Effectiveness of Community Health Worker/Nursing Student Teams as a Strategy for Public Health Nursing Education

ABSTRACT A unique program that partners community health workers with nursing students was developed in response to community‐based participatory research data and integrated into a public health practicum at a baccalaureate nursing program in West Michigan. The goal of the program is to promote the health of 3 underserved urban neighborhoods while educating nursing students in population health and public health nursing. The purpose of this paper is to describe program conception and implementation and discuss evaluation of educational outcomes as a public health learning experience.     

Enhancing cultural competence: Trans‐Atlantic experiences of European and Canadian nursing students

This paper describes the enhancement of cultural competence through trans‐Atlantic rural community experiences of European and Canadian nursing students using critical incident technique (CIT) as the students' reflective writing method. The data generated from 48 students' recordings about 134 critical incidents over a 2‐year project were analysed by qualitative content analysis. Five main learning categories were identified as: cross‐cultural ethical issues; cultural and social differences; health‐care inequalities; population health concerns; and personal and professional awareness. Four emergent cultural perspectives for the health sector that became apparent from the reflections were: health promotion realm; sensitivity to social and cultural aspects of people's lives; channels between the health sector and society; cultural language and stories of local people. CIT was successfully used to foster European and Canadian undergraduate students' cultural reflections resulting in considerations and suggestions for future endeavours to enhance cultural competence in nursing education.     

Use of health fairs to develop public health nursing competencies

This paper describes a community-campus partnership for health education established through the effort of faculty, students, and the community. Health fairs designed to address issues of concern to a community agency were originally conducted with nursing students. This partnership between nursing and a community was expanded to include social work, physical therapy, and medical students. A shared learning experience was structured through the presentation of health fairs in collaboration with agencies in Burlington, Vermont. One goal of nursing education is to produce professionals who have the beginning competencies of public health nursing. Reflection on the process, relationships, and outcomes of the health fairs revealed that students attained these beginning competencies in all eight public health nursing competency domains. Combining community-campus partnerships and an interdisciplinary focus enabled nursing students to become more responsive to community needs and to learn to work collaboratively toward creating healthier communities, thus building skills required for public health nursing.     

Roles and functions of community mental health nurses caring for people with schizophrenia in Taiwan

Aims and objectives. The study aimed to understand the nursing roles and functions of public health nurses and home health nurses in Taiwan and the factors that affect nursing roles and functions of nurses that provide community mental health home visiting services. Background. Although community nurses provide more psychiatric home visiting services than other psychiatric professionals, little research on their roles and functions has been conducted. Design. Nursing roles and functions were developed through use of grounded theory method of Strauss and Corbin. Methods. Data were collected using semi‐structured face‐to‐face in‐depth interviews and unstructured non‐participant observations. The constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected using theoretical sampling. Final sample size in this study comprised a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home visiting. Public health nurses conducted a total of 16 (eight carers and eight clients) services and home health nurses conducted 16 (eight carers and eight clients) services. Results. Fourteen nursing roles were identified. These roles included assessor, supporter, educator, consultant, counselor, negotiator, harmoniser, collaborator, advocate, placement coordinator, resource provider, care provider, case manager and case finder. Moreover, several factors that affect nursing roles and functions in the community mental health home visiting service in Taiwan were also identified. Conclusion. This is the first study to identify the role of public health and home health nurses caring for people with schizophrenia in the community in Taiwan. Relevance to clinical practice. The recommendations based on the findings of this research can be used as a guide to improve the delivery of psychiatric home visiting services to community‐dwelling clients with schizophrenia and their carers.     

Teaching/Learning Strategies for the Essentials of Baccalaureate Nursing Education for Entry‐Level Community/Public Health Nursing

The purpose of this article is to describe teaching/learning strategies for each of the 15 Essentials of Baccalaureate Nursing Education for Entry‐Level Community/Public Health Nursing (ACHNE, 2009). Carper's ways of knowing serve as foundations for creating classroom and clinical experiences that focus on clinical action with community as client. Each community/public health essential is defined with relevance to community/public health nursing practice. Five teaching/learning strategies have been delineated for each essential with suggestions of teaching resources and/or target population application. Teaching/learning strategies that focus on community as client, population health, and the essential knowledge and competencies of C/PH nursing will help ensure preparation of baccalaureate prepared nurses with knowledge and skills to improve the health of populations.     

