Journal of Community Health Nursing

ISSN: 0737-0016 (Print) 1532-7655 (Online) Journal homepage: http://www.tandfonline.com/loi/hchn20

Evaluation of Public Health Science in the Graduate Community Health Nursing Curriculum Jacqueline Blank Sherman & Kathleen M. May To cite this article: Jacqueline Blank Sherman & Kathleen M. May (1991) Evaluation of Public Health Science in the Graduate Community Health Nursing Curriculum, Journal of Community Health Nursing, 8:2, 113-119, DOI: 10.1207/s15327655jchn0802_6 To link to this article: http://dx.doi.org/10.1207/s15327655jchn0802_6

Published online: 07 Jun 2010.

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JOURNAL OF COMMUNITY HEALTH NURSING, 1991, 8(2), 113-1 19 Copyright O 1991, Lawrence Erlbaum Associates, Inc.

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Evaluation of Public Health Science in the Graduate Community Health Nursing Curriculum Jacqueline Blank Sherman, PhD, RN, and Kathleen M. May, DNSc, RNC The University of Arizona

The purpose of this article is to describe and evaluate a unique course in Public Health Science that has recently been implemented in our College of Nursing. This course seeks to provide a synthesis of public health and nursing. The course description as well as the course objectives are outlined. A 22-item questionnaire was developed to obtain demographic information regarding thle students enrolled in the course, their community health experience prior to entering the graduate program, their clinical area of specialization, reasons for enrollpent in the course, strengths and weaknesses of the course, the degree to which the cqurse met the objectives, and recommendations for future courses in Public Health Science. The findings suggest that the content of Public Health Science has been lintegrated into the graduate community health nursing program with much success.

The sperialty area of community health nursing has a history of identity associated with both nursing and public health science, directed toward the health of the community. Community health nursing reflects nursing practice and public health science alqng with the respective body of knowledge for each discipline (Hanchett & Clarke, 1988). This dual focus of community health nursing requires a critical analysis of t~heeducational preparation necessary for practice. A sydthesis of conceptual components of both fields is necessary in order to develop the body of knowledge unique to community health nursing (Hanchett & Clarke, 1988). A landmark attempt to define the field occurred with the separate publicadion of two documents, one by the Public Health Nursing Section of the American Public Health Association (1980) and one by the Division on Community Health Nursing of the American Nurses' Association (1980). Both documents identified the dual bases of community health nursing and made recommendations for education and practice. There has been a heightening of interest in clarifying the concepts unique to the field (Hamilton & Bush, 1988; Hanchett & Clarke, 1988; Schultz, 1987). Reque$ts for reprints should be sent to Jacqueline Blank Sherman, PhD, RN, Assistant Professor, College of Nursing, The University of Arizona, Tuscon, AZ 85721.

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The "Consensus Conference on the Essentials of Community Health Nursing Practice and EducationyyU.S. Department of Health and Human Services (1985) identified essential content for graduate education in community health nursing. These include epidemiology, biostatistics, community assessment, program planning and evaluation, nursing theory, management theory, change theory, economics, politics, interventions at the aggregate level, public health administration, research, history of community of health, and issues in community health.

