Creating Innovative Educational Modalities to Transform Community Health Nursing

Introduction:   Nursing faculty have long been resolute in fostering an educational environment where high quality, fiscally-responsible, student-centered, and evidence-driven curricula are standard.  Online education is growing exponentially and is a critical component of academic institution’s long-term strategies.  The perception of the value of online education increased from 57.2 to 69.1 percent between 2003 and 2013.  (Allen & Seaman, 2013).  The purpose of this presentation is to highlight the clinical component of a virtual-based course offered in a southwestern University for the past ten years. The initial virtual clinical was designed 10 years ago by an inter-professional team with two math faculty including the Team Leader who is the author of the abstract. The course was initiated by this nursing faculty in 2004 with Hesi exams to measure learning outcomes of students from the objectives in the virtual course and a real setting in which the students were in the community. This virtual course continues to add flexibility for students in managing their course work, diminishes costs associated with travel to campus, allows for creative development of their work, and produces a professional learner product .

Methods:  A gap analysis was conducted in order to identify strengths and opportunities with course innovation.  The gap analysis was conducted in 2014, and demonstrated areas within the virtual clinical that could be more user friendly and more adaptive to the current literature, and student population. Gap analysis recommendation led to the program redevelopment with townships added to the virtual Island (Lil-Wald) named after the Founder of Public Health Nursing—Lillian Wald. 

Based on the findings, the designer, community health team members, and an undergraduate computer science major began revising the Island which includes 10 townships.  Student feedback and a comprehensive review of the salient literature were obtained to provide a roadmap for incorporation of relevant evidence-based findings and structured revision of the course.  The designer analyzed  opportunities, delineated current and desired states, identified two-and five-year goal statements, and outcome indicators. The team also created interviews from individuals, families, and communities in each township that represented the theme of the township. For example, Clara Barton (founder of the American Red Cross) where interviews have proposed disasters, such as tornadoes.  

Scope:  The faculty was intentional in aligning the virtual education with national standards proposed by AACN guidelines.  The innovative constructive pedagogy names townships on the Lil-Wald Island which includes the names of past nurse leaders.  In-depth study about prominent nurse leaders revealed several noteworthy leaders from the past such as Florence Nightingale, Mary Brackenridge, Margaret Sanger, Mary Mahoney and present nurse leaders such as Jean Watson, Virginia Henderson, Margaret Leininger, and Luther Christman.  These nurse leaders are not limited to these few mentioned. The students in the Blackboard course have the ability to review nursing history of these leaders in placing the cursor over the township that is named after each person with a drop down picture and brief history of each. In addition, participants review the YouTube Windshield Survey (which assesses a town or neighborhood), and then conduct their own survey on the link provided in the course of google maps.  The students have the ability of reviewing their real community setting of their choice from the region of the State that the student lives in by selecting a health department located online, and near them. The learner than selects online data from this health department following the guidelines provided for them.  The community assessment is continued by utilizing the online resources available for the student, such as the Center for Disease Control, the US Census Bureau, the State Department of Health and Human Resources to name a few.  Once the community is assessed, the learner analyzes the data obtained, and establishes three problems with two priority problem that is translated into two Nanda Community Nursing Diagnoses.  The next steps include development of a plan and intervention for the Nursing Diagnoses.  The plan is usually a teaching plan that is outlined.  Evaluation follows.

Results:  In choosing a student peer as a partner in the clinical virtual, the students have an opportunity to interact with each other in formulating their assessment of the community –both in the virtual setting, and the real setting.  The pair search individually for online resources that are given them in resource links provided on Lil-Wald Island.  Links such as the Center for Disease Control, the U.S. Census Bureau, and others enrich their data assessment including of course links to the University library.  After the assessment of the individual, family, and aggregate/community, the students analyze their assessment data, and formulate priority problem lists culminating in two community health diagnoses. With the priority Nanda community diagnosis, the students integrate more evidence-based information for their plan and intervention.  The plan which is designed to be delivered to the appropriate audience then is evaluated for effective learning outcomes, and a conclusion written that reflects their work and outcomes.

Conclusion:  The community health nursing course is an online didactic with the virtual community health clinical innovation in Blackboard technology.  The students are able to access on computer, and/or mobile device.  This course has surpassed our expectations in providing both the knowledge base in community health nursing care, and meeting the clinical course objectives and learner outcomes. This innovation is inclusive of all cultures and genders, and it has a focus on the underserved populations with health disparities.   The virtual Lil-Wald Island includes nursing history, as well as focuses on past and current nurse leaders.  From there, the students apply and demonstrate knowledge and application of the nursing process and demonstrate these principles in a professional paper.  This innovative clinical assessment has a long term record of effectiveness and student success with initial Pre-Post customized community health nursing Hesi Tests which demonstrated higher mean scores than the real community setting.

Recommendation:  Because of the effectiveness of this innovation, this virtual modality is recommended for other academic health programs as well as community health nursing clinicals.  Health care programs could emulate this virtual online community health course in similar community health clinical courses in this time of faculty shortage, distance education, and cost effectiveness.