Disrupting the epistemic arrangements of nursing education canon: Reflections about a prelicensure Community Engagement series

Nursing education, as with professionalization projects, is fraught with epistemicide, false separations, and a focus on expertise over relations and accountability. This is a critical reflection of the first 5 years of a four-semester prelicensure Community Engagement course series. As the course lead, I have consistently initiated adjustments, based on experiences teaching multiple sections and synthesizing comments and feedback from students and faculty, with an eye toward longstanding and pressing concerns in the world around us. Two broad epistemic arrangements emerge from this critical excavation: (1) naturalized hierarchy, false separations, and appraisals of relevance and (2) relationality and reflection as unsettling. There is a need for sustained collective examination and shift in how the nursing education and healthcare industries curate the meanings and practice of "community," "health," and "nursing," peering out from the regulatory oversight of neoliberal forces. How might we situate student progression, program implementation, institutional contracts, and curricular standards within the contexts of nursing programs' responsibilities to local communities in light of unfolding events locally and globally and their historical antecedents? How are we all, as faculty, disrupting siloes, false separations, and the contradictions of professionalism and the biomedical model to intentionally advance health equity? May we continue to illuminate the presence of community as being everywhere, not merely in juxtaposition to acute care. May we unsettle the prevailing theorization and practices of community throughout nursing education and commit to imagining and practicing relational praxis.

Minority Student Perspectives of Barriers, Supports, and Christian Virtues in an Undergraduate Christian Nursing Program

ABSTRACT

Diversity and inclusion are critical priorities in nursing education programs. Literature has focused on minority student experiences of barriers and supports-but not through a Christian worldview. This qualitative study using a phenomenological-hermenuetic approach gave voice to the experiences of 15 self-identified minority student graduates from a Christian baccalaureate nursing program. Data analysis revealed opportunities for growth in providing a supportive climate within the program and how Christian virtues of hospitality, humility, and reconciliation can be employed to achieve this goal.

Community-based learning in medical education: A starting guide and lessons learned

Community-based medical education (CBME) addresses real-world health problems and is characterized by its emphasis on reciprocity and collaboration with community stakeholders. Limited evidence shows that CBME is an effective learning strategy to care for underserved communities. However, medical schools and nursing schools struggle to implement CBME in their curriculum. In this article, we present four practical examples of CBME from medical and nursing schools in Belgium and the Netherlands. By taking the lessons learned derived from these practical examples into account, all students can have an authentic learning experience within the community, which empowers community members and increases their health.

Community-based education programmes in the context of dental education: A scoping review

BACKGROUND

Community education programmes are vital tools for teaching skills, such as understanding the larger cultural, economic and social determinants of health and how these factors impact people's health. It is currently unclear whether community education programmes in the field of dentistry deliver adequate value. This review aims to scope, collate and analyse globally published evidence concerning community education programmes in dentistry from inception, to gain an understanding of the intentions for these programmes and establish whether outcomes have shifted over time from the original intentions.

METHODS

Arksey and O'Malley's framework for scoping reviews was employed to guide the reviewers. A systematic search of electronic databases and the reference lists in key papers was conducted.

RESULTS

A systematic search concerning community education in dentistry identified a total of 140 papers for full-text evaluations. After further exclusions, 115 articles were selected for data charting. There was a lack of clarity in the literature concerning programmes' definitions and strategies for achieving intentions. Origins, intentions and motivations of the programmes were identified. The literature largely focused on assessing students' clinical treatment skills, contradicting the programme's original idea and intentions. Only a few studies incorporated patient and community perspectives, and the majority of assessments were self-reported, primarily by students.

CONCLUSIONS

There is broad interest in integrating community education into dental curricula to teach complex concepts, dental public health principles and to ensure professional skills development. We identified issues in the literature around programme definitions, strategies, measurement approaches and programme success requiring additional research.