REVIEW OF GRADUATE COMMUNITY HEALTH NURSING EDUCATION

A recurring issue for years was whether community health nursing education would be better accomplished through schools of public health or schools of nursing (Golden & Moore, 1987). One report provided recommendations for programs in schools of public health; joint programs, multidisciplinary education, and evaluation of programs in public health and in nursing (Damman et al., 1966). A joint program that existed from 1953 to 1961, The Simmons-Harvard Graduate Program had temporary success (Golden & Moore, 1987). However, the divisions between the school of public health and school of nursing and between nursing in public and private agencies, the trend toward programs in schools of nursing, and other factors resulted in difficulty attracting students to the program (Golden & Moore, 1987). In the 1970s there was increased emphasis on community health nursing in graduate nursing programs which led to more attention on research and theory development (Ohlson & Shine, 1979). Conceptual development in the field of community health nursing is reflected in the pattern of development typified in three graduate programs described in the 1970s to 1980s. The Indiana University program in community health nursing focused on populations and community (Flynn, Gottschalk, Ray, & Selmanoff, 1978). At the University of Kansas School of Nursing, the program addressed change at the societal, individual, and family levels, with "the total community as patient" (Cobb, 1977, p. 41). Nurse-managed clinics were identified as a way to integrate clinical, aggregate foci, and research in the field (Cobb, Derr, & Pieper, 1980). At the University of California-San Francisco, the master's program provided a synthesis of nursing and public health, with public health science and nursing science cores (Archer, 1982). These selected programs focused on the community as client and emphasized the synthesis of nursing and public health. The evolution of conceptualizations of community health nursing stimulated development of the specialty and the recognition of the importance of both nursing and public health content (Barkauskas, 1982). Hanchett and Clarke (1988) described the synthesis of nursing theory and public health science and the need to address the complementarity of these two paradigms.

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The areas of congruence and incongruence are addressed and have been considered in the implementation of the course that is described.

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COURSE DESCRlmlON The course entitled Public Health Science is available to all graduate students and a required course for those in the community health nursing major. There are no prerequisites except that the student be admitted to graduate study. The course is a three-credit course held one evening per week for one semester. This graduate level course focuses on a synthesis of theories from nursing and the public health sciences. The emphasis is on improving the health of the community by identiifying subgroups within the community populations that are at high risk for illness, disability, or premature death. This course focuses on primary prevention and health promotion directed toward a total community or population group. Course content includes epidemiology, history of public health, social policy, legislative/political issues related to public health, economics, administration, and change theories as applied to advanced community health nursing. The objectives of the course include the ability of the students to: 1. Document the U.S. and international need for primary prevention and health promotion. 2. Identify community and population groups as a unit of intervention from an epidemiological perspective. 3. Identify historical practice and impact of public health science nationally and internationally. 4. Analyze legal/political mechanisms for facilitating primary prevention and disease prevention related to extant public health issues. 5. Identify the community health nursing role as practitioner, researcher, and consultant. 6. Examine economic forces and issues pertinent to community health nursing practice nationally and internationally. 7. Synthesize relevant public health and nursing theories. 8. Identify research-based, effective community health nursing interventions.

The teaching methods include lectures, guest presentations, seminars, and discussion and analysis of community health practice. Two assignments are provided to address the course objectives. A seminar conducted by each student is focused around a major national or international public health issue within the community health nursing purview. Included in the seminar are the identification of the historical origin of the problem, epidemiological base for the problem, impinging and facilitatinlg community factors, and the research base for interventions attempted in regard tro the problem identified. The second assignment is an intervention paper addressing the same problem

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chosen by the student for the seminar presentation. The student is required to document the problem biostatistically; identify relevant economic, legal, and political forces; propose a theory-based community health nursing intervention with a community or population group as the client; and propose an evaluation plan. The course is organized around the Institute of Medicine Report, The Future of Public Health (1988), addressing the current public health issues facing our nation. The students have the opportunity to participate in the nominal group process (sharing of ideas independent of the ideas of others), identifying research priorities for community health nursing in conjunction with the research priorities developed by the Center for Nursing Research, National Nursing Research Agenda (Hinshaw, Heinrich, & Bloch, 1988). The students identify several areas of priority for research in the field. These include environmental health, mental health, health promotion, prenatal care, acquired immune deficiency syndrome (AIDS), and communicable diseases, among others. A discussion of strategies to address each of the program-relevant areas followed the nominal group process. The students have described feeling challenged to influence health policy in regard to these research priorities. The stimulation the students received from the content explored in the course was evident through student discussion, seminars, and written assignments. The uniqueness of this first course in Public Health Science at our College of Nursing formed the basis for conducting an evaluation strategy. INSTRUMENT A 22-item questionnaire was developed to obtain demographic information regarding the student group, their community health experience prior to entering the graduate program, their clinical area of specialization, their reasons for enrollment in the course, the strengths and weaknesses of the course, the degree to which the course met the objectives, and recommendations for future courses in Public Health Science. The questionnaire was assessed for content validity.

