Perceptions of the camp nurse role are often colored by childhood experiences as campers, and frequently include vague ideas about administering medications, dispensing bandages, and nurturing homesick youngsters. In reality, the role includes health promotion, health teaching, accident and illness prevention, assessment and treatment of a wide variety of actual health problems, the evaluation of outcomes of care, and collaboration with other health professionals (Rauckhorst & Aroian, 1987). The nursing process and the ANA Standards for Nursing Services in Camp Settings provide a framework for what can be a challenging role.
As competition among universities for clinical experiences within hospitals increases and the focus of health care shifts to the community, the potential of camp as a clinical site within nursing education programs should not be overlooked. The purpose of this article is to share some experiences in the use of a camp for diabetic children as a clinical site for graduate students in pediatrics and to oner some practical guidelines for structuring such experiences.
Summer Camp aa a Setting for Clinical Practice
The Care of Children and Families concentration within the graduate program of the University of Rochester School of Nursing prepares advanced practice nurses to function in either clinical nurse specialist or pediatrie nurse practitioner roles. The curriculum includes three major clinical courses.
The first clinical course focuses on health assessment and intervention, and includes the major bodies of knowledge pertinent to the health of well children. Clinical management included in this course focuses on young children, wellness care, and some minor illness management. Students are prepared in pediatrie physical assessment through a six-week laboratory session and are placed at primary care clinical sites.
The second clinical course focuses on the management of complex health problems. Child and family responses to major illness, disability, and hospitalizaron are addressed. The clinical care of children with major chronic illnesses and disabilities is included, and students are placed in both primary care and specialty care clinical sites.
The third clinical course focuses on developing leadership abilities within the health care system and within interdisciplinary teams, especially in relation to indirect care services. Continued refinement of advanced skills in case management and direct care is also stressed. Students continue clinical placements in both primary care and specialty sites.
All of the students who arranged for part of their clinical requirements to be met within the camp setting had completed the first two clinical courses of the Care of Children and Families Program. These students had spent part of the preceding semester in a clinical placement with the Pediatrie Diabetes Clinic at the University of Rochester Medical Center and were precepted by the author, who is a member of the pediatrie nursing faculty and holds a clinical appointment as a clinical nurse specialist in a pediatrie endocrine practice.
For many years the author has coordinated the medical care at a camp for diabetic children sponsored by the American Diabetes Association. The philosophy of care at this camp includes helping children to adapt positively to diabetes, taking advantage of the unique opportunity for education about diabetes, and striving to maintain or attain optimal glycémie control and metabolic safety, including avoidance of severe hypoglycemia and ketoacidosis. To meet these goals, a team approach is used, including physicians, nurses, dietitians, and program and counseling staff The camp serves a maximum of 90 children per week for two weeks and maintains a ratio of one nurse and one physician per cabin of 20 campers.
Initially, the inclusion of graduate nursing students in the diabetes camp team was motivated by the need for nurses who possessed well-developed health assessment and clinical decision-making skills and would be able to intervene appropriately with this population of children with complex health needs. Graduate nursing students who had spent a semester learning about assessment, intervention, and case management of diabetic children in an outpatient setting were uniquely prepared to assist at camp. For many students, the opportunity to spend two weeks of intensive clinical time during the summer apart from other academic pursuits and pressures was ideal.
The Camp Experience
Students at camp functioned as cabin clinicians, responsible for the 24-hour diabetes care of one cabin unit under the supervision of a resident camp physician. Cabins were grouped according to sex and age, so that students could choose to focus on early or middle school-age children, or on adolescents. Specific responsibilities of the cabin clinicians included the following:
* Initial health screening on intake day and review of usual diabetes management practices and recent glycémie control with parente and campers;
* Instruction/supervision of the cabin counselors in blood glucose testing and recognition and treatment of hypo- and hyperglycémie;
* Daily review of blood glucose readings and decision making (in collaboration with the camp physician) regarding insulin adjustments;
* Consultation with the camp dietitian regarding the adequacy of the individualized meal plans of campers;
* Diabetes knowledge assessment and education of campers in the assigned cabin;
* Rotation of "on-call" responsibility for SAM blood glucose testing for campers who were hypoglycémie at bedtime;
* Communication of progress and plans with parents on the last day of camp;
* Communication with referring health care providers regarding significant changes in medical management or psychoeocial concerns.
Throughout the semester that preceded the camp experience, students were required to read materials relevant to the care of children with diabetes. Thus, students entered the camp experience with a strong foundation of knowledge. The camp medical "curriculum" for all participating health care providers included readings and nightly didactic sessions with the camp medical director on such topics as insulin therapy, hypoglycémie, dietary management, and psychosocial concerns. The author was on-site at all times to provide direct supervision and precepting of the students. Progress toward meeting personal clinical objectives was recorded in a log that the students kept, which was regularly reviewed by the author as well.
Benefit to students
Campe for children with chronic illness or disability provide a unique environment for learning for both campers and professionals. In few other environments are the daily demands of management or the impact of the disease on activities so dramatically demonstrated. The different challenges of various developmental stages can be noted and the impact of varying levels of family/social support and professional input is readily apparent.
The graduate nursing students have the opportunity to become "surrogate parents," and to experience firsthand the anxiety that is evoked by severe hypoglycémie reactions or even minor adjustments in insulin dosage, which are accompanied by unanticipated changes in exercise or diet. The complexities of the disease become obvious and students experience firsthand the frustration and fatigue that parents express. Without exception, their experience promotes a new respect and empathy for the children and their families, and a heightened understanding of how difficult it may be to comply with seemingly simplistic management recommendations. Students experience the difficulty of avoiding overtreatment of low blood sugare, the complexities associated with adjusting a meal plan when faced with fluctuating blood sugars, and the realities of how time consuming regular blood glucose monitoring and recording can be.
In hospital or outpatient settings, students often find their efforts to provide diabetes education to children affected by constraints of the setting, the lack of appropriate patients to fit the students' availability, and other demands of care. Camp provides the luxury of large numbers of children who can benefit from both individualized and group instruction that is well designed and creatively implemented. The pressure to make educational sessions fun and interactive in order to fit in with the overall camp mode encourages students to analyze and reconsider the more traditional patient education programs to which they have been exposed.
Students aleo have many opportunities to participate in the education of counseling and program staff at camp. The students' ability to plan and implement initial sessions on blood glucose testing, hypoglycémie recognition and treatment, and then to evaluate directly the effectiveness of their instruction provides an excellent foundation for future work with school personnel or day care staff
Other experiences in the camp setting
Camp also providee an opportunity for obtaining noninvasive data on a large number of diabetic children in a short period of time. Well-constructed studies that do not interfere with the major purposes of camp may help to advance our knowledge about effective teaching strategies and facilitators of adjustment and good control. Graduate students who are interested in obtaining experience in research can provide a valuable source of manpower in such studies.
Campe serving chronically ill or developmentally disabled populations are rich sources of clinical or research experience for motivated students. Mutually beneficial arrangements can be negotiated that allow for provision of high quality nursing services to campers while meeting students' experiential needs.
Faculty preceptors must be on site and be recognized and accepted by camp staff in order to facilitate the experience. Students must also have written prerequisite requirements and expectations in order to maintain the authenticity and focus of the clinical experience. With these factors in place, however, camp may provide an untapped clinical site in this time of scarce resources.
- Rauckhorst, L.M., & Aroian, J.F. (1987). Camp nursing: A way to season your summer? Journal of Pediatrie Nursing, 2, 167-173.