A creative and effective leadership experience for baccalaureate nursing students is implementing community health fairs. For the past four years, three to eight students each year have chosen to work with the Greater Cincinnati Healthworks project as a clinical requirement for the leadership course.
Healthworks is a health promotion program that sponsors approximately 60 annual health fairs in the Cincinnati metropolitan area. The fairs, which focus on health education and screening activities, are based on the 1974 Health Fair Model held in Washington, DC. This first fair originated under the auspices of Dr. John F. Brenski, a National Institutes of Health research physician who was concerned about fragmented health promotion activities- Since then, health fairs have been implemented in many cities with assistance from the National Health Screening Council for Volunteer Organizations (American Red Cross, 1985).
In the past two years, eight students have been assigned to the project. They have sponsored two sites, one in an urban senior center and the other in a regional university. Four students for each health fair site form a clinical team with a faculty member serving as a resource person. Evaluation of the experience by both students and faculty has indicated that course objectives were met and positive student leadership behaviors were developed.
Leadership skill development is a necessary component of baccalaureate nursing education. The leadership in nursing courses is designed to synthesize previous knowledge and to enhance and improve leadership behaviors in students. A model from Yura, Ozimek, and Walsh (1981) has been helpful in conceptualizing these elements of professional nursing leadership. For several years the four process components from this model have been used as a framework for leadership skill development. Using the processes of deciding, relating, influencing, and facilitating to move from goal setting to goal achievement has been helpful in framing the needed behaviors for effective leadership roles. Although this course was designed for a BSN completion program for registered nurses based on adult learning theory (Cross, 1981), the synthesis of nursing concepts and leadership skill development derived from the clinical Healthworks project would be congruent with any baccalaureate program outcomes that are consistent with National League for Nursing program criteria.
As students begin the Healthworks project, a learning contract is developed by each student using course objectives as a base. Through the use of this tool and ongoing group conferences, decision-making principles (Tappen, 1983) are applied by the individual student and by the clinical group. The contract provides the students with a framework for assessing their own learning needs, developing a plan to meet these needs, outlining strategies for achievement, and evaluation of outcomes. Two other tools used in the course are a leadership profile and decision making style profile. These tools assist students in analyzing their roles for the project. The concepts of deciding and relating are used as students engage in extensive group process activities to determine the roles each member will assume. The strengths, weaknesses, needs, and interests of individual members are examined to decide who will assume each role as defined in the Healthworks site manual (American Red Cross, 1985). The four roles for each Healthworks site are site coordinator, medical director, non-medical director, and publicity director. This is the earliest point at which leadership behaviors emerge. The four students are given the written job descriptions and asked as a group to study them and decide which student would best fit each description. This particular process also assists students in applying situational leadership theory (Mersey & Blanchard, 1977). In identifying the basic leadership style of group members and tasks according to the specific roles, they can better determine the role in which they would be most comfortable and effective.
In role selection, the position of site coordinator is given priority because this person is responsible for the overall operation of the health fair. This involves attending Healthworks planning meetings, communicating effectively with other group members and faculty, and assuring that deadlines and criteria for other roles are effectively met. The students recognize that the person who assumes that role must be respected by the other students and be able to effectively communicate with the faculty and community. The site coordinator is chosen by consensus of the group and the selected student.
The student who assumes the role of the medical director is responsible for obtaining registered nurses, student nurses, and laboratory technicians for the specific screening procedures provided by the health fair. The non-medical director is responsible for obtaining volunteers to provide manpower for registration and tabulation procedures.
The publicity director coordinates all communication activity with the sponsoring agencies. This student also coordinates and distributes informational posters to display in local businesses. Each team member works to obtain the necessary supplies; however, it is the publicity director who is responsible for soliciting all monetary donations necessary to implement the fair.
After the roles are chosen, the group performs a needs assessment of the particular population each Healthworks site will serve. This needs assessment is based on socioeconomic and developmental factors, as well as related health education and screening needs of the target populations for each site. The present sites are a senior citizen center in a densely populated urban area and a university community. These sites provide student involvement with populations with diverse health education needs. The needs assessment involves using health survey data, studying demographics, and contacting community leaders and other community resources for information about the specific population.
The planning process continues to involve group decision-making and relating behaviors. Based on the needs assessment of the community, ideas for learning centers are developed by the entire team and ultimately coordinated with community resource people.
