Successful health outcomes in community-based nursing: Competent students and healthy families
Wood, Marilynne R
Schools of nursing consistently struggle in their efforts to provide appropriate clinical experiences for their students. Community-based nursing programs form partnerships with and provide services to non-hospital based sites (Wink, 2001). Families and clients who come to these sites bring additional issues and unique perspectives in addition to health concerns. Success of community church-based clinics is enhanced by attention to holistic needs of the client (Baldwin, Bevan, & Beshalske , 2000). The students engaged in open discussions with their clients regarding safety concerns, health needs, support systems, and access to health care. Both clients and students benefitted from these clinical experiences. The purpose of this article is to demonstrate one example of positive student and client outcomes in a church-based clinic.
KEY WORDS: Church-based clinics; Clinical outcomes.
Schools of nursing consistently struggle in their efforts to provide appropriate clinical experiences for their students. Community-based nursing programs form partnerships with and provide services to non-hospital based sites (Wink, 2001). Families and clients who come to here sites bring additional issues and unique perspectives in addition to health concerns. Success of community church-based clinics is enhanced by attention to wholistic needs of the client (Baldwin, Bevan, & Beshalske, 2000). The purpose of this article is to demonstrate one example of positive student and client outcomes in a church-based clinic.
Students in the Associate Degree Nursing Program in this urban Midwestern University have clinical experiences during their first semester. By the end of this semester, students are expected to have successful achievement of outcomes related to critical thinking, cultural awareness, nursing process, safe provider of care, communication, teaching/learning, and professionalism. The experiences in the church-based clinics have provided multiple opportunities for student learning in all these areas. In addition, there have been numerous benefits shared by the community and the clients as well. The clients, families, and churches have benefited by the activities of the students, such as community lunches, health fairs, home visits, and outreach education. As a result of these activities, the students have gained confidence and experience in time management skills, effective communication, record-keeping skills, interviewing techniques, educational presentations, and assessment skills.
Ten Successful Outcomes
Community partnerships require a high level of communication skills. First level nursing students are exposed very early to therapeutic communication and effective listening skills in client interactions during home visits, outreach programs, and community luncheons. Clients feel comfortable to “tell their story” in the privacy of their own home. Students develop a comfort level with phone conversations and interviewing techniques. After a few encounters, students were confident informing clients of future activities and provide educational presentations. Feedback from ministers, community representatives, and clients helped guide our communication with the community. With the use of church bulletins, student generated flyers, TV, radio, newsletters and posters, we were able to disseminate information in a short period of time. At the end of the semester, students identified needs and priorities of the community.
2. TIME MANAGEMENT
Students are taught how to organize and make good use of their time. On a typical clinical day, the student would make a client home visit, plan an outreach presentation, work on their care plan, and develop a poster for a health fair or community luncheon. Although these experiences were ongoing, the student needed to be aware of travel time and variable timing of the home visit. On any one clinical day, students may be involved in activities at three or four different sites. There is little doubt that rigid scheduling or set plans do not fit in the community setting. In their journals, students frequently referred to their need to improve their organizational skills. One student relates, “During the home visit, my client had so much to tell us about her health history. I was concerned about time, but knew the development of my client’s trust was the priority.” The community luncheons provided time for clients and students to enjoy good food, conversation, and educational presentations and posters. The students discovered that health education can occur during meal preparation and clean up. The students realized that diabetic and hypertensive clients did not always understand their medications or lifestyle modifications. They organized their time to research the information for their clients.
3. COMMUNITY BENEFITS
Helpful sources of information to acquaint students to the community included windshield surveys, learning about the community on foot, and talking to neighborhood residents. The students discovered that their own perception of health needs and that of their clients varied. They recognized cultural and generational influences on how clients viewed their own health ( Feenstra, 2000). The students utilized these findings when they developed age appropriate and culturally sensitive educational materials. The topics of their presentations were determined by their interactions with clients in the community.
The community benefits from the students’ presence. “Students get to know the community and community members, and the community gets to know the students” (Wink, 2001, p. 72). New students benefit from client relationships established by past students. Church leaders and staff look forward to the return of the students. The wife of one of the church pastors stated, “Our church members enjoy talking with the students, having their blood pressures checked, and learning about their medications and nutrition.”
