Journal of Nursing Education

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Major Article 

Using Professional Specialty Competencies to Guide Course Development

Gwendolyn F. Foss, DNSc; Janice K. Janken, PhD; David R. Langford, DNSc; Margaret M. Patton, MSN, MSEd

Abstract

This article describes how an RN-to-BSN community health nursing (CHN) course was reconceptualized from a traditional model to a competency-based model. The traditional course assigned students to CHN preceptors and required a set number of clinical contact hours. As clinical preceptor placement opportunities diminished, students and faculty became increasingly dissatisfied with the course structure and requirements. Faculty endorsed the use of professional competencies to measure course learning outcomes and selected competencies identified by the Association of Community Health Nursing Educators. These competencies were clustered into units, with learning activities and grading criteria based on the critical knowledge, values, and clinical skills needed to demonstrate mastery of specific competencies. Course faculty, rather than agency preceptors, assessed student learning outcomes and mastery of competencies. The students demonstrated mastery of competencies and liked the degree of self-directed learning that built on their professional status as RNs.

Dr. Foss, Dr. Janken, and Dr. Langford are Associate Professors, and Ms. Patton is Lecturer, Department of Family and Community Nursing, School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina.

Address correspondence to Gwendolyn F. Foss, DNSc, Associate Professor, Department of Family and Community Nursing, School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223-0001; e-mail: gffoss@email.uncc.edu.

Received: July 16, 2003
Accepted: January 23, 2004

Abstract

This article describes how an RN-to-BSN community health nursing (CHN) course was reconceptualized from a traditional model to a competency-based model. The traditional course assigned students to CHN preceptors and required a set number of clinical contact hours. As clinical preceptor placement opportunities diminished, students and faculty became increasingly dissatisfied with the course structure and requirements. Faculty endorsed the use of professional competencies to measure course learning outcomes and selected competencies identified by the Association of Community Health Nursing Educators. These competencies were clustered into units, with learning activities and grading criteria based on the critical knowledge, values, and clinical skills needed to demonstrate mastery of specific competencies. Course faculty, rather than agency preceptors, assessed student learning outcomes and mastery of competencies. The students demonstrated mastery of competencies and liked the degree of self-directed learning that built on their professional status as RNs.

Dr. Foss, Dr. Janken, and Dr. Langford are Associate Professors, and Ms. Patton is Lecturer, Department of Family and Community Nursing, School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina.

Address correspondence to Gwendolyn F. Foss, DNSc, Associate Professor, Department of Family and Community Nursing, School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223-0001; e-mail: gffoss@email.uncc.edu.

Received: July 16, 2003
Accepted: January 23, 2004

The unique challenges of educating RNs who pursue baccalaureate degrees are well known. Most RN-to-BSN students are employed and work rotating shifts. Such students have been successful in the work environment where they gain useful clinical knowledge and, thus, have little patience with coursework that seems redundant with what they already know. Faculty at the University of North Carolina at Charlotte, School of Nursing found it increasingly challenging to find traditional, pedagogically sound ways for RN-to-BSN students to use their prior professional knowledge as building blocks for new learning, without wasting time on superfluous assignments.

Competency-based learning is a method of education that allows for flexibility, reduction of duplicity, and building on previous knowledge (Knowles, 1975, 1980). Burz and Marshall (1997) used the term “performance-based education” to refer to the process of teaching students to be accountable for their learning and to apply it in measurable and observable ways. Tanner (2001) defined competency-based nursing education as that which emphasizes individualized teaching-learning processes and flexible ways of achieving knowledge and performance outcomes.

To clarify the concept of competency-based learning, the National Postsecondary Education Cooperative (NPEC) (2002) convened a group of experts in competency-based, postsecondary education to synthesize knowledge and develop a guide for college educators interested in implementing competency-based learning. This group defined competency as the blend of skills, abilities, and knowledge needed to perform a specific task. In addition, it conceptualized competency-based learning as a four-level pyramid. At the base are those characteristics and traits innate to individuals that help explain differences in learning styles and learning achievements. At the next level are the skills, abilities, and knowledge that are learned, whether through formal education or work and life experiences. Competencies are the third level and result from being able to merge knowledge, skills, and abilities into useful tasks. At the peak of the pyramid is assessment of the competency through demonstration. Thus, competency-based education is aimed at defining, teaching, and assessing competencies.

