The process of becoming: from specialty practice to community-based nursing

This article reports on the experience of the School of Nursing at Creighton University in cross-educating faculty to community-based nursing. In the late 1990's the Helene Fuld Health Trust recognized the importance of preparing nursing faculty for community-based nursing because of changing trends in the health care system. Placed in the historical context of the early beginnings of nursing practice in the community, this renewed emphasis led to seeking grant support from the Trust to strengthen the place of community-based nursing for faculty and students alike to be responsive to future changes in health care.     

Empowering nursing faculty and students for community service

As the health care delivery system moves from acute care settings to community-based services, nursing education must examine the experiences that increase students' abilities to function within a changing system. Currently, students receive community-based experiences that involve teaching health promotion concepts. However, students are not routinely prepared with specialized screening skills to use in the community. Using a train-the-trainer model, faculty and students were taught four specialized screening skills: Early and Periodic Screening, Diagnosis, and Treatment, Denver II Developmental Screening, vision screening, and hearing screening. Initially, faculty obtained certification as trainers for these specialized skills. Then, faculty educated students and provided enhanced, guided community experiences. Undergraduate, RN-to-BSN, and graduate family nurse practitioner students participated in this community-based experience. Project outcomes were evaluated based on the number of students and faculty who were certified and participated in these community activities.     

Institutional collaboration and competition in community-based education

We sought to determine whether competition for community-based training sites exists among health professions schools, and to examine faculty and senior administrators' perspectives on institutional collaboration for community-based education. Eight academic health centers (AHCs) in the USA were selected by objective criteria for their significant community involvement. Chief executive officers, vice chancellors, deans, and the individuals responsible for community-based education, research and community service responded to written surveys. The overall response rate was 79% (n = 91). Responses were subjected to quantitative and qualitative analyses. Leaders of community-based education reported that "competition for community-based training sites" is a barrier to community involvement. "Competition for community-based training sites"was positively related to 'call for increasing percentage of graduates to enter primary care careers' (0.30, p < 0.01) and negative related to "collaboration exists between the community and your school/AHC" ( - 0.28, p < 0.05). Respondents reported that a moderate level of collaboration across schools exists. While medical school respondents reported having collaborative relationships with other health professions schools and with the community, nursing respondents reported medicine's performance at a significantly lower level. Public health and nursing faculty reported that they are competing with medical schools for sites they had traditionally used for their students. Competition for sites is an unintended outcome of the increased emphasis on community-based education in health professions curricula. We recommend AHCs form joint committees across schools to effectively address community-based sites as a limited resource, and to consider a wider range of community-based organizations as training partners.     

Institutional collaboration and competition in community-based education

We sought to determine whether competition for community-based training sites exists among health professions schools, and to examine faculty and senior administrators' perspectives on institutional collaboration for community-based education. Eight academic health centers (AHCs) in the USA were selected by objective criteria for their significant community involvement. Chief executive officers, vice chancellors, deans, and the individuals responsible for community-based education, research and community service responded to written surveys. The overall response rate was 79% (n?=?91). Responses were subjected to quantitative and qualitative analyses. Leaders of community-based education reported that ‘competition for community-based training sites’ is a barrier to community involvement. ‘Competition for community-based training sites’ was positively related to ‘call for increasing percentage of graduates to enter primary care careers’ (0.30, p?<?0.01) and negative related to ‘collaboration exists between the community and your school/AHC’ (???0.28, p?<?0.05). Respondents reported that a moderate level of collaboration across schools exists. While medical school respondents reported having collaborative relationships with other health professions schools and with the community, nursing respondents reported medicine's performance at a significantly lower level. Public health and nursing faculty reported that they are competing with medical schools for sites they had traditionally used for their students. Competition for sites is an unintended outcome of the increased emphasis on community-based education in health professions curricula. We recommend AHCs form joint committees across schools to effectively address community-based sites as a limited resource, and to consider a wider range of community-based organizations as training partners.     

Interagency collaboration: head start and a school of nursing

Agency collaboration is gaining importance for schools of nursing as changes in health care systems focus on the community as a principal environment for health care delivery. Nursing faculty seeking settings in the community to prepare future nurses find Head Start especially interesting as a model of comprehensive care for low-income families. The skill required to develop successful collaboration between community agencies and schools of nursing is often underestimated. Polivka in a conceptual framework for community interageacy collaboration identifies factors to consider. Successful collaborative relationships require that goals be achieved, that relationships be satisfying, and that outcomes have value for all collaborators.     

Changing the face of nursing faculty: minority faculty recruitment and retention.