Partnerships begun with churches and community groups do not end at the semester, but continue with the next group of first level students. Beginning students develop comprehension of the concepts and process of community-based nursing practice. They learn the importance of empowering their community clients to restore and maintain their own health. In their own environments, client health determinants are more obvious than in the hospital setting (Moll, Cook& Saul,2001). Students identify these positive and negative factors when gathering data for their nursing care plans.
At the community health fair, clients take advantage of free glucose screening, pulmonary function testing, and blood pressure readings. Elementary school children learned about the functions of the heart, lungs and five senses, and won prizes for their knowledge at the Fishing Game. Church ministers were grateful to be able to offer these increased services to their congregation and neighbors.
4. ASSESSMENT SKILLS
During the first few weeks of the clinical experience, students worked with faculty to assess the health needs of the community. A windshield survey was completed and discussed. Students identified safety issues, availability of grocery stores and pharmacies, geophysical attributes, police and fire protection, churches and schools. When students went on foot to distribute our church clinic flyers, they interacted with store owners, bank tellers, school personnel, and barbers. Students were visible in their white laboratory coats and University Logos. The community benefited from a new health clinic in the area and community luncheons and health fairs. The students gained an increased awareness of the environment.
Physical assessment skills were taught early in the semester and students performed repeat demonstrations. They utilized the knowledge in the clinical setting to assess their clients on their own turf. Students successfully made adaptations to provide continuity of care. From week to week, the student assessed changes in their client’s health status. The clients looked forward to the home visits and kept records of their blood pressure readings and health education materials. The student recorded their assessments findings with each visit. These progress notes were later bound in a notebook for continuity from semester to semester.
5. MULTICULTURAL EXPERIENCES
Cultural competence is an imperative for health promotion and successful outcomes for illness experiences (Anderson,.& McFarlane, 2000). Student nurses who are knowledgable of their cultural values, beliefs and attitudes are capable of establishing more empathic and culturally relavent care plans (Napholz., 1999).
The students’ journals reflected their multicultural beliefs and differences in their clients. Because the students took an interest in their clients, the clients’ comfort levels increased. The clients benefitted because the students adapt, respect, and understand their cultural beliefs, traditions, and norms. For example, students were sensitive to clients’ needs when preparing foods for the community luncheons. They discussed menus with clients to provide culturally sensitive meals and good nutrition. The clients were sensitive to the students’ likes and dislikes also, and brought delicious desserts.
The students were exposed to a variety of socioeconomic groups during their home visits. Some clients were not financially able to purchase prescription medications and lacked transportation to doctor visits. Another client needed a ramp so she could leave her home in her wheelchair. Students learned health behaviors and risk factors of different clients and how to assist them.
Principles of teaching and learning were examined in classroom theory discussions associated with this course. During the clinical experience, students applied this content and identified learning needs of their clients to design an individual care plan specific for teaching/learning. Those topics students identified as important to their clients, or those related to the disease processes which affected their clients, were then chosen as educational presentations and posters. These educational materials were utilized at community luncheons and health fairs, outreach treatment programs, or for display in the churches and the college nursing resource center.
Students reviewed literature and completed a community scavenger hunt for educational resources for their teaching projects. For the periods of time between semesters, materials were left with the pastors for display in the church foyers according to his discretion. Students gathered and organized extra teaching materials for an educational resource cabinet in the nursing resource center. All the fliers and notices for health fairs, lunches, and special events were designed and distributed by the students.
Developmentally appropriate instruction was given to several groups, for example, handwashing was taught to two-year-olds in one church program. Clients shared about their medications, diseases, and life issues; they also received health education which was very helpful to them for health promotion and disease prevention. Clients received informational fliers, some of which were designed by the students, and other information as requested. Students learned from the people who came to the lunches and fairs, from the pastor or church representatives, and from community resources. Students evaluated what they taught, how their audience responded, and how they may adapt their materials for the next time.
7. RECORD KEEPING
Following an encounter with a client or family or educational audience, each student wrote a narrative progress note, a journal entry, and worked on a client care plan. Appropriate documentation was stressed. Students sometimes rely on the checklists they become accustomed to for charting in acute-care facilities; here they were asked to write a narrative under the guidance of the faculty. Client information was organized in a notebook for each particular site; notebooks were forwarded to the nursing program director for reference as needed if a client were to call for assistance between semesters. Vital signs were written for the clients so they could be shared with the client’s health care provider at his/her next visit. The clients could keep a record of blood pressures and blood sugars for improved self care.
