Public Health Nursing Vol. 30 No. 6, pp. 537–547 0737-1209/© 2013 Wiley Periodicals, Inc. doi: 10.1111/phn.12033
SPECIAL FEATURES: EDUCATION
Teaching/Learning Strategies for the Essentials of Baccalaureate Nursing Education for Entry-Level Community/ Public Health Nursing Bonnie Callen, Ph.D., P.H.C.N.S.-B.C., R.N.,1 Claudia M. Smith, Ph.D., M.P.H., R.N.-B.C.,2 Barbara Joyce, Ph.D., C.N.S., R.N.,3 Jayne Lutz, M.S., P.H.C.N.S.-B.C., R.N.,4 Nancy Brown-Schott, M.S.N.,C.N.S., R.N.-B.C.,5 and Derryl Block, Ph.D., M.P.H., R.N.6 1
University of Tennessee College of Nursing, Knoxville, Tennessee; 2Community/Public Health Nursing, Bowie, Maryland; 3Beth-El College of Nursing and Health Sciences, University of Colorado at Colorado Springs, Colorado Springs, Colorado; 4University of North Carolina Greensboro School of Nursing, Greensboro, North Carolina; 5College of Nursing, Health Science Campus, University of Toledo, Toledo, Ohio; and 6Dean College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois Correspondence to: Bonnie Callen, College of Nursing, University of Tennessee, Knoxville, 1200 Volunteer Blvd., Room 241, Knoxville, TN 37996. E-mail: [email protected]
ABSTRACT The purpose of this article is to describe teaching/learning strategies for each of the 15 Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing (ACHNE, 2009). Carper’s ways of knowing serve as foundations for creating classroom and clinical experiences that focus on clinical action with community as client. Each community/public health essential is defined with relevance to community/public health nursing practice. Five teaching/learning strategies have been delineated for each essential with suggestions of teaching resources and/or target population application. Teaching/learning strategies that focus on community as client, population health, and the essential knowledge and competencies of C/PH nursing will help ensure preparation of baccalaureate prepared nurses with knowledge and skills to improve the health of populations. Key words: entry-level community/public health nursing practice, essentials of community/ public health practice, teaching/learning strategies, ways of knowing.
The Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing (Association of Community Health Nursing Educators [ACHNE], 2009) provided a seminal framework for planning and implementing baccalaureate nursing curricula to prepare graduates for entry-level community/public health (C/PH) nursing practice. This article builds on these Essentials of Baccalaureate Nursing Education for EntryLevel Community Health Nursing Practice as a basis for describing teaching/learning strategies for use by community/public health nursing
educators in creating classroom and clinical experiences that focus on clinical action with community as client. The Essentials document explicated to nursing, public health, and other communities, the theoretical and clinical practice underpinnings necessary for C/PH nursing education and practice.
Background This most recent edition of the Essentials of Baccalaureate Nursing Education for Entry-Level Community Health Nursing Practice (ACHNE, 2009,
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2010) was based on careful review of and is consistent with foundational documents pertinent to community/public health nursing (C/PHN) and baccalaureate generalist nursing education. The following documents were critically analyzed to delineate appropriate concepts and competencies for this edition: The Essentials of Baccalaureate Nursing Education for Entry-Level Community/ Public Health Nursing (ACHNE, 2000), The Essentials of Baccalaureate Education for Professional Nursing Practice (American Association of Colleges of Nursing, 2008), Public Health Nursing Scope and Standards of Practice (American Nurses Association, 2007a,b), and the Quad Council PHN Competencies (Quad Council of Public Health Nursing Organizations, 2004). In this article, each of the 15 community/public health essentials is defined with relevance to community/public health nursing practice. Five teaching/learning strategies have been presented for each essential, with suggestions of teaching resources and/or target population application. Teaching/learning strategies that focus on community as client, population health, and the essential knowledge and competencies of C/PH nursing will help ensure preparation of baccalaureate prepared nurses with knowledge and skills to improve the health of populations. All teaching/learning strategies may be adapted for individual or group assignments. Selected strategies, such as those that require self-reflection are indicated as being most appropriate for individual assignments. Some strategies, especially those for community assessment or planning are indicated as being primarily group assignments at the baccalaureate level.
Integrating didactic and clinical teaching using carper’s theory of knowledge development Nursing educators are being called on to strive for in-depth, integrative didactic, and clinical teaching. Benner, Sutphen, Leonard, and Day (2010) called for an essential shift in nursing education so that students understand the nature of practice situations through the integration of classroom and clinical teaching. C/PH nursing education has a long history of integration of didactic and clinical teaching. This integration requires that students learn through multiple ways of knowing as espoused in
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Carper’s theory of knowledge development (Chinn & Kramer, 2011). There are multiple ways of knowing, including empirical, aesthetic, ethical, and self-knowledge (Carper, 1978). “Knowing refers to ways of perceiving and understanding the Self and the world” (Chinn & Kramer, 2011, p. 3). Nursing education and practice involve all of these ways of knowing. Empirical ways include traditional reading, listening to lectures, observing and describing, and participating in quantitative research. Aesthetic ways of knowing foster interpretation; they include exploring meaning with clients, peer sharing, and participating in qualitative research, cross-cultural experiences, and the arts. Ethical ways of knowing include studying human rights and codes of ethics, exploring values, critiquing power structures, and participating in ethical decisions. Self-knowledge involves clarifying one’s own values, spirituality, and commitments, as well as accepting uncertainty. Chinn and Kramer (2011) added a fifth way of knowing, emancipatory, which includes recognition of unjust social conditions. When a variety of teaching/learning strategies are incorporated into nursing courses, all five ways of knowing can be elicited. C/PH nursing requires factual knowledge of essential public health and nursing content, experiences to develop practice competencies, knowledge of the meaning of health in various communities and populations, ethical grounding for social justice, and self-awareness as a reflective practitioner. Unless noted, the teaching/learning strategies in this article foster empirical learning. In addition, teaching/learning strategies that foster aesthetic, ethical, self-knowledge, and emancipatory ways of knowing are identified. Because core values underlying C/PH nursing practice include prevention and partnership with diverse populations, aesthetic learning is essential for baccalaureate students. The students must attempt to understand the meaning of the experiences of the persons and groups with whom they work. Student self-knowledge is essential to developing cultural awareness and competency as C/PH nurses. Because values and power structures vary among and within groups and communities, ethical learning is essential. Public health ethics involves more than ethical care with specific individuals;
Callen et al.: Teaching/Learning Strategies for the Essentials programs and services are to preserve, protect, and promote the “autonomy, dignity, and rights of the population or community” (American Nurses Association, 2007b). To reduce health disparities and social injustice, emancipatory learning is essential to successful C/PH practice (Chinn & Kramer, 2011). To facilitate use of the Essentials (ACHNE, 2010) document, examples of teaching/learning strategies are presented below. The strategies were developed through a series of planned discussions by the authors and feedback from ACHNE conference presentations (Callen et al., 2010, 2011). The purpose of this article was to delineate examples of teaching/learning strategies that foster application of essential content and the development of basic competencies for entry-level C/PHN practice. Examples of teaching/learning strategies suitable for didactic or clinical environments are given for each Essential. Each of the teaching strategies has been used by one or more of the authors.
