American University of Beirut
The advanced practice public health nursing curriculum innovation is part of a HRSA supported graduate nursing distance education program that is shared with students in advanced psychiatric mental health nursing. The program is located in medically underserved areas across the State of Michigan. The shared clinical courses provide 2 credit hours of didactic work and then 4 credits of clinical experiences in the nursing specialty of the individual student (Public Health Nursing or Psychiatric-Mental Health Nursing). As part of the joint educational experience students collaborate on community-based intervention projects such as disaster management or emergency preparedness. The combination of public health nursing with psychiatric advanced practice nursing results in community interventions that provide a range of essential services. A recent class project on school violence was presented at a regional meeting of campus security services. The program has enrolled 30 advanced practice public health nurses and 70 psych NP nurses. There have also been 2 DNP graduates with a concentration in public health nursing.
Feleta Wilson, PhD, RN
Wayne State University
California State University-Long Beach
Undergraduate and Graduate Program
The California State University at Long Beach provides summer engagement programs in community health nursing to undergraduate and graduate students through placement in various international locations that allow a group of students and a faculty member to engage in community health projects in developed, developing, and domestic locations. These projects focus on the social determinants of health and may range from work on clean water projects in Tanzania to rural development projects in underserved areas of the United States. Graduate students have a chance to present their class and research projects at international global, cultural, and social issues conferences. During these times, the time is extended into visiting community settings visits that enlighten students by partaking in experiences such as visiting villages on the Amazon River and doing community needs assessments and addressing health issues as part of their clinical experiences.
Another interesting approach to community health nursing in this program is through the academic practice partnership with Long Beach Memorial Hospital. This partnership was developed by Dr. Pyllis Cooper in consultation with Dr. Savitri Singh-Carlson at California State University, Long Beach. In this partnership senior undergraduate students are assigned to patients who access the emergency room for non-emergent conditions. The students assess the patients and then arrange to follow-up with them in the community. During this experience undergraduate students learn to link families with essential community services that enable them to avoid unnecessary emergency room use. The students develop skill in creating community linkages, following-up on conditions in the home that might lead to acute care utilization, and increasing family health. The project creates a bridge between the acute care setting and the community health setting and teaches the undergraduate student to address family health needs using community resources. Graduate students are engaged in collecting data to evaluate the program, measure outcomes, and work with the undergraduate students. Undergraduate students demonstrate a clear change in attitude after the experience, they realize the need for interdisciplinary work and for developing community linkages.
Savitri Singh-Carlson, PhD
California State University, Long Beach
Undergraduate and Graduate Program
The Millikin University School of Nursing places traditional undergraduate, pre-licensure graduate and RN to BSN students in a Federally Qualified Health Center (FQHC) in Decatur, Illinois. Students are members of the case management team that includes nurse practitioners, pediatricians, family practice physicians, physician assistants, nutritionists, and licensed counselors. Students are active partners in the design and delivery of case management plans tailored to the medically underserved client and family. The experience includes active engagement of students in mentoring and coaching patients and their families. Students are also exposed to the social determinants of health as they focus on problems such as access to care, lifestyle choices, and health disparity that impact patients and families. This partnership has been ongoing since the late 1980s and provides students an opportunity to learn critical health education, community health, and interdisciplinary team skills. The experience involves senior year undergraduate and pre-licensure graduate students who engage with the Community Health Improvement Center (FQHC) for a nine credit academic experience.
N. Jo Carter, EdD., RN
Northern Kentucky University
The Nurse Advocacy Center for the Underserved (NACU) was established in 2003 by nursing faculty at Northern Kentucky University who recognized that there was an ever widening gap in health services for the poor in the community. Faculty and community health nursing students partner with agencies to assist underserved clients in managing their health problems and gaining access to necessary primary health care services. Baccalaureate students are placed in NACU sites 1 day a week for 8 weeks and they earn academic clinical credit for their work. Students develop rapport with community members and appreciation for the concepts of social justice and equal access to necessary care as they develop their clinical assignments. Students work alongside faculty and volunteer RNs to provide clinical support services such as health screening, Blood pressure and blood glucose monitoring, and basic wound care. Clinical sites include places where the homeless gather including an emergency overnight shelter and church which serves twice weekly free meals; subsidized public housing sites; and two residential substance abuse treatment centers for men and women. They also learn population assessment and observational skills as they work in the NACU sites. Implementation of the NACU services is important since the underserved community uses the emergency room when other services are not available. In areas where nurses are working emergency room use has decreased by 70%. The critical element that assures effectiveness is the partnership with the community and the trust relationship that has been built over time. The NACU is in its 10th year of operation and has been very effective in providing safety-net care in urban areas that are not well linked with the health services infrastructure. The NACU is increasingly important to the community and as a public health nursing teaching opportunity since public health department that also worked with students has experienced recent budget constraints.
