Public Health Nursing Vol. 31 No. 1, pp. 69–78 0737-1209/© 2013 Wiley Periodicals, Inc. doi: 10.1111/phn.12061

SPECIAL FEATURES: EDUCATION

Community-Based Health and Schools of Nursing: Supporting Health Promotion and Research Crystal Shannon, Ph.D., R.N., M.B.A. School of Nursing, College of Health and Human Services, Indiana University Northwest, Gary, IN Correspondence to: Crystal Shannon, Assistant Professor, Indiana University Northwest, College of Health and Human Services, School of Nursing, 3400 Broadway, Gary, IN 46408. E-mail: [email protected]

ABSTRACT Objective: This article examines the role of community-based schools of nursing in the promotion of public health and research in poverty-stricken areas. Design and Sample: This was a three-phase study (questionnaire and key-informants interviews) that surveyed representatives of prelicensure associate and baccalaureate nursing schools (n=17), nursing-school key informants (n=6) and community leaders (n=10). Measures: A 13-question web-based survey and semistructured interview of key informants elicited data on demographics, nursing program design, exposure of faculty and students to various research and health promotion methods, and beliefs about student involvement. Results: Nursing schools participated minimally in community-based health promotion (CBHP) and community-based participatory research saw reduced need for student involvement in such activities, cited multiple barriers to active community collaboration, and reported restricted community partnerships. CBHP was recognized to be a valuable element of health care and student education, but is obstructed by many barriers. Conclusions: This study suggests that nursing schools are not taking full advantage of relationships with community leaders. Recommendations for action are given. Key words: CBHP, CBPR, community-based health, community-based schools of nursing, health promotion, nursing, nursing schools, participatory, public health.

Researchers recognize that community-based health promotion (CBHP) models are important if we are to improve health decisions by going “beyond individual lifestyles to distal factors that influence health…” (Pender, Murdaugh, & Parsons, 2006, p. 75). This recognition encourages health care providers to engage with factors such as social conditions that influence health. The Essentials of Baccalaureate Education for Professional Nursing Practice (American Association of Colleges of Nursing, 2008) requires nurses to provide care from a holistic base and across all environments. The aim of this study was to gather evidence about present and future incorporation of CBHP and especially participatory research within nursing education.

Theoretical framework Leininger and McFarland (2002) recognize community-based education as one of the most important aspects to delivery of culturally sensitive care. In their theoretical framework, before a system can deliver effective health services, providers must recognize and understand cultural universalities and diversities. Once health providers are educated in cultural factors, the authors recommend nurses use “culture care accommodation, negotiation and culture care restructuring” (p. 320) in equally important roles to assess, identify (diagnose), implement (plan), and to evaluate individuals and environments needing health care assistance. Inclusion of this theory into mainstream health care and the nursing process will improve the participatory

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nurse–client relationship and patient health outcomes (Leininger & McFarland, 2002). Community-based collaborative partnerships are recognized as a highly effective method for addressing population health while maintaining cultural awareness and sensitivity (Cashman et al., 2008). A requirement for such collaboration is active involvement of all stakeholders (e.g., nursing education, community members). Thus, stakeholders establish a mutually directed process to meet the needs of everyone involved. Such mutual direction varies from traditional research and volunteer efforts by transforming the community from a passive to an active role. Seifer and Calleson (2004) have identified this collaborative method as the most important factor to address community-based health care issues. Of course, many schools of nursing (SON) report service learning (SL) activities that encompass the principles of CBHP. Yet researchers have recognized that nursing could further assess the true nature and design of SL-based health education to ensure “true” empowerment of the collaborating community partner (Furco, 2002).