Building a Community‐Academic Partnership to Improve Health Outcomes in an Underserved Community

ABSTRACT East Garfield Park, IL, is an impoverished community with 59.7% of residents falling below twice the poverty level and 42.6% of its children in poverty. In 2001, the leading causes of hospitalizations were heart disease (10.3%), diabetes (2%), and asthma (3.9%), all of which occur at frequencies 33% greater than the Chicago average. Finally, a review of the health care facilities in the community suggests that there is a need for accessible primary health care services in the area. The purpose of this project was to improve health outcomes in an impoverished, underserved community with documented health care needs and lack of adequate health care services by creating a community‐academic partnership to provide on‐site, interdisciplinary, health care services within an established and trusted community‐based social service agency, Marillac House. The short‐term objectives for this project included creating a community‐academic partnership between Marillac House and Colleges of Nursing, Medicine, and Health Sciences; providing comprehensive health care services; and developing an innovative clinical education model for interdisciplinary care across specialties. Long‐term objectives included providing preventative services; evidenced‐based management of acute and chronic illness; evaluating client's health outcomes; and creating a sustainability plan for the long‐term success of the health center.     

Globally Engaged Nursing Education with Local Immigrant Populations

This case study describes how a community health nursing practicum course was redesigned to increase undergraduate students' knowledge of and interactions with local immigrant populations. The goal of this tailored practicum is to develop students' sense of global engagement while remaining in the local community. The GENE framework is applied to course planning, delivery, and evaluation of the experience. The key components of the GENE framework are organizational mission/course goals, global health core content, program characteristics, learner characteristics, reflection, and transformational learning. The practicum design, learning objectives, and community partnership development served to create a co‐learning environment. Use of an experiential education philosophy allowed the practicum to evolve as students, faculty, agency staff, and community residents learned together over the practicum. Students developed a more complex understanding of health and social conditions of immigrant populations. They moved from a primarily mono‐ to an increasingly multicultural orientation. The GENE model was useful in offering a globally focused learning experience within a local community.     

The Bucket List: a service-learning approach to community engagement to enhance community health nursing clinical learning

Community health nursing education at the undergraduate level is experiencing new and distinct challenges. Reduction in funding for public health services creates fewer resources and learning opportunities for students. To effectively deal with this problem, it is necessary to reconsider how clinical experiences are implemented. Using a service-learning theoretical framework to engage students in a mutually beneficial relationship with underserved and vulnerable populations could address the issue. The "Bucket List" of service-learning and community engagement activities was developed with the goals of improving quality and comprehension of community health didactic, addressing the need to restructure community health clinical experiences, and meeting projected demands for community health nursing services in partnership with communities.     

Incorporating a built environment module into an accelerated second-degree community health nursing course

ABSTRACT Environmental quality is a leading indicator of population health. Environmental health content has been integrated into the curriculum of an Accelerated Bachelor of Science in Nursing program for second-degree students through development of an environmental health nursing module for the final-semester community health nursing course. The module was developed through collaboration between two professional schools at Duke University (the School of Nursing and the Nicholas School of the Environment and Earth Sciences). It focused on the role of the built environment in community health and featured a mix of teaching strategies, including five components: (1) classroom lecture with associated readings, (2) two rounds of online small-group student discussions, (3) assessment of the built environment in local neighborhoods by student teams, (4) team presentation of the neighborhood assessments, and (5) individual student papers synthesizing the conclusions from all team presentations. The goal of the module was to provide nursing students with an organizing framework for integrating environmental health into clinical practice and an innovative tool for understanding community-level components of public health.     

Transitioning a bachelor of science in nursing program to blended learning: Successes,challenges & outcomes

To help address the challenges of providing undergraduate nursing education in an accelerated time frame, the Teaching and Transforming through Technology (T3) project was funded to transition a second-degree ABSN program to a blended learning format. The project has explored the use of blended learning to: enable flexible solutions to support teaching goals and address course challenges; provide students with new types of independent learning activities outside of the traditional classroom; increase opportunities for active learning in the classroom; and improve students' digital literacy and lifelong learning skills. Program evaluation included quality reviews of the redesigned courses, surveys of student perceptions, pre- and post-program assessment of students' digital literacy and interviews with faculty about their experiences with the new teaching methods. Adopting an established quality framework to guide course design and evaluation for quality contributed to the efficient and effective development of a high-quality undergraduate blended nursing program. Program outcomes and lessons learned are presented to inform future teaching innovation and research related to blended learning in undergraduate nursing education.     