Kristine Pfendt, Associate Professor
Northern Kentucky University
Oregon Health and Science University
The Oregon Health and Science University undergraduate nursing program has developed an interprofessional care access network (I-CAN). This project is funded by a HRSA grant that supports partnership development and interprofessional practice. The I-CAN Project involves the School of Nursing, the School of Medicine, and the Global Health Center as founding educational partners. The initial community partners are a primary care clinical and two community organizations focused on providing supportive services to the vulnerable populations in inner-city Portland. Community health student teams are composed of medical and undergraduate nursing students who cooperate with a faculty in residence to provide public health outreach to these vulnerable clients. The focus of the team’s interventions is healthcare services that maximize access to the social determinants of health. For example, student teams may help a vulnerable client navigate the complex health insurance system in order to gain safety-net health insurance coverage. Teams also work with chronically ill clients to understand and cooperate with complex medication regimens. The I-CAN Project has incorporated iPAD-based technology that enables student teams to upload community health and client data directly to a secure server for later analysis, provides immediate access to student-produced client education materials, and provides a real-time link to translation resources so that student teams can communicate with non-English speaking clients wherever they are. The goal of the I-CAN Project is to decrease unnecessary emergency room and 911 use age by supporting effective wellness and primary care services. The outcomes of the I-CAN Project experience are defined by client satisfaction with services provided as well as outcomes that signal appropriate use of health resources and decreased health emergencies. Baseline population data has been collected on the social determinants of health including housing, insurance coverage, and access to health care services. The project will expand to additional sites in southern Oregon and Portland in subsequent grant years. A course rubric for evaluation of the public health nursing competencies is available upon request.
Peggy Wros, PhD, RN
Oregon Health and Science University
The Interprofessional Collaborative (2011) Core Competencies for Interprofessional Practice
I-CAN Video Announcement
Pima County/University of Arizona
Undergraduate and Graduate Program
An exciting partnership between the Pima County Public Library and the Pima County Health Department has created opportunities for public health nursing in the Tucson, Ariz., public library system. This partnership was created to provide more help to library patrons seeking information about health and health care services, address the increasing numbers of behavioral health issues in the library, and to reduce the number of 911 calls related to behaviors. Frequently, patrons required more help and support than the librarians alone could provide, so the library system approached the county health department for assistance. One FTE of a public health nurse position from the Pima County Health Department was assigned to the library. The cost of this position is shared between the library and the county health department. The public health nurse provides health information, referral services, health screening, and follow-up to ensure that patrons are able to find needed services. For the homeless library patrons, the nurse is a source of help, information, and support to get connected to services. The public health nurse also advocates for patrons in need of help who might not be able to afford to pay for services. The University of Arizona sends nursing students to the library for their community health rotation. These students have worked with the public health nurses to conduct community assessments, health education classes, and targeted community interventions such as a falls prevention program. The nursing students also developed a project to address hunger in the community. Staff involved in the library community health program says that good planning, clear goals, and the use of a planning model are building blocks that lead to program success. Since the program began, there has been a decrease in 911 calls from the library for behavioral health issues; at the same time, there has been an increase in 911 calls for urgent health problems that might have been missed without the public health nurse’s intervention. There is a great deal of community support for the program, which successfully addresses critical community needs.
