An assessment of students' confidence in performing psychiatric mental health nursing skills: the impact of the clinical practicum experience

Background: In 2008, the American Psychiatric Nurses Association and the International Society for Psychiatric Nursing jointed developed Psychiatric Mental Health Nursing competencies for BSN students. In the newly created accelerated track of the BSN program, students spend less time than traditional students in psychiatric mental health (PMH) clinical practica. Objectives: The primary objective was to discover how the PMH practicum experience influences BSN students' perceptions of their confidence in performing PMH clinical skills. Design: An evaluation design was used in this study. Results: There was significant improvement in students' confidence performing PMH clinical competencies after completing the PMH nursing practicum. The current structure of clinical provides students with experiences that promote their confidence. Conclusions: Students self-assessment about learning needs and skill level should be assessed preclinically to allow for practice to gain confidence.     

Matching a graduate curriculum in public/community health nursing to practice competencies: the Rush University experience

An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing.     

A competency-based approach to public health nursing performance appraisal

OBJECTIVES: To integrate public health nursing (PHN) competencies into a comprehensive performance review instrument for nurses at multiple practice levels in an urban public health department. DESIGN: Based on thorough review of PHN competency literature, the tool evaluates performance for 5 nursing practice classifications (Staff RN, Public Health Nurse, Nurse Practitioner, Clinical Nurse Specialist, Nursing Supervisor) in eight PHN domains (assessment, policy development/program planning, evaluation, communication, cultural competency, partnership/collaboration, disease prevention/health promotion, leadership/systems thinking). SAMPLE: Tool was piloted with over 50 nurses from PHN workforce (n>400) of Public Health-Seattle & King County (Washington). METHOD: Pilot testing includes all components of the performance appraisal system: Public Health Competency Grid, statement of general workplace expectations, Nursing Performance Appraisal Tool, and supporting documents defining performance elements by job classification. RESULTS: Supervisors find the tool easy to use and report that it provides opportunity for real communication between employee and supervisor. Nurses at all practice levels report that it effectively describes/evaluates their practice. CONCLUSIONS: This tool is an efficient performance appraisal instrument providing meaningful feedback to nursing employees within a framework of PHN competencies. Adopting such tools in PHN practice can help nurses to better understand their role in population-based public health efforts.     

Using portfolios to evaluate achievement of population-based public health nursing competencies in baccalaureate nursing students

Public health nurses from 13 local public health agencies and nurse educators from five schools of nursing developed population-based public health nursing competencies for new graduates and novice public health nurses. Educators in one nursing program used a portfolio assignment to measure achievement of the competencies by traditional and RN to BSN students in a community health nursing course. Data were collected from surveys and focus groups to determine students' responses to the portfolio and their use of population-based public health nursing concepts. The assignment enhanced students' critical thinking skills; however, concerns about the structure and evaluation of the portfolio decreased student satisfaction. Recommendations are made for improving the portfolio format, increasing students' valuing of the portfolio, managing the tension between assessment and learning, and orienting clinical agency staff and nursing instructors.     

Use of the professional nurse case study as a method to earn credit in an RN to BSN program.

This article describes the author's experience in developing a professional nurse case study as a means of allowing registered nurse students enrolled in a baccalaureate degree nursing program to satisfy the clinical requirement at a public institution in New Jersey. The author used a survey to assess the lower level competencies of their RN students. In addition, a survey was mailed to the BSN graduates who completed the program within the past five years to determine if they would have selected an alternative to the clinical examination. Results showed that the PNCS could validate prior learning of basic nursing competencies for RNs returning to obtain a BSN degree.     

Collaboration Between Communities and Universities: Completion of a Community Needs Assessment

Abstract Health care reform can provide opportunities for collaboration between universities and the public at large. An advanced community nursing class within a post-RN program at a university combined resources with a nearby rural community to complete a community health and social needs assessment. The partners in the project included the local hospital, health unit, and the university; funding was secured from the Regional Center for Health Promotion and Community Studies and the two health agency partners also made a financial donation. Community liaisons who were both registered nurses and residents of the community were instrumental in completing tasks and activities related to the project. The students were taught the various data collection methods and participated in class assignments refining the necessary skills required for the actual assessment. This project benefited the community by providing baseline health status and social needs data in an era of dramatic health care reform while simultaneously affording undergraduate nursing students the opportunity to apply theory to practice.     

