Course Overview
The Institute of Medicine (IOM) believes that the nursing workforce requires higher levels of education to meet the needs of a changing population and healthcare system (American Association of Colleges of Nursing, 2019). At the moment, only 55% of nurses have Bachelor’s degrees, while the IOM’s goals include a 80% rate in the next decade (American Association of Colleges of Nursing, 2019). Encouraging more nurses to continue their education may require reinventing and tailoring the curricula to their demands and demonstrating that pursuing a higher degree will equip them with skills to handle more complex problems. The present course spans eight weeks and covers some of the most important topics in community health with regard to nursing practice.
Aspects of the Course
Benefits for the Learners
Learners are offered a concise but informative course that discusses a wide range of important topics relevant to the community nurse’s role. One of the benefits for the learner is seamless translation of theory into practice with a special focus on clinical thinking and communication skills. As opposed to the more traditional lecture format, students are given a voice and an active role in the process. Students operate through the spectrum of treatment and observe real-life scenarios they can encounter throughout their professions. All in all, the course is well-rounded in its coverage of crucial questions and developing complementing soft skills for navigating the future workplace environment.
Specific Concepts Emphasized in the Course
This course covers a wide range of concepts that can be roughly put into three categories. Firstly, the course introduces students to community health, social determinants of health, distribution of health outcomes, and the nurse’s role in their improvement. These concepts are more general and, therefore, lay a theoretical foundation for the next modules that rather focus on specific issues, such as nutrition, substance use, and sexual illiteracy. The last two modules highlight the practical approaches to community health and cover questions, such as “Collecting comprehensive information about a community’s health status” and “Changing community attitudes, beliefs, or social norms.”
Relevance to Professional Practice
The course seeks to develop practical skills that nurses need in everyday practice. According to the Center for Healthcare Strategies (2020), 36% of Americans have low health literacy, which translates into $236 billion in healthcare expenses each year. For this reason, there is a growing need for educating populations and promoting a proactive approach to maintaining and improving one’s health. However, nurses are not always well-equipped for dealing with diverse groups of people and finding the right communication tools for persuasion, rapport building, and conflict resolution. This course offers solutions to the most common nursing education problems and, what is more important, encourages nurses to develop self-confidence, charisma, and approachability.
Cultivation of Course
The course structure is in line with the scaffolding strategy. In learning, scaffolding refers to systematically building on students’ previous knowledge and experiences for developing new skills and integrating new information. As seen in the course overview, the course opens with the “Introduction to Community Health.” Not only does the module serve as a smooth transition into a new role, it also encourages nurses to define what community nursing means for themselves. The next module, “Population Health,” builds upon the definition of community health and takes a closer look at what shapes health outcomes in communities from socioeconomic perspectives. “Population Health” touches upon some chronic and acute diseases that receive more attention in the module “Epidemiology.”
Once the general theoretical foundations are outlined, the students are ready to study specific problems in community health closer. “Nutrition” addresses the effects of food on life and health outcomes, which also includes the discussion of social determinants of health. “Substance use” also keeps socioeconomic factors in focus, interweaving with the psychology and physiology of alcohol and drug abuse. The same goes for the “Sex education” module where students need to understand not only the etiology of diseases but also understand the barriers to family planning and safe sex practices. Lastly, “Community Assessment” and “Health Promotion” build upon the previously acquired knowledge to equip students with valuable practical skills.
Student-Centered Learning
Student-centered teaching refers to a broad range of educational initiatives, learning environments, teaching methods, and academic-based techniques tailored to meet the distinct learning desires and preferences of particular students. This course rejects the traditional lecture format and amplifies students’ agency and voices. By doing so, it turns the professor from a source of knowledge into the mentor and mediator. Below is a description of how each module promotes student-centered learning:
- “Introduction to Community Health” allow each student to define for themselves how they understand the role of a community nurse;
- “Population Health and Epidemiology” give the freedom to choose any population for research;
- “Nutrition,” “Sex Education,” and “Substance Use” imply that students choose or develop scenarios that they deem the most relevant based on scientific literature;
- “Health Assessment” and “Health Promotion” include peer-reviewed individual projects.
Professional Standards and Guidelines
The following analysis utilizes “Quality and Safety Education for Nurses (QSEN) competencies” issued by the Frances Payne Bolton School of Nursing (n.d.) (see Table 1). Created by a board of experts in clinical practice and education, the standards apply regardless of a graduate’s medical specialization or patient population focus.
Table 1. Alignment of key concepts with QSEN competencies.
Alignment of Weekly Key Concepts to Overview
The course covers eight aspects that have a direct relation to professional nursing practice in community settings. “The nurse’s role in the community” outlines the scope of responsibilities and expectations. “Social determinants of health” and “Distribution of health-related states” continue to build a scientific and theoretical basis for future practice by introducing nurses to the key concepts in population health. The next three concepts “Effects of nutritions,” “Substance abuse counseling”, and “Family planning and healthy practices” all cover specific, more narrow issues. The last two modules and their concepts focus more on the practical side of community health by teaching nurses to assess populations and take interventions.