Some critics of competency-based education are concerned that it is overly reductionistic and results in teaching to the task, rather than developing critical thinking (Tanner, 2001). However, advocates identify its focus on outcome behaviors that can be clearly articulated to students and future employers, its flexibility in shaping learning experiences, and its ability to match skill development in education with those needed in the work force as strengths (Evers, Rush, & Berdrow, 1998; Halstead, Rains, Boland, & May, 1996; Knowles, 1980; NPEC, 2002) Alice Voorhees (2001) noted that professional programs enjoy a natural connection with competency-based education because of the clear relationship between student performance and work force expectations.

Competency-based learning is not new to nursing. In fact, del Bueno was an early proponent (del Bueno, 1978; del Bueno, Barker, & Christmyer, 1981). However, recent developments in higher education, the workplace in general, and health care more specifically have made the adoption of competency-based education more appealing. Richard Voorhees (2001) observed that a revolution is occurring in which the labor market progressively holds postsecondary institutions more accountable for demonstrating that students have learned the competencies needed in the workplace. O’Rourke (2003) based a theoretical model on the use of professional nursing competencies to show how employees successfully assume practitioner, scientist, and leadership roles in the work environment. Terkla (2001) asserted that demonstration of student learning outcomes will increasingly become linked with accreditation.

More specific to nursing, the highly regarded Pew Health Professions Commission identified competencies required of health care professionals in the 21st century (O’Neil & Pew Health Professions Commission, 1998) and, subsequently, offered additional guidance to encourage educators to conceptualize teaching in these terms (Long, 2003). Some educators have used professional competencies as a basis for clinical teaching. Kaiser and Rudolph (2003) used the American Nurses Association’s community/public health nursing standards to develop a clinical performance tool, and Patterson, Crooks, and Lunyk-Child (2002) described how they revised their BScN program to follow the steps of self-directed or competency-based learning.

This article describes how a community health nursing (CHN) course in an RN-to-BSN program was reconceptualized from a traditional model to a competency-based model, but the process is applicable to other clinical courses. The goals were to ensure faculty were preparing students for the unique needs of the CHN work force and to create a course with more flexibility and less redundancy for RN-to-BSN students.

Evolution from a Traditional to a Competency-Based Model

Impetus for Change

Prior to becoming competency based, the CHN course for RN-to-BSN students was very traditional. Its philosophical basis conformed to the pervasive expectation that RN-to-BSN students need the same CHN course content, supervised clinical experiences, and clinical hour requirements as prelicensure students (Davidhizar & Vance, 1999; Marcus, Swint, Valadez, Ward, & Williams, 1986). The original course followed the standard practice of most RN-to-BSN programs that required preceptor-guided clinical experiences in traditional settings, such as health departments, home health agencies, occupational health, and health promotion centers for a set number of hours (Bittner & Anderson, 1998; Kalischuk & Thorpe, 2002; Rosenlieb, 1993).

From the students’ perspective, the time constraints imposed by the CHN course were viewed negatively. Most students worked full time, which made scheduling an educational clinical day into a Monday-through-Friday framework difficult. The students often voiced dissatisfaction with their clinical placements with preceptors, viewing them as redundant and irrelevant to their personal educational and career goals.

The traditional approach to education became progressively less satisfactory for the faculty as well, although for different reasons. The question of whether or not students were learning essential content became bothersome. Students maintained journals and logs to provide evidence they were attaining course objectives. However, the typical pattern was that students listed activities they had completed and the time spent on each. Faculty realized that students probably were recording what they were doing but not what they were learning.

