Combining the two concepts of health promotion and communitybased service learning, Wellness Wednesdays haa filled a need for both lastsemester nursing studente and employees on a university campus. The weekly health promotion program, targeted to university faculty and staff, provides a setting in which students learn health promotion assessment and counseling skills, and university employees gain the skills and information they need to make informed and effective healthy lifestyle decisions.
The Wellness Wednesdays program addresses the changing focus in health care and in nursing from the institution to the community, and from illness care to health promotion and disease prevention (Pew Health Professions Commission, 1995; American Association of Colleges of Nursing, 1997). The program targets priority areas of the national health promotion and disease prevention objectives presented in Healthy People 2000 United States Department of Health and Human Services, Public Health Service [USDHHS PHS], 1991). General areas include physical activity and fitness, nutrition, mental health, and educational and communitybased services. Specifically, the program addresses Objective 8.5 to
increase to at least 50% the proportion of poetsecondary institutions with inetitution-wide health promotion programa for atíldente, faculty, and staff CUSDHHS PHS. 1991, p. 256).
The program focuses its efforts on an adult population group that frequently has difficulty accessing health promotion services and information because of work and family responsibilities. According to Pender (1T96), the worksite, as a setting for health promotion, provides convenience, can offer environmental and social support for healthy behavior changes, and is more cost effective for employers and employees than community programa.
Last-semester senior nursing students who participate in the Wellness Wednesdays program are able to see, in their learning experiences, the three principles of service learning proposed by Sigmon(1979>, a pioneer in the use of service as a learning tool. These principles are (Sigmon, 1979, p. 10):
* Those being served control the eerviceisi provided.
* Those being served become better able to serve and be served by their own actions.
* Those who Berve aleo are learners and have significant control over what is expected to be learned.
Health promotion services offered by Wellness Wednesdays are individualized, emphasize personal responsibility for health care decisions, and involve learning on the part of both the participants and the students.
The College of Nursing at the University of Southwestern Louisiana, in response to health care trends, haa been increasingly active in developing community-based health promotion programs in a variety of settings. These settings include senior centers, apartment complexes for elderly and handicapped individuals, and homes of individual cliente and families. In each of these settings, the emphasis is on the concept of health promotion as developed by Pender (1996) in the Health Promotion Model. Health promotion activities are seen as actions or attitudes that enable an individual or group to attain a higher level of wellnees. The nursing role is that of educator, counselor, and coach. Nurses assist with realistic and priority goal setting, but responsibility and accountability for change remains with the clients.
Wellness Wednesdays, which commenced in February of 1997, is an extension of this concept of health promotion to employees on the university campus. The program is held each Wednesday afternoon during the fall and spring semesters, in a clinic-type setting, in the centrally located College of Nursing building on campus. The program is staffed by graduating senior nursing studente and community health nursing faculty.
Goals of the Wellness Wednesdays program areto:
* Improve and maintain the health of faculty and staif by providing health promotion information and services in a manner that is accessible and acceptable to them.
* Provide opportunities for nursing students to gain experience in assessing health promotion parameters, counseling in areas of health promotion, and evaluating outcomes of health promotion behavior changes.
Services are designed to meet the individual needs of participante and are structured to provide ongoing evaluation. Services also are designed to enhance the health responsibility of the faculty or staff attendee by requiring each person to actively participate in planning for health promotion behavior changes. We line a a Wednesdays services currently include the following:
1. Individualized health promotion assessment.
a. Health Promoting Lifestyle Profile-? Walker, 1996): a paper-and-pencil 52-item, Libert scale questionnaire that assesses self-reports of behaviors in the areas of health responsibility, physical activity, nutrition, stress management, social support, end spiritual growth.
b. Health screening including height, weight, percent body fat, body mass index, blood pressure, pulse, total cholesterol, blood sugar, hearing, and vision.
2. Individualized explanations and interpretations of assessment results.
3. Guidance in setting short-term, realistic health promotion goals in areals) selected by the individuals.
4. Guidance in determining specific actions to reach these goals.
5. Provision of health promotion materials and information in areas selected by the individuals.
6. Follow-up appointments to determine attainment of goals and to revise goals as needed.
7. Referrals back to private physicians for information and follow up in areas other than health promotion,
8. Referrals to other community agencies for specific information or services beyond the scope of the health promotion program.
Description of Program Participants
The target population for the Wellness Wednesdays program is the approximately 1,586 faculty (630 or 40%) and staff (956 or 60%) on the main campus of a public university with approximately 17,000 students. The program is advertised by flyers at the beginning of each semester, by voice mail, and by word-of-mouth. Participants are encouraged to make appointments but are seen on a walk-in basis as needed. Undergraduate and graduate students who walk in are accepted and included, although the services are not targeted directly for them.
A total of 165 new visits and 37 followup visits were recorded during the first two semesters of the program. Preliminary figures indicate 147 total visits during the third semester, with 91 of these classified as initial visit« and 56 as return visits. Summary data for the first two semesters has shown that the participants were predominately female (64.2%), and between the ages of 31 and 50(67%). Most were married (58.8%). The participants classified themselves as staff (48%), faculty and administration 24%}, and undergraduate and graduate students (26%). The majority of the students who attended the program were graduate teaching or research assistants and work-study students. (Data for the third semester is currently being analyzed.)
The majority of the participante ranked their health as either good (63.6%) or excellent (17.6%). The most frequent reasons given for wanting to improve health were to be more energetic (24%), live longer (17%), stay healthy (13%), feel better (9%), and to have a better quality of life (9%).
