Nurse Educator Vol. 39, No. 4, pp. 175-178 Copyright * 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Academic-Practice Collaboration in Nursing Education Service-Learning for Injury Prevention Gina K. Alexander, PhD, MPH, RN & Sharon B. Canclini, MS, RN, FCN, CNE Debbie L. Krauser, MSN, APRN, ANP-BC, CEN Teams of senior-level baccalaureate nursing students at a private, urban university complete a population-focused public health nursing practicum through service-learning partnerships. Recently, students collaborated with local service agencies for Safe Communities America, a program of the National Safety Council in affiliation with the World Health Organization. This article describes the student-led process of community assessment, followed by systematic planning, implementation, and evaluation of evidence-based interventions to advance prescription drug overdose/poisoning prevention efforts in the community. Keywords: academic-practice collaboration; injury prevention; population health; prescription drug overdose; service-learning


he value of academic-practice partnership for nursing education is not new. Nurse historians have documented lessons learned and opportunities for collaboration over time.1 In the current healthcare reform climate, the need for vibrant academic-practice partnerships is clear. Much of the recent published literature in nursing education describes partnerships in the inpatient setting.2-6 However, community-based, population-focused academicpractice partnerships provide valuable opportunities for community engagement, service-learning, and interprofessional education.7-10 The purpose of this article is to describe an academic-practice collaboration for evidence-based injury prevention in the community.

Service-Learning Model For more than 10 years, nursing students at an urban private university have completed a senior-level community/public health nursing clinical practicum with objectives focused on aggregate care and service-learning to benefit schools, churches, and nonprofit organizations throughout the community. In general, students work in teams of 10 under the direction of a faculty member. By the end of the clinical practicum, students achieve key clinical outcomes: assessment of a community aggregate; use of effective communication with community members and groups; strategic planning, implementation, and evaluation of evidence-based public health Author Affiliations: Assistant Professor (Dr Alexander), Assistant Professor of Professional Practice (Ms Canclini), Harris School of Nursing, Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth; Program Director (Ms Krauser), Fort Worth Emergency Services Collaborative, Texas. The authors declare no conflicts of interest. Correspondence: Dr Alexander, TCU Box 298620, Fort Worth, TX 76129 ([email protected]). Accepted for publication: March 1, 2014 DOI: 10.1097/NNE.0000000000000044

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nursing intervention; and professional accountability to the community and multidisciplinary stakeholders. To provide valuable service to the community agency and to enhance clinical learning, students practice a range of skills over the course of the practicum. As they learn to focus on the aggregate instead of the individual, students become more adept in observation of the environment and interaction with community members in a noninstitutionalized setting. To supplement subjective assessment findings with objective data, students navigate a broad range of health informatics systems to collect relevant biostatistics and to conduct a review of evidence. In short, students apply a wide range of analytic skills for collaboration and advocacy to the benefit of vulnerable and underserved populations.

Safe Communities America Recently, nursing students partnered with multisectoral leaders to achieve Safe Community designation for the local community, through the Safe Communities America initiative of the National Safety Council, in affiliation with the World Health Organization (WHO) Collaborating Centre on Community Safety Promotion. Safe Communities America is a national campaign promoting the capacity of communities to create a sustainable infrastructure for injury prevention.11 Through coalition building among multiple sectors, including local government, civic organizations, businesses, nonprofit organizations, and concerned citizens, a community can promote health by preventing injuries and making the community safer for everyone. To earn the Safe Community designation at the national level, a community must demonstrate 4 competencies outlined by the National Safety Council: (1) sustained collaboration, (2) understanding of community data, (3) program development specific to the intentional and unintentional injury patterns in Volume 39 & Number 4 & July/August 2014

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the community, and (4) understanding of evaluation. To earn international designation as a Safe Community, a community must fulfill 7 indicators developed by the WHO: (1) collaborative leadership among all safety-related sectors, (2) long-term, sustainable programs that encompass all residents and support disaster preparedness, (3) programs aimed at safety promotion for high-risk, vulnerable populations, (4) evidence-based programs, (5) comprehensive data collection regarding injury rates and causes, (6) process- and outcome-based program evaluation, and (7) networking with national and international Safe Communities.11