A second faculty concern was the increasing difficulty of identifying a sufficient number of traditional CHN clinical sites for both the RN-to-BSN and prelicensure students. Funding for area public health programs declined every year. In an attempt to provide needed services, the local county government contracted with a hospital system to provide services that traditionally had been provided by health departments. The hospital system restructured the health department and closed or merged many community-based clinics with other hospital services. Community health nurses who had worked as preceptors for the university were no longer assigned to traditional CHN roles. At the same time, local home health agencies experienced decreased Medicare funding and increased their productivity expectations of nurses. Facing declining resources, agencies became reluctant to provide support for preceptors. As a consequence of this widespread restructuring and shrinking numbers of community health facilities, finding suitable clinical placements for RN-to-BSN students became increasingly difficult.

A final issue concerned the growing administrative responsibilities placed on course faculty. Each time the CHN course was offered, faculty had to locate appropriate preceptors, generate individual contracts for each preceptor and student, and orient preceptors to their responsibilities. In addition, when new clinical sites were used, the university required an institutional contract. Faculty began to feel they were spending more time on administrative tasks than on teaching. Given these concerns, CHN faculty decided to explore alternative ways of providing clinical learning experiences for RN-to-BSN students.

Quest for a New Model

The process of change began with informal discussions among faculty about educational philosophies. Ideas and assumptions about the purpose of the CHN clinical experiences and the relative roles of learners, teachers, and preceptors were discussed at length. Faculty compared the purposes of clinical experiences for prelicensure and RN-to-BSN students. They discussed theories of adult learning (Knowles, 1980) and ways to apply theories that support performance-based education in a clinical course. The advantages and disadvantages of substituting competency-based clinical experiences for preceptor-guided experiences were debated. A central question was how to ensure the clinical experiences fostered appropriate learning and how this learning could be measured. During the conversations, faculty identified assumptions about RN-to-BSN education that they shared and that were also consistent with competency-based learning theories (Table 1).

Faculty Assumptions About RN-to-BSN Education that are Consistent with Competency-Based Education

Table 1:

Faculty Assumptions About RN-to-BSN Education that are Consistent with Competency-Based Education

Throughout the discussions, the advantages and disadvantages of competency-based learning became clearer. The most attractive advantage was the flexibility it provided students to learn and apply CHN concepts. Since the focus would be on outcome, rather than process, the students could practice at times convenient for them and develop their skills in settings other than traditional community health agencies. Nonetheless, a lingering concern was that students may not have enough hours or clinical experiences in CHN.

Conveniently, these discussions occurred at the same the Association of Community Health Nursing Educators (ACHNE) was revising and updating a document that identified core competencies for community and public health nursing practice (ACHNE, 2000). Looking at the proposed competencies made it easier to visualize how the clinical component of a CHN course could be transformed to competency-based learning.

Identifying and Selecting Competencies

When faculty begins the design of competency-based education, the initial hurdle is to articulate and reach consensus on the competencies required for success in the work force (Jones, 2001). Fortunately, within nursing, numerous groups of professional experts have been convened to identify requisite competencies (Quad Council Public Health Nursing Organizations, 2003; Tanner, 2001; U.S. Department of Health and Human Services, Public Health Service, 1997). Jones (2001) encouraged using competencies identified by professional groups in curriculum development because they reflect the best thinking in the field and demonstrate clear links between education and success in the work force. O’Rourke (2003) built on these links to demonstrate workplace role development.

The competencies identified by the ACHNE (2000) were part of a document designed to describe the essential elements of entry-level CHN practice that can and should be expected as outcomes of baccalaureate education. The document identifies five professional values core to CHN: health promotion, prevention of illness and injury, partnership, respect for the environment and respect for diversity. In addition, it names 12 areas of core knowledge, each accompanied by specific competencies that could be demonstrated. For example, the core knowledge area of epidemiology and biostatistics is tied to the following competencies:

  • Interpret basic epidemiological measures and aggregate-level data.
  • Link the natural history of disease model, levels of prevention, and the epidemiological triangle with appropriate interventions.
  • Interpret probability, proportion, and measures of risk.
  • Interpret and apply population-based research to practice.

