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HealthNovember 05, 2020

A COVID-19 lesson: The emphasis of community/public health practice in nursing education

By: Dana Martin, DNP, MSN, RN, CNE
Nurses are educated not only to care for individuals, but to also care for families, communities, and populations. The Covid-19 pandemic has brought community/public health nursing practice to the forefront.

This situation has highlighted the importance of educating future nurses about community, public and population health concepts and practices; nurses educated at every academic level should be competent and confident in the care of individuals and the public during disaster situations, including pandemics. A better understanding of the way illness can impact the global population was effortlessly applied to the lived situation experienced during this global pandemic. What better time is there than now to assure that the community/public health course curriculum in your program provides the opportunity for students to meet necessary competencies related to population health nursing? This article suggests activities for undergraduate nursing programs to assist all faculty in broadening the application of population health competencies.

In 2019, the Future of Nursing Campaign for Action in conjunction with the Robert Wood Johnson Foundation and the AARP Foundation, released a report entitled, “Nursing Education and the Path to Population Health Improvement” (FON, 2019). This profound and timely report should be used to shape the future of nursing education and improve students’ understanding of population health concepts. The research team for this Future of Nursing study consisted of nursing and public health leaders; in the study, nursing programs that were found to successfully target population health competencies in their curriculum across the undergraduate and graduate nursing programs were surveyed and visited to determine best practices (FON, 2019).

Population health competencies

The report identified foundational population health competencies that included knowledge of the following:

  • Health policy
  • Epidemiology
  • Determinants of health
  • Health equity
  • Collaborating with other disciplines
  • Health care economics
  • Systems thinking (FON, 2019)

While many of these areas are broad and are addressed in various nursing courses to some degree, often the population health perspective of these objectives are left for the community/public/population health faculty to cover; however, the competencies should be incorporated throughout the undergraduate nursing curriculum (FON, 2019).

Key content areas

The report identified key areas of content that should be included in nursing courses at every academic level:

  • Determinants of health
  • Interventions that improve current issues identified in the population
  • Interprofessional collaboration within the community and with other healthcare providers
  • Systems approaches
  • Utilizing community and population data to improve health (FON, 2019)

These topics should also be integrated into every course, not just the community/public/population health courses (FON, 2019).

Undergraduate nursing education examples

It is important for undergraduate nurses to understand the importance of population health concepts, including continuity of care, from the beginning of the nursing program. Faculty members with population health expertise can work with other faculty to determine ways to incorporate population health concepts into their courses. Examples of approaches for this integration include the following:

  • In courses with clinical components, challenge students to address the needs of the client after discharge. What might this client with heart failure need to keep him/her healthy and out of the hospital after discharge? What might this adolescent mother with a newborn need to keep her and her newborn healthy and thriving after discharge? What are local community resources that can aid in the health of these clients? This example reinforces systems thinking, determinants of health, community/public health interventions to improve health and interprofessional collaboration.
  • Develop simulations in all courses with a clinical component that incorporates continuity of care measures throughout the curriculum. What interventions can be applied after discharge for a ten-year-old with frequent hospitalizations due to sickle cell disease crises? What evidence-based interventions will support a newborn addicted to opioids after hospital discharge? What community resources are available for a client recovering from a myocardial infarction who is not able to afford his/her medications or a healthy diet once they leave the hospital setting? These examples target determinants of health, community/public health interventions to improve health, interprofessional collaboration, evidence-based practice and systems thinking.
  • Any course professor can utilize case studies that highlight current population problems related to topics covered in class. When discussing diabetes mellitus, a pathophysiology course educator could incorporate a case study that examines the care of a client with diabetic ketoacidosis in the hospital setting and in the community. Additionally, a behavioral health nursing professor could develop a case study involving the care of a client with schizophrenia that also addresses the integration of the patient back into the community. Case studies like these emphasize determinants of health, community/public health interventions to improve health, interdisciplinary collaboration, application of data and evidence-based practice and systems thinking.
  • Service-learning opportunities for students can be incorporated into any course, as well. An educator that teaches a nursing research course could have students analyze research related to nursing care of the homeless population and then have students volunteer with a local program that serves the homeless population. A fundamentals nursing professor could have students investigate social determinants of health that have impacted clients observed in the clinical setting during the semester and identify programs in the community that help to decrease the burden of the determinants; the professor could then encourage the students to volunteer with the program to gain a better understanding of how the program functions. Service-learning activities address determinants of health, community/public health interventions to improve health, interdisciplinary collaboration and systems approaches.

In undergraduate community health nursing courses, it is important for nursing professors to develop learning strategies such as deliberate community health nursing clinical practicums, interdisciplinary partnerships, case studies, simulations, web-based opportunities and expert discussions about specific population health concepts including, but not limited to, the following:

  • Interventions to address current community/public/population health issues
  • Basics of epidemiology
  • Community resources
  • Determinants of health
  • Infectious diseases
  • Disaster planning and triage
  • Environmental health
  • Nursing influence on health policy
  • Health promotion and disease prevention
  • Public health economics
  • Evidence-based practice
  • Population health assessment strategies
  • Health disparities, health equity, and social justice
  • Care of clients across the lifespan
  • Global health
  • Systems approaches (FON, 2019)

Students will learn more about these topics if given the opportunity to be engaged in the topic rather than only listening to a lecture. Some innovative examples for delivering information related to these topics include the following:

  • Participating in a simulation that involves a disaster situation wherein students can triage clients but also explore the care of victims after the disaster in addition to long-term recovery measures. The simulation should also involve interprofessional education and community partnerships, when possible, to improve the realism of the simulation.
  • Analyzing how global health can impact local health. The Covid-19 pandemic lends itself well to this topic.
  • Developing plans for the college/university or local community in the case of an infectious disease outbreak. Students can work individually or in groups to devise this plan.
  • Using social media to provide health education on current population health concerns (such as Covid-19) or as a health promotion/disease prevention strategy. Students should incorporate reputable evidence-based information into their health education.
  • Working to ensure students’ clinical experiences provide care for clients, families, and populations across the lifespan. Students should encounter clients who need prenatal care through end-of-life care for the most-enriching clinical experience.
  • Developing hypothetical community programs that decrease the influence of health disparities or physical and social determinants of health. This strategy can be used as an in-class group activity where students collaborate together to establish a program that also includes a budget for the program.
  • Completing case studies that focus on continuity of care for clients with specific health conditions or vulnerabilities.
  • Examining their environments (on campus, at home, or at work) for possible health hazards. Students can complete this activity individually or in groups. For example, students could explore the campus observing for positive factors that influence health (like designated cross-walks, first aid kits, AEDs, etcetera) and factors that challenge health (vending machines without healthy options, slippery floors without designated signage, etcetera).

Conclusion

These examples are just a few of the activities that can be incorporated into undergraduate nursing programs to target population health concepts in every course. Lessons from the Covid-19 pandemic illustrates to nurse educators across the country the importance of facilitating nursing students in becoming proficient and confident in population health nursing competencies.

Dana Martin, DNP, MSN, RN, CNE
Nursing Education Author, Wolters Kluwer Health
  1. Future of Nursing Campaign for Action (FON) (2019). Nursing education and the path to population health improvement. Retrieved from https://campaignforaction.org/wp-content/uploads/2019/03/NursingEducationPathtoHealthImprovement.pdf
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