Pima County Public Library
Public Health Administrator
Nursing Services, Pima County Health Department
Richmond City Health District Virginia Commonwealth University
The Richmond City Health District and the Virginia Commonwealth University (VCU) School of Nursing have developed a partnership to support public health nursing clinical training in the health district. The five satellite clinics of the health department have been established in public housing complexes in the district. The Richmond Health District developed these satellite clinics with Title 10 funding beginning in 2009 with one site. Today there are five sites serving as gateway clinics connecting local residents to primary care and providing preventative and health education services to public housing residents. These services are provided cooperatively between the health district and VCU School of Nursing students and faculty. Three of the clinics act as community health clinical sites and both RN and NP staff at all sites serve as preceptors to undergraduate and graduate students. One specific clinic, the Mosby Resource Center, is financially supported by the School of Nursing and also utilizes a nurse practitioner from the school to provide clinical services one day a week. Services at the clinics focus on health education, health system navigation, and health promotion and disease prevention programs. Services are delivered using a nurse-driven model of care utilizing community health workers as well as nursing providers.
Undergraduate nursing education is supported with didactic coursework that focuses on community-level needs assessment, epidemiology, communication, and evaluation skills. The three-credit didactic course is paired with a two-credit clinical rotation, and follows a service-learning model in which the students are embedded in community sites for the duration of the course. This course is placed in the last semester of the undergraduate year, so that students are able to incorporate knowledge from previous undergraduate clinical rotations, while partnering with the community members who work in and access these services. Students, faculty, and community members collaborate to develop a semester-long service-learning project that meets a community-identified need. Students then present their projects at a professional-style poster session at the end of the semester. Many of these projects support community health priorities in the practice setting. Recent projects included providing a flu vaccine clinic to community residents, developing a map of accessible resources for low-income residents, and running a health careers club for school aged children.
Student evaluations of the experience are positive and the experience has also become a public health workforce development bridge since several undergraduate students have selected public health nursing as their professional focus upon graduation, while others have chosen to enter graduate education in public health.
For further information on this exciting partnership between the Richmond City Health District and the Virginia Commonwealth University please contact:
Amy Popovich, RN MSN
Resource Center Supervisor
Richmond City Health District
400 E. Cary St.
Richmond, VA 23219
The University of Tennessee Health and Science Center
The University of Tennessee Health Science, Center College of Nursing partners with two state health departments to provide support for mutual collaboration and program improvement in the delivery of public health nursing to citizens in Tennessee and Arkansas. The program provides opportunities for faculty, public health practitioners and PHN DNP students to use reflection about opportunities to improve public health nursing practice. The PHN DNP students base interventions on the needs of the communities they serve using Quad Council public health nursing competencies. One of the challenges in this practice improvement partnership has been to shift the emphasis from individual-level interventions in the community to population-level systems impact. The involvement of public health nursing faculty together with senior management at the health department has motivated line managers and students to learn these important skills and make this important change in evidence-based effectiveness. The program has enabled line managers and senior managers in the health department to improve leadership skills through planning and communication about program goals. The students, practitioners, and community faculty focus on common ground when considering goals that have population and system’s impact. The program emphasizes PHN clinical interventions that are based solidly on the implementation and documentation of the public health nursing core competencies as they apply to the communities’ defined needs. Students, practitioners and community faculty design logic models with action plans that are based on the expressed community needs and then match the core competencies to professional capacity and competence. Students also build a portfolio of activities to demonstrate expertise in each core competency area. Summaries of the issues and evidence-based recommendations for improvement are produced by the student. The programs use logic models to link clinical process measures with anticipated short and long term outcomes. The “CAN-DO-IT” program, developed with HRSA funding, provides participants with a better understanding of how their everyday actions translate into effective, evidenced-based public health nursing interventions. It also has provided students with a deeper insight into population perspective necessary for effective primary, secondary, and tertiary prevention in public health. Dissemination of the “CAN-DO-IT” program through presentations at APHA meetings by several of the faculty and students have demonstrated the effectiveness of the model. Follow-on projects include analysis of school and homeless health programs, disaster and syndrome surveillance programs, minority health interventions focused on improving infant mortality, congestive heart failure, equity and access to health care, and programs that support the development of public health nursing leadership in selected southern states. Today the “CAN-DO-IT” model supports a number of community safety-net organizations as well as a collaborative and developing program to respond to elder abuse and neglect in the region.
