Community connections: Influencing health and health care through collaboration
To effectively help people manage their diabetes, nursing leaders must understand more than individuals’ eating habits and glucose levels – they must understand the communities in which the people live and the health systems that serve them.
That’s the guiding principle behind the Betty Irene Moore School of Nursing Community Connections course. The course partners students in its Nursing Science and Health-Care Leadership master’s degree program with area community organizations and health-system leaders to research service provision challenges and seek community-specific data, identify appropriate analyses and formulate strategies for solutions.
"This year-long field assignment is an applied experience to equip students to understand population health, identify social determinants of health and to make systems-level change," says Jann Murray-García, a consulting faculty member at the Betty Irene Moore School of Nursing who is a co-instructor of the course.
"These tenets are consistent with the vision of the Betty Irene Moore School of Nursing in educating the next generation of nurse leaders, educators and research scholars."
The course is unique in that it not only sends students to research and partner with community organizations, but it also places students in health-care systems to study organizational structures and cultures.
"Our students learn how to examine the environment around them, whether it’s a county public health department, food bank or a multi-hospital system," says Debra Bakerjian, an assistant adjunct professor who is the other co-instructor of the course.
Redefining an expert
Offered to the inaugural class at the nursing school, the course seeks to redefine what it means to be an "expert."
Experts may hold advanced degrees in nursing, public health or medicine, but an expert also may be a mother receiving nutritional guidance from counselors at a local food bank, the course posits. That mother may understand the strengths and deficiencies of a specific community program better than the highly educated policy leaders who design or operate it.
"It is a little bit of a different take on expertise," says Murray-García. "We are trying to get the nurse scholars to see that community expertise, to believe in it as necessary and valuable, and to incorporate it into what will then likely be the most effective, relevant and sustainable improvements, precisely because they are community-owned and community-informed."
"This year-long field assignment
is an applied experience to equip students to understand population health, identify social determinants of health and to make systems-
Students enrolled in Community Connections participate in weekly classroom seminars that examine academic issues such as organizational development and design, the varied means of financing health-care systems and the strategies of Brazilian educator Paulo Freire, who encourages community participation in arriving at solutions. The students are educated in research methodology, which allows them to frame and design evidence-based community projects in which they put their academic knowledge into use in the community.
The students, all registered nurses, also spend a considerable amount of time discussing the issues and challenges they face within the health-care delivery systems in which they are currently employed.
"These are nurses who are already experienced," says Bakerjian. "We also ask them to talk about their experiences."
Throughout the year-long course, students in Community Connections design and implement a study in which they examine a health-care issue in the community or within a health-care delivery system and try to develop a community-specific solution to the problem. The students’ projects range from examining childhood obesity in Placer County to running focus groups with mothers using the services of the Sacramento Food Bank to implementing a "just culture" within a Northern California health-care delivery system or patient-care unit.
Working in teams
The students work in teams to develop and implement their research projects. They partner with community liaisons within the agencies or areas they are studying.
"They work in teams so they have support systems," says Bakerjian. "Our goal is for the students to recognize that anytime you are trying to do anything within an organization, you can’t do it alone, you have to do it in teams."
Students Gretchen Spickler and Maureen Murphy are studying childhood obesity in Placer County. In addition to collecting data to ascertain the prevalence of childhood obesity in the county, Spickler and Murphy are developing proposals to combat the problem. For instance, they are looking at policies regarding sugary drinks for sale in area schools.
Combating childhood obesity
To conduct that research, they are collaborating with officials within the Placer County Office of Education as well as the Placer County Community Health and Human Services Department. By the end of the course, the students hope to make recommendations to both agencies on how they might work to combat childhood obesity.
"We’re hoping our interventions are specific to Placer County," says Murphy, who is a registered nurse. "Our recommendations will be based on our research findings and tailored to the community’s needs and resources."
"We’re hoping our interventions [to childhood obesity] are specific to Placer County. Anything we suggest will be based on evidence that we hope will work here with the resources they have."
Joe Arsenith, a program manager for Placer County Health and Human Services Department, is working closely with the students in guiding the design and implementation of their project. He says their research is a huge boon to Placer County, which is underfunded due to the faltering economy.
"We are suffering from a small staff, and this is not an area that I have program staff for," says Arsenith. "They are doing the local level research that I would have to find staff to do."
Arsenith says the student research project arrives at an opportune time, since funding to combat childhood obesity may come to Placer County from national health care reform.
"They are helping us to position ourselves if that funding comes down (to the local level)," says Arsenith.
Spickler and Murphy say the project and the Community Connections course are empowering them to grow into health-care leaders.
"I’m becoming better prepared to gain a leadership role to make improvements in the health-care system," says Spickler.
"It allows nurses to understand their strength in the health-care system and how they can contribute to changes in health-care delivery," says Murphy.
Other students are studying the Sacramento Food Bank and its parenting classes and resources for new mothers. These nurse scholars, as they are described by Murray-García, are learning to design and implement focus groups to interview the mothers who receive the services so they may ascertain what changes might be needed in the programs.
Listening to the concerns of the recipients of the services follows the teachings of Brazilian theorist Paulo Freire, who advocates mitigating the power imbalances within communities by inviting community members to define an issue from their perspective and then design and propose a solution.
"[The students] work in teams so they have support systems. Our goal is for the students to recognize that anytime you are trying to do anything within an organization, you can’t do it alone, you have to do it in teams."
"They create a solution that is more culturally relevant and ultimately more sustainable," says Murray-García.
"It’s putting the power back into the community," says Linda Luna, a registered nurse who is working on a project at the Sacramento Food Bank. "We are going to listen to the mothers as the experts they are to guide our research."
Bakerjian says the school has established partnerships with three other area hospital systems to enable the students to work with them to, for example, improve patient safety methodology. Part of that improvement involves developing a "just culture" within the system, in which health-care workers feel they may raise concerns to management and others without retribution.
"The idea is that people can raise issues and don’t have to worry that they will be fired because they made a mistake," says Bakerjian.
Bakerjian adds that one of the pleasant surprises of the course is how excited members of the communities are about having nursing students implement research projects within their organizations.
"What’s been really fantastic is that the community is really with us," says Bakerjian.