Community-based health promotion, community-based participatory research, and service learning Although similar in design and focus, CBHP, SL, and community-based participatory research (CBPR) differ in their approaches to communitybased health. CBHP is a framework designed to focus on population health and education within a community (Merzel & D’Afflitti, 2003). Service learning has been defined as “a form of experiential education in which students engage in activities that address human and community needs together with structured opportunities intentionally designed to promote student learning and development” (Jacoby, 1996, p. 5). Thus, a traditional definition of SL submerges cultural factors under the general concept of community needs. Community-based participatory research (CBPR) is known as an approach to research that uses the combined efforts of trained professionals and community members in activities that promote the advancement of community health and safety (Israel et al., 2010). The primary components of CBPR are community involvement, buy in, and empowerment. This research method places great emphasis on the inclusion of community-centered

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care and interventions. Although most research is centered on the work performed by the researcher, CBPR requires that stakeholders participate in assessing their own community, developing their research questions, planning, implementing, and even evaluating the results. CBPR has been proven to promote partnership development, equitable sharing of knowledge and responsibility, and the use of community-specific data to optimize impact (Minkler & Wallerstein, 2008). Although undergraduate nursing students may not participate in active research such as CBPR, the principles that guide this method are important to the overall design of any community-based intervention. The primary theory behind CBPR posits that health resources and promotion emerge from within a community, not from the health care environment (Jewkes & Murcott, 1998). This approach of encouraging stakeholder participation from within the social contexts in which disease states occur is in alignment with nursing values of patient- and community-centered care. While each method (CBHP, SL, and CBPR) includes a connection with the community, the process and degree of community involvement vary. SL is primarily focused on the educational needs of the student through the use of community service, volunteerism, and community-directed care. CBHP focuses on the delivery of community-based projects designed to improve community health but CBPR focuses on the active involvement (participation) of all stakeholders in the full process of researching community issues. While CBPR is a mainly noted as a research process, it is guided by patient- and community-centered principles that merit the focus of the nursing profession.

Purpose of the study The purpose of this study was to evaluate the current actions taken by nursing education units in CBHP and research (e.g., CBPR) and identify areas for improvement. As elaborated above, CBHP is not simply the provision of care within the community, but includes the philosophy and characteristics of environmental contexts that support management of social and economic influences, person (community) centered care, and community empowerment in health care assessment, program development, implementation, and evaluation (Baker & Brownson, 1998; Schultz, Krieger, & Galea, 2002). CBPR explicitly includes stakeholder input in health

Shannon: CBHP and Nursing Schools promotion and research, and postulates that community collaboration is known to influence social change (Minkler & Wallerstein, 2008). Many SON are located within high morbidity and mortality communities, and CBPR is acknowledged to be a key factor in understanding and reducing these rates (Israel et al., 2010). An extensive literature review discovered that there was limited research related to the CBHP and CBPR activities of nursing schools in the Chicago metropolitan region. Yet in 2009, approximately 20% of Chicago, Illinois, residents had income below the federally designated poverty level—versus 11.9% for the entire state (City Data, 2009). In high-poverty communities, community-based SON are uniquely positioned to provide quality education and develop collaborative and mutually beneficial community partnerships.

Methods Design and sample A qualitative inquiry was performed to explore how Chicago metropolitan SON representatives and community informants understand and value CBHP, and the frequency and nature of past and present

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collaboration in CBHP and CBPR. A survey was sent to the Deans, Program Directors, or designated personnel (as chosen by the SON) of all nursing schools in the Chicago metropolitan region (N = 44) requesting demographic details, the involvement of educators and students in community health research and practice, and the factors that influence their participation or nonparticipation in such activities. In addition, semi-structured interviews were conducted with key informants from low-income communities (n = 10) and their nursing schools (n = 6). The interviews sought to identify factors influencing CBPR activities and participation, SON perceptions of CBPR importance and value to students, and community-member key informant (CKI) perceptions of value to the community (see Table 1). Permission to perform the study was obtained from the appropriate university Institutional Review Board and signed informed consents were obtained from study participants. There were no hypotheses being tested in this study and all quantitative data collected were used to label SON characteristics and to explain their relationships with CBPR. Descriptive analysis was used to categorize and compare the variables (SON type, location, participation in CBPR activities, perception of value, community poverty rate), and then to evaluate the results.