Local Safe Communities Coalition In the fall of 2011, city leaders and stakeholders initiated the process of earning Safe Community designation; representatives from multiple sectors comprised the steering committee of the Safe Communities Coalition. At the initial meeting, stakeholders reviewed 2010 data on the leading causes of injury in the city, based on a report by the local county Medical Examiner’s office.12 After reviewing these data, the committee identified 9 priority areas, each of which would become a task force: child injury prevention, fall prevention, drug overdose/ poisoning prevention, motor vehicle injury prevention, domestic violence prevention, sports injury prevention, suicide prevention, disaster preparedness, and occupational safety. Each task force met on a monthly basis; the steering committee convened on a quarterly basis to receive updates from each task force and to maintain momentum toward Safe Community designation. The focus of this article is on servicelearning projects with the Drug Overdose/Poisoning Prevention Task Force.

Drug Overdose and Poisoning: Scope of the Problem In 2010, drugs/poisoning represented the 4th leading cause of injury death in the local county, representing 16% of injury deaths during that year. Moreover, the second leading cause of unintentional injury death was drugs/poisoning, representing 28% of unintentional injury deaths during that year. Among 30- to 59-year-olds, drugs/poisoning represented the leading cause of accidental death.12 These trends reflect national patterns of injury death. According to 2009 data from the Centers for Disease Control and Prevention, unintentional poisoning (including accidental drug overdose) was second only to motor vehicle crashes as a cause of unintentional injury death nationwide among all age groups. In 2010, however, unintentional poisoning was the leading cause of injury death for ages 25 to 64 years, surpassing death by motor vehicle accidents, homicide, and suicide.13

Drug Overdose/Poisoning Prevention Task Force During initial meetings in early 2012, the task force discussed the various root causes of poisoning-related death and decided to focus on 2 primary areas: the safe disposal of drugs and responsible prescriptive practices related to narcotics. Both of these areas are considered critical for risk reduction in the current prescription drug overdose epidemic.14 The task force prioritized 3 goals: (1) Continue involvement and 176

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support for the semiannual Take Back Meds program, (2) establish a permanent drug disposal system, and (3) develop standard guidelines for the evaluation and treatment of chronic pain patients seen at emergency departments in the community. A team of 10 nursing students worked on the first 2 goals. The third task force goal was met through the formation of a new committee charged with establishing chronic pain evaluation and treatment guidelines and addressing the nonmedical use of prescription narcotics. Although not directly involved with this committee, the students received a committee update at the monthly task force meeting. A team of 5 students (Team Take Back) worked on social marketing for the Take Back Meds program, which aligns with the Drug Enforcement Administration’s (DEA) semiannual National Take Back Initiative.15 The purpose of this initiative is to gather expired, unused, and unwanted prescription medications and over-the-counter medications to reduce drug abuse, accidental poisonings, and water contamination. The other team of 5 students (Team Dropbox) worked on advocacy and fundraising for a pilot drug disposal dropbox program, a more permanent model for safe drug disposal used in other cities with success.16,17

Take Back Meds: A Temporary Solution The objective of Team Take Back was to develop and implement a social marketing strategy for the Take Back Meds event by the end of April 2012, at which time the citywide event would occur. Toward this end, Team Take Back surveyed the community and identified key agencies for contact. The students visited each contact, discussing the event and providing educational and promotional materials. In addition, students modified the marketing materials to improve appeal and relevance for a broader audience. In addition to these social marketing efforts, the team developed a public service announcement, in collaboration with key stakeholders, which aired on a local radio station. A student-run media outlet also produced a promotional film on student involvement in servicelearning and community engagement for the Take Back event. The evaluation of the social marketing intervention occurred on the day of the event. Community members disposed of medications at each of the designated Take Back sites; DEA officers and volunteers (including Team Take Back and Team Dropbox) collected a total of 2046 lb of drugs. Although the effort was successful, this event represented a temporary solution to the problems associated with accumulation of unused, expired medications.