Essential I: Communication Definition and relevance Communication is soliciting and interpreting information from clients (individuals, families, communities, and populations) and sharing information related to client care with clients and relevant others such as families, communities, other providers, and health planning teams. C/PH nurses must consider the client’s level of engagement, health literacy, and culture and communicate effectively to identify the strengths and needs of clients, deliver appropriate care, and evaluate outcomes. Teaching/Learning strategies 1. Read a short paragraph (supplied by faculty) in a foreign language or in a high level of computer jargon. Discuss feelings about being expected to understand this material. (Self-knowledge) 2. Videotape a 5-min health teaching session. Watch and critique the health teaching session and develop three questions for evaluation of client learning. 3. Prepare a few sentences explaining the concept of infant mortality for local business leaders,
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Board of Health members, and pregnant teenagers. Discuss why aspects of the three explanations differ. Use the SMOG formula to determine readability (Heiss, 2013). 4. Critique the role play interaction of a nurse and client in a family-centered home visit. (Aesthetic) 5. Interview a Standardized Patient (Anderson, Holmes, LeFlore, Nelson, & Jenkins, 2010) who has a complex family situation. Critique the communication techniques and analyze client verbal and non-verbal responses. (Aesthetic)
Essential II: Epidemiology and Biostatistics Definition and relevance Epidemiology is the systematic study of the distribution and determinants of health and disease. Population-based data (biostatistics) expand the boundaries of practice of community/public health nurses beyond an individual client. C/PH nurses identify relevant health-related data, evaluate the quality of data sources, and interpret and use health-related data to plan interventions. Teaching/Learning strategies 1. Utilizing a community centered case study and worksheet that describes population size, births, deaths, and number of cases of specific diseases for two communities, calculate the following for each community: birth rate, death rate, infant mortality rate, and incidence of specific diseases. 2. Apply the concepts of agent, host, environment, natural history of disease, and primary prevention, secondary prevention and tertiary prevention to analyze a selected health problem. (Group) 3. Using relevant/realistic data of a food-borne outbreak, identify pertinent questions for understanding the chain of events and web of causality. (Group) 4. Prior to participating in a health fair, investigate the local, state, and national incidence and prevalence of topics to be addressed at each of the health booths. (Group) 5. Engage in a jeopardy-type game for learning epidemiological concepts. (Group)
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Essential III: Community/Population Essential IV: Community/Population Assessment Planning Definition and relevance Defining the community/population is the first step in the assessment process. One of the core public health functions, assessment is the process of identifying assets, needs, beliefs, practices, resources, and environmental factors of the community/population being studied (American Nurses Association, 2007b). A basic understanding of epidemiology and application of biostatistics is necessary for community/population assessment. C/PH nurses assess the health status of specified populations for the purpose of planning to improve population health and decrease health disparities. Teaching/Learning strategies 1. Apply a basic framework to assess a community. A system-based framework, developmental framework, epidemiological framework and/or structural/functional framework can be used. 2. Choose a census tract of clinical practice within the community. Collect, describe, and interpret demographic data from http://www.census.gov. (Group) 3. Assess an identified census track or community by walking or driving (windshield survey) using vision, hearing, smell, taste and interaction with community members to collect data. (Group, Aesthetic, Ethical, Empirical) 4. Determine the vulnerability of a specified population by collecting data from: a) web sites (e.g., www.cdc.gov, www.healthypeople.gov and state and local health department web sites); b) interviews with key informants from educational, religious, political, and health care systems; c) discussions about data with groups within a selected community or population; d) existing reports or publications within a community (local newspaper, radio, and television media that may identify health or social issues for this population); and e) participant observation. (Group, Aesthetic, Ethical, Empirical, Emancipatory) 5. Formulate and prioritize community health nursing diagnoses based on the community or population data.
Definition and relevance Planning is a decision-making process that leads to goals, interventions, and expected outcomes. The planning process is based upon the assessment of a community and/or population. C/PH nurses plan health care services and programs to strengthen community assets and address specific health needs that impact communities and populations. Teaching/Learning strategies 1. Collaborate and create partnerships with groups within a selected community or population (i.e., senior center, homeless clinic, schools within an urban or rural setting) to discuss accuracy of data obtained from an assessment. (Group, Aesthetic) 2. Plan relevant intervention activities that could be carried out to meet health needs of the community. Examples: health fair, community garden planting, health information focus groups, health education programs, screening programs, establishing services (school health or nurse managed homeless clinics), and health literacy activities. (Group) 3. Utilize the Minnesota Wheel Intervention Model in planning strategies for implementing programs (Minnesota Department of Health, 2001). 4. Consider resources and develop a budget for the planning and delivery of programs that will address the identified health goal(s). (Group) 5. Develop a plan to evaluate the process and outcomes of the program. (Group)
Essential V: Policy Development Definition and relevance Policy development, a core public health function, is the process of planning and developing healthrelated rules and guidelines along with plans for their enactment. C/PH nurses use policy development to improve access, equity, and care for individual, family, community, and population clients. In their
Callen et al.: Teaching/Learning Strategies for the Essentials advocacy efforts, C/PH nurses often share data and stories about clients with policymakers.
Teaching/Learning strategies 1. Analyze the strengths and weaknesses of a current policy in a health agency or organization. (Group) 2. Draft a simple health-related policy for an organization (i.e., student access to vending machines during high school hours). 3. Recommend improvements in care delivery based on a client satisfaction survey (i.e., survey employees of a company to determine what services are wanted in an occupational health clinic). (Aesthetic, Ethical) 4. Identify organizations that support a policy perspective on a specific issue and attend a community-based meeting to network with these key stakeholders. 5. Write a letter/e-mail to a local, state, or federal legislator in support of or opposition to a proposed bill. (Self-knowledge, Ethical)
Essential VI: Assurance Definition and relevance Assurance, a core public health function, is the process of ensuring that needed infrastructure (i.e., trained personnel, laws, resources, and services) for supporting health and safety are present, utilized appropriately, and evaluated. C/PH nurses’ participation in assurance includes development and implementation of legislative mandates, development and implementation of adequate plans for crises, and maintaining accountability by setting program objectives, providing care, and evaluating process and outcomes. Teaching/Learning strategies 1. Provide home visits to families with children to determine their barriers for not adhering to immunizations schedules. (Individual or Pairs of Students, Empirical, Aesthetic) 2. Collaborate with community organizations to identify strengths and limitations for service availability and accessibility (for instance, evening hours are needed for primary care for low
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income residents). (Group, Empirical, Aesthetic, Ethical) 3. Work with individuals in a “safety-net” clinic regarding screening, health promotion, adherence to medication, and finding dental care. 4. Determine assurance by evaluating compliance with a policy (i.e., compliance with a “no smoking policy” at a work site or health clinic). 5. Using ACHNE Essentials to conduct self-evaluation of nursing competencies (ACHNE, 2010). (Self-knowledge)
Essential VII: Health Promotion and Risk Reduction Definition and relevance Health promotion and risk reduction are actions targeted at modification of health behaviors and conditions to increase well-being and decrease risk of adverse health outcomes. C/PH nurses focus on behavioral and environmental interventions that promote health and reduce risk of adverse health outcomes in individuals, families, communities, and populations. Interventions include screening, case-finding, health education and counseling, reduction of environmental hazards, and social marketing. Teaching/Learning strategies 1. Write personal short- and long-term goals related to an area of health promotion from the United States Department of Health and Human Services [USDHHS], 2011 document. Write journal entries on progress toward personal goals. At the end of the semester, complete a self-evaluation of overall progress. (Individual, Self-knowledge) 2. Plan and participate in a screening for health risks such as diabetes or hypertension in a community health fair. 3. Inform clients who have undergone health screening about their results. Explore risk factors with clients and discuss strategies to promote behavior change. 4. Design and conduct health promotion education in a school setting in collaboration with school personnel regarding nutrition, physical exercise, or hand washing.
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5. Develop a poster or a 30 s Public Service Announcement (PSA) promoting an increase in consumption of fruits and vegetables.
Essential VIII: Illness and Disease Management Definition and relevance Illness and disease management is the coordination of health-related activities that help individuals, families, communities, and populations effectively manage their illness responses and treatment regimens in a comprehensive and holistic way. C/PH nurses help clients to manage their illness responses and treatment regimens through home visiting, case management, and referral to community resources. Teaching/Learning strategies 1. Provide case management through home visits and/or phone calls to an individual (e.g., in a homeless shelter or senior housing) by assessing; mutually planning; giving direct care, educating, referring, and/or coordinating; evaluating outcomes; and documenting care. (Individual or pair of students, Empirical, Aesthetic, Ethical) 2. Using an actual or written case study/patient scenario, participate in a simulation to develop an age-appropriate plan of care based on evidence of best practices. (Group) 3. Develop an age-appropriate lesson plan for a group of older adults related to safe medication management of community dwelling older adults. 4. Develop a family tree to identify genetic and familial patterns of illness and disease. 5. Based on a scenario about a communicable disease outbreak in a community, develop a plan of care for case-finding and follow-up. (Group)
Essential IX: Information and Health Care Technology Definition and relevance Information and health care technology is the introduction and application of current and emerging
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methods of discovering, retrieving, and using information in C/PH nursing practice. C/PH nurses have basic information management and computer-based skills to utilize computer programs, the internet, and resources for interventions. These skills are also important for documentation of practice. C/PH nurses are aware of the roles of geographic information systems (GIS) and the electronic data exchange (EDI).