TABLE 1. Description of the Recruited Samples Recruitment population total

Study population (response rate)

Web-based questionnaire

44

17 (40.4%)

SON key informants interviews

13

6 (46%)

Community member key informants interviews

12

10 (83%)

Research tool

Inclusion criteria Location of SON in Chicago, IL Location of SON within 50 miles of Chicago city limits Provision of Baccalaureate or Associate Degree Registered Nursing Education Consent to participate Location of SON in Chicago, Il. Location of SON within 50 miles of Chicago city limits Provision of Baccalaureate or Associate Degree Nursing Education Located in a community where families and/or individuals fall below the poverty level at a higher rate than the national average (key informants interview only). Consent to participate Geographical location in Chicago, IL or within a 50-mile radius of Chicago Participation in community-based activities Recommendation from interviewed SON Key Informants Identified by SON Key Informants as a community partner Consent to participate.

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Measures Data were collected via two instruments: a webbased survey questionnaire (n = 17) and the protocol for the key informant interviews. Key informants came from two groups: Chicago metropolitan SON key informants (SKIs) (n = 6) and CKIs including community leaders (n = 10). Phase I. Data were collected in three phases. The first phase included mailing a 13-question webbased survey (see Table 2) of SKIs (N = 44) within a 30-mile radius of the city of Chicago, Illinois. Potential survey participants were recruited by e-mail and were provided the web link to the survey, complete with instructions. Eleven schools (24%) were located within the city limits of Chicago,

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24 (54.5%) in the suburban region, and nine (20%) in northwest Indiana. The 13-item questionnaire solicited school location, academic type of nursing program (BSN and ADN), participant’s academic role, current level of competence in CBPR of nursing faculty, degree of perceived responsibility toward community health promotion, past and present CBPR activities, and factors influencing CBPR participation (including barriers to involvement). Phase II. In the second phase of data collection, the researcher selected SKI respondents (n = 6) from schools within high-poverty communities and interviewed them. These semi-structured interviews (See Table 3) sought to ascertain how involved these schools were in participatory

TABLE 2. Web-based Survey Questions to Representatives of Chicago-area Schools of Nursing 1. Please provide some demographic information about your school. 2. What is your academic position? 3. How are your nursing students educated about community health? 4. Please indicate how strongly you agree or disagree that nursing student involvement in community-based health promotion (CBHP) activities is a part of your professional responsibility. 5. What types of experiences do your students obtain in applying community health concepts? 6. What is your personal knowledge or experience related to Community-Based Participatory Research (CBPR)? 7. When considering your nursing faculty as a whole, what is the knowledge base or experience related to CBPR of your faculty? 8. How many CBPR initiatives has your school participated in within the past 5 years? 9. How many CBPR initiatives has your school participated in within the past 10 years? 10. How many CBPR activities are currently active within your school? 11. Please describe the types of CBPR projects or initiatives currently underway within your school of nursing. 12. What are the factors that most influence your program’s participation in CBPR projects or initiatives? What are the barriers to your participation in these activities? 13. To what extent is CBPR a part of your nursing school curriculum?

TABLE 3. School of Nursing Representative Key Informants Interview Questions 1. Describe how your nursing school has chosen to assist community partners with community-based health care issues 2. How frequently does this occur? 3. Please describe the types of partnerships that took place? 4. Who are some of your past and present community partners? What is their contact information? 5. What is your understanding of: 6. Community-based Research 7. Community-based Health Promotion 8. Community-based Participatory Research? 9. What would you say are the advantages of these activities (Community-Based Research, Community-Based Health Promotion and Community-Based Participatory Research) for a nursing school? 10. And what would you say are the advantages to the community of these activities (Community-Based Research, Community-Based Health Promotion and Community-Based Participatory Research) 11. To what extent are your students prepared to become involved in community-based research and health promotion? 12. Would you like to see your SON more involved with community-based health promotion activities? 13. If yes, how? What resources would be required to meet this plan?

