Description, Application, and Evaluation of a Model to Teach Community-Based and Population Health across Diverse Clinical Experiences

Both population health and direct nursing care in the community are important elements in educating baccalaureate nurses.  The Pillars Constructivist Model was devised to facilitate clinical teaching at both levels and offers a unifying clinical paradigm with structural and contextual components to support learning at diverse public health sites.  The foundation of this model rests upon five conceptual Pillars.  These Pillars include:

1. Incorporate determinants of health in nursing care of population aggregates and communities.

2. Provide direct care based on evidence and best practices in community settings.

3. Integrate sensitivity to and appreciation of lived experiences of health and illness into nursing practice.

4. Align the comprehension of public health nursing roles with one’s own ethical and professional formation.

5. Demonstrate the ability to collaborate as a member of a multidisciplinary team within the health care system to develop, implement, and evaluate health care provided to clients across the age span.

There has been a call within nursing education to generate evidence that demonstrates the efficacy of models for community/ public health clinical education.  The author’s approach was a mixed-method study to assess the efficacy of the Pillars Constructivist Model under two overarching questions.  The first question was whether the model was able to serve as a unifying structure to facilitate consistent opportunities for student learning in all areas across diverse clinical experiences.  The second question was to explore if the model was able to consistently facilitate growth in understanding and disposition to act in all five conceptual Pillars.

A total of 36 students and 6 faculty members participated in in the evaluation to assess the model after its inaugural semester of implementation.  The methods included a rating scale measuring the model’s ability to provide consistent learning opportunities at both population and direct care clinical sites, a case study that measured student growth within the five conceptual Pillars and a faculty focus group. 

Results were calculated utilizing descriptive, parametric and non-parametric testing.  The rating scale of perceived support of the model demonstrated a student average of 6.51 on a 0 to 10 scale, while faculty average mean was 8.18.  Faculty ratings were higher than student ratings for each Pillar with these differences significant for Pillar 2 (p = .014) and Pillar 5 (p = .008).  The semester case study results were tabulated based on a rubric and the difference in means between the pre and post semester results were calculated.  Results revealed significant growth from beginning to end of semester for Pillar 5 only (p = 0.04).   With the exception of Pillar 4, the remaining Pillars indicated some improvement of growth.  The summed results of the case study (with the exception of Pillar 4) identify a significant change in total concepts from beginning to end of semester (p= .05).

The findings indicate that the model was able to serve the use of multiple small direct care and population focused sites while maintaining consistent concept based learning opportunity for all students.  The findings from the case study are nonconclusive regarding demonstration of student growth, however results are suggestive of efficacy of the model as a whole.  Although our inaugural evaluation was small in size, the data provides a first step in measuring change in application of knowledge and experience that is relevant to considering the impact of this model on future nursing practice.  The authors are led to recommend the continued use and evaluation of the Pillars Constructivist Model and that the model be considered for use in baccalaureate nursing programs.