When It Works: Learning Community Health Nursing Concepts from Clinical Experience

Article excerpt

ABSTRACT Clinical faculty often struggle to design competency demonstrations that promote quality learning experiences. A nursing program in Oregon combined mental health and community health nursing practica and required well-planned, integrated competency demonstrations. This requirement became the impetus for students to promote the health of clients and learn clinical concepts that are difficult to experience in a typical term. Faculty coached students to make a significant contribution that would last beyond their clinical practica. A case study in competency demonstration design is described, and implications for curriculum development are presented.

Key Words Clinical Education--Clinical Concepts--Health Promotion --Community as Client--Community Partnering

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FACULTY ALWAYS HOPE THAT CLINICAL EXPERIENCES WILL PROVIDE STUDENTS WITH THE OPPORTUNITY TO GRASP THE CONCEPTS OF THEIR SPECIALTY AREAS AND SEE POSITIVE OUTCOMES FROM THEIR WORK. If a practice-based learning project can cross over into service learning--a curricular activity that provides the opportunity to engage with and give back to the community or agency that offered the experience (1)--so much the better. * Two concepts of community health nursing--community as client, where "the nursing focus is on the collective ... good of the population" (2, p. 345), and community partnering, "collective action for a common endeavor or goal" (3, p. 451)--are introduced to students in community health theory. However, during a nine-week term in a clinical setting, students rarely have sufficient time to experience these concepts. Further, although students often come into contact with individuals from at-risk populations throughout their education, they may not have the opportunity to assess or intervene on their behalf as an aggregate.

THIS ARTICLE reports on what happened when competency demonstrations were combined to integrate the concepts of community as client, community partnering, and populations-at-risk and students had the opportunity to make significant contributions to clients and to the community.

Community/Mental Health Practicum CURRICULUM The community health nursing courses in an upper-division nursing program at a major medical research campus are senior-level courses that represent an often challenging paradigm shift for students who previously engaged primarily with individual clients. With the first group of accelerated baccalaureate students admitted to the program, community health nursing was combined with mental health nursing to become an eight-credit clinical course, "Community Mental Health Nursing." The accelerated baccalaureate program was designed for students who came to nursing with baccalaureate degrees in other majors, having demonstrated student success in higher education. The curriculum spanned six terms.

This clinical course was offered as part of the final term, when students were enrolled concurrently in both the community and mental health nursing theory courses. Competency demonstrations for the combined clinical included a mental health assessment, a process recording, a comprehensive community assessment, a health promotion teaching project benefiting an at-risk population, and case management for one to three clients. Students were initially overwhelmed by these projects until they recognized that they could integrate one with the other, enhancing and intensifying their learning while increasing their potential to make relevant contributions to the community that they served.

SETTING The primary and secondary authors were the clinical faculty and the other co-authors were three of 10 students assigned to an inner-city outreach center in Portland, Oregon. According to the brochure, the center's primary mission is to build community while fostering the "sacredness and dignity of all individuals." Another of its stated purposes is to serve as a "site for service education about the issues of poverty, social justice, mental illness, and community building. …