ST1. Keep the same types of programs we currently have. No change needed ST2. Not an option, barriers are too great ST3. A needed change is recognized and encouraged ST1. Student preparation not applicable for undergraduate students ST2. Student preparation is optional ST3. Student preparation is required ST1. Buy in ST2. Increasing involvement ST3. Improved assistance ST1. Improved understanding of community members ST2. Increase in knowledge ST3. Purpose of CBHP is primarily for student practicum rotations ST1. Pride, excitement and eager to share ST2. Request standard definitions Subthemes (ST)

Question 6

T6. Increasing involvement of SON in Communitybased health promotion

Question 5

T5. Student Preparation

Question 4

T4. Advantages to the community

Question 3

T3. Advantages to a SON

T2. Understanding of Community-based Research, CBHP, Community-based Participatory Research ST1. Yes to CBR ST2. Yes to CBHP ST3. Yes to CBPR

Question 2 Question 1

T1. Past assistance with community partners

Analytic strategy Analysis of qualitative data was performed using Microsoft Excel for the descriptive statistics of the study and NVIVO©. Data analysis began with evaluation of all the variables described in the survey and interview instruments. The collected data were checked for accuracy, and all responses were within expected range. Analysis of the interview data also included consideration of internal consistency, specificity, iteration, and field-notes on contextual variables. For example, several interviewees answered questions with an elevation in voice inflection, indicating they were surprised by the question or were unsure of its meaning or intent. Such responses cued the researcher to clarify,

Major theme (T)

research; how well they knew CBPR; how willingly they might participate in CBPR-related activities; and how they perceived the advantages/barriers to such activities for nursing students. In the interviews, SKIs discussed past and present community partnerships; knowledge and general understanding of CBHP and CBPR; current level of, and plans for, academic-community partnerships, challenges to these activities, and types of support needed to develop them further. Inclusion criteria for the interview were location of SON in or within 50 miles of downtown Chicago, provision of BSN or ADN, location within a high-poverty community, and consent to participate. The recruited SON representatives were from BSN (54%) and ADN (46%) nursing schools within the Chicago city limits (54%), the suburban region (23%), and neighboring northwest Indiana (23%). Phase III. A third and final step included interviews with a convenience sample of local CKIs (n = 10). The CKIs were past community partners of SON, who had been identified via feedback from the SON interviews. They represented the same regions as the SON and were community health leaders at various home health care agencies, nonprofit organizations, local hospitals, and federally funded community clinics. The interviews primarily took place at the CKI’s location or preferred area and included discussions centered on the understanding and experience with CBHP, perceived advantages to the community of CBHP and particularly CBPR, types of activities and partnerships designed with local SON, and perception of areas for collaborative-relationship development (Table 4).

TABLE 4. Themes of Schools of Nursing (SON) Interviews Concerning Community-based Health Promotion (CBHP) and Community-based Participatory Research (CBPR)

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repeat questions, and review content until the interviewee confirmed comprehension. Interview responses. Initially, broad-brush coding was performed with NVIVO© using wordfrequency query from the transcribed interviews of both the SKIs and CKIs. This initial coding allowed for unitizing and categorizing the data. As additional data were collected, further categorizing was performed in a similar manner until a set of themes was established. With the initial coding complete, interview participants were again contacted to confirm ideas, statements and reports as needed; and major themes and subthemes were confirmed. The framework for the data collection and processing was established as recommended by Lincoln and Guba (1985) who acknowledged the use four principles when determining the point at which data collection and processing should terminate the following: exhaustion of sources, emergence of redundancy, emergence of themes, and feelings of irrelevance. The following steps were taken during the data collection and processing phases for both the SKI and CKI interviews: 1. Interview transcription of SKI and CKI using Dragon Naturally Speaking Software© 2. Transcription of field notes 3. Manual coding of field notes’ common themes 4. Manual coding of SKI and CKI transcription 5. Word-frequency query using NVIVO© for both SKI and CKI interview transcripts to determine possible further coding themes 6. Creation of code-books for both SKI and CKI interviews. Frequent cross-checking was performed to confirm emerging themes. Cross-checking involves multiple methods (three in this study) to crossexamine the results (O’Donoghue & Punch, 2003). For example, the SKI (n = 6) and CKI (n = 10) interviews were directly obtained from the data sources; the researcher then used Dragon Naturally Speaking© software to transcribe the interviews. This software required the researcher to listen to and orally repeat all interview responses and to cross-check the software-generated transcription for accuracy. The last steps in the thematic process included a three-level data analysis process designed to offer additional researcher opportunity to reduce transcription error, coding error or misinformation.

