Over the last decade, prompted by the recommendations from the Institute of Medicine’s (IOM) Future of Nursing (2010), nurses have been charged to become fully engaged healthcare practitioners and leaders who collaborate with interdisciplinary and interprofessional teams in providing high quality, evidence-based care for a healthcare system which is going through a rapid transformation. The face of healthcare and nursing care in the United States has been changing from that of an acute care model where the focus is on treating illness, to that of prevention and promotion of health on the community level which includes addressing the social determinants of health (SDOH) (Mason, 2016; Storfjell, Winslow & Saunder, 2018; Thornton & Persaud, 2018). Organizations such as the Robert Wood Johnson Foundation (RWJF) and nursing leaders, are strongly recommending nurse educators to incorporate community-based care into nursing courses which have historically focused on acute care settings, and through novel clinical placements, experiences, and education which focus on leadership, community building, advocacy, health equity, and SDOH (Mason, 2016; Murray, 2017; Storfjell et al., 2018; Thornton & Persaud, 2018).
The American Association of Colleges of Nursing (AACN) The Essentials of Master’s Education in Nursing (2011) support the IOM report in that healthcare delivery is complex and dynamic (IOM, 2010). Master’s prepared nurses are therefore to be educated as change agents who continue to learn and grow in their profession, supporting the need for nurses to assume leadership roles in advanced practice and through multiple roles in a wide variety of settings.
To meet the AACN guidelines and the goals for the nursing profession championed by the IOM, RWJF, and others, a graduate practicum capstone was designed and completed which focused on preventing disconnection in youth, addiction, and the lack of access to treatment and recovery services in rural Eastern Delaware County, New York (NY). The practicum experience culminated with a Community Action Summit which was held in January, 2019 in the village of Margaretville, NY. The capstone experience provides a unique model for application in other graduate student practicums, and for rural communities struggling with the opioid crisis.
Implementation
The graduate student role during the practicum was multifocal. The work included but was not limited to: a) literature searches; b) collaborative community-based teamwork and planning; c) community education via multiple media outlets; d) application of knowledge in website design, social media, printing, graphic design, web-based communication, spreadsheet, and word-programming; e) professional event organization; and d) public speaking. Supportive evidence was gathered from the New York State Department of Health, Measure of America, public health repositories, and other sources. These resources provided background information on the issues, to frame the work of the Summit on prevention of disconnection in youth, opioid statistics and addictions, and a lack of access to treatment and recovery services for the area of Eastern Delaware County, NY (Measure of America, 2019; New York State Department of Health, 2018). Interprofessional, collaborative experiences were accomplished chiefly through membership in a recently formed volunteer coalition who had recognized the issues within their county. The members represented important sectors of the community including education, criminal justice, mental health, the arts, business, and healthcare. Additional interprofessional relationships were forged through outreach and connection with local, statewide, and nationwide organizations or individuals involved in youth advocacy, healthcare, mental health, the arts, and substance abuse services.
A collaborative communication plan guided by the practicum preceptor, was used to educate the community on the recognized issues. Production and co-hosting of bi-weekly radio programs, articles in the local newspaper, and social media postings were developed. Using a public health framework of primary, secondary, and tertiary prevention, the media presentations discussed prevention of disconnection in youth, information on addictions, treatment and recovery, along with a Coalition supported youth photography project, and the planned Community Action Summit.
In partnership with the Coalition members, professional event organization and leadership skills were applied through the co-development of the Summit agenda, speaker recruitment, breakout group topics, and plan. Event materials for attendees were gathered, designed or co-designed, with consideration of project budget constraints. Development and distribution of Summit invitations transpired as well, with careful consideration to include key stakeholders from a multitude of community sectors. On the day of the Summit the graduate student presented on the role of business in supporting youth, facilitated a breakout group on increasing the number of peer recovery coaches in the County, and assisted in the development of a workgroup action plan.
Evaluation
Evaluation of the student practicum participation occurred through the development of two learning contracts that incorporated outcomes and planned projects, along with a summary of activities and evidence. These contracts were dynamic, as they were updated and assessed by the student and program faculty throughout the practicum course period. Web-based presentations were completed at the end of the practicum experience which included evidence of accomplishments, reflections of the work completed, and the learning which was achieved. Additionally, the steering committee of the Coalition invited the graduate student in continuing to work as a volunteer member.
Evaluation of the Summit was measured through the use of a post-Summit survey. Of the attendees who completed the evaluation on the objectives of the Summit being met or highly met, between 95-97 % rated the objectives as “highly met”.
Conclusion
The practicum work provided a dynamic, challenging, and forward-thinking approach to graduate nursing education. This experience was a personal and professional undertaking of enormous growth and impact for future advanced practice. One of the most powerful lessons was that through the development of leadership, community building, and media skills, nurses can make a considerable impact on the health of a community, and gain experience with speaking to the public through radio, presenting at community meetings, or writing.
Implications for Practice
The forthcoming National Academy of Medicine report on The Future of Nursing 2020-2030, will focus on nurses’ roles in building a culture of health, particularly in communities (National Academy of Medicine, 2019). In anticipation of this report, the introduction of complex, community-focused practicum opportunities for graduate nursing students should be incorporated into nursing curricula now.
To address the urgent healthcare needs of our country, nurses must be challenged to develop their skills in community leadership, community-building and engagement, population health, advanced communication and use of media, and collaborative interprofessional teamwork. As the Woodhull Study Revisited reported, “nurses remain invisible in health news media” (Mason et al., 2018, p. 695). While nurses are knowledgeable experts and powerful patient advocates, they need to develop their skills in using the media to speak with authority on health topics. However, to do so they require education in messaging and use of the media (Mason et al., 2018).
Integration of multifocal community-based practicums will provide graduate students with the leadership, media, interprofessional and collaborative experiences needed to care for communities now and in the future.
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