Critical shortages in the nursing workforce pose life-and-death decisions for health care institutions. Similar shortages of nursing faculty, particularly nursing faculty with doctoral degrees, confront schools of nursing. Competition among health care institutions and schools of nursing for master's- and doctorally prepared nurses is fierce. Credentialed minority faculty are in even greater demand. Rising salaries and increasing opportunities outside of academia present significant barriers to schools of nursing seeking to recruit and retain minority nursing faculty. Challenges to increasing the number of minority nursing faculty surface very early in the pipeline and include competition among health professions and other disciplines for minority students. Successful long-term strategies to increase the number of minority nursing faculty must include strategies to attract higher numbers of minority students into baccalaureate, master's, and doctoral nursing programs. Several initiatives to increase minority student enrollment in the health professions are highlighted. Finally, strategies for recruiting, empowering, and retaining minority nursing faculty by schools of nursing are presented.     

Preparation of community health nursing leaders for social action

Indiana University School of Nursing graduate Department of Community Health Nursing has been preparing community health nurses for primary health care practice, as defined by the World Health Organization since 1978. The faculty are committed to preparing community health nursing leaders for social action aimed at improving the health of the community in both the Department's major in the master's programme and its new major in the doctoral programme. The core curricula for these majors in both programmes are presented. The master's curricula is based on integrating public health principles with those of community development. The doctoral major builds on this base of primary health care practice with a curriculum focused on the contribution of community health nursing to public and health policy. The graduates of the master's programme are prepared to work with community groups as a social force in promoting the health of the community. The graduates of the new doctoral major entitled "Health Policy and the Health of the Community" are being prepared as community health nursing leaders with expertise in health care policy and the legislative process with a focus on issues related to nursing and community health. These graduates will be able to function within the broader community, including national and international settings. Based on experiences in graduate education in community health nursing recommendations are made for the response graduate nursing education must make in order to prepare appropriate leaders who can work toward the goal of improving the community's health.     

Primary care providers' views of precepting nurse practitioner students

PURPOSE: To explore perceived barriers to and facilitators of precepting as viewed by experienced community-based preceptors. DATA SOURCES: Twenty-four nurse practitioner and physician preceptors participated in a 20-minute telephone interview, using a semi-structured format. The interviews were audio-taped and transcribed. Constant comparative analysis was used to organize the preceptors' responses into thematic categories. CONCLUSIONS: Overall, most preceptors were satisfied with the precepting experience; however, many preceptors cited increasing difficulty with teaching students in primary care sites due various organizational constraints such as the imperative to increase productivity. Good communication with school of nursing faculty was cited as the key factor to continued willingness to precept. IMPLICATIONS FOR PRACTICE: Understanding factors that are important for preceptors continuing in their clinical teaching role is important for schools of nursing, especially given the increasing time-limitations that many providers face due to social and economic changes in health-care delivery.     

Collaboration Between Schools of Nursing and Local Education Agencies to Provide Health Care Services to Pre-Kindergarten through Twelfth Grade Students: Elements of Cooperative Agreements

Abstract Establishing cooperative relationships between schools of nursing and local education agencies for the delivery of health care services to children from pre-school through the twelfth grade is a process all too often characterized by numerous legal, insurance, and administrative roadblocks. While nursing faculty and their students may wish to cooperate with professional educators and their students to enhance the health care of the children, there are obstacles. Both institutions are represented by attorneys, insurance companies and others who must attend to aspects of the process other than direct health care delivery. A model for joint planning and a list of elements of effective agreements are offered as a way of engaging all parties in a constructive and useful process of collaboration.     

Combining creativity and community partnership in mental health clinical experiences

Lack of parity for mental health treatment, coupled with the trend toward more community-based care, has challenged nurse faculty to identify quality, creative psychiatric clinical sites. The purpose of this article is to educate nurse faculty on practical, creative ways to identify nontraditional community psychiatric clinical experiences. Service learning, community partnerships, and group interaction are emphasized. Literature regarding recent health care initiatives and widely accepted criteria for quality nursing education are discussed as foundations for creating alternative mental health clinical experiences. The authors' experiences implementing these concepts are discussed. Community partnerships and alternative clinical sites/experiences benefit students, faculty, institutions, and the community.     

Transitioning a classroom-based RN-BSN program to the Web

Many schools of nursing are transitioning traditional and broadcast registered nurse to bachelor of science in nursing programs to the Web. A variety of options exists when placing material on the Web for nursing programs. Some challenges include having adequate numbers of faculty to implement Web-based education; student access to adequate and available computer and broadband technology; faculty readiness and development; and resources needed for a smooth transition. The authors discuss these challenges and some options for making the transition to a Web-based delivery method.     

An educational collaboration for student nurse engagement on the essential skill of delegation

A common goal for healthcare providers and nursing faculty is the provision of effective delivery of care and safe practice settings. Decisions around the delegation of care are critical for quality patient outcomes. The purpose of this collaborative project between schools of nursing and a local community healthcare facility was to provide educational training to prelicensure nursing students on the delegation expectations for nursing professionals.     