The faculty judged the ACHNE (2000) document to be compatible with its emerging reconceptualization of the CHN course. The document not only identified competencies but connected them with knowledge requirements. In addition, the document was developed in a manner consistent with the best practices of competency-based education. According to the NPEC (2002), a principle of competency development is to include in the deliberations key stakeholders, such as policymakers and employers. The ACHNE used documents from the American Nurses Association, Council of Community Health Nurses (1986), the Quad Council of Public Health Nursing Organizations (1999), the American Association of Colleges of Nursing (1998), and the Pew Health Professions Commission (O’Neil & Pew Health Professions Commission, 1998) to identify essentials of generalist baccalaureate nursing education and entry-level CHN practice. Furthermore, nurses from education and practice from different regions of the United States provided critique and input to the final document (Kaiser, Carter, O’Hare, & Callister, 2002).

After extensive discussion of how the ACHNE (2000) competencies would facilitate transformation to self-directed learning by RN-to-BSN students, the CHN faculty agreed to adopt the ACHNE document as a framework, and redesign the course to make the clinical component competency based. The didactic component would be directed at critical knowledge and values students need to develop the competencies. Faculty would no longer control all clinical learning experiences, but instead would facilitate and guide the RN-to-BSN students in the application of CHN values and knowledge to practice.

Connecting Competencies to Learning Processes and Assessment

The next step for the faculty in transforming the course was to connect the ACHNE competencies with learning processes and determine how to measure competency attainment. However, before proceeding, it was essential to seek support from the RN-to-BSN program director and other faculty colleagues who taught other courses in the program. As anticipated, these individuals voiced questions and concerns similar to those already discussed and debated by the CHN faculty. Four points seemed particularly persuasive to colleagues and administrators:

  • The clinical experiences clearly centered on development of knowledge and values that undergird professional practice and evidence-based, standards-related practice.
  • Proposed learning experiences would be based on sound adult learning principles.
  • Learning experiences would acknowledge the past experiences and education of RN-to-BSN students, rather than assuming they have the same learning needs as prelicensure students.
  • Faculty time normally spent locating and orienting preceptors and generating contracts could be redirected to teaching and scholarly pursuits.

After support from these colleagues was obtained, CHN faculty began course redesign. The challenge became connecting the ACHNE competencies, course teaching and learning strategies, and competency assessment criteria into a unified whole. To accomplish this, the entire list of ACHNE competencies was reviewed. Some competencies were omitted from this CHN course because they were part of other courses in the program. For example, all RN-to-BSN students took courses specifically aimed at learning skills associated with nursing informatics and technology, and nursing management. Consequently, ACHNE competencies related to core knowledge and value development associated with “information and healthcare technology” and “coordinator and manager” were assigned to those courses.

Jones (2001) advised faculty who are linking competencies with learning experiences to consider where in the curriculum students will learn important skills such as writing, teamwork, public speaking, and critical thinking. At this university, all students are required to take a writing-intensive course in their major. The CHN course meets this graduation criterion for undergraduate students enrolled in nursing. Thus, the writing-intensive requirement needed to be considered when the course was reconfigured into competency units.

To organize faculty thinking, grids were constructed to cluster ACHNE competencies and align them with teaching-learning strategies and a method for measuring whether the competencies had been attained. This endeavor resulted in seven learning units. Six units included clinical competency-based assignments. The first unit introduces the foundations of community/public health nursing and, thus, is not specifically linked with any competencies. Table 2 depicts the six clinical learning units aligned with the competencies addressed in the revised CHN course.

Organization of Community Health Nursing Course by the Association of Community Health Nursing Educators (ACHNE) Competencies (2000)

Table 2:

Organization of Community Health Nursing Course by the Association of Community Health Nursing Educators (ACHNE) Competencies (2000)

The critical components of each unit included:

  • Explanation and analysis of the specific knowledge and CHN values that inform the clinical activity.
  • Articulation and explanation of the specific skill-building clinical activities that must be completed to meet the competency.
  • Description of the specific items that validate the students’ mastery of the skills and knowledge for each competency.

Table 3 shows how selected competencies for the community-as-client unit were attained and validated by faculty. Faculty conceptualized environmental health knowledge as an essential component of any community assessment, so it was included here.

