Knowledge, skills and experiences for community health nursing practice: the perceptions of community nurses, administrators and educators

Nursing in Canada is committed to preparing all new graduates at the baccalaureate level for entry to nursing practice by the year 2000 This goal has major implications for community health nursing education and practice Health care reform is also expected to move care out of the hospital and into the community It was against this backdrop that the researchers mounted a study on the educational preparation needed for graduates to begin to practice community health nursing In this paper, the knowledge, professional and personal skills, and experiences that graduates need to begin community practice are reported The study was carried out within an action-research framework All major groups of stakeholders involved in community health nursing throughout the study province were involved in the project This included nurses and administrators from two public health agencies (provincial and municipal), home care nurses, home health nurses (l e non-governmental visiting nurses), community health centres, provincial health care and nursing consultants, and faculty from two universities In addition to the generation of relevant research findings for use by the educational institutions, the study was initiated to set the stage for future and ongoing interactions between the researchers and community experts to implement the findings from the project Data were collected from 118 participants by means of 27 focus groups of community nurses, administrators and educators Interviews were tape-recorded transcribed and analysed using latent content analysis and constant comparison techniques Findings indicated that qualified nurses from university programmes need a wide range of knowledge, skills and experiences to begin to practice community health nursing Detailed accounts of these requirements are outlined and the implications for practice and education put forward     

International collaborative workshops. A 6-year partnership between Canada and China

Interprofessional exchanges such as workshops are common activities in international development programs. The authors describe processes used to select, implement, and evaluate six collaborative workshops held in Tianjin, China, between 1990 and 1995. These workshops targeted curricular change for a baccalaureate nursing program in Tianjin Medical University. Our experience highlights the importance of understanding the assumptive base for change, developing an institutional memory in both partner universities, introducing interactive teaching methods congruent with Chinese value systems, and using a formative evaluation strategy to foster cross-cultural dialogue and mutual understanding among project partners.     

Community as Client: A Challenge for Nursing Education

Abstract The mandate of public health departments has been, and continues to be, to provide and deliver a variety of health programs and services pertinent to local circumstances and needs. Public health nurses are the largest group of health care professionals who deliver these services. The objectives of this paper are to identify what policy makers expect of public health nurses related to community development for health, and to describe the educational components necessary for baccalaureate nursing curricula if these expectations are to be met.     

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.     

Student Experiential Learning: A Collaborative Community Practice Project

Abstract Theoretical and experiential learning in community assessment are essential components of the preparation of first-level community health nurses. This article describes a collaborative community practice project in which faculty incorporated senior baccalaureate community health nursing students as participants. Students assessed availability and utilization patterns of health care services in Spokane. Washington. Data derived from the survey were used by community planners in addressing issues of access to health care by low-income persons. Learning outcomes of this experiential process are described within the context of Burnard's Experiential Learning Model and community health nursing course objectives. Recommendations for design of similar experiential learning opportunities are made.     

Population-focused practice: introduction to baccalaureate-level nursing students

This article describes a clinical nursing experience which introduces baccalaureate students to population-focused practice in the community. The importance of such practice in community health nursing is discussed as is the rationale for including it at the undergraduate level. An overview of how the experience fits within the baccalaureate nursing curriculum is presented. Individual and group student responsibilities are outlined, explaining the structure of this nursing experience. Student projects with two groups--the well elderly and the school-aged are described to illustrate the clinical experience. Finally, an evaluation of the experience is presented which indicates that it has benefits for clients, community health nurses, students and faculty.     

Practicing Autonomously: A Comparison of Nurses

Forty-five subjects including community health nurses with baccalaureate nursing degrees, senior-level generic nursing students, and registered nurses in a baccalaureate nursing program were compared on age, years of employment in nursing, and three variables of professional autonomy: nurses' rights and responsibilities, the nurse-patient relationship, and nurses' role in health care delivery. It was predicted that nurses from baccalaureate programs and those practicing in community health nursing would perceive themselves as more autonomous and that age and years of employment in nursing would not appreciably alter perceptions of autonomy. An analysis of variance confirmed the initial prediction at the 0.01 level of significance or better for nurses' rights and responsibilities and their role in health care delivery. A significant negative correlation was obtained between age and nurses' rights and responsibilities for the community health nurses; a significant positive correlation was obtained between years of work experience and nurses' rights and responsibilities for only the registered nurses. This study is perceived as an initial step in a lengthy process aimed at identifying factors that influence nurses' perceptions about professional autonomy.     

Community as Client: A 'Hands-On' Experience for Baccalurate Nursing Students

This article describes how Bachelor of Science in Nursing (BSN) students are introduced to the concept of community as client. Although this concept is widely accepted, at least theoretically, the majority of community health nursing practicums for baccalaureate students are in working with individuals and families as clients. The community health nursing faculty at La Roche College believe that undergraduate students should not only have the experience of decision making and problem solving at the individual and family level but also at the aggregate or community level. The process of actualizing the community as client concept through 'hands on' experience is the focus of this article. Our student body consists of registered nurses seeking their baccalaureate degree in nursing.     

Cooperation project in basic nursing education--the introduction of a new nursing education program in Tianjin, China.

