One of the challenges of managing clinical courses for students in graduate nursing education is finding clinical site locations. This can be particularly difficult in regions where a variety of graduate programs are attempting to place students in a limited number of clinical sites. I faced this challenge while teaching an advanced health assessment course. I was having particular difficulty placing students in clinical sites that met the pediatrie assessment components of the course. After developing many options, I was able to enhance pediatrie clinical experiences using creative planning.
The advanced health assessment course in the College of Nursing at Valparaiso University focuses on gaining advanced skills in history taking and physical examination techniques across the Ufe span. This clinical course is required for both the master of science program and the post-master's family nurse practitioner program. As part of this course, graduate students must complete a required number of hours in a clinical setting or settings that allows them to gain assessment skills.
The greatest difficulty for students is gaining access to clinical sites for the pediatrie assessment component that encompasses both well-child and ill-child visits. This difficulty is compounded by several factors:
* Other programs in the college of nursing and in surrounding universities are vying for the same clinical sites.
* There are a limited number of pediatrie practices in the region, and some of them are unwilling to take students.
* Many local family practice settings see few infants and young children.
After several unsuccessful attempts to expand pediatrie advanced assessment experiences, I was able to create three new methods of acquiring additional clinical sites.
New Site Acquisition Methods
Working With a Local School
The first method was to work with a school in the area- During the summer, a local school needed help completing sports physicals for children who planned to be active in school sports during the fall. I was able to work with the school nurse and arrange for the graduate students to participate in the sports physicals. The students were responsible for completing various parts of the sports physicals under the supervision of an area physician who volunteered to help with this process. This was an excellent opportunity for the graduate students to practice history taking and physical examination techniques specific to sports physicals across various school-age groups. In addition, the college of nursing was able to provide a service to a local school.
Working With a Local Hospital
The second method involved working with the local hospital health care system. Previously, the local hospital had purchased a mobile health van to provide selected health care services throughout the county. I proposed a method of using the health van to provide free developmental screenings for infants and children at various community sites. A key component of the hospital approval process was that I provide a clear description of the students' activities during the screenings and the ways they would be supervised. A nursing administrator wanted to assure the local medical community these developmental examinations were not replacing the medical services provided by physicians.
The emphasis of the proposal was on students' providing primary prevention and education during the developmental screenings. I suggested the mobile health van be driven to a variety of locations, such as playgrounds, parks, and a free nursemanaged health center associated with the hospital. These sites were identified because of their easy accessibility for the health van and the likelihood of children being present.
After approval was obtained, the first site was selected. The free nursemanaged health center was selected as the first site because its clients would benefit from the services and because the center received support from the college of nursing and the hospital. Advertising was provided to announce the free developmental screenings to center clients and the larger community. On identified dates during the course, graduate students offered screenings and education under faculty supervision.
Working With Child Care and Preschool Facilities
The third method grew out of using the mobile health van. This idea was to offer free developmental screenings at child care and preschool facilities, which were excellent sites because of the potential number of well infants and children. One child care center was selected as the first site because of its familiarity with the college of nursing. Based on discussions with the center director, permission letters were created and sent home to the children's parents. The permission letter explained the purpose of the screenings and identified who was offering them.
On selected dates, the mobile health van was driven to the child care center. Under faculty supervision, students offered free developmental screenings. The program was well received by the majority of the parents who gave permission for their children to participate. To help the children become familiar with the graduate students, a child care center staff member accompanied each child during the screening when the parent was not able to attend. This technique added to the success of the experience. The graduate students were able to take histories and complete physical examinations for infants through preschool-age children. To coincide with the developmental screenings, the child care center planned to use their daily educational materials related to staying healthy during this same time.
One note of caution is that an outcome of these screenings and examinations may be identification of a developmental delay or specific health problem. It is important to identify how such outcomes will be managed before beginning any developmental screenings. Advanced practice nurses are responsible for educating individuals and making necessary referrals based on information collected during health assessments. Therefore, I made arrangements with local health care providers for potential referrals prior to beginning these clinical experiences.
These three settings provided additional pediatrie health assessment clinical sites that other faculty may be able to adapt for their institutions. For example, if graduate students need to assess geriatric clients, adult day care centers may be an excellent clinical site for taking health histories, completing physical examinations, or performing screenings. Although managing these experiences was time consuming, the graduate students, facility staff, parents, and children who participated all benefited. The parents of the infants and children who were screened received a copy of the findings and were provided with anticipatory guidance on developmental needs. The parents commented on the helpfulness of these materials.
Overall, these three creative methods of expanding clinical sites were successful because the experiences provided opportunities for graduate students to increase their pediatrie advanced health assessment skills. In addition, the experiences not only added to the availability of health care services in the community, but also increased the visibility of the college of nursing and the role of advanced practice nurses.