Most nursing programs find it difficult to offer summer options that include the theory and clinical courses needed by BSN students to complete their nursing requirements. This can result in frustration among student populations that have significant percentages of students with either a bachelor or higher degree in other disciplines, as well as returning RN students maintaining full-time employment while attending classes. These students often need to complete their nursing degree with minimal commitment and impact on their personal and professional Uves. Summer coursework can and does provide that flexibility. This was the finding at the authors' institution, a state-supported college in the pacific northwestern United States. Through the creative work of nursing faculty, a summer offering was developed that benefited these students in meeting their goals for a quality nursing education, while also accessing a more "efficient" format.
Nursing literature contains an increasing number of reports that support the use of camp communities as successful clinical sites. Some educators have discussed how valuable these sites are in providing students with practice in the advancing role of health promotion (Matteson, 1995). However, few authors have explored the use of a community as partner model (Anderson & McFarlane, 1996) to establish a long-term relationship based on the concept of community as client. One nurse educator (Praeger, 1997) discussed the importance of careful camp selection as part of the successful student outcomes needed for quality course delivery, but the majority of educators seem to focus more on special needs camps as the ideal source of such learning opportunities (Alaniz, 1995; Allen, 1995; Praeger, 1997. However, the objectives for those experiences primarily are based on individual clients and do not focus on the concepts surrounding community-based care.
However, one educator (Clark, 1995) has explored the possibilities of using a public health nursing model as a way of performing community assessments for health needs at a particular summer camp. Although the model is not one that is truly community as partner, it does focus on aggregate needs of populations versus individual client care. It became clear from the scarcity of such reporting in the literature that camps have not been considered key areas for introducing community concepts to nursing students, while also giving students opportunities to provide hands-on health care to their assigned camp population.
Rationale for Using Camp Communities as Clinical Sites
Students' written and oral feedback throughout the years of piloting this particular type of clinical option continued to strongly support the value of both the hands-on pediatric experience, as well as considering the camp a unique community arena. Students also benefited from indepth exposure to people with disorders that were challenging to both medicine and nursing, such as:
* Physical disabilities (e.g., muscular dystrophy, spine bifida, cerebral palsy).
In addition, students gained valuable experiences with other such high-risk groups:
* Youth with developmental delays and challenges.
* Youth with learning and behavioral challenges.
* Youth with at-risk socioeconomic or family systems.
Students also voiced strong, positive learning outcomes from being able to participate in complex medication and treatment protocols with a variety of campers and staff throughout their clinical practicum. Some of the conditions reported in student logs included:
* Seizure management and stabilization.
* Complex diabetic control issues.
* Behavioral challenges that included pharmacological interventions.
* Unusual dietary regimens.
* Crisis intervention with patients with asthma.
* Concerns surrounding immobility and elimination within the medically fragile populations.
Camp nursing clinicals also provided an abundance of situations requiring students to perform focused assessments and make accurate and rapid nursing judgments. The most commonly cited situations in the health logs were:
* Orthopedic injuries.
* Daily management of asthma, seizures, diabetes, and other chronic disease conditions.
* Interventions surrounding violent and potentially dangerous activities.
* Common camp concerns with dehydration, nutrition, sleep deprivation, and communicable diseases.
Students quickly learned how to access community and public health resources as issues related to environmental concerns, psychological and behavioral problems, and communicable diseases - risks that were seen as everyday concerns of any camp community.
The participating camp communities credited nurse students for enhancing the actual camp experience for their campers. Campers experienced both increased access and visibility of the professional camp nurse role. The students also brought a much needed outsider perspective that helped the camp staff recognize familiar camp challenges, such as adequate handwashing and hydration, as key factors in assuring a healthy camp experience for all.
History of Course Offering
Initially, this course was designed as a summer elective offering. During its initial phases, it was a 1-credit to 2-credit practicum in which students spent 1 to 2 weeks at a camp, assisted the camp nurse, and provided some type of educational project. The projects were determined by the faculty and students, with little input from camp health care and administrative teams. As an elective offering, it was marginally successful. Many students expressed an inability to participate in purely elective offerings, although they expressed their interest in pursuing this type of clinical offering if it could be designed to meet the community health requirements of the curriculum.
