Dr. Dunlap is Associate Professor of Nursing, Belmont University, Dr. Marver is Associate Professor, Vanderbilt University Medical Center, and Director of Research, Meharry-Vanderbilt Alliance, Ms. Morrow is Director, Edgehill Family Resource Center, and President, Edgehill Homes Resident Association, Ms. Green is Director of Nursing, Metro Public Health Department, and Ms. Elam is Nurse Anesthetist, Anesthesia Services Associates, Nashville, Tennessee.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Ruby K. Dunlap, EdD, MSN, APRN-BC, Associate Professor of Nursing, Belmont University, Nashville, TN 37212; e-mail: firstname.lastname@example.org.
This article describes a community health nursing partnership and the challenges of both vision and execution that a group of nurse educators, community partners, and nursing students faced beginning in 2002 and continuing to the present. The group began their work together with some shared key assumptions and commitments. Behind the proverb “It takes a village to raise a child,” which was popularized to the point of cliché by Hillary Clinton’s 1996 book titled It Takes a Village, is the truth that human beings are social creatures and that one of the conditions for human thriving is the formation and maintenance of well-functioning social support networks. This is true not only for child rearing but also for any other developmental age. The absence of mutually supportive social networks, whether called village, neighborhood, or community, puts individuals of any age at risk, directly or indirectly, for the negative effects of isolation. In addition to the obvious unmet need for socialization and the resulting psychological distress of loneliness, isolated individuals are at risk for nutritional deficits, physical injuries of many kinds, diseases that run their natural courses without intervention, and even death (Seeman, Kaplan, Knudsen, Cohen, & Guralnik, 1987).
With shared understandings and commitments such as these in place, a group of nursing educators along with representatives from community agencies began meeting to explore collaborative work approximately 8 years ago in Nashville, Tennessee. They decided to call themselves Nursing Education Partnership for Community Health Improvement, or NEPCHi. As the group members have reflected on their experiences since that beginning, it has become clear that “village building” has been a primary source of motivation and cohesive power for what has been accomplished in the intervening years. Their evaluation of their activities has been guided both by the outcomes of those activities and also by comparison with the experiences of others who have engaged in similar campus-community partnerships (Otterness, Gehrke, & Sener, 2007).
As has been the experience of others (Hubbell & Burman, 2006) working from shared abstractions to something more concrete, the members of the group navigated many meetings to articulate a mission and vision that all of the members could commit to, searched for funding and leadership, and adapted to changing conditions from the group’s beginning. Despite the difficulties of identifying common process and outcome objectives, this partnership’s experiences with these fit with campus-community partnership models such as the Community-Academic Partnership model described by Lucey and Maurana (2007, p. 180) or what others have called Clinical Microsystems (Thies & Ayers, 2007, p. 327). Because naming themselves was closely connected with finding a shared mission and vision, these activities took many meetings, especially since the membership of the group also evolved until it reached some stability approximately 3 years into the partnership’s existence.
Although the group was not formally named until the spring of 2003, the original impetus for NEPCHi came from a meeting initiated by a representative of the Meharry-Vanderbilt Alliance in the fall of 2002 to explore the possibilities for an interaction between two schools of nursing related to the initiatives of the Meharry-Vanderbilt Alliance. The common goal that emerged was to plan a joint community health clinical experience for nursing students that would focus on improving the health status of a specific community within Nashville.
A group of interested individuals began meeting on a regular basis at the Alliance in February 2003. The purpose of the meetings was to review local health education and improvement projects already in progress in various communities. At one of the earliest meetings, it was suggested that the group be expanded to include all schools of nursing in the area, and within a month, representatives of all of the area nursing programs joined the group. Another crucial partner was Nashville’s Metropolitan Public Health Department (MPHD). Meharry Medical College, which currently lacks a school of nursing, sent a nurse representative for community health education.
To help identify an area of the city for focused collaborative efforts, the director of nursing at the Metropolitan Public Health Department provided health statistics in terms of total population; race; morbidity/mortality/hospitalization prevalence and hospitalization data with respect to asthma, diabetes, heart disease, and stroke; behavioral information (i.e., smoking, obesity, and physical activity); community resources such as shopping, schools, public housing, parks, and libraries; and poverty rates and median household income for all geographical areas throughout Nashville. By early July 2003, the group had analyzed the assessment data and decided to focus its efforts on Edgehill, a historical African American community within Nashville. The community is supported in many of its endeavors by a strong neighborhood-based action group named Organized Neighbors of Edgehill (ONE). In September 2003, leaders from ONE began regularly participating in NEPCHi assessment and planning meetings.