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This involved adding the researcher’s field notes and the member check results. Member check is acknowledged as a process by which qualitative data are validated and confirmed with sources (Lincoln & Guba, 1985). The member check process was performed on the interview participants to allow the opportunity for theme and transcript confirmation and clarification. Cross-checking was performed at varying stages of data collection to ensure accuracy of data and to maintain reflexivity for the researcher in encouraging self–awareness and frequent self-correction. Macbeth (2001) recognized cross-checking as an important tool in qualitative analysis to assist the researcher to reduce or remove bias while performing continual self-analysis and self-reflection.

Results Descriptive characteristics Data collected from the web-based survey included five areas: SON frequency of CBPR participation, personal knowledge of CBPR, faculty knowledge of CBPR, perceived responsibility toward promoting CBPR, and number of full-time faculty and students. The results showed the average survey responder was a Program Director or Coordinator of a school with an average of 13 nursing educators and 212 enrolled students. Survey responders reported little experience or knowledge of CBPR, no nursing faculty knowledge or experience with CBPR projects or initiatives, and no inclusion of CBPR as a part of prelicensure nursing education. In addition, responders expressed feelings of only “some” professional responsibility (vs. a great deal) toward including nursing students in community health promotion activities and research. Themes from interviews Analysis yielded the following themes and subthemes: pride or excitement for past health promotion with community partners (83%), verbalized understanding of CBPR (17%) and CBHP (67%). Asked about the potential advantages of CBPR for their students, SKIs (50%) saw such projects not as improving understanding of the community, but as a source of practicum rotations. Only one responder (17%) reported that their nursing program required student preparation in CBPR. The other

Shannon: CBHP and Nursing Schools responders were equally divided: half reported that CBPR student preparation was not applicable to undergraduate students and half that such preparation was optional in their program. Interviewed community members (n = 10) also reported valuable feedback regarding the involvement of local SON in community-based projects. The following themes and subthemes were derived from the interviews:

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Although the majority of CKIs reported no experience with CBPR, 80% of them verbalized an interest in partnering with local SON for CBHP and CBPR projects. This is in contrast to the 33% of SON representatives who recognized and encouraged an increased student involvement in these activities. Of the CKI responders, 60% admitted to prior or current experience with CBHP that involved a local SON. However, 50% of the respondents offered recommendations to local SON, requesting increased student exposure and involvement in CBHP activities. They cited the goal of improving students’ sense of value and responsibility toward community health and expanding SON relationships with community partners. The CKIs discussed concerns that the current relationship between local SON and both community agencies and individuals was limited and of questionable effectiveness.

schools had little experience or knowledge related to CBPR and did not include CBPR as a part of prelicensure nursing education. According to the SON program representatives, faculty also had no knowledge or experience with CBPR activities. Furthermore, survey participants were only slightly more than neutral in their perception of professional responsibility toward promoting nursing student involvement. In addition, only 33% of SKIs interviewed discussed the presence of a college or university level of commitment to community health, with many participants reporting multiple barriers (e.g., time, personnel, student interest, and cost of resources) to this process. One SON interview participant replied: “…we always wished we could do more (activities) but you do what you can…” Another participant voiced a concern about their nursing students doing “too much” in terms of CBHP and questioned the consideration of increasing the amount of student participation: “…I don’t know, more involved? Obviously we are always looking for increased opportunities for students. However, there are (only) so many hours in a day …” Interestingly, ADN representatives responded more favorably (vs. BSN representatives) to the interview questions related to increasing or improving student involvement in community-based health efforts. This finding is surprising based on the lack of specific community health nursing education within the traditional curriculum design of ADN programs. However, the majority of prelicensure RN programs represented in the SKI interview process were those from a BSN school (response rate 67%). Further breakdown of the web-based survey respondents was limited due to the anonymity of the participants. However, both SON survey and interview responders also mentioned lack of program focus and design as being a factor in lack of CBHP activities. Half (52%) of the sample for the web-based survey and 54% of the interviewed school leaders represented ADN programs—not required by the state to teach community health as such.

