Case study

A university had a contractual relationship to provide healthcare services for an underserved urban community, physically located near its catchment area. The school of nursing (SON) intended to engage the community with the goals of providing health-promotion services, health education, and primary care to improve the health of the community, as well as to provide a site for student clinical education. Beyond the high-level agreements that were in place, a relationship had to be forged among SON faculty, administrators, students, and community members in order to realize the goals of the SON. Mutual goal setting was needed in order to fully develop a partnership that would be “real” and “realistic,” not just an agreement on paper. SON held meetings with various community groups interested in engagement as part of the assessment process. Elements of the assessment process can be related to the Action Model to Achieve Healthy People 2020 goals (The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, 2008). In the assessment phase, conversations between the SON and multiple community partners centered on the organizational culture, timing of services, need for health services, and feasibility. Some of the organizations that the SON had conversations with had health services needs that were far beyond what undergraduate and graduate nursing students could provide; others proved to have a different culture. A collaborative learning model was sought, one in which community members and students could learn from each other. Multiple projects were anticipated, with different characteristics and service provisions. One relationship that developed was between the SON and a church nurse group. During the assessment and initial collaboration stage, several common elements were found. First, a major purpose of the church nurse group was health promotion and education, mirroring the community health and primary care focus of the nursing curriculum. Members of the church nurse group were not professional nurses; by and large, they were caring individuals who were called to care for the sick and address health concerns in their church community. Second, timing was important. Classes for the SON and church nurse meetings were held at night. The timing fit well into students’ schedules, and as a result, no class rotations had to be rearranged. The services of health promotion and education were handled by the undergraduate students; concomitantly, graduate nurse practitioner students rotated through a clinic setting to provide direct primary carerelated services under the auspices of the university’s nursing care center. A small foundation grant was secured to offset some of the anticipated costs associated with the program—church suppers, educational material, supplies, and advertising. Thus, the feasibility of the partnership was assured. A premise of the collaboration was that addressing individual behaviors would impact the health of the community at large. This premise was held by both the church members and the SON faculty and students. The relationship between the two groups deepened as discussions were held on what health behaviors the two groups would address. The format of the program was to include education sessions in a church-supper format and health fairs, and referrals to clinics for acute care problems. The SON faculty and students proposed a curriculum based on health disparities addressed in Healthy People 2010. The church nurse group proposed topics that they felt were the most pressing concerns in the community. Discussion shifted away from the federal guidelines to the real issues of health in the community. The church nurses identified uncontrolled diabetes as a problem and wanted to host a health fair and were able to tailor a health program to the needs of the community. They implemented a diabetes screening program and performed mass finger sticks to identify persons with high blood glucose levels. This strategy is not in the health-promotion guidelines, but was adapted for a successful health fair. Community members came to the health fair, and church nurses provided information on where to get low-cost or free diabetic supplies in the community. Additionally, they had some supplies on hand and urged people to “keep their sugar under control.” Student nurses provided one-on-one counseling for people with a known diagnosis of diabetes, answering questions about medication, diet, and exercise. The mass screening of 100 community members yielded four people with blood glucose levels well over 500 mg/dL, and they were referred to the nursing center for immediate followup. Student nurses worked to ensure individual privacy, whereas the community members saw the screening as a “family affair,” with each person responsible for his or her neighbor’s health. This unorthodox approach to health promotion education and screening caused a buzz in the community and paved the way for a multiyear health-promotion project and ongoing relationships. Evaluation of the program occurred at individual, group, and community levels. The success of the relationship was evident in the personal relationships that developed among students, faculty, and community members.

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