Teaching/Learning strategies 1. Use the Omaha System (Martin, 2005) to document community/public health practice in clinical settings. (Individual) 2. Use County Health Rankings for comparison of county health ratings within a U.S. state. (University of Wisconsin, Population Health Institute, 2011 http://www.Countyhealthrankings. org) 3. Utilize online data resources to assist with community assessment assignments. Examples are accessing http://scorecard.goodguide.com/ for air quality or http://wonder.cdc.gov/ for mortality information. 4. Create a blog describing learning that occurs during practicum experiences. (Aesthetic, Ethical, Self-knowledge) 5. Utilize current computer modules for learning selected content (Individual) a. A Disaster Module (Midwest Center for LifeLong Learning in Public Health, University of Minnesota School of Public Health, 2004) Outbreak at Water Edge. http://www.mclph. umn.edu/watersedge/teachers_guide.html b. An immunization module through Center for Disease Control (CDC, 2011) www2a.cdc.gov/ nip/isd/ycts/mod1/courses/genrec/ce.asp
Essential X: Environmental Health Definition and relevance Environmental health “refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations” (American Nurses Association, 2010, p. 65).
Callen et al.: Teaching/Learning Strategies for the Essentials C/PH nurses monitor hazards in the home, school, worksites, and communities. Practice includes direct action to reduce environmental hazards and educating others about hazards so that they may change their behavior. C/PH nurses also provide input for organizational and public policy related to environmental health (ACHNE, 2010).
Teaching/Learning strategies 1. Conduct a windshield survey of environmental hazards in a community after viewing The National Library of Medicine’s (2010), ToxTown http://toxtown.nlm.nih.gov/ (Group, Empirical, Aesthetic, Ethical, Emancipatory) 2. Assess household products for ingredients that can have human health effects after viewing the U.S. Department of Health and Human Services (2011) Household products data base. http:// householdproducts.nlm.nih.gov/ 3. Review the film or book, A Civil Action, about environmental injustice (Harr, 1995; Zaillian, Wisnievitz, & Rudin, 1999). Reflect on the injustices and discuss implications for the population’s health status. (Empirical, Aesthetic, Ethical, Emancipatory) 4. Access information on national bio-monitoring of human exposure to environmental chemicals. CDC (2009). Fourth national report on human exposure to environmental chemicals. http:// www.cdc.gov/exposurereport/ Incorporate this information into assessment of communities and populations. (Group) 5. Develop an educational lesson plan to reduce asthma triggers in homes by using information from Healthy Homes II Asthma Project (2011) http://www.kingcounty.gov/healthservices/health/ chronic/asthma/past/HH2.aspx
Essential XI: Global Health Definition and relevance Global health is the consideration of health and disease from an international and worldwide perspective. Biological, social, political, economic, environmental, and cultural issues cross national boundaries and illustrate the interconnectedness of all people worldwide. C/PH nurses have basic knowledge about global health issues and determinants. They incorpo-
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rate knowledge about transnational population migration, disease transmission, and environmental events and conditions in caring for individuals, families, communities, and populations.
Teaching/Learning strategies 1. Explore and discuss a global health issue referred to in the media. (Group, Empirical, Aesthetic, Ethical, Emancipatory) 2. Based on international study abroad or in-depth discussion with people from other countries, compare and contrast health issues such as major causes of morbidity and mortality, nursing education, typical nursing roles in the community, and the health care system. (Group, Empirical, Aesthetic, Ethical, Emancipatory) 3. Discuss the geographic distribution and causes of diseases that are most prevalent in the world. (Group) 4. Review literature about a refugee population and discuss implications for community/public health nursing. (Empirical, Aesthetic, Ethical, Emancipatory) 5. Explore the consequences of a climactic event (such as a major freeze) on the food supply of various geographical areas.
Essential XII: Ethics and Social Justice Definition and relevance Ethics is the body of knowledge about societal values, codes, and principles that govern practice and decision making. Social justice is the fair and equal distribution of the benefits and burdens of society regardless of differences in economic status, class, gender, race, ethnicity citizenship, religion, age, sexual orientation, disability, and health. C/PH nurses use ethics as a foundation for guiding professional decision making. Assuring that basic human needs are met is the foundation for both the elimination of health disparities and the promotion of health for all. Teaching/Learning strategies 1. Collaborate with local nonprofit organizations to support the vision and mission of the organization to serve specific target populations. (Ethical)
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2. Partner with an existing community action coalition to advocate for solutions to meet the needs of vulnerable populations or advocate for healthier lifestyles or environments. (Aesthetic, Ethical, Emancipatory) 3. Discuss local examples of inequitable health care and resource allocation. (Ethical, Emancipatory) 4. Address the impact of a social determinant on an identified community, based on United States Department of Health and Human Services [USDHHS], 2011, topic area, Social Determinants of Health, http://www.healthypeople.gov/ 2020/about/DOHAbout.aspx (Group) 5. Discuss the tension between ethics related to care of individuals and public health ethics that focuses on the greatest good for the greatest number of persons (for example, immunization and quarantine).(Group, Ethical, Emancipatory)
Essential XIII: Human Diversity Definition and relevance Human diversity is differences in individuals, families, communities, and populations. Differences encompass language, culture, race, age, sexual orientation, ethnicity, religion, spiritual beliefs, health beliefs, lifestyle choices, socioeconomic status, environmental factors, genetic factors, disability, and other dimensions. C/PH nurses are concerned with diverse populations and demonstrate respect, curiosity, and openness to ideas and ways of life. Human diversity and related health disparities are taken into account when C/PH nurses design and deliver care. Teaching/Learning strategies 1. Discuss in small groups how culture affects personal health care practices. (Group, Empirical, Aesthetic) 2. Interview an invited panel of diverse community residents or diverse students about their health beliefs and practices. Discuss implications for designing and delivering nursing care. (Group, Aesthetic) 3. Use a cultural assessment tool (Andrews & Boyle, 2008; Giger & Davidhizar, 2008) to perform a cultural assessment of multiple individuals and relate findings to population-focused nursing care.
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4. Modify a standardized plan of care for clients with diabetes to reflect cultural beliefs and practices of specific populations for example, Hispanic or Native American people. (Aesthetic) 5. Participate in a poverty simulation such as The Poverty Simulation (Missouri Association for Community Action, 1975). http://communityaction.org/Poverty%20Simulation.aspx (Group, Aesthetic, Self-knowledge, Emancipatory)
Essential XIV: Coordinator and Manager Definition and relevance Coordinator and manager are roles that involve planning, delegating, providing, and evaluating holistic, evidence-based care of clients. C/PH nurses coordinate and manage client care. Working with multiple disciplines, systems, and clients is a key element of the coordinator and manager role. Teaching/Learning strategies 1. Collaborate with classmates from other disciplines to develop a plan of care for persons with multiple needs and problems. (i.e., developmental disabilities, post traumatic stress disorder [PTSD]). (Group, Empirical, Aesthetic) 2. Manage the care for a caseload of clients over a specified time period in collaboration with agency staff. Possible populations include residents of correctional facilities, senior citizens, and homeless persons. (Empirical, Aesthetic) 3. Use concepts of evaluation to critique the coordination and management of care to improve health care quality. (Empirical, Ethical) 4. Conduct a review of the literature to identify best practices for coordination of care. 5. Participate as a team member in the coordination of a community health event. (Group, Empirical, Aesthetic, Ethical, Self-knowledge)
Essential XV: Emergency Preparedness, Response, and Recovery Definition and relevance Emergency preparedness is actions or measures that can prevent or reduce the severity of the
Callen et al.: Teaching/Learning Strategies for the Essentials effects of an emergency, or increase effectiveness of response and recovery through personal, professional, and community preparedness. C/PH nurses collaborate with teams to develop a disaster response plan. C/PH nurses focus on population-based care, knowledge related to vulnerable populations, and specific community resources that contribute to a solid plan for disaster response and recovery.