Sample of Association of Community Health Nursing Educators (ACHNE) Competencies (2000), with Partial Description of Content, Skills, and Assessment for the Community-as-Client Unit

Table 3:

Sample of Association of Community Health Nursing Educators (ACHNE) Competencies (2000), with Partial Description of Content, Skills, and Assessment for the Community-as-Client Unit

As faculty developed the competency units, embedded ideas of traditional clinical learning experiences gave way to conceptualizations of population-based practice and learning that could be accomplished with populations in any setting. Faculty agreed that students could meet some of the competencies in their employment setting or other community agencies. They assumed students would have knowledge of and access to resources in the community in which they could develop such skills. Faculty expected to regularly consult with students to ensure selected experiences would be appropriate.

Implementation

The revised competency-based course was initially offered to a summer cohort of RN-to-BSN students in their last semester of the program. This cohort had no previous experience with competency-based learning. The assignments were presented in writing to the students and were discussed verbally with the entire class. The instructor focused on how the specific competency assignments recognized their status as licensed RNs, thus giving them a measure of freedom in fulfilling the requirements of the ACHNE competencies. Due dates for completion of the required assignments were left open to provide maximum flexibility and independence for the students throughout the 10-week summer session.

Student Reactions

Although the students were already licensed RNs, they initially embraced the traditional role of students as passive recipients of information. The students requested that all assignments and course requirements be so clearly defined that there was no latitude for interpretation that would or could lead to an assignment not being completed to the instructor’s specifications and receiving a lower grade. Zuzelo (2001) identified similar characteristics of RN-to-BSN students and postulated that these attitudes are possibly coping mechanisms used to help them manage their anxieties about completing school and juggling work, family, and school roles.

Many of the students experienced difficulty locating clinical experiences in their communities. This was especially true for students who had no work or volunteer experiences with any community agencies. Students who had participated in community activities in their work setting were more successful in identifying community health resources. Identifying appropriate experiences in the work setting was easier for the family and transcultural nursing competencies.

Faculty Response

Based on the experiences of the first class of students who implemented this competency-based approach to CHN, most faculty assumptions were validated. Validated assumptions included:

  • Clinical learning in CHN was not equated with a predetermined number of clinical hours.
  • The population-focused nature of the discipline did foster flexibility in learning.
  • The degree to which students mastered clinical competencies, with corresponding values and knowledge, could be assessed.
  • Students liked the self-directed nature of learning, which recognized their status as licensed RNs.

Although surprising, the finding that RN-to-BSN students were less confident and competent to locate community health experiences was consistent with the literature (Nickel et al., 1995).

When the course was offered a second time, the Quad Council of Public Health Nursing Organizations (1999) and the ACHNE competencies were discussed to a greater degree. Acceptable types of clinical experiences that would demonstrate specific competencies were discussed, and students were referred to appropriate community resources as needed. Structure was added to the course by clearly stating due dates for each competency activity. Students verbalized more comfort with this increased structure and located appropriate clinical learning experiences with few problems.

The university’s decision to offer a completely online option for the entire RN-to-BSN program, including the CHN course, coincided with the revision of the course after its initial offering. The same group of CHN faculty met regularly to modify the competency units into an interactive online format. The revised course was designed so similar versions could be offered in both classroom and online formats.

Evaluation

Faculty found that the assignments provided ample evidence of the degree to which students mastered the required competencies. The Assessment of Competencies section in Table 3 includes most of the required reports for the community-as-client unit. These assignments demonstrate how students provided evidence that they had mastered the skills of a community assessment and used core knowledge and values to discuss and explain their activities. Assignment of grades, based on the completeness and quality of papers and reports of clinical activities, was no less or more demanding than in a traditional course.

Student responses to the revised course have been enthusiastic. They particularly like the degree of self-directed learning that builds on their professional status as RNs. The synthesis of core knowledge and values with required skill development was identified as a strength. Several students stated that their perspectives of patients or families had broadened dramatically. They now understand how a patient in the hospital is part of a community and a population. Other students stated that participating in the required learning activities for the course resulted in awareness of the independent nature of nursing and how community health nurses possess the knowledge and skills to improve the health of specific communities and populations. Such comments contrast sharply with previous student comments that a CHN course was a “waste of time.”