Course Outline Relevance
In today’s evolving world, the school framework model is shifting towards high-quality education. Curriculum, together with other critical contributors, such as qualified instructors and the learning climate, is the center and primary function of an institution in developing an effective education framework (Khan, Hirani, & Salim, 2015). Lesson plan is the essence of education that brings vitality to the whole system of learning. Undeniably, it may be argued that the program is a practical element in turning the goal of the learning institution into reality. It is reflected as an outline which specifies the nature, structure of the program, tasks and evaluation for the achievement of educational objectives.
It is a continual method that includes the identification, preparation, interaction, and evaluation of student learning (Khan, Hirani, & Salim, 2015). Making the program functional is critical for it to be relevant to emerging patterns and specifications. The integration of the elements in the teaching methods is an essential feature and an attribute that is the basic foundation of the curriculum. This extends to all school programs, including nursing practice.
Currently, the health care sector confronts problems relating to patient acuity, affordability of quality services and innovations in information systems. Consequently, the congruence of those requirements in the program is one of the main elements that can be an important method in addressing the constraints of time and in training nurses to deliver professional treatment. The Nursing program aims to fulfill the various ideals and qualifications of its learners (Khan, Hirani, & Salim, 2015). The development of these principles in nurses will direct their service for patients, communities, the environment and society in general.
In addition, the nursing career often needs core skills such as analytical thought, psychomotor abilities, conflict resolution, and decision-making skills to support wellness and disease prevention. To obtain these qualifications, the nursing program requires a range of classes, including basic and applied sciences and humanities, which include the incorporation of theory into medical care. These courses allow student nurses to translate their skills into treatment in diverse clinical practice.
This transition involves a great deal of commitment from nursing students. Nurse educators instruct and test students in the domains of interpersonal skills, career development, nursing with clinical reasoning, concepts of health promotion and the implementation of psychomotor competencies. This strategy empowers learners to gain the proficiency of healthy and quality treatment for patients and their communities. It is also important for nurse instructors to align the content of teaching to the course at all stages to produce learning results that shape practical and skilled nursing care.
Learning Strategies
A learning strategy that is utilized throughout the course is group discussions. Stenlund, Jönsson, and Jonsson (2017) explain that collaborative or cooperative learning has been long accepted in educational settings and has grown to be a valuable learning condition. It is often argued that a group can achieve more than an individual, and group discussions can create a self-regulating system that weighs pros and cons of diverse opinions and challenges its participants. Stenlund et al. (2017) observe that group learning is superior to individual learning when it comes to problem-solving. Since the proposed curriculum has plenty of cases and scenarios, it is thought that group discussions will be one of the most effective approaches.
Another strategy is problem-based learning that operates on the premise that students process information better if they are offered complex real-world problems for resolving which they need to apply what they have just learned (Savery, 2015). Problems are the vehicle to promote student-centered learning of rules, frameworks, and principles as opposed to the traditional direct presentation of facts and concepts (Savery, 2015). Problem-based learning helps learners to develop their critical thinking skills and problem-solving abilities. Apart from becoming more autonomous in handling information, students that are taught using the problem-based method have the opportunity to develop their communication skills as well.
This module combines problem-based learning with role-playing another evidence-based method. Topîrceanu (2017) explains that role-playing is a part of the gamification teaching strategy that employs a game-like format for presenting new information and solving problems. 80% of students say they would be more productive if their school or workplace adopted a gamified approach to learning (Topîrceanu, 2017). Research has shown that roleplaying not only motivates and engages students but also boosts their attendance rates from 50-72% to 77-93% and full attendance rates from 12-16% to 50% (Topîrceanu, 2017). Thus, it is safe to assume that the selected strategy has practical benefits and enhances students’ emotional engagement.
Implementation of Learning Strategies
An identified active learning strategy is group activities, which can be achieved through cooperative learning. Group work offers learners the opportunity to use vocabulary in practical, systematic and exciting ways, gain self-esteem, and improve educational and social skills. The classroom structure should promote the combining of students with a variety of skills to enable interactive learning among students.
Group activities are structured in different forms, such as mixed academic successes, interest, vocabulary, mission, language and relationship. Small group work is organized in such a manner that students ought to be informed with the learning of all participants of the group as well as oneself. Groups are required to assist and inspire their participants to master scholarly materials. Each student in the community shall be collectively responsible for their learning. Explicit teamwork knowledge preparation takes place on a daily basis, and communities regularly process how well they function and learn together.
Assessment of Learning Needs and Styles
The learning strategies selected for this module will benefit verbal learners. To gauge this dimension, Richardson’s Verbalizer-Visualizer Questionnaire (VVQ) may be used (Koć‐Januchta et al., 2019). This questionnaire juxtaposes the verbal and visual learning styles, though it is not impossible for a person to combine the two. The questionnaire contains “I”-statements that the respondent needs to evaluate on a Likert Scale from 0 to 5 where 5 is “Strongly Agree.” Some examples of such statements include “I enjoy doing work that requires the use of words” and “My dreams are extremely vivid.”