Teaching Social Determinants of Health in Nursing Programs: An Integrative Review of Strategies and Effectiveness

BACKGROUND

Incorporating social determinants of health (SDoH) into clinical decision-making can clarify disease causes, enhance care planning, and improve health outcomes. Nurse educators should know which strategies are most effective for teaching SDoH in bachelor of science in nursing (BSN) programs.

OBJECTIVE

This integrative review synthesizes the literature on familiarizing BSN students with SDoH and identifies effective teaching interventions for SDoH in these programs.

METHODS

The researchers searched CINAHL, PubMed, Web of Science, and ERIC databases, and 21 articles met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines were followed for reporting.

RESULTS

The curriculum method, service learning, and international outreach experiences were frequently used teaching strategies. Qualitative evaluation was used to evaluate student outcomes.

CONCLUSIONS

Nurse educators should be mindful of these strategies. Interdisciplinary teamwork can bolster students' understanding of disadvantaged populations while integrating SDoH in nursing curricula. Quantitative evaluations of learning outcomes are needed to determine teaching effectiveness.

Teaming Up for Community Health Simulation Intervention: A Quasi-Experimental Study

AIM

The aim of this study was to examine whether participating in a team-based simulation intervention would improve nursing students' empathy and commitment to addressing social determinants of health (SDOH) and interprofessional teamwork attitudes, beliefs, and behaviors. Outcomes were compared for intraprofessional versus interprofessional team participation.

BACKGROUND

Nursing students must learn strategies to address SDOH, but this content is not well integrated in curricula. Teaming Up for Community Health was created to provide SDOH experiential team learning.

METHOD

Eighty-five nursing students participated in the intraprofessional comparison group or interprofessional intervention group. Surveys were completed before and after the intervention and two months later.

RESULTS

Participants had heightened empathy and commitment to addressing SDOH at baseline. Interprofessional teamwork beliefs and behaviors improved for both groups.

CONCLUSION

Experiential learning about SDOH should focus on improving students' self-confidence and performance. Based on the study results, experiential team learning should be threaded through curricula.

Exploring Nursing Strategies to Engage Community in Cardiovascular Care

PURPOSE OF REVIEW

This review aims to highlight some of the strategies nurses use to engage community members in cardiovascular care. We also elaborate on opportunities for improving community engagement.

RECENT FINDINGS

Community engagement occurs across a continuum of progressive levels of community involvement, impact, trust, and flow of communication. Successful community engagement has been shown to improve both patient-centered care and intervention design, implementation, and dissemination. Nurse strategies used for engaging community in cardiovascular care included more examples of outreach, consult, and involvement than collaboration and shared leadership. More attention is needed toward strategies that embrace collaboration and enhance trusting relationships to advance to shared leadership. Nurses must intentionally work in partnership with communities to improve cardiovascular health for all. Furthermore, assessing meaningful community engagement is necessary to achieve the desired outcomes, including optimal cardiovascular health and thriving communities.

Nursing Education and Social Determinants of Health: A Content Analysis

BACKGROUND

By integrating a social determinants of health (SDOH) perspective into nursing programs, there is potential to reduce health disparities shaped by these forces. However, little is known about the extent to which nursing program curricula include SDOH education.

METHOD

This study used course descriptions from 32 nursing programs in the United States to perform a frequency and content analysis on required course offerings. Healthy People 2020 was referenced to determine coding categories.

RESULTS

Although 18.5% of courses implicitly referenced SDOH, only 1% made explicit references to SDOH. Implicit references were likely to include themes such as cultural sensitivity and diversity, or social, cultural, economic, and political factors influencing health.

CONCLUSION

Although several required nursing course descriptions made implicit references to SDOH, explicit use of the term SDOH is still limited. Faculty, administrators, and program accrediting bodies must push to incorporate SDOH more thoroughly into nursing education. [J Nurs Educ. 2022;61(9):516-523.].

