Epidemiologic studies show that lifestyle and environmental and genetic factors are major determinants of population health in areas of health, illness, disease, disability, and mortality. As the health of the population shifts toward chronic illnesses and long-term disability, acute care and disease-based episodic interventions alone are inadequate for improving health (Allan et al., 2004; Allan, Stanley, Crabtree, Werner, & Swenson, 2005). Nurses must be adequately prepared to engage in activities that focus on health promotion and disease and injury prevention throughout the lifespan; therefore, it is essential that undergraduate nursing programs provide their students with health promotion clinical experiences. An Association of Community Health Nurse Educators’ (2010) report suggests that it is time to focus on practice where there is a community-level population focus and where support is available to develop essential nursing practice competencies that include partnership skills.
In addition, federal legislation enacted in early 2011 positions health promotion as an integral part of health care reform. The Affordable Care Act (U.S. Department of Health and Human Services, 2011) includes 37 separate provisions to enhance health through healthy lifestyles. Collectively, these provisions have the potential to make health promotion programs available to the majority of the American public. Furthermore, health promotion serves as critical content in nursing education, comprising between 6% to 12% of the content of the National Council Licensure Examination (NCLEX-RN®; National Council of State Boards of Nursing, 2010). The health promotion category of this examination requires nurse graduates to have the knowledge to incorporate prevention and early detection of health problems and strategies, which will help clients and their family and significant others to achieve optimal health. In addition, the American Association of Colleges of Nursing (AACN) includes an essential about health promotion, which states, “Health promotion, disease, and injury prevention across the lifespan are essential elements of baccalaureate nursing practice at the individual and population levels. These concepts are necessary to improve population health” (AACN, 2008, p. 4). The inclusion of health promotion on the NCLEX-RN examination and as an essential for nursing curriculum (according to the AACN) reinforces the concept of health promotion as a core component of the nursing profession. To prepare baccalaureate nursing students, the Capstone College of Nursing (CCN) provides an intensive health promotion focus at the senior level in the community health nursing course. The CCN students engage in health promotion activities through the training and delivery of health screenings, with accompanying health advising sessions, for The University of Alabama faculty and staff in the University’s signature health and wellness program, titled WellBAMA.
University as a Worksite
Most universities, regardless of size, can benefit from work-site health promotion programs that improve employee health. Further, universities have a unique opportunity to implement health promotion programs because of the health, recreation, and fitness resources offered there, as well as their ability to draw on health professionals to support the programs. Recent research indicates that health promotion programs provided by university nursing students can be effective (Carter, Gaskins, & Shaw, 2005; Hall-Barrow, Hodges, & Brown, 2001). One study on employee health promotion found that screening and health coaching provided by nursing students in a small industry setting increased employee knowledge, positive health behavior changes, and morale (Carter et al., 2005). Another study with Veterans Affair’s employees using a collaborative model and including nursing students lowered health care costs while demonstrating health improvements among employees (Hall-Barrow et al., 2001).
An Overview of WellBAMA
WellBAMA operates in a collaborative model, using partnerships with the Office of Health Promotion and Wellness (OHPW) and the CCN to develop strategies to encourage employees to make and sustain healthy behaviors. Health care professionals, undergraduate nursing students, and graduate students from nursing, dietetics, psychology, and kinesiology design, deliver, and evaluate the program. The program provides onsite health screening and assessments, timely health advising sessions, and assistance in setting and monitoring individual health goals to promote improved health. In addition, the program provides an innovative opportunity for nursing students to provide health promotion within an interprofessional framework while improving their clinical and communication skills. WellBAMA was introduced to employees through a campus-wide outreach in 2009. To date, the outreach has been delivered to all 17 colleges or divisions, and more than 1,500 employees have participated. Participants were recruited through multiple vehicles of communication, such as promotional flyers and memorandums. In addition, nursing students visited the buildings prior to WellBAMA events and handed out promotional postcards to faculty and staff.
Under the direction of the Office of Academic Affairs and with the support and direction from the provost and executive vice president, the OHPW was established at The University of Alabama in January 2007 with the hiring of a full-time director. The OHPW mission is to advance the health and well-being of The University of Alabama employees and their families through innovative, educational, and strategic wellness programs and services. Providing a customized approach for individual health and well-being is a primary goal. The OHPW oversees, coordinates, and evaluates WellBAMA. In addition, the director (R.K.K.) is a registered dietitian and a certified diabetes educator, has advanced degrees in both physical education and health promotion and health education, and provides the undergraduate nursing students with nutritional training on their WellBAMA clinical day prior to the event.
The OHPW and the CCN collaborate closely to implement WellBAMA. The CCN mission is to enhance the health and well-being of the people of Alabama by advancing the profession of nursing through education, scholarship, and service. A nursing faculty member serves as the assistant director for the OHPW. The nurse faculty member has advanced degrees in both adult health and community mental health. The assistant director (M.R.C.) works with deans or department chairs to set schedules for onsite screenings, communicates with community health nursing faculty to coordinate clinical schedules for nursing students, and provides intensive student training. Faculty and students from the community health nursing course assist with screening, health advising, and follow up. The nurse faculty train the nursing students to use health promotion techniques, including determining risk categories, recognizing metabolic syndrome risks, and strategies for improving health behavior and biometric risk factors.