SAMPLE The sample consisted of the 13 students enrolled in the course. This was the first semester the course was offered. The students were told the purpose for completing the questionnaire and assured of anonymity. Of the 13 students enrolled in the course, 11 questionnaires were returned. RESULTS Of the 11 students who returned the questionnaire, the mean age was 36.5 years with a standard deviation of 9.8 years. They were predominately women (91%),

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TABLE 1 Demographic Characteristicsof the Students.

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Variable Age in years Semesters/ in graduate program Years sinde Baccalaureate degree Sex Female Male Marital status Married Single Divorced Ethnicity White Asian Clinical area Commpnity health Materdal-child Medical-surgical Ever held a position in community health Yes No

Percentage

M

SD

36.5 2.6 9.5

9.8 1.8 9.0

91 9 73 18 9 91 9 55 27

18 36 64

married (73%), and White (91%), although the Asian population was also represented (9%). Demographic characteristics of the students are shown in Tmble 1. Three areas of clinical specialization were represented by the sample. Fifty-five percent identified community health nursing as their major, 27% identified materdal-child nursing as their major, and 18% identified medical-surgical nursing as their major. The mean semesters enrolled in the graduate program was 2.6 with a standard deviation of 1.8. The mean years out of the baccalaureate program was 9.5 years with a standard deviation of 9.0 years. The students were asked whether they ever held a position in community health nursing; thirty-six percent reported they had and 64% reported they had not. The students were asked why they enrolled in the course. Some reasons include the following: interest in community health nursing, the desire to expand their knowledge of community health nursing, the course's congruence with their career goals, the need to learn about current issues in community health nursing, the interdisciplinary nature of the course, and the focus on epideNiology. The students were also asked how they felt the course would benefit them in the future. Some responses were that the course would help them in identifying the epidemiological process, in incorporating community assessment into future practice, in international work, in clarifying the roles of the community health nurse (CHN), and in! explaining community health nursing to others. SoNe strengths of the course identified by the students included: the importance of the content presented, sharing experiences with students in other specialty areas, critical thinking, and the broad variety of perspectives offered. The weaknesses of

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Sherman and May TABLE 2 Course Objectives Evaluated by the Students

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Objectives 1 . Document the U.S. and international need for primary prevention and health promotion. 2. Identify community and population groups as a unit of intervention from an epidemiological perspective. 3. Identify historical practice and impact of public health science nationally and internationally. 4. Analyze legal/political mechanisms for facilitating primary prevention and disease prevention related to extant public health issues. 5. Identify the community health nursing role as practitioner, researcher, and consultant. 6. Examine economic forces and issues pertinent to community health nursing practice nationally and internationally. 7. Synthesize relevant public health and nursing theories. 8. Identify research-based, effective community health nursing interventions. Note.

M

SD

1.99 2.24

1.58 2.21

2.18

2.06

2.8

3.1

1.27 2.7

1.5 2.7

3.4 3.2

3.1 3.15

0 = 100% met and 10 = 100% not met.

the course included the general nature of the content and the limited number of grading methods. The course objectives and mean scores for whether these objectives were met by the course are shown in Table 2. The course objectives overall received a mean score of 2.47, with 0 = 100% met and 10 = 100% not met by the course. Lastly, the students were asked to make recommendations for future courses in Public Health Science. Some recommendations included the need to provide more in-depth study of material reflected in one or two objectives, to continue to offer the course in the evening, and to discontinue student presentations. DISCUSSION

