The recent focus on community and population based health care in nurse education means that effective clinical experiences within the community are an essential component of the nursing program. However, two factors have made this harder to do over the last decade as student nurse enrollment has increased annually but at the same time budget cuts have led to reductions in many traditional community health services. Therefore more students are competing for a limited number of spots in traditional community sites such as clinics, public health agencies and schools. This has led to a trend of implementing innovative community placements (ICP) in non-traditional sites within communities. Use of ICP increases student engagement, initiative, and critical thinking. Students were able to put into practice concepts such as community action, social justice and diversity.
Western University of Health Sciences is a non-for- profit private health professions university. The university offers graduate education and has nine colleges. The College of Graduate Nursing offers a variety of nursing tracks including the Master of Science of Nursing-Entry. The MSN-E offers a pathway for students with baccalaureate degrees in other fields to obtain RN licensure and then continue with graduate courses to obtain a Master of Science in Nursing degree. Community Health Nursing is required in the pre-licensure program. The university is located in Pomona, California. Pomona is a diverse community with over 72% Hispanic/Latino population. The median household income is $28, 407.
To explore the role of ICP in providing nursing students with comprehensive experiences with diverse population.
Eight out of the 58 MSN-E students were assigned to transitional housing complex for their 2-unit Community Health Nursing clinical. Students participating in this clinical site worked with the Laurel apartment dwellers in the Pomona area. This population consisted of low income families living in low cost housing. Most apartments included more than one family with children of all ages. Large portions of the population are Hispanic, with few Caucasian and African American families. Students predominantly conducted tutoring for children in the apartments (ages range from 4 to 15). During these tutoring sessions, students took the opportunity to educate the children about healthy eating and safety. The students also collaborated with dental medicine students to provide dental care to the children in the apartments. A garden project was started in order to provide healthy food choices and to teach the apartment dwellers about the therapeutic effects of gardening. Students also taught safety to the families through disaster preparedness. While working with this population, students had the ability to work with professionals in the community such as food banks, homeless outreach organizations, local substance abuse and mental health facilities, and the area police department.
The traditional sites included school nursing, community based clinic, and public health agencies.
A 10-item Likert scale survey to evaluate clinical experiences was created and validated by two faculties. The first 3 questions were about opportunities to interact with community organizations, diverse population, and collaboration with other disciplines. The rest of the questions inquired about student perceptions in patient centered care, safety, understanding and respecting culture and diversity.
Total of 48 students responded, 42 from traditional sites and 6 from the ICP site. Overall, the ICP group scored higher than the traditional clinical groups. ICP group scored slightly lower on the last three questions pertaining to the perceptions of patient centered care.
Small sample size of ICP group may have affected the mixed findings of the study. Survey tool may need to be retested for reliability and validity.
ICP may provide similar experiences as traditional sites to fulfill Community Health Nursing requirements. In addition, ICP experiences may provide better opportunities to provide comprehensive experiences with diverse population.
This is the first implementation of ICP experience, on-going evaluations and additional ICP sites are needed to provide more students with these types of diverse learning experience. Future research will focus on qualitative data to explore students lived experience with ICP. In addition community outcomes should be measured to evaluate the effectiveness of students’ interventions such as increase attendance in tutoring and wellness activities classes.
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