The Edgehill community is a population of approximately 6,000 residents (Metropolitan Government of Nashville and Davidson County, Tennessee, 2010) whose vulnerability can be assessed by several indicators including having one of the higher crime rates in Nashville (Metropolitan Nashville Police Department, 2009), 76% single-parent families compared to 37% for Nashville as a whole, 16% older than age 60, nearly 79% Black, and a 32% poverty rate compared to 13% for Nashville as a whole (Edgehill Family Resource Center, 2008). The neighborhood has several convenience stores selling alcohol and tobacco products but no grocery store or pharmacy.
Nursing students and their faculty, coordinating through NEPCHi, engaged in service-learning projects in Edgehill; these included students visiting older adults who had chronic disease or were socially isolated as well as holding community health fairs. Nursing students completed assessments of health status, both of the community as a whole and of families and individuals within the community.
Based on the assessed need, students provided health teaching on various topics such as diabetes, nutrition, and medication management. Students helped renew prescriptions by calling pharmacies or the prescribing providers; students also made referrals under the supervision of their nursing faculty. Residents who needed more than nurse visits were referred to their primary care physician or to a local neighborhood clinic if they did not have a primary care physician.
One of the more successful collaborations between schools of nursing occurred when one school planned to have students make home visits in the first half of the semester, while a second school planned to have students make home visits in the second half of the semester. With the guidance of their faculty, the nursing students in the first rotation met on site (a subsidized housing high-rise in Edgehill) and gave a thorough report on members of the household to the students replacing them. The students then went together to be introduced to the household members. This provided continuity of care for residents in the household as well as an opportunity for the students from two schools of nursing to interact with each other. The challenges of coordinating between two different nursing schools, one a state university and the other a private faith-based university, were met and overcome by the willingness of the two faculty to work closely together on behalf of the students and also on behalf of the community.
Members of NEPCHi contributed to coordinated efforts to establish a United Way-funded family resource center in Edgehill, increasing the capacity of the citizen leadership to establish their own goals, access resources, and enhance their solutions to the needs of their community. An advanced practice nurse who joined NEPCHi also happened to represent a commercial development complex in Edgehill. Ultimately, she and her husband provided a much-needed health education meeting place in the complex, as well as some financial support for health education and other joint activities in the neighborhood. The group learned through their experiences that both facilitating variables and barriers would impact their ability to work in a coordinated way for the improvement of health in Edgehill. These variables are summarized in Table 1.
Table 1: Variables Affecting Campus and Community Partnerships
The challenges continue to exist but ways of adjusting or compensating for them have been identified. For example, the various academic calendars require careful communication and coordination among the group members to identify shared times of access to students and their availability for service programs in the community. The changing student cohorts have become less destabilizing to community members as they have experienced a stable core of invested NEPCHi members working with them.
The referral mechanism and shared paperwork issues have never been satisfactorily resolved. Referral remains primarily word of mouth, and each institution within NEPCHi still uses its own paperwork. NEPCHi itself has evolved in the members’ understanding of how they are related to it and one another in their shared work. They have come to realize that a looser structural relationship is still consistent with joint efforts on behalf of a specific neighborhood. Examples of positive outcomes are listed in Table 2.
Table 2: Examples of NEPCHI Outcomes
The director of the Edgehill family resource center continues to provide leadership for coordinating services to benefit the residents in the Edgehill community. Partnering with the NEPCHi Program, the director participates in meetings to hear and give reports about community needs, make referrals to NEPCHi of residents in need of home visits, and get the word out in the community about the NEPCHi Program.
The family resource center vision for the youth and older adults who live in Edgehill is a combination of taking care of and educating each other. Youth who have not spent a lot of time around older adults find them to be fascinating individuals, with a wealth of knowledge about the past. Because reports of death, hunger, and loneliness among the older members of the Edgehill neighborhood touched the family resource center director and the youth, they decided to form a youth council in early 2007. Members of the family resource center youth council then began a seniors patrol. Their job is to check on isolated older adults in the Edgehill neighborhood and do small chores, such as taking out trash or washing dishes.