The findings suggest that the content of Public Health Science has been integrated into the graduate community health nursing program with much success according to the course evaluation data. One unique feature of this course was the student enrollment across several specialty areas. This is considered essential for the community health nursing majors as well as for the other students. This feature has allowed students in other specialty areas to be sensitized to the discipline of public health science and to be able to incorporate these principles into their selected area of specialization. This is one of the first attempts to educate students in other areas to the field of public health science and community health nursing. All too often, the limited exposure to one area of nursing precludes successful comprehensive nursing practice. Faculty as well as students must provide a dialogue between themselves if nursing is to be the profession it has acclaimed itself to be. The findings of this study provide implications and suggestions for courses in public health science, especially in colleges of nursing that do not stand affiliated with schools of public health. The synthesis of nursing and public health science has been evidenced. The results suggest content that should be incorporated into a course in public health science based on the course objectives and student evaluations. The data allowed for evaluative statements regarding the public health science

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curriculum. The results of this study can provide a basis for curriculum development and evaluation and can serve to further examine what the essential knowledge base is for the practice of community health nursing.

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REFERENCES American Nurses' Association, Division on Community Health Nursing. (1980). A conceptual model of contmunity health nursing. Kansas City, MO: Author. American Public Health Association, Public Health Nursing Section. (1998). The definition and role of public health nursing in the delivery of health care. Washington, DC: Author. Archer, $. E. (1982). Synthesis of public health science and nursing science. Nursing Outlook, 30, 42-44. Barkauskas, V. H. (1982). Public health nursing practice: An educator's view. Nursing Outlook, 30(7), 384-389.

Cobb, A, K. (1977). Developing a community health major on the graduate level. Image, 9(2), 38-41. Cobb, A, K., Derr, M. A., & Pieper, R (1980). Nurse managed clinics: An approach to graduate community health nursing education. Image, 12(2), 34-36. Dammaq, G., Dolan, M. B., Freeman, R. B., Mackenzie, C., McGill, C. F., McNeil, E. E., Mickey, J. E., & Murphy, M. (1966). Recommendations concerning the teaching of public health nursing in schools of public health. American Journal of Public Health, 56(5), 821-824. Flynn, B, C., Gottschalk, J., Ray, D., & Selmanoff, E. D. (1978). One master's curriculum in community hdalth nursing. Nursing Outlook, 26(10), 633-637. Golden, J., & Moore, P. (1987). The Simmons-Harvard Graduate Program in Public Health Nursing, 1953- 1961: An experiment in nursing education. Public Health Nursing, 4(2), 123- 127. Hamilton, P. A., & Bush, H. A. (1988). Theory development in community health nursing: Issues and recommendations. Scholarly Inquiry for Nursing Practice: An International Journal, 2(2), 145-160. Hanchett, E. S., & Clarke, P. N. (1988). Nursing theory and public health science. Is synthesis possible? Public Health Nursing, 5(1), 2-6. Hinshaw, A. S., Heinrich, J., & Bloch, D. (1988). Evolving clinical nursing research priorities: A national endeavor, Journal of Professional Nursing, 4(6), 398, 458-459. Institute of Medicine. (1988). Thefuture of public health. Washington, DC: National Academy Press. Ohlson, V. M., & Shine, E. C. (1979, May). Overview of public health nursing. In CIinicalpractice in commtrnity health nursing: Faculty roles and student education. Proceedings of a conference sponsored by College of Nursing, University of Illinois at the Medical Center, Chicago. Schultz, P. R. (1987). When client means more than one: Extending the foundational concept of person. Advances in Nursing Science, 10(1), 71-86. U.S.Dedartment of Health and Human Services. (1985). Consensus confemnce on the essentials of community health nursing practice and education. Rockville, MD: Author.

Evaluation of public health science in the graduate community health nursing curriculum.

The purpose of this article is to describe and evaluate a unique course in Public Health Science that has recently been implemented in our College of ...
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