ABSTRACT This article discusses practical aspects of providing community health nursing (CHN) education in community-based care in partnership with a community. Changing from traditional CHN clinicals to more current models involves a shift in values and implementation of principles leading to the change. These values are: refocusing the purpose of CHN education; broad (generalist) scope of practice; problem-solving as a means of discovery; collaboration with peers, faculty, community, and service providers; and working to empower individuals, families, and the community, as well as the students themselves. Principles for developing community-based educational programs in partnership with a community are: examining and incorporating critical concepts; identifying community needs and basing activities on these needs; providing services as a means of studying the community and its problems/needs; expanding and refining services based on problems/needs and assets of the community; and maintaining services based on problems/needs and assets of the community. Each principle is discussed in a process and application format.
Key Words Community Health Nursing Education - Community-Based Education - Education-Community Partnerships - Nontraditional Program Development - Service-Learning
Central themes in current nursing and other health professions education include an increased focus on community health, along with greater integration of community and societal needs and student learning.
There has been a paradigm shift toward balancing acute care and community health with the needs of the educational institution, the student, and the community. In essence, education in the health professions is moving toward partnerships with communities (1,2).
SEVERAL FACTORS HAVE CONTRIBUTED TOWARD THIS TREND (1-5):
* A shift from an exclusive focus on individual biomedical problems to a more holistic approach that includes all levels of prevention with individuals and populations.
* A shift in the care of patients with acute and chronic illnesses from hospital to community.
* Community criticism of the lack of connection between academic centers and local communities and problems.
* Efforts of influential organizations (e.g., Pew Charitable Trusts, Rockefeller Foundation, and W. K. Kellogg Foundation) to promote relationships between communities and academic centers.
* Movement among health professions educators toward community-academic partnerships, especially the service-learning and interdisciplinary education movements.
* In nursing, the work of the American Nurses Association, the National League for Nursing, and the American Association of Colleges of Nursing.
Of tremendous significance in the shift in education toward community is the elucidation of the "scholarship of application" (6, p. 21) concerned specifically with service. When rigorous and "tied directly to one's special field of knowledge and...flow(ing) directly (from) this professional activity," this scholarship of application is comparable to traditional research activities (6, p. 22). Indeed, at some prestigious institutions, there is explicit support for service. Johns Hopkins University, for example, "considers teaching, research, patient care, and community service in urban health as academic and clinical activities of the highest stature, worthy of the finest efforts of the nation's top hospital and leading schools of medicine, nursing, and public health" (7).
How then, does one "do" community-based care in partnership with a community? Among the several models for providing care, the most notable is service-learning, which may be defined as reciprocal relationships between students and communities in which both parties participate in service and learning (8). (See Sidebar 1.)
Efforts have been made to develop relevant community health nursing theory (e.g., 9,10). In addition, there are numerous examples of community health clinical placements in nontraditional as well as traditional settings. …