Drug Disposal Dropboxes: A More Permanent Solution To facilitate the ongoing collection of unused, expired medications, the objective of Team Dropbox was to secure funding from donors to cover the cost of the pilot drug disposal dropbox program. The pilot consisted of 3 medication dropboxes, located at local police stations with geographic information system-mapped high density of 9-1-1 calls related to overdose. Team Dropbox developed a fundraising letter, based on initial meetings with local leaders. Once the draft was complete, Team Dropbox circulated the letter among the task force members. On the basis of recommendations for revision, Team Dropbox finalized the letter, complete with signatures of the Safe Communities Coalition director and the medical director of the Nurse Educator

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local public health department, also a member of the task force. After completion of the letter, the team met with representatives from the local chambers of commerce for strategic planning to prioritize the agencies to receive the letter. Students hand-delivered the letter and supporting materials to local organizations; a week later, students followed up with telephone calls and e-mails to key contacts for each organization. The evaluation of the advocacy and collaboration intervention occurred in phases. By the end of April, a single donor had pledged support, followed by 2 additional donors. The combined financial support for the pilot program totaled just under $7000. In fall 2012, another team of 5 students (Team Dropbox Launch) not only worked to promote the September Take Back Event but also focused on the next phase of the pilot drug disposal dropbox program: a social marketing campaign to launch the program. An objective of Team Dropbox Launch was to increase community awareness of the dropboxes. To explore strategies for social marketing, team members met with the city neighborhood education manager, as well as representatives from the water department and a child safety advocacy group. As a result of these discussions, and in partnership with the task force, Team Dropbox Launch designed posters and flyers to advertise the dropboxes. In addition, the team collaborated with stakeholders to host a community-wide luncheon. Students envisioned the luncheon as an opportunity for engaged discussion among community members and leaders, with the hope that collaborative brainstorming and networking would lead to the development of action plans for raising awareness that the dropboxes are a means of safe disposal of unused, expired medications. Another objective of Team Dropbox Launch was to develop Web sites for dropbox advertising. The purpose of the Web sites was to promote the importance, use, and locations of the dropboxes. To achieve this objective, Team Dropbox Launch consulted with graphic design students. The consultation served a dual purpose: (1) an opportunity for nursing students to provide clear, concise Web site content and (2) a simulated client experience for graphic design students, in which they met the clients’ request for content while crafting attractive websites for consumer use. Evaluation of the social marketing interventions occurred in phases. At the September Take Back Meds event, volunteers collected 2150 lb of medication. At the Safe Medication Disposal Dropbox Luncheon, 22 members of the community participated, including representatives of the local clergy, police, neighborhood education coordinators, outreach coordinators from the local county commissioner’s offices, local children’s hospital nursing staff, child safety advocacy groups, emergency physician groups, and lay leaders. Participants discussed strategies to raise awareness of the dropboxes and to encourage use. The graphic design students presented the Web sites they had developed in collaboration with the nursing students. These Web sites were well received by stakeholders and fostered further discussion of the merits of interprofessional education for community service learning and health promotion. In early November 2012, the local police department installed the 3 pilot dropboxes. On average, the police deNurse Educator

partment collects approximately 200 to 400 lb of unused, expired medications each month. The police department has decided to maintain the dropboxes permanently at the current police stations and will consider expansion to other sites as well. In late November 2012, National Safety Council site visitors evaluated the injury prevention efforts throughout the city and determined that the city met all Safe Communities America criteria for designation. The city then received the official Safe Community designation. By the end of 2013, the police department had collected a total of 3230 lb of unused, expired medications via the dropboxes.

Community Impact and Student Learning Outcomes To evaluate the impact of the dropboxes throughout the community, particularly in the neighborhoods near the dropbox locations, the Safe Communities Coalition plans to conduct another geographic information system mapping of 9-1-1 calls related to overdose for a 1-year period beginning 6 months after the boxes were implemented (April 2013-April 2014). In the meantime, the collection of unused, expired medications at each of the dropbox sites remains consistent, indicating community support for safe medication disposal. During this clinical experience, students were able to meet key learning outcomes designed to facilitate understanding and application of public health nursing principles. In particular, students were able to complete a focused assessment of the community through evaluation of biostatistical data related to injury deaths, as well as interviews with community service providers. Students used a variety of methods to ensure effective communication with community members and groups. In addition, students completed strategic planning, implementation, and process evaluation of 3 evidencebased public health nursing interventions: collaboration, social marketing, and advocacy. Throughout the clinical experience, students were able to demonstrate professional accountability to the community and multidisciplinary stakeholders.