Teaching/Learning strategies 1. Work with a local health department emergency preparedness team to audit local agencies for presence of an institutional preparedness plan. (Group) 2. Participate with the university public safety office in a simulated mass disaster on campus. (Group) 3. Complete an emergency preparedness online training module such as the Fundamentals of Emergency Management at http://training.fema.gov/ EMIWeb/IS/is230b.asp (Federal Emergency Management Agency [FEMA] (2011) or Disaster in Franklin County: A Public Health Simulation (Midwest Center for Life-Long Learning in Public Health, 2011) at http://www.sph.umn.edu/ce/ trainings/coursepage.asp?activityId=7594 (Individual) 4. Develop and implement teaching programs for an assigned target population regarding emergency preparedness kits for home and/or business. (Group) 5. Facilitate planning and development of emergency preparedness plans for individuals, assigned agencies, and/or target populations.
Summary A definition of each of the 15 essentials of baccalaureate nursing education for entry-level C/PH nursing was provided along with related examples of teaching/learning strategies for classroom and/or clinical learning settings (Table 1). Review of seminal documents and group discussions at national ACHNE conferences provided validation that these teaching/learning strategies are appropriate for the baccalaureate generalist and for student learning. Teaching C/PH nursing in baccalaureate nursing education is challenging. Many students are
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TABLE 1. Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing Communication Epidemiology and biostatistics Community/Population assessment Community/Population planning Policy development Assurance Health promotion and risk reduction Illness and disease management Information and health care technology Environmental health Global health Human diversity Ethics and social justice Coordinator and manager of care Emergency preparedness, response, and recovery
focused on mastery of psychomotor skills, disease symptoms, and individual level interventions. This article provided creative teaching/learning strategies based on ways of knowing that foster active engagement of learners. In planning and implementing baccalaureate nursing curriculum for C/PH nursing, both didactic and clinical learning experiences should be addressed to provide an introduction to the essential content and application in clinical and simulation settings. Faculty assigned to C/PH nursing courses need to be academically and experientially qualified in community/public health nursing to teach and facilitate the suggested teaching/learning strategies for successful mastery of essential content and competencies. The teaching/learning strategies in this article are a sample of ways to teach essential C/PH nursing content. They can be used as presented, adapted, or serve as a springboard for creating other strategies. ACHNE provides a forum for sharing of teaching/learning strategies for C/PH nursing practice. Sharing of teaching/learning strategies and their relationships to essential content and competencies will help ensure an adequately prepared workforce that has the skills and knowledge to improve the health of individuals, families, communities, and populations.
References American Nurses Association. (2007a). Principles of environmental health for nursing practice with implementation strategies. Silver Spring, MD: Author.
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American Nurses Association. (2007b). Public health nursing: Scope and standards of practice. Silver Spring, MD: Author. American Association of Colleges of Nursing. (2008). Essentials of baccalaureate nursing education for professional nursing practice. Washington, DC. Retrieved from http:// www.aacn.nche.edu/education-resources/Bacc Essentials08.pdf American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author. Anderson, M., Holmes, T., LeFlore, J. L., Nelson, K. A., & Jenkins, T. (2010). Standardized patients in educating student nurses: One school’s experience. Clinical Simulation in Nursing, 6(2), e61–e66. Andrews, M., & Boyle, J. (2008). Transcultural concepts in nursing (5th ed.). Philadelphia: Lippincott Williams & Wilkins. Association of Community Health Nursing Educators [ACHNE]. (2000). Essentials of baccalaureate nursing education for entry-level community health nursing. Available from Association of Community Health Nursing Educators, 10200 West 44th Avenue, Suite 304, Wheat Ridge, CO. 80033. Association of Community Health Nursing Educators [ACHNE]. (2009). Essentials of baccalaureate nursing education for entry-level community health nursing. Available from Association of Community Health Nursing Educators, 10200 West 44th Avenue, Suite 304, Wheat Ridge, CO. 80033. Retrieved from http://www.achne.org/files/Essentials OfBaccalaureate_Fall_2009.pdf Association of Community Health Nursing Educators, Education Committee [ACHNE]. (2010). Essentials of baccalaureate nursing education for entry-level community/public health nursing. Public Health Nursing, 27(4), 371–382. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. California: Jossey-Bass. Callen, B., Block, D., Joyce, B., Lutz, J., BrownSchott, N., & Smith, C. (2010). Innovative strategies for teaching the essentials. Arlington, VA: Plenary session at the 2010 ACHNE Annual Institute, Preparing Public Health Nurses for 2020. Callen, B., Block, D., Joyce, B., Lutz, J., BrownSchott, N., & Smith, C. (2011). 2011 ACHNE Annual Institute, Preparing Public Health Nurses for 2020. Plenary Session: Innovative
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Strategies for Teaching the Essentials presentation June 10, 2011, Chicago, IL. Carper, B. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13–23. Center for Disease Control and Prevention [CDC]. (2011a). Immunization: You call the shots. Retrieved from www2a.cdc.gov/nip/isd/ycts/ mod1/courses/genrec/ce.asp Center for Disease Control and Prevention [CDC]. (2011b). CDC Wonder- Mortality. Retrieved from http://wonder.cdc.gov/Welcome.html Centers for Disease Control and Prevention [CDC]. (2009). Fourth national report on human exposure to environmental chemicals. Atlanta, GA: CDC. Retrieved from http://www.cdc.gov/ exposurereport/ Chinn, P., & Kramer, M. (2011). Integrated theory and knowledge development in nursing (8th ed.). St Louis: Mosby. Federal Emergency Management Agency [FEMA]. (2011). Fundamentals of emergency management. Retrieved from http://training.fema. gov/EMIWeb/IS/is230b.asp Giger, J., & Davidhizar, R. (2008). Transcultural nursing assessment and intervention (2nd ed.). St. Louis: Mosby. Harr, J. (1995). A civil action. New York: Vintage Books. Heiss, G. (2013). Health teaching. In F. Maurer & C. Smith (Eds.), Community/Public health nursing practice: Health for families and populations (5th ed., pp. 505–525). St. Louis: Elsevier. Martin, K.. (2005). The Omaha system. St. Louis: Elsevier. Midwest Center for Life-Long Learning in Public Health. (2011). Disaster in Franklin County: A public health simulation. Retrieved from http://www.sph.umn.edu/ce/trainings/course page.asp?activityId=7594 Midwest Center for Life-Long Learning in Public Health, University of Minnesota School of Public Health. (2004). Outbreak at waters edge Retrieved from http://www.mclph.umn. edu/watersedge/teachers_guide.html Minnesota Department of Health. (2001). Public health interventions: Applications for public health nursing practice. St Paul, MN: Author. Retrieved from http://www.health.state.mn. us/divs/cfh/ophp/resources/docs/phinterventions_manual2001.pdf Missouri Association for Community Action (1975). Community action poverty simulation.
