Quality improvements occur in the academic setting through the collaborative efforts of faculty translating evidence of student learning to strengthen didactic and clinical experiences and the achievement of transformational learning. The purpose of this project in an RN2BSN program was to evaluate the linkages among clinical practice experiences in Public Health Nursing (PHN) and student self-evaluation of transformative learning. The QUAD Council Coalition Community/Public Health Competencies were used to evaluate the PHN course and generate evidence for program improvement (QUAD Council Coalition Competency Review Task Force, 2018).
Methods:
A review of the amended Standard-III (key items G-H) Program Quality: Curriculum and Teaching-Learning Practices provided an opportunity to review learning activities and clinical practice experiences for an ONLINE PHN course and explore the evidence in an RN2BSN program (Commission on Collegiate Nursing Education [CCNE], 2018). Key items G-H recommend that students be exposed to diverse clinical experiences fostering inter-professional and collaborative practice integrating new knowledge. Transformative learning occurs when students are exposed to diverse aggregates within their community, are able to explore alternative nursing roles serving vulnerable populations, and are able to critically self-reflect upon assumptions about health service delivery. The PHN clinical in this RN2BSN program promotes student transformation about practice and leadership in primary care, providing evidence to track progress on the Future of Nursing Campaign Call for Action (CFA) to increase the number of RNs with a baccalaureate degree (Spetz et al., 2014).
The course description and outcomes for the clinical component enhances student awareness and provides an opportunity to develop skills for critical thinking about community care, the influence of the environment in the social determinants of health, and the care of aggregates across the lifespan. Students enter RN2BSN programs with an acute care and individual patient focus with little knowledge of PHN interventions or public health services in their local community. The PHN course includes an introduction to National Health Care objectives with a Healthy People 2020 (HP2020) assignment that provides evidence of aggregate or community diagnosis, intervention, and evaluation.
Results:
The student reflective logs, guided by the Minnesota Wheel of Interventions, provided evidence of transformative learning about PHN and public health services, civic engagement, the care of vulnerable populations, and the value of collaborative practice environments. Awareness and confirmation of emancipatory knowledge development through praxis is demonstrated with the self-reflective writings of the RN2BSN PHN student (Chinn & Kramer, 2015). Perletto (2015) suggests transformation is evidenced with increased confidence and empowerment. Becker (2017) suggests self-authored changes are personal transformation, changes in self, and a broader viewpoint. Anbari (2015) concluded that courses in community health (PHN), leadership, and research in RN2BSN curricula are considered transformative.
Conclusion:
Friesth and Krouse (2017) recommend future multi-site theory-based research is needed to demonstrate clinical learning in ONLINE programs. Discussion is ongoing for future evaluation of the clinical learning environment, teaching-learning practices, and the use of self-reflection for evidence of transformative learning and achievement of student learning outcomes.