Statement of the problem

Community/Public Health Nursing (C/PHN) proffers a variety of clinical opportunities for pre-licensure students (Frank, Adams, Edelstein, Speakman, & Shelton, 2005). Due to variable C/PHN care settings, clinical coordinators have difficulty garnering sites that support a uniform approach to C/PHN core knowledge, values, and competencies. Therefore, nurse faculty must supplement didactic and clinical experiences with innovative teaching methods (Callen, Smith, Joyce, Lutz, Brown-Schott, & Block, 2013; Valentine-Maher, Van Dyk, Aktan, & Bliss, 2014; Wade & Hayes, 2010).

Approach

Clinical simulation is a teaching method considered to be as effective as learning through direct patient care (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). Simulated experiential learning allows students to practice critical thinking and communication while acting as a C/PHN nurse (Gotwals & Yeager, 2014; Kim-Godwin, Livsey, Ezzell, & Highsmith, 2013; Wheeler & McNelis, 2014). The Debriefing with Good Judgment model reinforces clinical knowledge and self-reflective practice after simulation (Rudolph, Simon, Rivard, Dufresne, & Raemer, 2007).

Outcome

The University of Maryland School of Nursing utilizes clinical simulation to provide nursing students with the opportunity to conduct home visits. The Debriefing with Good Judgment model allows faculty to implement standardized learning experiences that align with C/PHN course objectives.

Implications

Clinical simulation is a teaching platform that ensures quality C/PHN experiences for students. The authors suggest that structured clinical simulation can be used to support fulfillment of C/PHN course objectives that are difficult to meet in varied clinical settings. Clinical simulation may also prepare students whose C/PHN placements entail home visiting.

A new teaching approach was designed for the nursing student clinical curriculum to demonstrate the importance of organized community health efforts with government and private organization involvement.  To engage students in active learning, a ten mile bike ride was developed, to integrate course objectives with interactions and experiences outside of the classroom.  As health care costs continue to rise, non-traditional health care assets such as parks and trails, cultural amenities, social gathering locations and smart growth policies are being revisited in a new light.  The bike ride experiential learning technique was integrated into the community clinical to highlight how the built environment has an effect on health.  The core public health functions of assessment, policy development, and assurance were highlighted at seven discussion stops along the way.

The “on-the-trail” experience provided students with real life examples and the need for multidisciplinary approaches to address the health of a community.  Students developed an appreciation of the importance of community health planning throughout the ride and in dialog with invited community experts from the local city planning office, health department, and regional planning commission.  During the seven stops students recognized and analyzed how land use development, community design, and transportation systems affect the health and quality of life in a community. This moving class room activity was highly evaluated by students and was not only fun but provided physical activity and burned calories. The experience helped demonstrate the important role students can have in the future health of their community.

Statement of the problem:  Providing a meaningful learning experience that conveys public health principles and the concept of social determinants to RN-to-BSN students oriented to individual-level care in clinical settings can be challenging.  Also, bridging disconnects between matters of social justice and health outcomes requires learning opportunities that compel students to think beyond pre-conceived perspectives and personal lived histories.

Approach:  Objectives for a RN-to-BSN community health nursing course calls for students to examine population-level health and nursing practice outside of clinical settings, and understand health professionals’ responsibility to participate in public health advocacy.  To accomplish this, students were trained on basic videography and computer-based media editing to produce a digital story of a public health issue affecting local, marginalized communities.

Product/outcome:  Partnering community-based action organizations led students on land and boat tours of Seattle neighborhoods along an EPA Superfund-designated waterway for first-hand views of how socio-ecological factors create environmental health threats for lower-income communities of color.  Seeing how didactically-presented content plays out in the real-world, students captured footage for their digital stories.  While creative freedom was encouraged, students were instructed that digital stories would be given to the community-based action organizations for policy advocacy and community engagement.

Implications:  This service-learning assignment was transformative by re-focusing students’ understanding of illness to consider multi-level, upstream societal factors.  The course was enhanced by infusing an unconventional digital arts component to enliven traditional didactic content.  And, community-based action organizations were supplied with media resources to aid their advocacy agendas to address public health concerns.

Background: The purpose of this study was to examine the nursing students’ critical reflections of a community’s health utilizing the photovoice method. This  method has been utilized in high education as a critical reflection methodology in the classrooms. As an active learning methodology, photovoice entails individuals engaging in direct experiences, human discussion and interaction, and observation. Although not widely used as an educational tool in nursing education, photovoice has proved to have a positive impact on the overall nurses and nursing students’ experiences. Photovoice provides the nurse with community participatory strategies that are essential in addressing community health problems.

 

Method: A descriptive cross-sectional qualitative design was utilized to collect data from a convenient sample of 96 nursing students enrolled in the community/public health nursing course. The study was approved by the university IRB. Students were asked to take pictures of activities, places and/or symbols throughout their clinical rotations and then share their written narrative reflections utilizing the ShowEd instrument. The content analysis method was used to analyze the narratives. The community as partner model was used to guide the analysis.

 

Results: A positive outlook for thriving communities was identified as a community’s strength.  Lack of access to healthy food choices, lack of economic opportunities, and unsafe communities were identified as community weaknesses. Students proposed actions for the communities included Education, Support and Empowerment.

 

Conclusions: The nursing education implications include the benefits and challenges of utilizing the photovoice methods as an innovative active learning strategy in community health clinical learning experiences.