The clinical specialist in community health nursing: a solution for the 21st century

The clinical specialist (CS) in community health nursing (CHN) addresses health problems in populations and communities in ways that are different from and complimentary to strategies used by practitioners of individualized patient care. Four programs based on comprehensive assessments, systematic program planning, deliberate implementation, and both formative and summative evaluation are presented. The programs were developed by graduate students in the CHN clinical specialization major at the Frances Payne Bolton School of Nursing. With expert faculty guidance and a competency-driven program of study, strategies were implemented to promote the health of community-dwelling well elderly people, home health care nurses who provide service to patients with respiratory problems, and high school students in a private religious school. Experienced parish nurses also benefited from a program designed to enhance their skills in theological reflection. This article also describes the curricular design developed to educate this clinician for the 21st century. Lastly, continued attention to the dynamic criteria of the American Nurses Association Standards of Community Health Nursing Practice is recommended as crucial to the further development of this clinical specialization.     

A pilot interprofessional program to promote oral health and wellness in Appalachian children

In a first of its kind authentic clinical interprofessional education (IPE) experience, University of Kentucky (UK) health profession students joined dental students to implement a pilot program to promote oral health and wellness with children living in underserved Appalachian communities. Known as hCATS (Health Colleges Advancing Team Skills) to Appalachia, a total of 113 students participated in interprofessional teams of 48 health profession students paired with 65 dentistry students to provide health services. Although the UK College of Dentistry has provided sealant services (tooth decay prevention) to elementary school children for several decades in eastern Kentucky counties, funding through the UK Women and Philanthropy Network allowed services to expand to include general health screening and age-appropriate education on oral health, nutrition, exercise, and prevention of substance abuse. The UK Center for Interprofessional Health Education (CIHE) coordinated the efforts for students from the colleges of Communication and Information Sciences, Health Sciences, Nursing, Pharmacy, Public Health, and Social Work. In addition to the clinical experience in the elementary schools, nursing and other health profession students explored the health resources of the communities visited and reflected on their experience in collaborative practice that the program was designed to encourage. The authors noted positive outcomes with interprofessional education competencies, although more structure for collaboration is required to ensure students who work with other professions in an authentic clinical setting can gain early relevant practice in, and experience the benefits of, collaborative patient care.     

An Open Letter to Public Health Nurses

ABSTRACT Public health nursing celebrated its 100^th anniversary in 1993. In a guest editorial for Public Health Nursing Dr. Marla Salmon, then director of the Division of Nursing, Bureau of Health Professions, U. S. Department of Health and Human Services, wrote a "retrospective vision" in which she projected the roles that American public health nurses would play in 21^st century health care reform. The picture she painted was highly optimistic and 16 years later the profession has yet to realize the accomplishments Salmon envisioned: a more visible leadership in directing health policy, creation of systems that expand public health department roles in both direct and indirect services, cooperation among agencies, and empowerment of the communities and individuals served by the public health care system. As she saw it, the period between 1893 and 1993 was a prelude to the coming of age of public health nursing as a specialty. She cautioned that those who practice public health nursing between 1993 and 2093 are responsible for authoring the next volume of history through their own actions. This historical reprint originally appeared in the December 1993 issue of Public Health Nursing .     

Research Prescription for Undergraduate Students: Research Mentoring in a Small Liberal Arts University

Creating and executing unique research projects for completion in four semesters is a challenge especially in a small liberal arts university in a rural Health Professions Shortage Area (HPSA) with a newly established BSN program. HPSAs are designations that indicate health care provider shortages in primary care, dental health or mental health. Undergraduate research is an emerging focus across campus with limited faculty funding. Most of our nursing faculty are in the process of developing their programs of research which required faculty of the research course to become mentors for both faculty and students. This article describes one strategy utilized in establishing an undergraduate research focus within a BSN nursing program. Working in small groups with a faculty mentor, students planned and conducted their entire research study, presenting their findings to the university community in the period of four semesters of the nursing program. Research course faculty served as mentors for less experienced faculty, involving the entire nursing program in research. Research projects were conducted in institutional and community settings to improve population health in our HPSA.     