School of nursing representative feedback Results showed that Chicago metropolitan SON participate in limited CBHP and no recent CBPR activities due to barriers related to cost of personnel, time, and curriculum design. Deans, Program Chairs, or designated personnel at the participating

Community member key informant (CKI) feedback Major themes noted from the CKI interviews were notable pride in helping others, infrequent or limited involvement in SON-related CBHP efforts, recognized advantages to the communities for SON

● Fifty percent of the respondents reported they participated in community-based projects because they wanted to do something for others. ● Only one respondent described health professions faculty/students as the leading contributors for any known CBHP activities. ● Sixty percent of the respondents reported improved understanding of the community is the primary advantage nursing schools gain when they participate CBPR projects. This is in contrast to only 33% of SON representatives who reported community understanding as the primary advantage to student participation in CBHP projects.

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collaboration, and lack of knowledge of CBPR (but visible excitement for participation in CBPR when explanation provided). Some of the suggestions from the CKI interviews included increasing the presence and number of nursing students at local community agencies, improving the students’ sense of value and responsibility toward community health, and expanding the development of SON relationships with community partners. For example, when asked about their thoughts regarding current SON and community relationships and what measures would they like to see implemented, one CKI replied “… I would like for it [practicum rotation] to be more of an encompassing experience than just learning technical skills; I want social skills as well….” In addition, one CKI mentioned a desire to be a part of a concerted effort to locate community-based collaborative partners to assist nursing educators in gaining meaningful student experiences. CKIs (n = 10) shared concerns that the activities of SON were greatly limited in terms of type, time, and student involvement. For example, one CKI acknowledged barriers that precluded continuing a previous relationship with the local SON: resistance to change, ineffective communication, and lack of interest. Despite this perception, many CKI’s were perceptibly excited and open to the idea of finding innovative ways of establishing or resuming collaborative partnerships.

Discussion Data from this sample of Chicago metropolitan SON suggest that most nursing schools were participating in limited collaborative partnerships. Many of these activities were designed only with the student’s educational need in mind and lacked participatory involvement between the schools and the community partners. Several schools described practicum-based activities in which the student was exposed to and delivered health care services in community settings, but with limited active involvement by stakeholders and students. The provision of care was presented as being directed at the community and not with the community. Although a few SON representatives described joint efforts with community partners in identifying communitybased issues for SON participation, most SKIs voiced little need for improving those partnerships. The feedback from the community partners identi-

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fied a theme of wanting to strengthen and grow the current relationships with the SON. The survey response of “some” professional responsibility (67%) versus “a great deal” of professional responsibility toward student involvement in CBHP (18%) is in direct contrast with the primary function of nursing as one of education, support and disease prevention. A choice of “some” professional responsibility also suggests that while SON survey respondents believed they should expose their nursing students to community health promotion activities, this was not a priority within their schools. Overall, both survey and interview responses emphasized a desire to keep many of the established programs. Most of the respondents either saw no need for improvements or changes to their community health curriculum, or they saw the barriers being too great to easily overcome. The responders shared concerns that nursing students have only received basic forms of communityhealth education, but questioned the need to provide additional research exposure. One responder stated that she “did not believe CBHP to be a great emphasis” in her nursing program and that time allotment affected this lack. Other responders reported that their students lacked sufficient understanding of research concepts to participate in CBPR activities. These findings are in direct contrast with the educational requirements of The Essentials of Baccalaureate Nursing Practice (American Association of Colleges of Nursing [AACN], 2008), which encourage clinicians to participate in research and utilize research findings. Although state licensure and accrediting boards require community health concepts to be taught to prelicensure RN students (National Council of State Boards of Nursing, 2010; National League for Nursing Accrediting Commission, 2010; AACN, 2008), the influence of program-specific measures potentially impacts this education and should be further investigated. The lack of SON participation and student education in research activities decreases the nursing student’s level of knowledge and ability to fully function within the scope of nursing practice. The Institute of Medicine (IOM, 2010) has researched and evaluated the role nurses would play in the future of health care. One of the primary recommendations recognized the need for nurses to become full partners with other health care professionals and be exposed to additional areas of health