The meaning of public health nursing: creating 24 hour care in a community in Japan

Abstract This case study describes the strategies and activities of public health nurses to increase the availability of services in a municipality of 36 000 and to transform community attitudes so that those needing services would feel free to use them. Strategies and activities are seen in the context of Japan, Minakuchi Town and the leadership of the chief public health nurse. Practicing in partnership with members of the community, strategies of public health nurses include technical activities (conducting needs assessment and framing program alternatives) and information sharing and health education (e.g. 75 meetings organized with health promoters for residents in the districts of the town). On the basis of the results of Minakuchi Town, viewed as an example of expert public health nursing practice, a general model for public health nursing practice is presented.     

Addressing the Community/Public Health Nursing Shortage through a Multifaceted Regional Approach

Despite increasing needs resulting from emerging societal and health care issues, the number of trained community/public health (C/PH) nurses in the United States is facing a precipitous decline. Numerous factors contribute to this shortage including an aging workforce, a poorly funded public health system, inconsistencies in C/PH nursing educational approaches and opportunities, and a shortage of sites for clinical training. Determined to address the C/PH nursing shortage in their region, a consortium of public health professionals, university deans and faculty, and state nursing leaders in southeastern Wisconsin came together to address these issues from three perspectives: (a) curricular analysis and redesign, (b) expansion of clinical placement opportunities, and (c) paid community/public health nursing internships for seniors in baccalaureate nursing programs. This article outlines briefly the activities undertaken related to curricular review and clinical placements, and then describes in detail the approach, challenges and results of the senior internship program. Together, these programs produced long‐lasting results including an unprecedented level of collaboration between academic institutions and public health nursing professionals, the expansion of both traditional and nontraditional clinical sites in the region, and a transformative learning experience for seventeen senior nursing students from five participating universities.     

An academic practice partnership: Building capacity to meet sexual health education policy requirements of a public school system

The purpose of this clinical concepts paper is to describe the development, implementation, and evaluation of a formal academic‐practice partnership between a large, urban, public school system and a college of nursing, based on the American Association of Colleges of Nursing's Guiding Principles to Academic‐Practice Partnerships. The overarching goal of the partnership was to increase the school district's capacity to meet sexual health education policy requirements while providing graduate nursing students with an opportunity to work with a diverse population of youth during a public health nursing practicum course. As a result of the partnership, over 2,000 public school students (grades 5–12) have received comprehensive sexual health education and increased their knowledge by an average of 19.7–32.7%. In addition, 79 prelicensure, graduate nursing students have been placed at the public school system for public health nursing practicum and 100% have met all clinical objectives. As with any partnership, successes and lessons learned were identified. Discussion of both is included in this paper and may benefit other organizations considering entering into similar partnerships. Ultimately, academic‐practice partnerships are an important mechanism to simultaneously meet the growing needs of community practice partners and nursing education programs, while strengthening public health nursing practice.     

Creating and sustaining an academic‐practice Partnership Engagement Model

Public health clinical educators and practicing public health nurses (PHNs) are experiencing challenges in creating meaningful clinical learning experiences for nursing students due to an increase in nursing programs and greater workload responsibilities for both nursing faculty and PHNs. The Henry Street Consortium (HSC), a collaborative group of PHNs and nursing faculty, conducted a project to identify best practices for public health nursing student clinical learning experiences. Project leaders surveyed HSC members about preferences for teaching‐learning strategies, facilitated development of resources and tools to guide learning, organized faculty/PHN pilot teams to test resources and tools with students, and evaluated the pilot team experiences through two focus groups. The analysis of the outcomes of the partnership engagement project led to the development of the Partnership Engagement Model (PEM), which may be used by nursing faculty and their public health practice partners to guide building relationships and sustainable partnerships for educating nursing students.     

Factors affecting metacognition of undergraduate nursing students in a blended learning environment

This paper is a report of a study to examine the influence of demographic, learning involvement and learning performance variables on metacognition of undergraduate nursing students in a blended learning environment. A cross‐sectional, correlational survey design was adopted. Ninety‐nine students invited to participate in the study were enrolled in a professional nursing ethics course at a public nursing college. The blended learning intervention is basically an assimilation of classroom learning and online learning. Simple linear regression showed significant associations between frequency of online dialogues, the Case Analysis Attitude Scale scores, the Case Analysis Self Evaluation Scale scores, the Blended Learning Satisfaction Scale scores, and Metacognition Scale scores. Multiple linear regression indicated that frequency of online dialogues, the Case Analysis Self Evaluation Scale and the Blended Learning Satisfaction Scale were significant independent predictors of metacognition. Overall, the model accounted for almost half of the variance in metacognition. The blended learning module developed in this study proved successful in the end as a catalyst for the exercising of metacognitive abilities by the sample of nursing students. Learners are able to develop metacognitive ability in comprehension, argumentation, reasoning and various forms of higher order thinking through the blended learning process.     