The Kansas Health Education Training Center: caring for the underserved

The State of Kansas was awarded Health Education Training Centers (HETC) DHHS/HRSA, BrHPr Federal funds for the first time in 2002 through 2005. The three-year grant award was under the leadership of the Nurse-Midwifery Education faculty of the University of Kansas (KU) School of Nursing. Federal objectives included: 1. To facilitate interdisciplinary clinical training for health professions students from nursing, medicine, and allied health at targeted underserved communities. 2. To deliver culturally appropriate health care information to underprivileged populations at targeted underserved communities. 3. To conduct continuing education activities for community health workers and health professionals serving vulnerable urban and rural populations. 4. To recruit and mentor high school students from disadvantaged populations to pursue health professions. This three-year state-wide program addressed access to quality health care for underprivileged and underserved populations in select communities to improve health status, through community-based care that is culturally competent, multidisciplinary, sensitive to needs of special populations and augmented by health professions students. This article provides a review of two selected community-based interventions in Sedgwick and Wyandotte counties (addressing BrHPr federal objectives one and two) implemented to enhance care for immigrant pregnant women and underserved patients diagnosed with diabetes, respectively. Also included is a review of literature related to the efficacy and utilization of community based health workers (CHWs) in caring for vulnerable populations.     

Development and testing of a practicum matching program for baccalaureate nursing education,a local public health unit

This article describes a novel approach to nursing education, designed to improve the experience of both students in public health nursing, and the local public health unit where they affiliate. Students, faculty, and public health department staff developed a method for matching programs and needs of the local public health unit to the skills and learning needs of nursing students. We describe our experience articulating student competencies, program-specific functions, and an approach to matching student interests and learning opportunities to agency needs. Students, faculty, and staff rated the program moderately to very high in feasibility, satisfaction, and acceptability. Data suggest the novel program served to improve the quality of the practicum affiliation, to the satisfaction of both the school and agency, while contributing to a robust public health learning experience for emerging professional nurses.     

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.     

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.     

Public health nursing competencies 1953-1966: effective and efficient

The Quad Council of Public Health Nursing Organizations developed public health nursing competencies in 2003. They are guides for determining skills at two levels, and they identify public health nurses as providing care to individuals and families or to populations and systems with the nurse having proficiency, awareness, or knowledge. The primary purpose of this paper is to discuss historical nursing roles and qualifications as judged by the 2003 competencies, including educational preparation and experience for the administrative and staff nurse. The historical exemplar for the nursing roles is a combination public/private nursing association, referred to as the partnership, that took place in 1953-1966. Primary sources include archived material from the Instructive Visiting Nurse Association, Richmond, VA. Administrative responsibilities were divided between the chief nurse and the nursing supervisors. Staff nurse responsibilities included clinic activities, home visitation, and referral coordination between health care organizations. The delineation of nursing roles demonstrates nurses' meeting the 2003 competencies. Based on the Quad Council's 2003 public health nursing competencies, the partnership nurses were competent.     

Community Nursing Competencies: A Comparison of Educator, Administrator, and Student Perspectives

Abstract Perceptions of functioning levels of baccalaureate students nearing graduation were assessed, comparing views of 15 educators, 15 health department administrators, and 185 students. A modified list of the 47 essential public health nursing competencies identified through the U. S. Department of Health and Human Services Division of Nursing served as the basis for data collection and analyses. Student competencies in individual skills were ranked higher than group and community competencies by all three groups surveyed. Students ranked competencies at higher levels than educators and educators at higher levels than administrators. Although administrators continue to advise new graduates to work in acute care before entering community health, support for continuation of this practice was not observed based on administrator ratings.     

The Quad Council Practice Competencies for Public Health Nursing

This article describes the most recent efforts by the Quad Council of Public Health Nursing organizations to review and revise the competencies for PHN practice, and highlights the implications of these competencies for practice, education, and research. The Quad Council is a coalition of four nursing organizations with a focus on public health nursing and includes the Association of Community Health Nursing Educators; the Association of Public Health Nursing (known prior to July 1, 2012 as the Association of State and Territorial Directors of Nursing); the Public Health Nursing section of the American Public Health Association; and the Council on Economics and Practice of the American Nurses' Association. The Quad Council competencies are based on the Council on Linkages competencies for public health professionals and were designed to ensure that public health nursing fits in the domain of public health science and practice.