Patricia M. Speck, DNSc, APN, FNP-BC, DF-IAFN, FAAFS, FAAN
The University of Tennessee Health and Science Center College of Nursing
University of Buffalo
The University at Buffalo School of Nursing uses a variety of approaches to provide community health, pediatric and mental health nursing experiences. These include placing student in residential addiction program for women and their children, a Dedicated Education Unit (DEU) with the VNA for home visits across population groups including pediatric and mental health, and a DEU in a community based hospice program with an inpatient and home care service. Recent health system changes as a result of the Affordable Care Act (ACA) have resulted in less availability of acute care pediatric experiences since inpatient unites have closed. Responding to the need for hands-on experiences for students in pediatrics the School of Nursing has collaborated with a child care center on campus as well as with a day camp for medically fragile and underserved children from the community. These experiences have been hands-on community pediatric experiences that have worked well to enable students to gain experiences in pediatric nursing as well as community and mental health care. Upper division nursing students will be placed for 5 weeks with the VNA and 5 weeks in acute care as well as in a DEU focused on hospice home care. During the Public Health for Population Health course students engage in service-learning activities with community based health and social service agencies. During these experiences students conduct a community assessment and also learn descriptive epidemiology in order to understand the distribution and determinants of disease in the target populations and to understand community disease patterns. The curriculum emphasizes critical thinking skills, leadership at the bedside to promote quality health outcomes and safety, and evidence based practice. To reinforce these practices, students complete the IHI Basic Certificate on Quality and Safety. The University at Buffalo School of Nursing was the first SON in the United States to implement this requirement within the curriculum. Students’ NCLEX scores have improved and remained high during the curricular shift to hands-on community-based care. Faculty emphasize the need for students to have hands-on community care experiences that provide the opportunity to develop clinical skills and critical thinking in the community setting.
Berwick, D.M., Nolan, T.W., and Wittington, J., (2008). The triple aim: care, health, and cost. Health Affairs. 27:3, 759-769. DOI: 10.1377/hlthaff.27.3.759
Institute for Health Improvement. IHI Open School Courses and Certificates.
S. Grinslade, PhD, APRN-BC,
Undergraduate Program Director and Clinical Professor
University at Buffalo, School of Nursing
University of Hartford
Undergraduate and Graduate Program
The University of Hartford RN to BSN and MSN students participate in Project Horizon, a service learning experience, for 1 day a week during their senior year. Project Horizon was developed over 20 years ago by nursing faculty at the University of Hartford in response to community needs in nearby Hartford, Connecticut. Hartford is one of the poorest urban areas in the United States with 32.9% of the population below the poverty line. All students who participate in Project Horizon are registered nurses who are students in either the RN to BSN program or the MSN program in public health nursing or nursing education. Project Horizon is based on the internship model described by Switzer and King (2009). In this model students are encouraged to understand not only the phases of learning inherent in the internship experience, but also to develop self-understanding as they participate in this experience. (Switzer, F.H.and King, M., 2009, p 13). Consistent with this model, the Project Horizon experience is organized into a day-long 3 credit didactic class and a 3 credit service learning experience. After a careful orientation that includes principles of safety, training in communication, and cultural awareness students are introduced to the service learning sites. Students spend either the morning or early evening hours at these sites that include a soup kitchen, urban school, senior center, homeless shelter or boys/girls club. The didactic portion of the class is held mid-day. An important feature of Project Horizon is the level of clinical supervision that is offered during the service learning. Carefully selected adjunct clinical instructors visit the clinical facilities weekly during the first semester and biweekly during the second semester. This level of clinical guidance provides a solid basis of support for both the facility and the student. Evaluation of the experience is based on the principles of participatory action research (Simonson, L.J. and Bushaw, V.A. , 1993). In this model the agency and the community are active participants in evaluation of the student and the project. On June 12, 2013, Project Horizon will receive the first-ever Campus-Community Partnership Award from the Connecticut Campus Compact. The Campus-Community Partnership Award recognizes an outstanding campus-community partnership that is built and sustained on strong principles of equity, trust and respect. The purpose of the award is to honor partnerships that have successfully demonstrated the true value of collaboration between higher education and its identified communities. This award drives the improvement of health outcomes by highlighting Project Horizon as exemplary in the collaboration between academia and public health. Follow the links below to learn more about this award and other publications about Project Horizon.