Callen et al.: Teaching/Learning Strategies for the Essentials Retriever from http://communityaction.org/ Poverty%20Simulation.aspx Public Health – Seattle & King County. (2011). Healthy Homes-II Asthma Project. Retrieved from http://www.kingcounty.gov/healthser vices/health/chronic/asthma/past/HH2.aspx Quad Council of Public Health Nursing Organizations. (2004). Public health nursing competencies. Public Health Nursing, 21(5), 443–452. Scorecard: The pollution information site. (2005). Air. Retrieved from http://scorecard.goodguide.com The National Library of Medicine. (2010). ToxTown environmental health concerns. Retrieved from http://toxtown.nlm.nih.gov United States Census Bureau. (2011). Data access tools [Data base]. Available at http://www. census.gov/main/www/access.html United States Department of Health and Human Services [USDHHS]. (2011). Healthy People
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2020, About Healthy People: Determinants of health. Retrieved from http:// www.healthypeople.gov/2020/about/DOHAbout. aspx University of Wisconsin, Population Health Institute. (2011). County health rankings. Retrieved from http://www.Countyhealthrankings.org U.S. Department of Health and Human Services. (2011). Household products data base. [Data base]. Available from http://householdprod ucts.nlm.nih.gov/ Zaillian, S. [Producer], Wisnievitz, D., & Rudin, S. [Directors] (1999). A civil action [Motion Picture]. United States of America: Touchstone Pictures/Miramax Films. Retrieved from http://www.bing.com/movies/search/overvi ew?q=A+Civil+Action&id=8b3cffa3-7307-478 c-b6bc-1d7d11da7eb9&qpvt=a+civil+action movie+studio&FORM=DTPSHA
SPECIAL FEATURES: EDUCATION
Teaching/Learning Strategies for the Essentials of Baccalaureate Nursing Education for Entry-Level Community/ Public Health Nursing Bonnie Callen, Ph.D., P.H.C.N.S.-B.C., R.N.,1 Claudia M. Smith, Ph.D., M.P.H., R.N.-B.C.,2 Barbara Joyce, Ph.D., C.N.S., R.N.,3 Jayne Lutz, M.S., P.H.C.N.S.-B.C., R.N.,4 Nancy Brown-Schott, M.S.N.,C.N.S., R.N.-B.C.,5 and Derryl Block, Ph.D., M.P.H., R.N.6 1
University of Tennessee College of Nursing, Knoxville, Tennessee; 2Community/Public Health Nursing, Bowie, Maryland; 3Beth-El College of Nursing and Health Sciences, University of Colorado at Colorado Springs, Colorado Springs, Colorado; 4University of North Carolina Greensboro School of Nursing, Greensboro, North Carolina; 5College of Nursing, Health Science Campus, University of Toledo, Toledo, Ohio; and 6Dean College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois Correspondence to: Bonnie Callen, College of Nursing, University of Tennessee, Knoxville, 1200 Volunteer Blvd., Room 241, Knoxville, TN 37996. E-mail: [email protected]
ABSTRACT The purpose of this article is to describe teaching/learning strategies for each of the 15 Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing (ACHNE, 2009). Carper’s ways of knowing serve as foundations for creating classroom and clinical experiences that focus on clinical action with community as client. Each community/public health essential is defined with relevance to community/public health nursing practice. Five teaching/learning strategies have been delineated for each essential with suggestions of teaching resources and/or target population application. Teaching/learning strategies that focus on community as client, population health, and the essential knowledge and competencies of C/PH nursing will help ensure preparation of baccalaureate prepared nurses with knowledge and skills to improve the health of populations. Key words: entry-level community/public health nursing practice, essentials of community/ public health practice, teaching/learning strategies, ways of knowing.
The Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing (Association of Community Health Nursing Educators [ACHNE], 2009) provided a seminal framework for planning and implementing baccalaureate nursing curricula to prepare graduates for entry-level community/public health (C/PH) nursing practice. This article builds on these Essentials of Baccalaureate Nursing Education for EntryLevel Community Health Nursing Practice as a basis for describing teaching/learning strategies for use by community/public health nursing
educators in creating classroom and clinical experiences that focus on clinical action with community as client. The Essentials document explicated to nursing, public health, and other communities, the theoretical and clinical practice underpinnings necessary for C/PH nursing education and practice.
Background This most recent edition of the Essentials of Baccalaureate Nursing Education for Entry-Level Community Health Nursing Practice (ACHNE, 2009,
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2010) was based on careful review of and is consistent with foundational documents pertinent to community/public health nursing (C/PHN) and baccalaureate generalist nursing education. The following documents were critically analyzed to delineate appropriate concepts and competencies for this edition: The Essentials of Baccalaureate Nursing Education for Entry-Level Community/ Public Health Nursing (ACHNE, 2000), The Essentials of Baccalaureate Education for Professional Nursing Practice (American Association of Colleges of Nursing, 2008), Public Health Nursing Scope and Standards of Practice (American Nurses Association, 2007a,b), and the Quad Council PHN Competencies (Quad Council of Public Health Nursing Organizations, 2004). In this article, each of the 15 community/public health essentials is defined with relevance to community/public health nursing practice. Five teaching/learning strategies have been presented for each essential, with suggestions of teaching resources and/or target population application. Teaching/learning strategies that focus on community as client, population health, and the essential knowledge and competencies of C/PH nursing will help ensure preparation of baccalaureate prepared nurses with knowledge and skills to improve the health of populations. All teaching/learning strategies may be adapted for individual or group assignments. Selected strategies, such as those that require self-reflection are indicated as being most appropriate for individual assignments. Some strategies, especially those for community assessment or planning are indicated as being primarily group assignments at the baccalaureate level.
Integrating didactic and clinical teaching using carper’s theory of knowledge development Nursing educators are being called on to strive for in-depth, integrative didactic, and clinical teaching. Benner, Sutphen, Leonard, and Day (2010) called for an essential shift in nursing education so that students understand the nature of practice situations through the integration of classroom and clinical teaching. C/PH nursing education has a long history of integration of didactic and clinical teaching. This integration requires that students learn through multiple ways of knowing as espoused in
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Carper’s theory of knowledge development (Chinn & Kramer, 2011). There are multiple ways of knowing, including empirical, aesthetic, ethical, and self-knowledge (Carper, 1978). “Knowing refers to ways of perceiving and understanding the Self and the world” (Chinn & Kramer, 2011, p. 3). Nursing education and practice involve all of these ways of knowing. Empirical ways include traditional reading, listening to lectures, observing and describing, and participating in quantitative research. Aesthetic ways of knowing foster interpretation; they include exploring meaning with clients, peer sharing, and participating in qualitative research, cross-cultural experiences, and the arts. Ethical ways of knowing include studying human rights and codes of ethics, exploring values, critiquing power structures, and participating in ethical decisions. Self-knowledge involves clarifying one’s own values, spirituality, and commitments, as well as accepting uncertainty. Chinn and Kramer (2011) added a fifth way of knowing, emancipatory, which includes recognition of unjust social conditions. When a variety of teaching/learning strategies are incorporated into nursing courses, all five ways of knowing can be elicited. C/PH nursing requires factual knowledge of essential public health and nursing content, experiences to develop practice competencies, knowledge of the meaning of health in various communities and populations, ethical grounding for social justice, and self-awareness as a reflective practitioner. Unless noted, the teaching/learning strategies in this article foster empirical learning. In addition, teaching/learning strategies that foster aesthetic, ethical, self-knowledge, and emancipatory ways of knowing are identified. Because core values underlying C/PH nursing practice include prevention and partnership with diverse populations, aesthetic learning is essential for baccalaureate students. The students must attempt to understand the meaning of the experiences of the persons and groups with whom they work. Student self-knowledge is essential to developing cultural awareness and competency as C/PH nurses. Because values and power structures vary among and within groups and communities, ethical learning is essential. Public health ethics involves more than ethical care with specific individuals;
Callen et al.: Teaching/Learning Strategies for the Essentials programs and services are to preserve, protect, and promote the “autonomy, dignity, and rights of the population or community” (American Nurses Association, 2007b). To reduce health disparities and social injustice, emancipatory learning is essential to successful C/PH practice (Chinn & Kramer, 2011). To facilitate use of the Essentials (ACHNE, 2010) document, examples of teaching/learning strategies are presented below. The strategies were developed through a series of planned discussions by the authors and feedback from ACHNE conference presentations (Callen et al., 2010, 2011). The purpose of this article was to delineate examples of teaching/learning strategies that foster application of essential content and the development of basic competencies for entry-level C/PHN practice. Examples of teaching/learning strategies suitable for didactic or clinical environments are given for each Essential. Each of the teaching strategies has been used by one or more of the authors.