Learning through practice: Enhancing students' communication skills in community-based nursing

ABSTRACT

Service-learning experiences have been shown to improve nursing students' clinical and cultural awareness skills. This article discusses the implications of a collaborative service-learning program at a nursing center, particularly in improving nursing students' communication skills, and its potential for successful replication in other community health nursing settings.

Strategies for Incorporating Health Disparities and Cultural Competency Training into the Pharmacy Curriculum and Co-curriculum

Objective. To identify and review strategies reported in the literature for strengthening instruction about both health disparities and cultural competency (HDCC) within various portions of the Doctor of Pharmacy curriculum and co-curriculum.Findings. The classroom strategies reported in the literature for incorporating HDCC into the PharmD curriculum involved teaching a single course or series of courses in HDCC. Activities found to be effective in teaching HDCC were those that involved case-based and community engagement exercises. Recommendations for incorporating HDCC into the experiential education included preceptor development in areas of HDCC to assess student understanding of health disparities concepts, increasing student engagement with diverse patient populations, and implementation of cross-cultural communication models at clinical sites. Co-curricular and interprofessional (IPE) portions of pharmacy training were found to permit greater methodological flexibility for incorporating training in HDCC, as they often confronted fewer time or space constraints than classroom endeavors. Documented methods for teaching HDCC within co-curricular and IPE experiences included service learning, study abroad, symposia, and forums.Summary. There is a paucity of literature describing processes for incorporation of health disparities and cultural competency education and training into the PharmD program. Findings suggest that conceptual frameworks for HDCC should be used throughout the pharmacy curriculum, with learning activities mapped to relevant pharmacy education standards to ensure coverage of important practice competencies. Best practices also involve the use of contemporary tools, strategies, and resources from a cross-section of disciplines that provide opportunities for learners to correct misconceptions and biases through active situational problem-solving.

Preparing nursing students for home health using an escape room: A qualitative study

BACKGROUND

As healthcare continues to shift from hospitals to community settings, it is vital to prepare nursing students for community-based care, including home health.

DESIGN AND OBJECTIVES

This exploratory descriptive qualitative study examined students' experiences with a home health escape room and their perceptions of how the experience affected their learning.

METHODS

To escape the simulated apartment residence, student teams solved three challenges related to fall risks, food insecurity, and polypharmacy. Sixteen baccalaureate nursing students participated in focus groups and thematic analysis was conducted.

RESULTS

Four themes emerged: Being in the home and taking it all in; Elements that maximized thinking; Practicing and reflecting on teamwork; and Using lessons learned.

CONCLUSIONS

Simulated escape rooms offer a unique way to provide experiential learning to prepare students for home health clinical experiences.

Conceptualizing Social Ecological Model in Pharmacy to Address Racism as a Social Determinant of Health

Racism has been declared a public health crisis. The COVID-19 pandemic has highlighted inequities in the US health care system and presents unique opportunities for the pharmacy Academy to evaluate the training of student pharmacists to address social determinants of health among racial and ethnic minorities. The social ecological model, consisting of five levels of intervention (individual, interpersonal, organizational, community, and public policy) has been effectively utilized in public health practice to influence behavior change that positively impacts health outcomes. This paper adapted the social ecological model and proposed a framework with five intervention levels for integrating racism as a social determinant of health into pharmacy curricula. The proposed corresponding levels of intervention for pharmacy education are the curricular, interprofessional, institutional, community, and accreditation levels. Other health professions such as dentistry, medicine, and nursing can easily adopt this framework for teaching racism and social determinants of health within their respective curricula.

Global Health in Swedish Nursing Curricula: Navigating the Desirable and the Necessary

Global health challenges are likely to be aggravated in the coming years by rapid climate change and environmental degradation. To address the resulting health inequities, nurses need an integrated understanding of environmental and social determinants of health. This study adopts an explorative inductive approach to examine how global health and sustainability are expressed the course syllabi of undergraduate nursing programmes (n = 24) in Sweden. After excluding biomedical and other unrelated content, 67 syllabi were selected for a thematic analysis. Results indicate that global health, the social determinants of health and sustainability tend to appear in a fragmented manner in the syllabi. Global health content is often limited, relegated to elective courses, or altogether missing. A theoretical framework is lacking, and focus lies on an individual rather than structural perspective. Based on international policy, earlier studies on undergraduate nursing education and theoretical work, suggestions are made for how global health and sustainability content could be integrated into nursing education, notably by using a structural competency approach.

