underserved populations. All students gain from practicing in the community and applying their classroom instruction to the care of children.