Essential I: Communication Definition and relevance Communication is soliciting and interpreting information from clients (individuals, families, communities, and populations) and sharing information related to client care with clients and relevant others such as families, communities, other providers, and health planning teams. C/PH nurses must consider the client’s level of engagement, health literacy, and culture and communicate effectively to identify the strengths and needs of clients, deliver appropriate care, and evaluate outcomes. Teaching/Learning strategies 1. Read a short paragraph (supplied by faculty) in a foreign language or in a high level of computer jargon. Discuss feelings about being expected to understand this material. (Self-knowledge) 2. Videotape a 5-min health teaching session. Watch and critique the health teaching session and develop three questions for evaluation of client learning. 3. Prepare a few sentences explaining the concept of infant mortality for local business leaders,
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Board of Health members, and pregnant teenagers. Discuss why aspects of the three explanations differ. Use the SMOG formula to determine readability (Heiss, 2013). 4. Critique the role play interaction of a nurse and client in a family-centered home visit. (Aesthetic) 5. Interview a Standardized Patient (Anderson, Holmes, LeFlore, Nelson, & Jenkins, 2010) who has a complex family situation. Critique the communication techniques and analyze client verbal and non-verbal responses. (Aesthetic)
Essential II: Epidemiology and Biostatistics Definition and relevance Epidemiology is the systematic study of the distribution and determinants of health and disease. Population-based data (biostatistics) expand the boundaries of practice of community/public health nurses beyond an individual client. C/PH nurses identify relevant health-related data, evaluate the quality of data sources, and interpret and use health-related data to plan interventions. Teaching/Learning strategies 1. Utilizing a community centered case study and worksheet that describes population size, births, deaths, and number of cases of specific diseases for two communities, calculate the following for each community: birth rate, death rate, infant mortality rate, and incidence of specific diseases. 2. Apply the concepts of agent, host, environment, natural history of disease, and primary prevention, secondary prevention and tertiary prevention to analyze a selected health problem. (Group) 3. Using relevant/realistic data of a food-borne outbreak, identify pertinent questions for understanding the chain of events and web of causality. (Group) 4. Prior to participating in a health fair, investigate the local, state, and national incidence and prevalence of topics to be addressed at each of the health booths. (Group) 5. Engage in a jeopardy-type game for learning epidemiological concepts. (Group)
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Essential III: Community/Population Essential IV: Community/Population Assessment Planning Definition and relevance Defining the community/population is the first step in the assessment process. One of the core public health functions, assessment is the process of identifying assets, needs, beliefs, practices, resources, and environmental factors of the community/population being studied (American Nurses Association, 2007b). A basic understanding of epidemiology and application of biostatistics is necessary for community/population assessment. C/PH nurses assess the health status of specified populations for the purpose of planning to improve population health and decrease health disparities. Teaching/Learning strategies 1. Apply a basic framework to assess a community. A system-based framework, developmental framework, epidemiological framework and/or structural/functional framework can be used. 2. Choose a census tract of clinical practice within the community. Collect, describe, and interpret demographic data from http://www.census.gov. (Group) 3. Assess an identified census track or community by walking or driving (windshield survey) using vision, hearing, smell, taste and interaction with community members to collect data. (Group, Aesthetic, Ethical, Empirical) 4. Determine the vulnerability of a specified population by collecting data from: a) web sites (e.g., www.cdc.gov, www.healthypeople.gov and state and local health department web sites); b) interviews with key informants from educational, religious, political, and health care systems; c) discussions about data with groups within a selected community or population; d) existing reports or publications within a community (local newspaper, radio, and television media that may identify health or social issues for this population); and e) participant observation. (Group, Aesthetic, Ethical, Empirical, Emancipatory) 5. Formulate and prioritize community health nursing diagnoses based on the community or population data.
Definition and relevance Planning is a decision-making process that leads to goals, interventions, and expected outcomes. The planning process is based upon the assessment of a community and/or population. C/PH nurses plan health care services and programs to strengthen community assets and address specific health needs that impact communities and populations. Teaching/Learning strategies 1. Collaborate and create partnerships with groups within a selected community or population (i.e., senior center, homeless clinic, schools within an urban or rural setting) to discuss accuracy of data obtained from an assessment. (Group, Aesthetic) 2. Plan relevant intervention activities that could be carried out to meet health needs of the community. Examples: health fair, community garden planting, health information focus groups, health education programs, screening programs, establishing services (school health or nurse managed homeless clinics), and health literacy activities. (Group) 3. Utilize the Minnesota Wheel Intervention Model in planning strategies for implementing programs (Minnesota Department of Health, 2001). 4. Consider resources and develop a budget for the planning and delivery of programs that will address the identified health goal(s). (Group) 5. Develop a plan to evaluate the process and outcomes of the program. (Group)
Essential V: Policy Development Definition and relevance Policy development, a core public health function, is the process of planning and developing healthrelated rules and guidelines along with plans for their enactment. C/PH nurses use policy development to improve access, equity, and care for individual, family, community, and population clients. In their
Callen et al.: Teaching/Learning Strategies for the Essentials advocacy efforts, C/PH nurses often share data and stories about clients with policymakers.
Teaching/Learning strategies 1. Analyze the strengths and weaknesses of a current policy in a health agency or organization. (Group) 2. Draft a simple health-related policy for an organization (i.e., student access to vending machines during high school hours). 3. Recommend improvements in care delivery based on a client satisfaction survey (i.e., survey employees of a company to determine what services are wanted in an occupational health clinic). (Aesthetic, Ethical) 4. Identify organizations that support a policy perspective on a specific issue and attend a community-based meeting to network with these key stakeholders. 5. Write a letter/e-mail to a local, state, or federal legislator in support of or opposition to a proposed bill. (Self-knowledge, Ethical)
Essential VI: Assurance Definition and relevance Assurance, a core public health function, is the process of ensuring that needed infrastructure (i.e., trained personnel, laws, resources, and services) for supporting health and safety are present, utilized appropriately, and evaluated. C/PH nurses’ participation in assurance includes development and implementation of legislative mandates, development and implementation of adequate plans for crises, and maintaining accountability by setting program objectives, providing care, and evaluating process and outcomes. Teaching/Learning strategies 1. Provide home visits to families with children to determine their barriers for not adhering to immunizations schedules. (Individual or Pairs of Students, Empirical, Aesthetic) 2. Collaborate with community organizations to identify strengths and limitations for service availability and accessibility (for instance, evening hours are needed for primary care for low
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income residents). (Group, Empirical, Aesthetic, Ethical) 3. Work with individuals in a “safety-net” clinic regarding screening, health promotion, adherence to medication, and finding dental care. 4. Determine assurance by evaluating compliance with a policy (i.e., compliance with a “no smoking policy” at a work site or health clinic). 5. Using ACHNE Essentials to conduct self-evaluation of nursing competencies (ACHNE, 2010). (Self-knowledge)
Essential VII: Health Promotion and Risk Reduction Definition and relevance Health promotion and risk reduction are actions targeted at modification of health behaviors and conditions to increase well-being and decrease risk of adverse health outcomes. C/PH nurses focus on behavioral and environmental interventions that promote health and reduce risk of adverse health outcomes in individuals, families, communities, and populations. Interventions include screening, case-finding, health education and counseling, reduction of environmental hazards, and social marketing. Teaching/Learning strategies 1. Write personal short- and long-term goals related to an area of health promotion from the United States Department of Health and Human Services [USDHHS], 2011 document. Write journal entries on progress toward personal goals. At the end of the semester, complete a self-evaluation of overall progress. (Individual, Self-knowledge) 2. Plan and participate in a screening for health risks such as diabetes or hypertension in a community health fair. 3. Inform clients who have undergone health screening about their results. Explore risk factors with clients and discuss strategies to promote behavior change. 4. Design and conduct health promotion education in a school setting in collaboration with school personnel regarding nutrition, physical exercise, or hand washing.
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5. Develop a poster or a 30 s Public Service Announcement (PSA) promoting an increase in consumption of fruits and vegetables.
Essential VIII: Illness and Disease Management Definition and relevance Illness and disease management is the coordination of health-related activities that help individuals, families, communities, and populations effectively manage their illness responses and treatment regimens in a comprehensive and holistic way. C/PH nurses help clients to manage their illness responses and treatment regimens through home visiting, case management, and referral to community resources. Teaching/Learning strategies 1. Provide case management through home visits and/or phone calls to an individual (e.g., in a homeless shelter or senior housing) by assessing; mutually planning; giving direct care, educating, referring, and/or coordinating; evaluating outcomes; and documenting care. (Individual or pair of students, Empirical, Aesthetic, Ethical) 2. Using an actual or written case study/patient scenario, participate in a simulation to develop an age-appropriate plan of care based on evidence of best practices. (Group) 3. Develop an age-appropriate lesson plan for a group of older adults related to safe medication management of community dwelling older adults. 4. Develop a family tree to identify genetic and familial patterns of illness and disease. 5. Based on a scenario about a communicable disease outbreak in a community, develop a plan of care for case-finding and follow-up. (Group)
Essential IX: Information and Health Care Technology Definition and relevance Information and health care technology is the introduction and application of current and emerging
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methods of discovering, retrieving, and using information in C/PH nursing practice. C/PH nurses have basic information management and computer-based skills to utilize computer programs, the internet, and resources for interventions. These skills are also important for documentation of practice. C/PH nurses are aware of the roles of geographic information systems (GIS) and the electronic data exchange (EDI).