Description of the Project through the College of Education, Nursing and Health Professions
Project Horizon to Receive Inaugural Campus-Community Partnership Award
Simonson, L.J. and Bushaw, V.A., (1993). Participatory action research: easier said than done. The American Sociologist. 24:1, 27-34.
Karen Breda, PhD
University of Hartford
University of Hawaii at Manoa
Student Nurse Participation in Pacific Partnership Humanitarian Missions
The University of Hawaii at Manoa (UHM) School of Nursing participates in the United States Navy sponsored annual Pacific Partnership humanitarian mission. During Pacific Partnership, a multinational - interdisciplinary team of professionals from various sectors (including public health, acute care services, dentistry, veterinarian services, engineering and others) partner with the host nations for subject matter expert exchange endeavors and provision of services to individuals and communities. The primary role of the UHM School of Nursing (faculty and students) in Pacific Partnership is to engage in community/public health subject matter expert exchange endeavors which focus on topics such as disaster preparedness, community health, environmental health, prevention and management of communicable and non-communicable diseases. This program provides nursing students with valuable skills in community/public health nursing, and strengthens interest and awareness in global health. Many things are learned, including, how to work in multi-national, interdisciplinary teams, how to collaborate with and learn from other cultures, and how to function in low resource settings. UHM Nursing has participated in Pacific Partnership for the past three years, and has involved approximately 25 faculty and students. Program evaluation is done on two levels: formative evaluation to assess UHM planning for the mission, and summative evaluation to assess impact on faculty, students and host nation participants. Evaluation findings indicate that students increase their knowledge, skills, abilities and confidence for multidisciplinary collaboration with international partners, gain an understanding of different cultures (including the host nation and military cultures), and increase their own capabilities for providing nursing care in low resource environments. Through the reciprocal subject matter expert exchange activities, the host nation learns from the UHM faculty and students, and the UHM faculty and students learn from the host nation. There are many other volunteer humanitarian assistance programs that nursing students can engage in where similar community/public/global health knowledge, skills, abilities and attitudes can be can developed.
Kristine Qureshi, DNSc, RN, CEN, APHN-BC
University of Hawaii at Manoa School of Nursing
Commander, US Pacific Fleet
University of Missouri
The University of Missouri Sinclair School of Nursing provides a two-week study abroad opportunity in community health nursing to undergraduate students through placements in Cape Coast, Ghana or Cape Town, South Africa. This opportunity allows a group of students and a faculty member to engage in community health outreach and work in a public health clinic. The program runs twice a year typically the first two weeks of August and the first two weeks of January. Students learn adaptability, resourcefulness, cultural awareness and problem solving in the international setting. They also gain 90 community health clinical hours during the project. In addition to the field work, the students participate in afternoon classes focused on topics such as cultural competence, resourcefulness, social justice and problem solving. The logistics of the project are all managed by the school’s study abroad office at the University in cooperation with an external program that specializes in study abroad logistic management. The program has staff onsite that set up and help facilitate the experience during the two weeks of practice. Faculty is only responsible for managing for the academic content in the two week program. The program has been very successful, and will have over 60 undergraduate students since 2011. The evaluation of the project is conducted through a likert-scale attitude measuring tool as well as a journaling exercise. Students are required to respond to a journal topic before they travel, during their trip, and after their trip is completed. The journals provide evidence of significant attitude changes after the experience. This public health international immersion experience is being documented in several research projects including a doctoral dissertation focused on the study abroad experience. It will also be presented at the ACHNE/APHN meeting in June of 2013.