Shannon: CBHP and Nursing Schools care (e.g., community-based health care, public health). Lack of such prelicensure education limits the ability of the newly licensed nurse to fully understand the impact of culture and socioeconomic status on health care decisions and treatment. There was a notable difference between SON and community-partner perception of SON involvement in CBHP and CBPR. All community members voiced a desire to create dialogue and improve SON collaboration. In effect, they invited SON to discuss and share what the SON and community leaders have done and might do to address CBHP. During the personal interviews several CKIs verbalized a desire to improve the collaborative partnership with their community-based SON. Such region-wide joint collaboration could allow for multiple agencies to work together under jointly created missions and visions. These experiences would be focused on improving the health of the indigent and teaching the students community-based health concepts. Comments from both the SON key informants and CKIs acknowledged an increasing awareness of the changing focus of nursing practice from hospitalbased to community-based. CKIs also voiced a desire to build and expand their current relationships with SON in a joint effort to offer valuable training for students and provide health education and treatment to populations affected by high levels of morbidity and mortality. This area of focus requires nursing education to offer students additional real-world opportunities to practice community health concepts. These limited study data also suggest many nursing school faculty had very little knowledge of CBPR—community-based participatory research. CBPR terminology is more frequently used in public health education and research. However, the regulatory and accrediting requirements of “applying knowledge of new sciences” for newly trained nurses remains an important element within the profession. Despite the unfamiliar terminology, the principles of addressing community health are shared by public health researchers, officials, and nursing educators; thus they should be included in nursing education. Based on the data from this selective study, the following recommendations are offered to Chicago metropolitan nursing schools toward improving their relationship with the communities around them:

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1. Offer a day of dialogue for SON faculty, community partners, and community members to discuss current needs and scope of SON involvement. 2. Expose SON faculty to methods of community health promotion such as CBPR to potentially broaden their understanding of communitybased health care. 3. If not already done, create an alliance of regional SON devoted to identifying potential areas for improving student exposure to CBHP. Strengthen relationships between regional SON to identify potential areas for improving student exposure and participation in CBHP. 4. Acknowledge nursing as no longer being primarily hospital-based and increase student exposure to the methods of CBHP. 5. Expand into the community, asking for input and active involvement on the identification of their needs and how SON can better build lasting collaborative relationships with them. This study identified a need for improved collaborative partnerships between local Chicago metropolitan nursing schools and community partners. The restricted involvement of nursing schools and their students in CBHP is a lost opportunity to engage students with seasoned health care providers in direct patient care. In addition, the lack of CBPR principles and activities at local SON potentially minimize the impact of any health promotion efforts. Educators can no longer rely upon old methods of instruction, training and preparation when educating the nurse of the 21st century. Increasing student exposure to community settings is suggested to improve the opportunities students have to understand and apply community health promotion and research concepts. The principle of community participation requires a paradigm change and this is often met with considerable barriers (e.g., time, personnel and resources). These barriers potentially limit student exposure to “realworld” care environments and reduce the potential collaboration of nursing and public health experts to offer a more holistic health care regime and leadership foundation. Although various reasons and barriers to collaboration have been mentioned, active involvement of all health care personnel in CBHP and participatory research activities continues to be needed. The inclusion of nursing students

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and faculty in health promotion and research can be a winning combination, accelerating the development of grass roots participatory projects aimed at promoting student and community education.

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