Teaching/Learning strategies 1. Use the Omaha System (Martin, 2005) to document community/public health practice in clinical settings. (Individual) 2. Use County Health Rankings for comparison of county health ratings within a U.S. state. (University of Wisconsin, Population Health Institute, 2011 http://www.Countyhealthrankings. org) 3. Utilize online data resources to assist with community assessment assignments. Examples are accessing http://scorecard.goodguide.com/ for air quality or http://wonder.cdc.gov/ for mortality information. 4. Create a blog describing learning that occurs during practicum experiences. (Aesthetic, Ethical, Self-knowledge) 5. Utilize current computer modules for learning selected content (Individual) a. A Disaster Module (Midwest Center for LifeLong Learning in Public Health, University of Minnesota School of Public Health, 2004) Outbreak at Water Edge. http://www.mclph. umn.edu/watersedge/teachers_guide.html b. An immunization module through Center for Disease Control (CDC, 2011) www2a.cdc.gov/ nip/isd/ycts/mod1/courses/genrec/ce.asp
Essential X: Environmental Health Definition and relevance Environmental health “refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations” (American Nurses Association, 2010, p. 65).
Callen et al.: Teaching/Learning Strategies for the Essentials C/PH nurses monitor hazards in the home, school, worksites, and communities. Practice includes direct action to reduce environmental hazards and educating others about hazards so that they may change their behavior. C/PH nurses also provide input for organizational and public policy related to environmental health (ACHNE, 2010).
Teaching/Learning strategies 1. Conduct a windshield survey of environmental hazards in a community after viewing The National Library of Medicine’s (2010), ToxTown http://toxtown.nlm.nih.gov/ (Group, Empirical, Aesthetic, Ethical, Emancipatory) 2. Assess household products for ingredients that can have human health effects after viewing the U.S. Department of Health and Human Services (2011) Household products data base. http:// householdproducts.nlm.nih.gov/ 3. Review the film or book, A Civil Action, about environmental injustice (Harr, 1995; Zaillian, Wisnievitz, & Rudin, 1999). Reflect on the injustices and discuss implications for the population’s health status. (Empirical, Aesthetic, Ethical, Emancipatory) 4. Access information on national bio-monitoring of human exposure to environmental chemicals. CDC (2009). Fourth national report on human exposure to environmental chemicals. http:// www.cdc.gov/exposurereport/ Incorporate this information into assessment of communities and populations. (Group) 5. Develop an educational lesson plan to reduce asthma triggers in homes by using information from Healthy Homes II Asthma Project (2011) http://www.kingcounty.gov/healthservices/health/ chronic/asthma/past/HH2.aspx
Essential XI: Global Health Definition and relevance Global health is the consideration of health and disease from an international and worldwide perspective. Biological, social, political, economic, environmental, and cultural issues cross national boundaries and illustrate the interconnectedness of all people worldwide. C/PH nurses have basic knowledge about global health issues and determinants. They incorpo-
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rate knowledge about transnational population migration, disease transmission, and environmental events and conditions in caring for individuals, families, communities, and populations.
Teaching/Learning strategies 1. Explore and discuss a global health issue referred to in the media. (Group, Empirical, Aesthetic, Ethical, Emancipatory) 2. Based on international study abroad or in-depth discussion with people from other countries, compare and contrast health issues such as major causes of morbidity and mortality, nursing education, typical nursing roles in the community, and the health care system. (Group, Empirical, Aesthetic, Ethical, Emancipatory) 3. Discuss the geographic distribution and causes of diseases that are most prevalent in the world. (Group) 4. Review literature about a refugee population and discuss implications for community/public health nursing. (Empirical, Aesthetic, Ethical, Emancipatory) 5. Explore the consequences of a climactic event (such as a major freeze) on the food supply of various geographical areas.
Essential XII: Ethics and Social Justice Definition and relevance Ethics is the body of knowledge about societal values, codes, and principles that govern practice and decision making. Social justice is the fair and equal distribution of the benefits and burdens of society regardless of differences in economic status, class, gender, race, ethnicity citizenship, religion, age, sexual orientation, disability, and health. C/PH nurses use ethics as a foundation for guiding professional decision making. Assuring that basic human needs are met is the foundation for both the elimination of health disparities and the promotion of health for all. Teaching/Learning strategies 1. Collaborate with local nonprofit organizations to support the vision and mission of the organization to serve specific target populations. (Ethical)
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2. Partner with an existing community action coalition to advocate for solutions to meet the needs of vulnerable populations or advocate for healthier lifestyles or environments. (Aesthetic, Ethical, Emancipatory) 3. Discuss local examples of inequitable health care and resource allocation. (Ethical, Emancipatory) 4. Address the impact of a social determinant on an identified community, based on United States Department of Health and Human Services [USDHHS], 2011, topic area, Social Determinants of Health, http://www.healthypeople.gov/ 2020/about/DOHAbout.aspx (Group) 5. Discuss the tension between ethics related to care of individuals and public health ethics that focuses on the greatest good for the greatest number of persons (for example, immunization and quarantine).(Group, Ethical, Emancipatory)
Essential XIII: Human Diversity Definition and relevance Human diversity is differences in individuals, families, communities, and populations. Differences encompass language, culture, race, age, sexual orientation, ethnicity, religion, spiritual beliefs, health beliefs, lifestyle choices, socioeconomic status, environmental factors, genetic factors, disability, and other dimensions. C/PH nurses are concerned with diverse populations and demonstrate respect, curiosity, and openness to ideas and ways of life. Human diversity and related health disparities are taken into account when C/PH nurses design and deliver care. Teaching/Learning strategies 1. Discuss in small groups how culture affects personal health care practices. (Group, Empirical, Aesthetic) 2. Interview an invited panel of diverse community residents or diverse students about their health beliefs and practices. Discuss implications for designing and delivering nursing care. (Group, Aesthetic) 3. Use a cultural assessment tool (Andrews & Boyle, 2008; Giger & Davidhizar, 2008) to perform a cultural assessment of multiple individuals and relate findings to population-focused nursing care.
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4. Modify a standardized plan of care for clients with diabetes to reflect cultural beliefs and practices of specific populations for example, Hispanic or Native American people. (Aesthetic) 5. Participate in a poverty simulation such as The Poverty Simulation (Missouri Association for Community Action, 1975). http://communityaction.org/Poverty%20Simulation.aspx (Group, Aesthetic, Self-knowledge, Emancipatory)
Essential XIV: Coordinator and Manager Definition and relevance Coordinator and manager are roles that involve planning, delegating, providing, and evaluating holistic, evidence-based care of clients. C/PH nurses coordinate and manage client care. Working with multiple disciplines, systems, and clients is a key element of the coordinator and manager role. Teaching/Learning strategies 1. Collaborate with classmates from other disciplines to develop a plan of care for persons with multiple needs and problems. (i.e., developmental disabilities, post traumatic stress disorder [PTSD]). (Group, Empirical, Aesthetic) 2. Manage the care for a caseload of clients over a specified time period in collaboration with agency staff. Possible populations include residents of correctional facilities, senior citizens, and homeless persons. (Empirical, Aesthetic) 3. Use concepts of evaluation to critique the coordination and management of care to improve health care quality. (Empirical, Ethical) 4. Conduct a review of the literature to identify best practices for coordination of care. 5. Participate as a team member in the coordination of a community health event. (Group, Empirical, Aesthetic, Ethical, Self-knowledge)
Essential XV: Emergency Preparedness, Response, and Recovery Definition and relevance Emergency preparedness is actions or measures that can prevent or reduce the severity of the
Callen et al.: Teaching/Learning Strategies for the Essentials effects of an emergency, or increase effectiveness of response and recovery through personal, professional, and community preparedness. C/PH nurses collaborate with teams to develop a disaster response plan. C/PH nurses focus on population-based care, knowledge related to vulnerable populations, and specific community resources that contribute to a solid plan for disaster response and recovery.
