COMMUNITY-DRIVEN NURSING: TRANSFORMING Nursing Curricula and Instruction

Article excerpt

The nursing literature is replete with references to the changing health care environment. In response to recommendations from the PEW Health Professtons Commission (1,2), accrediting and regulating bodies have mandated new directions for nursing education (3,4). One clear direction being taken is toward community-based nursing education.

Background Over time, notions of what constitutes education in community care have changed. Historically, public health was synonymous with nursing in the community. Public health and, later, community health nursing were distinguished by attention to aggregates, prevention, promotion, and protection (5-8). Given these foci, it was argued that community health nursing was not interchangeable with the broader definitions of community-focused and community-based nursing.

The thrust of community-focused nursing education was to bring the knowledge and expertise of students and faculty to the community. It did not extend to changes in ideology. By contrast, community-based care was conceptualized as not only providing care in the community, but also altering the power structure in the provider-receiver dyad. A new term, community-driven, was introduced to identify more clearly the ideological commitment to health care driven by the needs of the community.

Community-driven education (9) shifts the relative focus from learning in the community to learning with the community. Most recently, service-learning has become part of the discourse as disciplines in higher education reclaim the practice of community service as essential to higher learning (10-13). Some nurse scholars (14-21) have embraced the term service-learning; others (22) have argued that clinical education in nursing is, by nature, service-learning.

ABSTRACT The aim of this study was to evaluate an innovative approach to teaching and learning community-based nursing. A hermeneutic research procedure was used to analyze data from individual interviews with undergraduate nursing students, faculty, and community preceptors. Two themes, or common meanings, of participation were identified: I) Forming new partnerships: Experiencing community-driven nursing, and 2) Creating new visions:Thinking about community-driven nursing. By describing and interpreting these themes, the authors show how nursing curricula and instruction should be transformed regardless of clinical setting.

Key Words Community-Based Nursing Education - Community-Driven Nursing - Curriculum Revision - Hermeneutic Research

Notwithstanding disagreement over terminology, there exists a common and sustained interest in providing care to persons in varying locations, as well as a growing mindfulness to form partnerships with those served. Around the globe, innovative nursing education programs are being developed to reflect new directions in health care. For example, nurse educators in South Africa used a reflective process to design and implement a curriculum concurrent with the country's initiative to embrace democracy (23). Likewise, at the University of Haifa and the Technion in Israel, a paradigm shift occurred through a rigorous analysis of traditional assumptions and processes in nursing education (24).

In the United States, efforts to improve community-based practice and education are numerous. Students in Ohio immersed themselves in the cultures of migrant farm workers, families needing respite care, and medically uninsured African Americans (25). Collaboration is key in an education-service partnership in northern Wisconsin, where university faculty and neighboring clinical staff share planning, responsibility, and decision making in a participatory teaching-learning endeavor (26). In a public-private partnership in Massachusetts, a model of community-based primary care education for nursing and medical students is purported to have "radically transformed health professions education..." (27, p. 38).

Despite documented innovations in community-based nursing education, numerous challenges remain. …