In addition, NEPCHi members began training youth to do simple health assessments such as questioning the older adults about how they were doing. NEPCHi also organized mentoring for the youth. The nursing students were strong role models for the youth, and they made themselves available to teach and encourage the youth to continue their own education.
With the guidance of NEPCHi, nursing students developed an instructional manual to teach the youth how to care for and talk to older adults as well as what signs of health impairment to watch for and report. Since then, the students worked with the youth to hone their skills in simple assessments and helpful interaction with older adults.
Nursing students from the universities also continue their home visits and teaching projects in Edgehill. The end results are that nursing students are helping youth, youth are training other youth, and older adult and youth partnerships are being developed to last a lifetime. With partnerships and projects like these, NEPCHi continues to invest time and effort toward health improvement in the Edgehill neighborhood.
Partnership Lessons Learned
Partnerships among multiple agencies and universities can thrive with positive health outcomes in a selected population if key leaders in these institutions are willing to continue to invest the time and effort to keep the vision alive and the practical commitments intact. The NEPCHi members learned by experience how critical it is to have individuals with vision, energy, and commitment involved in such a complex enterprise. The challenges can be daunting, but the rewards are significant.
Formal analysis of service-learning relationships among partnering students, neighborhood agencies, and universities includes the learning benefit for the students, the service benefit for the neighborhood, and recognition for each university or agency (Otterness et al., 2007). Students gain key insights into determinants of health as well as experience working across cultural and socioeconomic boundaries, and they also have opportunities to participate in complex problem solving. The neighborhood gains access to the expertise and science-based knowledge of students and faculty so that their options for problem solving are expanded. The university gains important community credibility by establishing a record of cooperative willingness to be invested in service to its neighbors. If the partners patiently persist, the individuals who ultimately benefit the most are those whose vulnerability is mitigated because a supportive village has grown up around them.
- Clinton, H. (1996). It takes a village: And other lessons children teach us. New York, NY: Simon & Schuster.
- Edgehill Family Resource Center. (2008). Measures for community goals. Retrieved from http://www.heros-inc.org/EDGEHILL%20FRC%20%202007-2008.pdf
- Hubbell, K. & Burman, M.E. (2006). Factors related to successful collaboration in community-campus partnerships. Journal of Nursing Education, 45, 519–522.
- Lucey, P. & Maurana, C.A. (2007). Partnerships to address social determinants of health. Nursing Economic$, 25, 179–182.
- Metropolitan Government of Nashville and Davidson County, Tennessee. (2010). Population and household. Retrieved from http://www.nashville.gov/mpc/population_projections2010.asp
- Metropolitan Nashville Police Department. (2009). Annual UCR report by zip code [Data file]. Retrieved from http://www.police.nashville.org/docs/stats/2008_Annual_UCR_by_Zipcode.pdf
- Otterness, N., Gehrke, P. & Sener, I.M. (2007). Partnerships between nursing education and faith communities: Benefits and challenges. Journal of Nursing Education, 46, 39–44.
- Seeman, T.E., Kaplan, G.A., Knudsen, L., Cohen, R. & Guralnik, J. (1987). Social network ties and mortality among the elderly in the Alameda County Study. American Journal of Epidemiology, 126, 714–723.
- Thies, K.M. & Ayers, L. (2007). Academic microsystems: Adapting clinical microsystems as an evaluation framework for community-based nursing education. Journal of Nursing Education, 46, 325–329.
Variables Affecting Campus and Community Partnerships
|Committed leadership||Academic calendar|
|Stable grassroots relationships||Changing student cohorts|
|Regularly scheduled meetings||Referral mechanism and shared paperwork|
|Diversity and number of academic and community organizations|
|Ability of schools of nursing to work together|
Examples of NEPCHI Outcomes
|Health care access||Nursing students help fill prescriptions and make appointments with health care providers|
|Primary prevention||Nursing students hold seasonal flu clinics|
|Social support||Neighborhood youth guided by professional nurses and nursing students interact with older adults|