Teaching/Learning strategies 1. Work with a local health department emergency preparedness team to audit local agencies for presence of an institutional preparedness plan. (Group) 2. Participate with the university public safety office in a simulated mass disaster on campus. (Group) 3. Complete an emergency preparedness online training module such as the Fundamentals of Emergency Management at http://training.fema.gov/ EMIWeb/IS/is230b.asp (Federal Emergency Management Agency [FEMA] (2011) or Disaster in Franklin County: A Public Health Simulation (Midwest Center for Life-Long Learning in Public Health, 2011) at http://www.sph.umn.edu/ce/ trainings/coursepage.asp?activityId=7594 (Individual) 4. Develop and implement teaching programs for an assigned target population regarding emergency preparedness kits for home and/or business. (Group) 5. Facilitate planning and development of emergency preparedness plans for individuals, assigned agencies, and/or target populations.
Summary A definition of each of the 15 essentials of baccalaureate nursing education for entry-level C/PH nursing was provided along with related examples of teaching/learning strategies for classroom and/or clinical learning settings (Table 1). Review of seminal documents and group discussions at national ACHNE conferences provided validation that these teaching/learning strategies are appropriate for the baccalaureate generalist and for student learning. Teaching C/PH nursing in baccalaureate nursing education is challenging. Many students are
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TABLE 1. Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing Communication Epidemiology and biostatistics Community/Population assessment Community/Population planning Policy development Assurance Health promotion and risk reduction Illness and disease management Information and health care technology Environmental health Global health Human diversity Ethics and social justice Coordinator and manager of care Emergency preparedness, response, and recovery
focused on mastery of psychomotor skills, disease symptoms, and individual level interventions. This article provided creative teaching/learning strategies based on ways of knowing that foster active engagement of learners. In planning and implementing baccalaureate nursing curriculum for C/PH nursing, both didactic and clinical learning experiences should be addressed to provide an introduction to the essential content and application in clinical and simulation settings. Faculty assigned to C/PH nursing courses need to be academically and experientially qualified in community/public health nursing to teach and facilitate the suggested teaching/learning strategies for successful mastery of essential content and competencies. The teaching/learning strategies in this article are a sample of ways to teach essential C/PH nursing content. They can be used as presented, adapted, or serve as a springboard for creating other strategies. ACHNE provides a forum for sharing of teaching/learning strategies for C/PH nursing practice. Sharing of teaching/learning strategies and their relationships to essential content and competencies will help ensure an adequately prepared workforce that has the skills and knowledge to improve the health of individuals, families, communities, and populations.
References American Nurses Association. (2007a). Principles of environmental health for nursing practice with implementation strategies. Silver Spring, MD: Author.
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American Nurses Association. (2007b). Public health nursing: Scope and standards of practice. Silver Spring, MD: Author. American Association of Colleges of Nursing. (2008). Essentials of baccalaureate nursing education for professional nursing practice. Washington, DC. Retrieved from http:// www.aacn.nche.edu/education-resources/Bacc Essentials08.pdf American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author. Anderson, M., Holmes, T., LeFlore, J. L., Nelson, K. A., & Jenkins, T. (2010). Standardized patients in educating student nurses: One school’s experience. Clinical Simulation in Nursing, 6(2), e61–e66. Andrews, M., & Boyle, J. (2008). Transcultural concepts in nursing (5th ed.). Philadelphia: Lippincott Williams & Wilkins. Association of Community Health Nursing Educators [ACHNE]. (2000). Essentials of baccalaureate nursing education for entry-level community health nursing. Available from Association of Community Health Nursing Educators, 10200 West 44th Avenue, Suite 304, Wheat Ridge, CO. 80033. Association of Community Health Nursing Educators [ACHNE]. (2009). Essentials of baccalaureate nursing education for entry-level community health nursing. Available from Association of Community Health Nursing Educators, 10200 West 44th Avenue, Suite 304, Wheat Ridge, CO. 80033. Retrieved from http://www.achne.org/files/Essentials OfBaccalaureate_Fall_2009.pdf Association of Community Health Nursing Educators, Education Committee [ACHNE]. (2010). Essentials of baccalaureate nursing education for entry-level community/public health nursing. Public Health Nursing, 27(4), 371–382. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. California: Jossey-Bass. Callen, B., Block, D., Joyce, B., Lutz, J., BrownSchott, N., & Smith, C. (2010). Innovative strategies for teaching the essentials. Arlington, VA: Plenary session at the 2010 ACHNE Annual Institute, Preparing Public Health Nurses for 2020. Callen, B., Block, D., Joyce, B., Lutz, J., BrownSchott, N., & Smith, C. (2011). 2011 ACHNE Annual Institute, Preparing Public Health Nurses for 2020. Plenary Session: Innovative
November/December 2013
Strategies for Teaching the Essentials presentation June 10, 2011, Chicago, IL. Carper, B. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13–23. Center for Disease Control and Prevention [CDC]. (2011a). Immunization: You call the shots. Retrieved from www2a.cdc.gov/nip/isd/ycts/ mod1/courses/genrec/ce.asp Center for Disease Control and Prevention [CDC]. (2011b). CDC Wonder- Mortality. Retrieved from http://wonder.cdc.gov/Welcome.html Centers for Disease Control and Prevention [CDC]. (2009). Fourth national report on human exposure to environmental chemicals. Atlanta, GA: CDC. Retrieved from http://www.cdc.gov/ exposurereport/ Chinn, P., & Kramer, M. (2011). Integrated theory and knowledge development in nursing (8th ed.). St Louis: Mosby. Federal Emergency Management Agency [FEMA]. (2011). Fundamentals of emergency management. Retrieved from http://training.fema. gov/EMIWeb/IS/is230b.asp Giger, J., & Davidhizar, R. (2008). Transcultural nursing assessment and intervention (2nd ed.). St. Louis: Mosby. Harr, J. (1995). A civil action. New York: Vintage Books. Heiss, G. (2013). Health teaching. In F. Maurer & C. Smith (Eds.), Community/Public health nursing practice: Health for families and populations (5th ed., pp. 505–525). St. Louis: Elsevier. Martin, K.. (2005). The Omaha system. St. Louis: Elsevier. Midwest Center for Life-Long Learning in Public Health. (2011). Disaster in Franklin County: A public health simulation. Retrieved from http://www.sph.umn.edu/ce/trainings/course page.asp?activityId=7594 Midwest Center for Life-Long Learning in Public Health, University of Minnesota School of Public Health. (2004). Outbreak at waters edge Retrieved from http://www.mclph.umn. edu/watersedge/teachers_guide.html Minnesota Department of Health. (2001). Public health interventions: Applications for public health nursing practice. St Paul, MN: Author. Retrieved from http://www.health.state.mn. us/divs/cfh/ophp/resources/docs/phinterventions_manual2001.pdf Missouri Association for Community Action (1975). Community action poverty simulation.
Callen et al.: Teaching/Learning Strategies for the Essentials Retriever from http://communityaction.org/ Poverty%20Simulation.aspx Public Health – Seattle & King County. (2011). Healthy Homes-II Asthma Project. Retrieved from http://www.kingcounty.gov/healthser vices/health/chronic/asthma/past/HH2.aspx Quad Council of Public Health Nursing Organizations. (2004). Public health nursing competencies. Public Health Nursing, 21(5), 443–452. Scorecard: The pollution information site. (2005). Air. Retrieved from http://scorecard.goodguide.com The National Library of Medicine. (2010). ToxTown environmental health concerns. Retrieved from http://toxtown.nlm.nih.gov United States Census Bureau. (2011). Data access tools [Data base]. Available at http://www. census.gov/main/www/access.html United States Department of Health and Human Services [USDHHS]. (2011). Healthy People
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2020, About Healthy People: Determinants of health. Retrieved from http:// www.healthypeople.gov/2020/about/DOHAbout. aspx University of Wisconsin, Population Health Institute. (2011). County health rankings. Retrieved from http://www.Countyhealthrankings.org U.S. Department of Health and Human Services. (2011). Household products data base. [Data base]. Available from http://householdprod ucts.nlm.nih.gov/ Zaillian, S. [Producer], Wisnievitz, D., & Rudin, S. [Directors] (1999). A civil action [Motion Picture]. United States of America: Touchstone Pictures/Miramax Films. Retrieved from http://www.bing.com/movies/search/overvi ew?q=A+Civil+Action&id=8b3cffa3-7307-478 c-b6bc-1d7d11da7eb9&qpvt=a+civil+action movie+studio&FORM=DTPSHA