WellBAMA health screening, conducted by health professionals from the OHPW and nursing students, consists of several components. First, employees complete written forms that consent to share health-related details and to participate in the physical and laboratory collections. Screening forms include program and research informed consents and a health risk appraisal. After form completion, employees rotate to different stations where nursing students complete biometric screenings that include height, weight, body mass index, waist circumference, and blood pressure measurements; these values are entered on a WellBAMA Club Status (WBAMACS) sheet. Fasting laboratory values using finger sticks are completed by nursing students for measurements of triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol, and glucose levels, and nursing students record these on the WBAMACS sheet. Nursing students place employees into health status categories depending on their biometric data, laboratory values, and assessment data. The categories created for developing health problems include crimson (very low risk), gold (low risk), silver (moderate risk), and bronze (high risk).
WellBAMA health advising involves a review of the health assessment forms, the WBAMACS sheet, and biometric and laboratory data. Nursing students conduct the health advising sessions under faculty supervision. During the health advising sessions, the nursing student provides counseling to assist the participant with setting-appropriate health improvement goals. Reinforcement of goal setting is completed through health information sheets. Nursing students provide referrals to other University health programs to aid in accomplishing identified goals. For example, to increase exercise, the student may refer the employee to a complimentary 3-month membership to the University’s Aquatic/Recreation Center or may suggest a campus or community 5K walk or run training program or other wellness program.
The 4-hour training for the WellBAMA health screening and health advising event occurs in the community health clinical orientation. The training session includes a 1-hour PowerPoint® presentation that provides an overview of the WellBAMA program, combined with a 30-minute Camtasia® training module of the WBAMACS sheet. Camtasia is a videorecording software that provides screencasts and voice-overs for training purposes. Additional time is spent in discussion and review of the WellBAMA event guide, the overview of the research projects, and the students’ role in data collection and data entry. The final hour is devoted to a lecture and discussion period on strategies for goal setting to improve health risks. These health risks include elevated blood pressure, abnormal cholesterol, triglycerides, or blood glucose levels, elevated body mass index, increased waist circumference, lack of exercise, and tobacco use. Because the students are delivering the health advising sessions, they review tip sheets for each health risk the employee has on the score sheet. The students conduct an in-depth review of the tip sheets, created by the OHPW staff, before attending the screenings. These tip sheets were developed by OHPW staff using guidelines from the National Cholesterol Education Council; the American Blood, Heart, and Lung Institute; the American Diabetes Association; and the Centers for Disease Control and Prevention. The undergraduate students are evaluated using the WellBAMA clinical evaluation rubric (Figure).
Figure. WellBAMA clinical evaluation form.
A WellBAMA research project is approved by the institutional review board of The University of Alabama and is currently being conducted. A baseline study of The University of Alabama employees’ health status and interests will be used to assess the effectiveness of ongoing screening and health advising in improving health status and to develop health promotion programs that are identified as needed and determined to be of interest to employees. Nursing students are involved in data collection and data entry, and an OHPW graduate assistant performs the data analysis. Pilot study findings are shared with the nursing students during their community health orientation. For many undergraduate nursing students, this is their first, and maybe only, opportunity to assist with a research project, and they gain an understanding of how the results can be used to improve the health of the university community. In addition, engaging students in the research has been shown to increase their knowledge of the research process and improves their research skills (Kardash, 2002; Ryder, Leach, & Driver, 1999; Seymour, Hunter, Laursen, & DeAntoni, 2004). Future research opportunities will include evaluation of the effect of the health promotion on student learning.
The literature supports health promotion experiences that help students learn positive health habits and demonstrates model approaches to promoting health and wellness (Kupchella, 2009). Kantor (2010) stated that the shift toward community, population health, and health promotion has provided a stimulus for nurse educators to reexamine curricula and provide opportunities to meet transformations in health care.
More than 300 senior community health nursing students and 20 graduate students have experienced health promotion through the clinical rotation in WellBAMA. The clinical rotation in WellBAMA has contributed to positive educational outcomes in nursing, with a 23% improvement in NCLEX scores in health promotion over a 2-year period. In fact, health promotion has been the highest content area on the NCLEX for the past several semesters, including the spring and fall semesters of 2010 and 2011. This improvement could be reflective of changes in teaching strategies; however, students have stated that WellBAMA made the difference. In addition, the program provides an innovative opportunity for undergraduate and graduate nursing students to experience structured health promotion while improving clinical, communication, and professional collaborative skills applicable to other health care settings. One nursing student stated, “I found WellBAMA to be a meaningful clinical experience. With the growing need for emphasis on prevention, this was a great opportunity to work in a collaborative health promotion model. This experience will shape how I teach my future patients.”
The WellBAMA collaborative model approach to worksite health promotion could be beneficial to other schools of nursing and university settings. Nursing faculty in community health could partner with student health services if a worksite wellness program is not available. In addition, schools of nursing could partner with community health centers and senior citizen programs for health promotion clinical opportunities. These types of collaborative partnerships provide a rich clinical opportunity that fosters students’ development of health promotion expertise.
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