Lynelle Phillips, RN MPH
University of Missouri Sinclair School of Nursing
University of Washington
Undergraduate and Graduate Program
The University of Washington has established three major academic/practice partnerships based on the participatory action research model. These multi-year partnerships have provided a solid base for faculty development, graduate and undergraduate education in community health. Faculty, graduate students, undergraduate students and the community engage in a collaborative relationship to support community-oriented health projects. The three communities that participate in the partnerships are Native American reservations, a Chinese Information and Service Center in an urban area, and an immigrant community that is part of the Seattle metropolitan area. Within these communities various agencies and tribes work closely with faculty and students on a diverse array of grass-roots projects that support community health. The projects include community gardens, obesity and diet education, breast cancer prevention, physical fitness, school health, food banks, adolescent health and wellness education, and community disaster planning. After a year of work at the grass-roots, graduate students focus their second year at the policy level to reinforce community action. The policy-level activities have been with organizations such as public sector health departments, non-profit community action coalitions, political action groups, and cultural advocacy groups who work with government to support community health. Faculty members are assigned to a specific academic/practice partnership and engage in teaching, research, and service with the partnership as their focus. Engaging tenure-track faculty in the partnership model ensures not only service and teaching, but also applied research. Faculty has received applied research grants that enable capacity-building projects that benefit the community partner as well as the faculty involved in the grant. These activities have resulted in faculty and student publications and support the scholarly development of the tenure-track faculty member in addition to support for the community partner. Evaluations of the partnerships show that students positively regard the partnership as an educational experience although they do have some concerns about faculty to student communication during the experience. The academic/practice partnership model of community health nursing is well-established at the University of Washington.
Noel J. Chrisman, PhD, MPH
University of Washington
Wichita State University
Wichita State University has completed a pilot project in public health nursing education involving 30 pre-licensure students in an accelerated program. Service learning concepts provided the framework for the curricular innovation pilot.
The purpose of the pilot project was to provide on-site population-focused nursing services at community agencies not previously utilized as clinical sites for the “Care of Populations” course. Two under-resourced private elementary schools and one PACE1 program site agreed to participate. No other schools of nursing were present during the clinical rotation, eliminating issues of competition for clinical placement sites. Clinical experiences were complemented by the didactic portion of the course which provided contextual knowledge to support the students’ field projects. Several guest speakers visited class including health department nurses and APRNs.
Accelerated students and experienced faculty worked closely together with faculty remaining on site to facilitate and troubleshoot as needed. These accelerated students required very little direct supervision. They brainstormed, reviewed literature, developed work groups, divided assignments, and ultimately performed at a high level that was not anticipated. Personal maturity and the strong work ethic for which accelerated students are known were likely contributing factors.
At the schools, students collaborated with students, principals, pastors, teachers, and cooks to determine areas of need that could be impacted rapidly in a short period of time. Health promotion needs were paramount, especially those related to risk assessment, water safety, nutrition, oral care, physical activity, heart disease, diabetes and cancer. Assessment and planning involved windshield surveys, visits to health departments and neighborhood grocery stores, among others. Interventions included age-appropriate experiential healthy snack classes, health fairs, and culturally appropriate parent education. New cafeteria policies regarding portion sizes and after school snacks are in process as a result of the students’ work at one school.
At the PACE site, the COPD patient sub- population was the focus of most student activities based largely on the assessment of the interprofessional staff and quality improvement data. Direct and indirect interventions included educational materials such as films, power point presentations, and posters geared toward staff and participants (patients). Correct use of spacers with metered dose inhaled medications, home oxygen safety, and dietary salt alternatives were areas of focus for the COPD sub-population. It will be interesting to see how these products are used in the future. Students noted that PACE bus drivers provided considerable social support while driving participants to and from various appointments and suggested future attention on the role of bus drivers and wellness promotion.
Implementation of this project required experienced and motivated faculty committed to innovation and to increasing nursing impact in community settings. Extra meetings were required to share experiences, ideas and to “tweak” the project as needed. Evaluations of the pilot project were favorable from the students, faculty and communities involved and the project will be continued in the accelerated program.
Future plans include partnering with more area private schools (especially those in low income areas) and possibly with senior centers. Traditional and accelerated public health faculty are currently working together to determine next steps in implementation of this clinical approach with much larger volumes of traditional students. Further evaluation and impact assessment are needed.
Peggy Hernandez, EdD, APRN, PMHCNS-BC, CNE
Assistant Professor of Nursing
Wichita State University
College of Health Professions
School of Nursing
1845 Fairmount Street
Wichita KS 67260-0041