The use of relating and influencing processes overlap; however, primary leadership skills in communication are stressed and developed as the students recruit volunteers to work on the health fairs. Volunteers are obtained from community organizations, educational systems, and healthcare agencies and institutions. These volunteers have varying levels of expertise; the art of recruiting for specific tasks involves a creative use of leadership skills to convince them of the value of the project and to enlist their support.
Other components of the influencing process relate to change theory and the understanding of how the organizational structures of the selected sites affect the leadership process. As students become involved in negotiating for learning centers, food, site set ups, and money, they quickly learn the importance of applying change theory (Bennis, Benne, Chin, & Corey, 1976). Early in the process, driving and restraining forces are identified as students enlist businesses, groups, and individuals for support. Political realities of bureaucratic structures have been enhanced since one site is held at a university. Budgetary, administrative and hierarchal protocols can be analyzed and compared with the more informal senior center site.
University policy prohibits direct donations from community businesses. Therefore, students must develop and submit a budget request to the university that covers the direct costs for the fair. In the senior center site, businesses donate materials and supplies for the fair.
In working through these processes, the site coordinator helps the group use decision theory to solve problems and reach a consensus. Again, the clinical conference is utilized to facilitate problem solving. Frequently, most of the discussion, decision, and planning initially takes place without the faculty resource input. The Healthworks team then meets with the faculty representative and discusses not only the decisions and plans but also, just as importantly, the group dynamics involved in the decision making process. These conferences are used by the faculty resource person to discuss communication principles of asserti veness, conflict resolution, confrontation, and collaboration as these pertain to group dynamics. These team and faculty conferences also serve as the arena in which the students learn and apply the "people skills" necessary to negotiate with the appropriate resource people within the university and community. Relating and group decision making is ongoing as the clinical group develops strategies to move toward a successful health fair, which is the group goal.
Facilitating is the last process identified in which the leadership skills of organization and time and resource management become very evident. Time management is an important skill that is identified and implemented by each student on the team in coordinating their individual and group responsibilities. Time lines are developed early in the semester for each student and the group as a whole. The site coordinator is ultimately responsible for the completion of all deadlines established by the individual team members and the group. Principles of time management (Tappen, 1983) are discussed in conference with the faculty resource person. Ail time lines are examined and re-evaluated at each weekly group conference.
The overall organization and implementation of the site including registration, screening stations, education booths, publicity, crowd control, and record keeping is a group activity. Systems theory (Lancaster & Lancaster, 1982), which has been applied throughout the students' program of study, is again very applicable as students realize how the separate pieces and responsibilities of the project interact for the achievement of a successful Healthworks site.
The final phase of this leadership learning experience is evaluation, an integral part of the course content. This phase involves outcome evaluation of the students and of the project.
The overall goal of the metropolitan project is change in community health behaviors. Although students are not involved in this ongoing documentation by the Healthworks office, they are aware of the process. In addition, the Healthworks office has criteria upon which the fairs are evaluated, such as numbers of participants, value as perceived by participants, and effectiveness of learning centers.
The students' learning contract is a basis for individual evaluation of the course objectives. These objectives relate to use of decision, change, communication, leadership, and group concepts and theories. Group process and informal evaluation continues through debriefing in clinical conferences following the fairs. This activity facilitates the students' analysis of their own effectiveness and the success of the overall group project. They identify individual and group strengths and weaknesses and how leadership skill has been developed, used, or enhanced.
An evaluation form of the leadership clinical experiences is used in this course. After four years, students have consistently evaluated the project as beneficial and as a creative way to use and develop leadership skills. Evaluation of the project by faculty has been more informal. However, they have observed increased abilities of students to communicate effectively, analyze their own styles, negotiate, organize, and handle conflict. Another value, albeit subjective, is the perception of faculty that student self-confidence in abilities and leadership potential is enhanced.
The ultimate outcome for the faculty has been the satisfaction of facilitating a positive clinical experience in which theoretical components of leadership are applied, thus fulfilling the course objectives in a unique and stimulating manner.
- American Red Cross (1985). Healthworks site coordinator's manual. Washington, D.C.
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- Yura, H., Ozimek, D., & Walsh, M. (1981). Nursing leadership, theory and process (2nd ed.). New York: Appleton-Century-Crofts.