Discussion

When transforming a CHN course from a traditional to a competency-based model, several issues need to be addressed by faculty. A major concern of CHN courses is to develop population-focused knowledge, values, and skills. At-risk populations exist in all practice environments. The challenge for CHN educators is to facilitate a transformation of thinking in RN-to-BSN students so they can reconceptualize patients from merely individuals in need of nursing care, to individuals who are members of groups, influenced by the environment, who need population-level interventions. While preceptors can offer assurances that students receive population-focused clinical experiences (Bittner & Anderson, 1998; Davidhizar & Vance, 1999), it is more difficult for them to ensure quality experiences if they are overwhelmed with agency responsibilities. By using a self-directed learning approach that measures outcomes of knowledge, values, and skills for specific competencies, students are able to learn and apply population-focused nursing care in a manner that strengthens their critical thinking abilities.

A related issue is the appropriateness of clinical experiences for specific competencies. Student responses to the first course offering made it clear they needed more specific guidelines for clinical experiences than faculty expected. When criteria for selecting the clinical experiences were clearly stated, students identified opportunities in agencies or at work that they had not previously considered to be “nursing” roles. For example, many students already volunteered in schools or with organizations such as scouting or boys and girls clubs. When they provided health education or health screening for targeted populations, the students suddenly realized what “population-focused nursing” actually meant. Faculty need to be prepared to coach and guide students in locating and using community resources to develop population-focused nursing skills.

An educational concern is recognition of student progress or failure, without direct validation from a preceptor. When the clusters of competencies that formed each unit were constructed so students had to synthesize requisite core knowledge, values, and skills to demonstrate mastery of the competency, the reports were sufficiently detailed so instructors could readily identify whether the students had both completed the required activities and engaged in the critical thinking process of synthesizing and analyzing the core knowledge and values supporting mastery of the clinical skill and, thus, the competency. Variations in the quality of student work were found, and the grades reflected those variations. Student reports included information such as agency addresses and names of contact individuals, which could be verified by the instructor if questions arose about actual completion of activities.

Summary

The nursing work force expects new graduates to demonstrate the competencies of the profession (NPEC, 2002; O’Neil & Pew Health Professions Commission, 1998; Quad Council of Public Health Nursing, 2003; A. Voorhees, 2001). RN-to-BSN students can and do learn essential knowledge and skills in a variety of settings and are able to demonstrate competency in clinical nursing. Competency-based learning allows them to build on their previous learning in a self-directed manner that fosters evidence-based thinking. The transformational power of such a course is summarized by one student who stated at the end of the revised course: “My thinking about nursing has changed from waiting to be told what to do, to thinking about what needs to done and then doing it.”

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Faculty Assumptions About RN-to-BSN Education that are Consistent with Competency-Based Education

RN-to-BSN students are adult learners and, as such, are self-directed.

Clinical expectations based on broad, population-focused practice are flexible and foster participatory self-directed learning.

RN-to-BSN students have completed programs in nursing and have been exposed to the values and knowledge base of nursing.

Community health nursing learning experiences must be grounded in the values and core knowledge of the discipline.

Clinical learning is not a function of a predesignated number of hours in a clinical agency.

The community health nursing course needs to recognize and build on RN-to-BSN students’ expertise in their areas of practice.

RN-to-BSN students know their communities and can use that knowledge to identify potential population-focused clinical experiences.

Students in the program will welcome recognition of their status as RNs.

Organization of Community Health Nursing Course by the Association of Community Health Nursing Educators (ACHNE) Competencies (2000)

Learning ModuleApplicable ACHNE Competencies
Community Assessment and Intervention

Interpret basic epidemiological measures, such as morbidity and mortality and incidence and prevalence rates.

Link the natural history of health problems with levels of prevention and appropriate interventions.

Interpret and apply population-based research to practice.

Demonstrate skill in the use of methods for assessing health risks of individuals, families, and communities.

Plan and implement multilevel approaches for health promotion and disease prevention.

Conduct a community, workplace, and home environmental assessment.

Identify and access environmental health information sources.

Link environmental exposure to illness/disease.

