Parable of the starfish: Making a difference one at a time

This paper describes the assessment framework used to identify and develop community based clinical experiences for senior level baccalaureate nursing students. When an agency was identified as a possible community partner, services were negotiated with the ultimate goal being twofold: nursing students would have the opportunity for health education, health promotion, disease prevention, case management, and leadership experiences; agency clients would receive health/nursing related services that would not be available to them if the service learning project was not there. Public health nursing clinical experiences that are truly service learning based are running in a school program for pregnant teens, a day program for women in poverty, a parish breakfast/advocacy program for homeless and poverty patrons, and two senior apartment buildings for lower income over 65 yr olds or those with special needs. Successes and failures are shared and analyzed. The ongoing pros and cons of less traditional placements outside of health departments and home health agencies are discussed. Student outcomes related to an understanding of service learning, true advocacy, underserved populations, and disparities in health outcomes has increased. Students analyze the health care delivery system using first-hand knowledge of their clinical experiences in accessing care for clients they are working with at their clinical sites. One unexpected outcome has been that some students volunteer to continue providing service to agencies after their public health nursing clinical component is completed. Nursing students and agencies are rating the partnerships as very positive.