Based on this feedback, faculty began to examine models that would give students flexibility in completing their community health clinical hours while taking the camp practicum. The model that initially emerged was to allow students partial credit for the hours they spent in their camp practicums. They then would complete the remainder of their clinical and theory requirements in the upcoming fall semester. However, faculty were concerned that the separation of clinical experience from a theoretical base would limit students from grasping key community as partner concepts. Therefore, the final phase of the project brought about a true community health summer offering that allowed students to complete both theory and clinical portions during the same summer semester.
Description of Theory Course Format and Changes Proposed for Upcoming Summers
The theory course currently is delivered in an "intense" format that allows students to come to class for several fullday sessions with allotted breaks for completion of assignments. Students can access readings and videotapes of class content prior to the initiation of the course. In fact, to ensure success, students are required to come to the initial class with a certain percentage of readings and accompanying assignments completed. Because some students travel long distances to access this offering, this format allows them to complete coursework with minimal onsite time.
To increase accessibility and flexibility, faculty currently are developing the course in a Web delivery format, which will allow students to complete more of the material in the convenience of their homes. They will have access to videotapes that cover the majority of course content, while using a chat room with faculty to increase accountability and enhance discussion on key community health issues. Students will spend some actual in-class time with faculty and classmates to clarify concerns, increase interaction with peers, and prepare them for clinical projects at their selected sites.
A small grant has been awarded to the nursing faculty to help in training additional instructors to supervise these types of clinical practicums. By increasing the expertise of several faculty, the course will no longer be limited to a small number of BSN students, thus providing this unique offering to other regional nursing programs. It also will allow faculty to pursue new and undeveloped partnerships in a variety of camp populations within the region.
Description of Clinical Course
The clinical hours are spent at a camp the students select among options that include traditional, special needs, and those serving underprivileged youths. The initial year of partnership is used to complete a thorough community assessment. Students use interviews, surveys, and observation to develop an in-depth picture of their community. They also study the surrounding areas and provide the camp administration with a demographic summary of the camp and its surrounding region. Students then provide their conclusions regarding the recommended projects that may be implemented by staff and students in the next summer session.
The students' work is considered part of the entire camp's desire to improve health care within their population. All written recommendations following the in-depth assessment are valued as coming directly from the camp community's health care needs. This process also allows for continuity because the next year's students will review the community assessment document and select projects from the recommended list compiled the previous summer.
Assessment is ongoing, and students meet with camp administration prior to their clinical week to determine exactly how their projects will be best accomplished. Reports and recommendations follow the completion of each project, and students also meet for a final day of conference to share their findings and celebrate the completion of their work.
Because students enjoy hands-on care, they find satisfaction in being able to help the camp nurse with the actual care of campers and the organization of the health care program, while completing their clinical project objectives. In thenlogs, students reported a "busy but funfilled" week and shared many examples of what they learned. Students also enjoy working with a partner on their projects (i.e., students are in pairs at each camp) and being allowed to plan and prepare for the projects prior to the beginning of the clinical week.
Nurse educators must continue to provide clinical and classroom offerings that represent both the realities of their student populations and the health care systems they will be serving. Therefore, faculty must increase the community-based clinical offerings within their curricula. They also need to continue to move toward increased flexibility in those course offerings. In addition, partnering with clinical agencies allows for a long-term commitment by both parties, which truly "tears down the ivy-towered walls of academia" and shows both the students and the community partners the critical need for professional nurses to practice from a community-based foundation. However, of utmost importance is the intrinsic value of summer camp clinical offerings. These sites offer excellent hands-on experiences with pediatric populations. When offered in flexible formats, such as the one described in this article, the partnerships truly can be viewed as "win-win" situations for all involved.
- Alaniz, K. (1995). Student nurses as staff at a camp for preschool children with asthma. Journal of Nursing Education, 34, 137-139.
- Allen, B. (Ed.). (1995). Students "can do" multiple sclerosis camp. Retrieved September 3, 1998, from http://oac3.hsc.uth.tmc.edu/ pub- affair s/mm/camp.html.
- Anderson, E.T., & McFarlane, J.M. (1996). Community as partner: Theory and practice in nursing (2nd ed.). Philadelphia: Lippincott.
- Clark, M.J. (1995). Using a public health nursing model to assess and plan for health needs at a summer day camp. Journal of Community Health Nursing, 12, 199-210.
- Matteson, P.S. (1995). Developing a clinical site at a day camp. Nurse Educator, 20(2), 34-37.
- Praeger, S.G. (1997). Establishing camps as clinical sites. Journal of Nursing Education, 36, 236-237.