Effectiveness of flipped classroom teaching models in nursing education: A systematic review

OBJECTIVES

The purpose of this systematic review was to reveal the evidence of how the method of flipped classroom was applied in nursing education and examine the results associated with this teaching method.

DATA SOURCES

Peer-reviewed studies published from 2013 to 2020 were selected from the PubMed, Web of Science, and Science Direct databases.

REVIEW METHODS

A systematic review was conducted according to the PRISMA Statement Guidelines. Electronic databases were searched using a range of keywords, and the findings were integrated into a narrative synthesis. Quality appraisal was undertaken.

RESULTS

In total, 7470 articles were retrieved including the 24 paper those were finally selected for the systematic reviews. The themes identified were: academic performance outcomes, student perceptions, activities, and structures.

CONCLUSIONS

It was determined that the flipped classroom method supported learning effectively and increased the quality of teaching. Nursing courses are suggested to be structured as flipped classrooms.

Nurses' perceptions: Addressing social determinants of health to improve patient outcomes

Nursing organizations and leaders adopted the social determinants of health (SDOH) as essential to the delivery of health care, but little is known about working registered nurses' (hereafter nurses) views on the SDOH. The purpose of this study was to (1) explore nurses' perceptions of how SDOH affect patient care and (2) describe nurses' ideas about how SDOH can be addressed to improve outcomes and services. Thirteen registered nurses with a baccalaureate in nursing beginning their online graduate advanced practice educational program were interviewed. This qualitative descriptive study used constant comparative analysis for data analysis. The analysis found two major themes: (1) SDOH are integrated into the nurses' care. The SDOH experienced by patients challenges the nurses to provide care at the patient's level and to provide usable patient education, and (2) health-care delivery change is needed to achieve equity and to provide health care to those in need. The nurses recommended more organized, seamless health-care delivery and interdisciplinary advocacy to achieve these needed changes. Nurse educators and nurse leaders can harness the frustration and ingenuity of nurses to help the nurses advocate for health-care change that integrates the SDOH.

Twenty Years of Leading the Way among Cohort Studies in Community-Driven Outreach and Engagement: Jackson State University/Jackson Heart Study

Background: History has recorded the tremendous concerns and apprehension expressed by African Americans about participating in research studies. This review enumerates the collaborative techniques that were utilized by the Jackson State University (JSU) Jackson Heart Study (JHS) community-focused team to facilitate recruitment and retention of the JHS cohort and to implement health education and health promotion in the JHS communities. Methods: This review describes the evolution of the JSU JHS community initiatives, an innovative community-driven operation, during the period 1999–2018. Results: JSU JHS community-focused investigators published approximately 20 manuscripts, including community-led research and publications with community lead authors and co-authors, research and publications in collaboration with other JHS staff, through other JSU-funded projects. The JSU JHS community-focused unit also initiated the JHS Community Training Activities, developed the Community Health Advisory Network (CHAN), and trained and certified 137 Community Health Advisors. In addition, the JSU JHS community-focused unit developed the Collaborative Community Science Model (CCSM) that symbolized its approach to community engagement and outreach, and a Trust Scale for ascertaining African Americans’ willingness to engage in biomedical research collaborations. Conclusion: This review offers educators, public health professionals, and research investigators a useful starting point for the development, selection, or improvement of techniques to motivate, inspire, and engage community residents in a community–academia partnership that yielded maximum benefits in the areas of health education, health promotion and interventions, and biomedical research. Substantial, meaningful community engagement is possible when prioritizing elimination of health disparities and long-term improvement in health care access in the target populations.