Two trends in attendance during these initial semesters may be useful to other college campuses developing similar volvmtary health promotion programa. The highest attendance in the program was recorded during March and October, the middle monthe of the spring and fall semesters. Higher attendance also was seen the last week of the month, regardless of the time in the semester. The first month of a semester and the first week of a month consistently resulted in fewer participants.
Service Learning Principle One: Participant Control
As identified by Sigmon (1979), the first key principle of service learning states that the participants control the services provided. The Wellness Wednesdays program is designed to be an individualized program of assessment, goal setting, and follow up in areas of health promotion chosen by the participants. Although the assessment procedures are similar with each new person, the interpretation of results leads to participant-driven services. For example, if a participant's Health Promoting Lifestyle Profile-II results show a lower subecale score in the area of nutrition when compared to other areas, and if the participant's weight, percent of body fat, body mass index, and total cholesterol are higher than recommended norms, then the person is encouraged to review the goals related to these needa. Htiwe^er, the final choice of areas for goal setting is determined by the participant. Short-term and long-term measurable goals are set by each person with assistance by the student, and health information is provided by the student to help the individual understand concepts related to the goals. Individualized follow up is scheduled to evaluate progress at a time agreed to by the participant.
Data compiled from the first two semesters of Wellnese Wednesdays has identified several common health promotion needs and interests of the target population (N = 165). The population as a whole is heavier than ideal body weight (IBW) for gender and height. The males, with an average height of 5 feet 10 inches and an average weight of 184 lbs (33 lbs > IBW), were more overweight than the females, with an average height of 5 feet 4 inches and an average weight was 154 lbs (28 lbs > IBW). However, the percentage body fat for malea averaged 22.43 (norm = 14 to 23), compared to the percentage body fat for females of 35.48 (norm= 17 to 27).
Mean Health Promoting Lifestyle Profile-? Bubecale acores (range, 4 = "routine" health promoting behaviors in the subscale area to 1 = no health promoting behaviors in the subscale area) showed: Physical Activity (mean = 2.29), Health Responsibility (mean = 2.38), Stress Management (mean = 2.44), and Nutrition (mean = 2.57) as the greatest areas of need in the Wellness Wednesdays population. Spiritual Growth (mean = 3.10) and Interpersonal Relations (mean = 3.08) showed the least need for change.
Reflecting these results, participants chose to set the most goals in the areas of physical activity and nutrition. The third most common area was Stress Management, with Health Responsibility fourth. No participants chose goals for Spiritual Growth or Interpersonal Relations.
Service Learning Principle Two: Enabling Participants
Sigmon's (1979) second principle states that service learning enables the participante to become better able to serve and be served by their own actions. After shortterm and long-term goals have been set, the student nurse assists the participante in identifying steps and means to reach the goals. The purpose of each chosen intervention is to build the individuals' confidence in their ability to make desired health behavior changes. Common skillbuilding interventions include providing information, providing social support, teaching self-monitoring techniques, teaching self- re ward techniques, and assisting the individuals to restructure the environment to promote healthy behaviors. Attainment of this service learning principle will be expanded as more participants make return visits and as methods are developed to evaluate the percentage of goal attainment in relation to the types of goals and types of interventions.
Service Learning Principle Three: Student Learning
This third principle states that through participation in service learning, the students are learners and retain some control over what is learned (Sigmon, 1979). Students are given the opportunity to reflect on their learning by means of weekly journals and clinical postconferences. Although the student-related goals for Wellness Wednesdays state that the students will gain experience in health promotion assessment, counseling, and evaluation, the content of the experience is determined by the students and the participants. Division of responsibilities within the clinic setting allows students to select their focus for the day. Students (unction as clinic managers who have initial and final contact with participants and coordinate the flow of participants through the clinic. They may divide assessment tasks and provide specific counseling on the screening tests they perform. Several students are needed each clinic day to provide the critical counseling for goal setting and goal revision.
Student learning includes the healthrelated information they select to share with the participante. For this health education component, students derive information from textbooks, health education literature, Internet resources, and previous learning. After appropriate information has been found, the students must decide on the most effective way to present the information to the individual participants.
Professional role development occurs for the students as they become the teachers and the "coaches* for faculty, many of whom have been their former classroom or clinical instructors. Staff and administrative personnel, who previously gave the students information and direction, now ask the students for information and guidance in areas of health promotion. Students begin to view themselves as professional nurses BH they gain confidence in their ability to use communication skills and psychomotor skills to assist others in making valuable lifestyle changes.
The Wellness Wednesdays program has shown itself to be an effective method for providing community-based service learning opportunities in a setting that is convenient for participants, students, and faculty. As the program continues to grow, it will provide opportunities for interdisciplinary collaboration with other health-related departments on campus. It also will provide a setting for faculty and student research in multiple areas related to management, health promotion, disease prevention, and health behavior motivation.
- American Association of Colleges of Nursing. (19971. Position statement: A vision of baccalaureate and graduale nursing education. Washington, DC: Author.
- Pender, N. (1996). Health promotion in nursing practice (3rì ed.), Stamford, CT: Appleton & Lange.
- Pew Health Professions Commission. (1995). Critical challenges: Revitalizing the health professions for the twenty-first century. San Francinco: UCSF Center for Health Professions.
- Sigmon, R (1979). Service-learning: Three principles. Synergist, SIlI, 9-11.
- United States Department of Health and Human Services, Public Health Service. (19911. Healthy people 2000: National health promotion and disease prevention objectives. Washington, DC: U.S. Government Printing Office.
- Walter. S. ( 1996). [Heliabilitiea for the HPLP-II scale and subecaiee]. Unpublished raw data.