Methods: In a Southeastern United States school of nursing, these themes have been integrated into a course that focuses on primary or ambulatory care nursing. Both global nursing and community service have been long-standing elements of this BSN program. However, as part of a course on Ambulatory Care Nursing, a clinical rotation was made available that provided experience in a setting that incorporated principles of both global health and primary care. In this clinical setting, students participated in a Nurse Practitioner (NP) led clinic that primarily served refugee or immigrant clients with little to no resources for healthcare.
Students in this course are in the last semester of their BSN program, and are expected to apply their knowledge of community health and service learning to this experience. The clinical objectives for these students are 1) to apply their clinical skills and critical thinking to a primary care environment, 2) to provide effective, culturally sensitive care to clients from diverse backgrounds, and 3) to understand the challenges in healthcare that are specific to the ambulatory care setting.
At this clinical site, additional objectives included 1) applying population health principles and skills to clients with the specific challenges of refugee or immigrant status, and 2) understanding the professional, management, and clinical structure needed in order to initiate and sustain practice in a clinic for underserved populations.
This is a free or low-cost clinic open to any client without insurance. However, because the population of the area is primarily refugees and immigrants, students also gained experience in the related challenges for this population, such as working through interpreters and addressing cultural or dietary barriers to optimal health. Student activities in the setting included obtaining the history of clients as they came to the clinic, making appropriate clinical assessments, assisting the NP in delivering care, and providing education. They also gained experience in the administrative functioning of a clinic through participating in the creation of standard operating procedures for different student roles.
Results: The student evaluation of this experience was strongly positive. The faculty obtained formative evaluation during the clinical day as well as in the end-of-clinical post conference. The students also provided summative evaluation through an anonymous survey at the end of the semester. A frequent suggestion was to increase the number of days for their participation in the clinic, and in fact many of the students continued to volunteer at the site during their free time.
Evaluation also was sought from the clinic NPs and participating faculty. The clinic leadership provided projects for student participation, and reviewed the results before implementation. With that input and course coordinator assessment, several plans for improvement were developed. They included increased outreach to the community through individual visits, increased student leadership, and more emphasis on the use of full scope of practice for the registered nurse in that setting.
Conclusion: This clinical experience was a successful collaboration that contributed to the success of a newly-created clinic as well as providing students in an ambulatory care course with a different perspective on the content. The future plans for this setting include additional home visits to provide both assessment and education, and initiation of student-led quality improvement or evidence-based practice projects. The combination of a global-at-home perspective and the primary care principles of collaborative, preventive, client-focused care provided an experience that will enrich the students’ professional careers in any setting.