Make referrals to appropriate environmental health resources in the community.

Assess the health needs and assets of communities and populations.

Use knowledge of disease transmission, health policy, and primary health care in planning for population health interventions.

Elected Body Report and Letter to Member of Policy-Making Body

Work as an advocate for community health.

Influence health-related legislation at the local, state, and national levels.

Interpret the effects of the economic and political environments and population growth on global health.

Use ethical problem-solving strategies to address ethical problems.

Transcultural Communication

Assess client definitions of health and culture.

Demonstrate skill in the use of methods for assessing health risks of individuals, families, and communities.

Deliver nursing and health care within the context of the global environment.

Complete a cultural assessment at the individual, family, and community levels.

Use the results of a cultural assessment to plan and implement culturally sensitive interventions.

Family Nursing

Demonstrate skill in the use of methods for assessing health risks of individuals, families, and communities.

Assess and monitor the health status of individuals and families.

Integrate knowledge of appropriate developmental and other theories into health planning and interventions.

Plan and implement appropriate interventions.

Health Screening

Demonstrate skill in the use of methods for assessing health risks of individuals, families, and communities.

Develop an assessment plan in collaboration with community partners.

Assist in the data collection process.

Interpret basic community data.

Use community assessment data in the development of appropriate interventions.

Participate with other community activists in planning, implementing, and evaluating health interventions.

Document appropriately in ethically challenging situations.

Interpret probability, proportion, and measures of risk.

Health Education

Initiate community partnerships for goal setting and development of interventions.

Inform and educate the public about health issues.

Adhere to professional standards of community health practice.

Identify appropriate participants in a community project.

Sample of Association of Community Health Nursing Educators (ACHNE) Competencies (2000), with Partial Description of Content, Skills, and Assessment for the Community-as-Client Unit

ACHNE (2000) Competencies

Interpret basic epidemiological measures, such as morbidity and mortality and incidence and prevalence rates.

Link the natural history of health problems with levels of prevention and appropriate interventions.

Interpret and apply population-based research to practice.

Demonstrate skill in the use of methods for assessing health risks of individuals, families, and communities.

Plan and implement multilevel approaches for health promotion and disease prevention.

Conduct a community, workplace, and home environmental assessment.

Identify and access environmental health information sources.

Link environmental exposure to illness/disease.

Make referrals to appropriate environmental health resources in the community.

Assess the health needs and assets of communities and populations.

Use knowledge of disease transmission, health policy, and primary health care in planning for population health interventions.

Theoretical Content: Community-as-Client Unit

Theoretical approach to community and population care.

Epidemiology.

Natural history of disease.

Levels of prevention.

Healthy cities.

Community and home environment assessment.

Environmental influences on health.

Community-level data sources and data collection strategies.

Government policy and regulation.

Clinical Activities
Conduct community assessment:

Choose geographical community.

Conduct windshield assessment.

Perform analyses of secondary data relevant to community’s health, available from sources such as the U.S. Census Bureau, the Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Reports, chambers of commerce, health departments, and newspapers.

Find out how the community rates environmentally by going to http://www.scorecard.org/.

Assessment of Competency
Submit a paper that will be evaluated on the following:

A community assessment is provided addressing the eight subsystems of the Community-as-Partner Model. (20 points)

Sources of data for the assessment are identified and referenced. (5 points)

Windshield survey results are attached as an appendix. (10 points)

Assessment data are summarized in a description of the community’s strengths and weaknesses. (10 points)

The community is used as the unit of analysis; the priority nursing diagnosis is identified; and the response (problem), what the problem is related to (cause), and how the problem is manifested (cues from the assessment data) are stated. (10 points)

A logical intervention is recommended for the nursing diagnosis, along with a statement of the desired outcome or goal for the intervention, and a statement on how the effectiveness of the intervention will be evaluated. (10 points)

A minimum of six scholarly references from the literature on the topic of the priority nursing diagnosis and proposed intervention are included in the reference list and cited in the text of the paper. (10 points)

The paper conforms to the Publication Manual of the American Psychological Association format, with appropriate grammar and style used. (10 points)

10.3928/01484834-20040801-03

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