The predominant learning style has not been chosen at random as the educator’s role relies heavily on interpersonal communication and the proper and effective use of words. Though some students are more verbally inclined, the course hinges on the premise that anyone and everyone can become an effective communicator. Role-plays and group discussions are organized in a friendly manner so that students can overcome their shyness or any other blocks.
Clinical Reasoning and Self-Reflection Skills
Clinical reasoning and self-reflection skills are vital to advancing in the nursing profession. Clinical reasoning is defined as the ability to integrate different types of medical knowledge and translate it into practice, all while critically assessing the assumptions and reflecting upon the process to arrive at the right diagnosis. As seen in the definition, self-reflection is an indispensable part of clinical reasoning.
In this context, self-reflection can be defined as an introspective capacity and ability to think about one’s character and actions. Every module reserves some space for self-reflection, but the concept has a special place within the “Introduction to Community Health” module. Within the module, students reflect on their own personal qualities and self-efficacy in relation to the studied role.. The modules “Community Assessment” and “Health Promotion” also develop self-reflective qualities as the themes require to take a look through the lens of personal perception. The same two modules are also best approached with clinical reasoning because making decisions should be based on scientific evidence.
Learning Environments
The proposed course promotes interprofessional teamwork and collaboration outcomes in a variety of environments: face-to-face, online, and clinical. As seen in the review, many activities involve live discussions and participation, especially when it comes to the second half of the course. Group discussions and question-answer tasks help learners to refine their face-to-face communication tasks. They become active listeners and public speakers, having to consider others’ points of view and substantiate their own. For example, after reading a journal article, two students can role-play two nurses from different departments (e.g. psychiatry and intensive care) that discuss how each of them can individually adapt the findings.
Student-centered outcomes are fostered through the mentor who serves as a “referee” for group discussions. He or she does not impose their opinion but steers the discussion and ensures that it stays on topic. Modules such as “Community Health Assessment,” “Substance Use,” and “Health Promotion” are probably the most relevant in terms of preparing students for navigating the clinical environment. The modules offer a variety of close-to-life scenarios in which students have to exercise their leadership qualities to serve as a medium between several parties, arrive at the right diagnosis, and take an intervention. For instance, one task may involve the roles of a physician, a social worker, and a nurse teaming up to counsel a patient who abuses opioids due to personal reasons.
Within this course, online communication is facilitated through discussion boards and forums. A variety of student-centered techniques are used, ranging from open-ended questions to encouraging student reflection. The online part of the course emphasizes student collaboration and group projects, which promotes students’ agency in group building and role assignment. The course also utilizes peer-review techniques, which allows a diversity of opinion and also develops students’ critical thinking skills. The “Epidemiology” and “Community Health” modules use the flipped classroom technique, which means that students have to study chosen populations at home and present results in class with a discussion to follow. The format allows participants to set their own pace and focus on self-chosen points of importance.
Nursing Students’ Experiences
Diverse cultural, societal, and life experiences can affect academic performance and learning outcomes. Roso-Bas, Jimenez, and García-Buades (2016) point out two categories of factors that shape learning experiences and impact the dropout rate in nursing students. Firstly, there are institutional aspects, such as scholarship systems, quality of education, support services, and staff qualification.
Chiu et al. (2016) add that the perceived parental income and parents’ education level (especially that of the father) is associated with learning opportunities and motivation in students. At the same time, the evidence that race and ethnicity have a relationship with academic outcomes is conflicted. The second category of factors belongs to the cognitive-emotional domain. Roso-Bas et al. (2016) specifically single out poor emotional intelligence, pessimism, and depressive rumination as traits and behaviors that discourage nursing students from learning. The instructional design may have to be tailored to meet particular students’ needs.
Learning Theories
The cognitivist learning theory is the predominant learning theory for this course. Cognitivism in education developed in response to behaviorism that required and measured learning outcomes by an outward exhibition of knowledge. In other words, behaviorists saw learning as merely a reaction to a stimulus, dismissing the role that cognitive processes play in processing new information and developing new skills. Conversely, cognitivists put a focus on the internal processes and mental connections that occur during learning (Arab, Ghavami, Akbari Lakeh, Yaghmaie & Hosseini-Zijoud, 2015).
From this perspective, the learner is seen not as a reservoir for knowledge but as an information processor. This course utilizes the cognitivist learning theory by making students active participants of the learning process. While performing well on tests is important, it is the personal understanding, encoding, and storage of information that matter the most. For this reason, the course incorporates a lot of tasks that revolve around self-reflection, problem-solving, and group discussions. Aside from that, the instructional design takes into consideration the diverse learning styles of students, such as visual and verbal, to tailor information presentation.
References
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