FOUR SITES -- Hawai'i, Minnesota, Texas, and Massachusetts -- were selected by the NLN to participate in the National League for Nursing Vision for Nursing Education: Phase II Project, a one-year initiative focused on community-based nursing education. This initiative, for the year 1995-1996, was funded by the W. K. Kellogg Foundation and coordinated by a national project director. Each site received $ 100,000 to be used to develop curricular models for community-based nursing. Other components of the initiative as it took place in Hawai'i --- an exploration of regulatory issues regarding community-based nursing education and a description of the process of change are reported elsewhere (I).
An Overview of the Vision Initiative The Board of Directors of the Hawai'i League for Nursing was the recipient of the Phase II project funds. Board members were actively engaged in each aspect of the project through the formation of a central task force and sub-task forces.
Primary health care (PHC), the main strategy of the World Health Organization to achieve Health for All (2), was used as the conceptual framework of the initiative (3). PHC is based on five principles: community participation; a comprehensive or multi-sectoral view of the determinants of health; appropriateness of the initiative within the unique community context; sustainability and integration within the context; and equitable distribution of resources (2).
The statewide task force identified 12 themes that would be appropriate for a community-based curricular model. (See Table 1.) Three were specific to nursing and are highlighted in this article. Nine were considered important to various health disciplines including nursing.
Table 1. Curricular Themes from the Vision for Nursing Education:
Phase II Project in Hawai'i
Nursing history, culture, and identity.
Evolving nursing practice.
Regulation of the profession: Safety of the public/students.
Knowing the community.
Working with the community.
Working with people over a period of time.
Knowledge of the health care system, economics, and politics.
Focus on outcomes and accountability.
Knowing how to learn,and work over a lifetime.
Ability to use information systems and technology.
The Qualitative Research Study Following submission of the final report in June 1996, leaders from the NLN indicated interest in a qualitative research study to clarify the information embedded in themes specific to nursing. In other words, what unique perspective, knowledge, and abilities must be included in the curriculum to provide the basis for nursing practice in the evolving community-based health care system? The study, conducted during the spring of 1997, elaborates on and clarifies concepts embedded in the three curricular themes specific to nursing.
Assumptions Early in the process, the researchers identified their own assumptions, which included the following:
* Nursing is based on core values, such as holism, that often are not overtly stated.
* Nurses work in the community at multiple levels of direct and indirect care.
* Nursing care may be focused on the person or population across the life span.
* Nursing knowledge encompasses more than what is prescribed or seen by others, which may lead to the undervaluing of nursing.
* Much of what nurses do is paid for indirectly.
* While the discipline of nursing stresses the importance of health promotion and disease prevention, it is difficult to determine if these are carried out in practice.
Structural Framework The qualitative study was developed using a structural framework proposed by Lincoln and Guba (4). An adapted focus group method was used, which is consistent with PHC principles of community participation and multisectoral collaboration. …