Special Features: Education: Challenges and Opportunities Associated with Preceptored Community Health Clinical Experiences

ABSTRACT Preceptored community experiences present challenges different from those of preceptored experiences in the acute care setting. Instead of focusing on psychomotor skills, faculty must address population‐based skills and assess students' abilities to practice these skills. Faculty and preceptors' lack of knowledge to teach these skills further complicate the experiences, an issue indirectly related to faculty and nursing shortages. Although preceptors guide students, faculty are responsible for evaluating students in community preceptored experiences. The Association of Community Health Nursing Educators (ACHNE) Essentials of Baccalaureate Education (Essentials) offers opportunities for guiding and evaluating community health preceptored clinical experiences. Assignments and activities that reflect the ACHNE Essentials provide a firm foundation for the population focus of the course. This focus is validated through faculty visits to students in a variety of community settings. To plan successful community experiences and evaluate students, faculty must be knowledgeable about the population focus of community courses, apply this knowledge to students in a variety of settings, and ask challenging questions to assess student learning.     

Home‐visit nurses' attitudes for providing effective assistance to clients with schizophrenia

There were two objectives of this study. The first was to identify the attitudes of home‐visit nurses towards clients with schizophrenia that lead to the provisions of effective care and positive client outcomes for clients with schizophrenia. The second was to develop a framework to understand how nurses acquire nursing attitudes that lead to such provisions. Seven expert home‐visit nurses who had successfully prevented rehospitalization of clients with schizophrenia for more than 2 years were interviewed. In the semistructured interviews, the nurses described their experiences in assisting one or two clients. Data were analyzed qualitatively. The central theme was having equal footing with the client. An effective nursing attitude was acquired through recognizing one's own preconceptions of clients with schizophrenia through two steps: encountering unexpected client behaviours and becoming aware of one's problematic care. For these clients, it was essential that the nurses reflect on their preconceptions towards clients with schizophrenia and alter these preconceptions by working with the clients and believing in their innate ability to live in the community. The findings suggest that the field of mental health home‐visit nursing might benefit from adding these educational components in order to cultivate effective nursing attitudes for assisting clients with schizophrenia.     

Mental health nurses’ contributions to community mental health care: An Australian study

Australian mental health policy is focused on providing mental health care in the community setting and community mental health teams provide services to clients in a shared model with primary care. The historical literature reports that community mental health nurses’ experience high levels of stress and are often allocated the most complex and challenging clients managed by the team. Yet information on their specific roles remains limited. This paper reports on research conducted at one Australian public mental health service to identify the components of the community mental health nursing role and to quantify the time nurses spent in each component during the study period. Six focus groups were conducted with community mental health nurses to identify their perceived role within the team. Data analysis identified 18 components of which 10 were related to direct clinical contact with clients and eight covered administrative and care coordination activities. A data collection tool based on the findings of the focus groups was designed and nurses recorded workload data on the tool in 15‐min intervals over a 4‐week period. Seventeen nurses collected 1528 hours of data. Internal coordination of care was identified as the top workload item followed by clinical documentation and national data collection responsibilities supporting the complexity of the community mental health nursing role. The high rating attached to the internal coordination of care role demonstrates an important contribution that community mental health nurses make to the functioning of the team and the delivery of quality mental health care.     

Integrating environmental health into an undergraduate community health nursing course

Nurses are often the first members of the healthcare system to whom the public turns when environmental health hazards cause concern. Yet most nursing programs include scant formal environmental health content. This article describes a project that integrated significant environmental health content into an undergraduate community health nursing course. The revised course included additional environmental health classroom content and field experiences. Details are provided regarding changes to classroom content, revision of written assignments to include environmental health issues, planning and implementation of nursing student field experiences with environmental health professionals, and evaluations of the revised course. The article concludes with three recommendations to guide other schools of nursing, wishing to integrate environmental health into their curricula.