Over the last few decades, traditional basic nursing education has taken place in nursing schools in China. In 1988, a new cooperation project for basic nursing education was tried between a Tianjin nursing school and several hospitals (Tianjin is one of the industrial cities in China). In this paper, an experiment in nursing education in Tianjin is described. In order to help readers to understand the Cooperation Project, the preparation courses are also described. Several advantages and disadvantages are discussed; some new proposals are also put forward at the end of the paper.     

Cooperation project in basic nursing education—the introduction of a new nursing education program in Tianjin, China

Over the last few decades, traditional basic nursing education has taken place in nursing schools in China. In 1988, a new cooperation project for basic nursing education was tried between a Tianjin nursing school and several hospitals (Tianjin is one of the industrial cities in China). In this paper, an experiment in nursing education in Tianjin is described. In order to help readers to understand the Cooperation Project, the preparation courses are also described. Several advantages and disadvantages are discussed; some new proposals are also put forward at the end of the paper.     

Nursing education, practice, and professional identity: a transcultural course in England.

Students from a baccalaureate program at the University of Delaware participated in a 4-week course in England, exploring nursing's role in the health care system of that country. Students observed and interacted with a variety of clients and nurses in diverse settings; they observed similarities and differences in nursing education, practice, and professional identity between nurses in England and in the United States. The course was timely and valuable--it provided students with the opportunity to enhance their awareness of another culture and it allowed them to recognize nursing's importance in global health concerns.     

Aggregate/Community-Centered Undergraduate Community Health Nursing Clinical Experience

Abstract Debate continues about the appropriateness of clinical experiences targeting aggregates in undergraduate community health nursing education. This paper describes a practical model to teach, through experience, the concepts of aggregate/community-centered practice at the baccalaureate level. As a voluntary alternative to the usual community assessment paper, groups of students worked in partnership with community groups to define health needs and to address one need. Sequential student groups focused the assessment and implemented a plan. The required time for each project varied. One project is described to illustrate the model. While independent community-centered practice is not expected of the B.S.N. graduate, the model described here develops comprehension of the concepts and process of such practice.     

Modular Curriculum Development in Community Health Nursing

Integrated curricula for baccalaureate education in nursing have many advantages but present problems for faculty. Several problems were identified in our community health nursing curriculum. For example, difficulty coordinating theory with clinical practice, lack of structural organization for the curriculum, inadequate coverage of key areas such as epidemiology and community assessment, and lecture format made it difficult to meet the learning needs of different student groups such as returning registered nurses and other adult learners. A modular community health nursing curriculum was developed. Not only were the instructional problems resolved, but satisfaction with the curriculum was expressed by both faculty and students.     

Clinical Competencies for Community Health Nursing

Cost-containment strategies initiated in the early 1980s caused a major shift in site of care delivery for persons needing nursing care. Where once the majority of clients were cared for in the acute-care setting until they were self-sufficient, now most are discharged to the home environment still requiring acute-care nursing interventions as well as community health nursing skills. This rapid shift in practice sites has placed severe strain on community health nursing agencies. Not only are more nurses required to fill the increased demand for services, but the demand comes at a time when we are experiencing a severe nursing shortage. This has forced many agencies to hire acute care nurses who have little or no community health nursing experience. These nurses come to community health nursing expecting to use the same set of skills and knowledge base used in their acute-care practice; however, the skill levels and concepts required for community health nursing are quite different from the acute care setting. Educational preparation has not kept pace with this shift in practice. Consequently, many nurses are not adequately prepared to enter community health nursing. Preparation must include theoretical and experiential components that focus on assessment skills (of the community and individual), decision making, case management, health systems management, teaching, and leadership. Collaborative efforts between community health organizations and educational institutions would seem to be one solution that would ensure adequately prepared nurses for community health nursing. The establishment and maintenance of strong staff-development programs within community health nursing agencies are also required.     

Collaboration: Integrating Practice and Research in Public Health Nursing

The need to integrate clinical practice and research has been stressed for many years in both public health and nursing. This article describes such a collaborative project between two rural upper Midwest public health nursing agencies and public health nursing faculty from a small, liberal arts, baccalaureate nursing program. The high-risk prenatal research project provided an opportunity for nursing staff and faculty research consultants to work together on a clinical study. A model for collaborative research is illustrated, and advantages and disadvantages for practice, administration, and research are discussed.     

Caseload management skills for improved efficiency

This article provides information about caseload management, which was one of a group of six competencies identified by nurse administrators as needed by new baccalaureate graduates. Caseload management is an important skill for nurses who work with caseloads of patients or clients (e.g., home health nurses, public health nurses, case managers, ambulatory care nurses). Because inadequate information about caseload management is contained in community health nursing textbooks, continuing education and staff development programs need to include caseload management skills to improve the efficiency and quality of nursing care.     

Epidemiology and Biostatistics Content in Baccalaureate Education for Community Health Nursing

Abstract Community health nursing leaders recommend including epidemiology and biostatistics in baccalaureate curricula but do not define essential content. Topic coverage and emphasis vary across schools; students differ in academic achievement and in readiness for an epidemiologic approach to nursing. A review of textbooks showed wide variance in topic presentation. A survey of baccalaureate community health nursing faculty in a southeastern state uncovered a core of epidemiology course work comparable to that in graduate programs. Biostatistical content was sparse, and participatory learning strategies were seldom noted. Definition of essential introductory epidemiology and biostatistics content and greater linkage between knowledge and application is necessary to show their congruence with community health nursing practice, and enable differentiation between the level and scope of learning appropriate for undergraduate and graduate education.