Students utilized a variety of methods to find out what resources were available for clients and for professionals in the community. Most students lived in areas away from our clinical sites; they were able to become familiar with the neighborhood and also to find which agencies and other resources could be available. They learned how to access these resources or services, and shared knowledge and materials with their clients and their peers. Clients benefitted greatly from these student investigations. While the students were in the community, they noted various needs and shared this information with the student nurses’ organization, who planned to collect goods for needy families (food, socks, etc.). Some students traveled to a soup kitchen for free groceries for some of their families. Other students identified safety concerns of their clients, and because of a negotiation between our program director and a local door company, free security doors were donated to several families.
9. HEALTH BEHAVIORS
Clients and families benefitted from student teaching. Students and families identified risk factors and together discussed plans of care. The presence of our church clinics provided an opportunity for regular screening of blood pressure and blood sugar. The clinics, health fairs, and luncheons also provided for health education discussions regarding medication, exercise, menu planning, or any other topic. Many clients were proud of their successes each week: “I ate breakfast each day”, “I remembered my medicine every day”, or even “I feel better after I talk to you girls”. As students helped their ore aware of their own health promotion behaviors and discussed attempts to improve self-care in their journals.
10. SOCIAL GATHERING AND FREE FOOD
Everyone enjoyed the opportunity for a relaxed meal! Neighbors and congregation members gathered for food and educational information. Students gained information regarding the ethnic meal traditions of the attendees, and intermingling occurred among all guests. As the result of contacts at these community events, faculty were invited to present information regarding the clinics on radio and television. Church members assisted faculty with meal preparation and students appreciated a free meal.
Clinical experiences for student nurses in communitybased church clinics have resulted in very positive outcomes for both students and clients. Students were participants in a number of activities which exposed them to various population groups with a variety of needs. Students were sensitive to holistic needs of their clients and families, gained an awareness of community resources and health information. Clients and families enjoyed the genuine concern and educational material shared by the students. Student evaluations of the clinical experience were very positive. Feedback from pastors, community leaders, and neighborhood residents was encouraging and appreciative.
Experiences such as these also are in congruence with the objectives of Healthy People 2010. A competent healthcare workforce provides health education and other services in a culturally sensitive manner. Places of worship are an important setting for health promotion initiatives and they reach some underserved populations. Valuable health benefits have been achieved by our community-based clinical experiences. Community-based approaches in conjunction with schools of nursing increase the likelihood for success to improve personal and community health.(U.S. Department of Health and Human Services, 2000).
Anderson, E., & McFarlene, J. (2000). Community as partner – theory and practice in nursing. Philadelphia: Lippincott.
Baldwin, C. M., Bevan, C. & Beshalske, A. (2000). At-risk minority populations in a church-based clinic: Communicating basic needs. Journal of Multicultural Nursing and Health, 6, (2), 2628.
Feenstra, C. (2000). Community based and community focused: Nursing education in community health. Public Health Nursing, 17 (3), 155-159.
Moll, R., Cook, L. & Saul, J. (2001). Church programs as a first clinical experience. Nurse Educator, 26 (3), 122-124.
Napholz, L. (1999). A comparison of self-reported cultural competency skills among two groups of nursing students: Implications for nursing education, Journal of Nursing Education, 38 (2) 81-83.
U. S. Department of Health and Human Services. (2000). Healthy people 2010. (2nd ed.). With understanding and improving health and objectives for improving health (Volumes I and 11). Washington, D.C.: U.S. Government Printing Office.
Wink, D.M. (2001). Developing a community nursing center. Nurse Educator, 26 (2), 70-74.
Marilynne R. Wood, MSN, BSN, RN, Visiting Assistant Professor, University of Toledo Associate Degree Nursing Program, Toledo, Ohio; Betty Ann Swat Masiulaniec, MSN, BSN, RN, Visiting Assistant Professor, University of Toledo Associate Degree Nursing Program, Toledo, Ohio.
Copyright Riley Publications, Inc. Center for the Study of Multiculturalism and Health Fall 2001
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