Taking on the challenge of clinical teaching in nursing homes

While the goal of professional nursing programs is to ensure that students have a basic level of competency to care for older adults in a variety of care settings, the greatest challenge is to garner students' enthusiasm about caring for older adults in nursing homes. To increase and strengthen the professional nursing workforce in nursing homes, schools of nursing must ensure that students have appropriately placed, well-designed, and innovative clinical experiences in nursing homes with faculty who are knowledgeable about the nursing home environment and the professional nursing care needs of its residents. Four factors identified as keys to success in developing exemplary clinical experiences for students in nursing homes include: (a) nursing homes with positive reputations and providing quality care, (b) faculty knowledgeable and enthused about nursing homes, (c) committed partnerships between schools of nursing and nursing homes, and (d) creative and innovative clinical teaching strategies.     

The clinical home community: a model for community-based education

BACKGROUND: Escalating health care costs, racial inequities and socioeconomic disparities have limited access for many to even the barest of health care services. The paradigm shift to a health promotion, disease prevention, and health restoration model within a community-based framework demands greater integrated learning experiences for nursing students that are centred where clients live, work, and play. AIM: To describe the process of developing, implementing and evaluating a rural New England University's experience of piloting a clinical home community model within its existing baccalaureate curriculum. CONTENT: The model describes how it is possible to break free from traditional acute care settings in hospitals and mental health institutions. Students are provided with maternal-child and adult mental health experiences that are available in a targeted clinical home community setting where consumers are increasingly seeking health care. The concepts that directed curriculum revision from a traditional to a community-based educational framework are discussed. OUTCOMES: Strengths and limitations of the model are presented within the context of student, faculty and consumer partnerships. Implications for global development of the clinical home community model in nursing are proposed.     

A unique strategy for pediatric community health nursing for ADN students.

Students were overwhelmingly positive when given the opportunity to evaluate the pilot project and the model of pediatric community health nursing. According to the students, the strong points of the model were the orientation before the community experience, the presence of faculty of the community, the ability to contact faculty when needed, and the postclinical conference. The students' comments confirmed the faculty's belief that a clinical experience in community health nursing must place more emphasis on the specialty of community health nursing to be meaningful for students. To do the of job of educating tomorrow's nurses, ADN faculty should develop new strategies for teaching the pediatric clinical component of community health nursing. Clearly, hospitals are no longer the exclusive sites where students learn about patient and family needs and nursing care delivery. Community-based and community-focused experiences will continue to be required so that nursing students are prepared to practice in a dynamic and changing healthcare environment.     

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.     

The New Paradigm: Concepts and Application in Community Health Nursing

Abstract The central role of community health nursing in future health care delivery systems is undisputed. The abilities and characteristics of nurses who will practice in those systems depends to a large extent on their learning experiences in basic nursing programs. Educators are being asked to prepare skilled, compassionate scholar-clinicians to provide care for the complex needs of clients, despite already packed curricula. The curricular changes cannot be additive; learning must be designed to empower students to become nurses who are both skilled and compassionate. Certain faculty attitudes and behaviors are essential to this new educational paradigm, and student activities and assignments must foster confident, effective practice.     

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.     

Community health nursing clinicals: an examination of the present and ideas for the future.

As part of a curriculum revision for a baccalaureate school of nursing, a nationwide survey examined how schools of nursing structure community health nursing (CHN) clinical experiences. Results indicate that a wide variety of settings and agencies (public health departments, schools, clinics, home health, and many more) are being used. Use of preceptors, use of multiple and single agencies, observational visits, time scheduled, projects, and faculty philosophy of CHN were examined. Although many settings, courses, and projects are traditional, this study reveals that some nursing schools are responding to changes in health care and population needs and are structuring CHN clinicals accordingly. Ideas for clinical courses for the future are offered.     

"Razoo Health": a community-based nursing education initiative

When statistics depicted a health crisis for people of all ages living in Louisiana, and New Orleans in particular, school of nursing faculty designed and instituted a neighborhood-based initiative to "Razoo Health." This initiative facilitated a paradigm shift from exclusively illness management to include health promotion and disease prevention. "Razoo," a local colloquialism used to claim an opponent's marble during game play, means to snatch or claim. Appropriately, Razoo Health refers to the intent of Louisiana citizens to reclaim and take back the health of the people in the cities' neighborhoods. Working with four inner-city parochial schools and churches as hubs, nursing faculty and students mobilize neighborhood assets, talents, and capacities to form partnerships for healthy change. The Centers for Disease Control and Prevention Coordinated School Health Model is employed within each neighborhood school to provide health care access, decrease absenteeism, raise test scores, and deliver worksite health programming to faculty and staff and to neighbors and parishioners. Nursing students work with citizens and students of other health care professions to learn community assessment skills and deliver primary, secondary, and tertiary services to individuals, families, and the community. Citizens wear crowns of empowered sovereignty as they take back, or razoo, what is rightfully theirs--health.