Conclusion Service-learning partnerships promote community engagement among students and facilitate the development of meaningful projects for nursing students completing a public health nursing clinical practicum. In this example, a local community achieved Safe Communities America designation through the efforts of many concerned citizens and multisectoral leaders, including academic and clinical stakeholders who collaborated for the prevention of leading causes of injury in the local community. Acknowledgments The authors would like to acknowledge all Safe Communities Coalition members and stakeholders, all nursing students involved in the Safe Communities Coalition work, and Dr Dusty Crocker and his graphic design students for their participation in the process.

References 1. Libster MM. Lessons learned from a history of perseverance and innovation in academic-practice partnerships. J Prof Nurs. 2011;27(6):e76-e81. Volume 39 & Number 4 & July/August 2014

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2. Beal JA. Academic-service partnerships in nursing: an integrative review. Nurs Res Pract. 2012;2012:501564. 3. Breslin E, Stefl M, Yarbrough S, et al. Creating and sustaining academic-practice partnerships: lessons learned. J Prof Nurs. 2011; 27(6):e33-e40. 4. Erickson JM, Raines DM. Expanding an academic-practice partnership. J Prof Nurs. 2011;27(6):e71-e75. 5. Murray TA, Crain C, Meyer GA, McDonough ME, Schweiss DM. Building bridges: an innovative academic-service partnership. Nurs Outlook. 2010;58(5):252-260. 6. Wurmser T, Bliss-Holtz J. Thinking strategically: academic-practice relationships: one health system’s experience. J Prof Nurs. 2011; 27(6):e114-e118. 7. Glazer G, Ponte PR, Stuart-Shor EM, Cooley ME. The power of partnership: addressing cancer health disparities through an academic-service partnership. Nurs Outlook. 2009;57(3):123-131. 8. Jackson CL, Marley JE. A tale of two cities: academic service, research, teaching and community practice partnerships delivering for disadvantaged Australian communities. Med J Aust. 2007;187(2):84. 9. Lashley M. Promoting oral health among the inner city homeless: a community-academic partnership. Nurs Clin North Am. 2008; 43(3):367-379. 10. Tanner CA. Transforming prelicensure nursing education: preparing the new nurse to meet emerging health care needs. Nursing Educ Perspect. 2010;31(6):347-353.


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11. National Safety Council. Safe Communities America. Available at Pages/SafeCommunitiesAmericaHome.aspx. Updated 2014. Accessed January 27, 2014. 12. Tarrant County Medical Examiner’s Office. Leading Causes of Injury Death in Tarrant County. Fort Worth, TX: Author; 2011. 13. Centers for Disease Control and Prevention. Drug overdose in in the United States: fact sheet. Available at http://www.cdc .gov/homeandrecreationalsafety/overdose/facts.html. Updated September 9, 2013. Accessed January 27, 2014. 14. Maxwell JC. The prescription drug epidemic in the United States: a perfect storm. Drug Alcohol Rev. 2011;30(3):264-270. 15. US Department of Justice, Drug Enforcement Administration, Office of Diversion Control. Got drugs? National TakeBack Initiative. Available at drug_disposal/takeback/. Updated 2014. Accessed January 27, 2014. 16. Pitt County Sheriff’s Office. Operation Medicine Drop: Permanent Drop-Off Box Program. Available at OSFM/Safekids/Documents/OMD/OMDPermDropBox.pdf. Updated February 2011. Accessed January 27, 2014. 17. San Diego County Sheriff’s Department. Prescription drug dropboxes. Available at .html. Updated 2013. Accessed January 27, 2014.

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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Academic-practice collaboration in nursing education: service-learning for injury prevention.

Teams of senior-level baccalaureate nursing students at a private, urban university complete a population-focused public health nursing practicum thro...
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