Nursing Students Prepare for Active Roles in the Community By Mike Field In a bright and sunny meeting room in a downtown Baltimore health clinic, a nursing school instructor talks about providing health care to the city's poorest residents. "You need to get comfortable asking drug and alcohol questions, no matter what their needs," she says. Around the table, four nursing students in white coats bearing the blue and gold Hopkins student nursing emblem shift uncomfortably in their chairs. It is 9 o'clock on a Thursday morning at the Health Care for the Homeless Clinic on Park Avenue, just blocks from the Baltimore Arena. The students--just into their seventh week of an intensive yearlong accelerated nursing program--are about to have their first experience in community outreach, an important component of every Hopkins nurse's education. Just a trace of nervousness shows on their faces. Today, they will confront the multifaceted health problems of the city's homeless population. Drug abuse and alcoholism, they learn, are among the most common problems afflicting the homeless. Dental problems are another frequent complaint at the clinic. "A lot of the time you'll see people in here with dental problems," says Kathleen Becker, a nurse practitioner and instructor in the School of Nursing. Baltimore, says Becker, has only one free dental clinic, operated by the city Health Department, with very limited hours. "And they don't fill teeth there," she explains. "If you have a problem they pull it." Without thinking, the student to Becker's right rubs her jaw. Community nursing, say instructors and students engaged in reaching out to the city's underserved populations, is "real world nursing." It exposes students to the complex and often chronic health problems that afflict the region's poorest citizens. And it provides them with more of an in-depth exposure to those problems than they would ordinarily receive in a hospital environment. As part of the process, the students will assist the paid and volunteer staff of nurses and one doctor to identify clients' health problems. Later, they will discuss and review the day's events with Becker, whose experience includes more than a dozen years in providing health care to the homeless. Fulfilling a need "The School of Nursing was involved in community health efforts before the whole emphasis on health care reform brought this need to the public's attention," said Stella Shiber, associate dean of undergraduate programs in the School of Nursing. "Every one of our undergraduate students takes Nursing for Community Health, which is actually the last of the clinical courses in a nurse's education. The emphasis is in preparing our students to deal with multiproblem families and communities, primarily through a family nursing approach." The school's increasing emphasis on community nursing was not a sudden decision Dr. Shiber said, but a series of programmatic steps developed in response to the rapidly changing health care field. "About five years ago we started increasing the community health nursing focus in response to the needs expressed by our students enrolled in the returning Peace Corps volunteer program," Dr. Shiber said. "These students, and others with similar backgrounds in our program, weren't looking for the critical care emphasis typical of hospital-based education. They were quite committed to learning and serving in areas where there is a great need, such as underserved populations in the inner city." Last year, the school introduced a community health track to its undergraduate programs, making it one of the first nursing schools in the country to do so. "This whole process has been accelerated and supported by what's happening in the health field in general," Dr. Shiber said, referring to the developing trend to de-emphasize hospital-based care in favor of greater reliance on individual practitioners and clinics. "Currently, however, these programs are somewhat unique to us." Community nursing's increasing importance as a component of the School of Nursing curriculum was evidenced recently by a $500,000 grant from the Americorps National Service Program, announced earlier this month. Next month, former Peace Corps volunteers already enrolled in the School of Nursing will begin working in underserved Baltimore communities as part of a national service initiative signed into law by President Clinton. Under the new program, 10 former Peace Corps volunteers will work with families participating in the Rutland Transitional Housing Program in East Baltimore to improve their health and social status through intensive case management and health education in areas such as parenting and life skills. Rutland provides transitional housing and comprehensive social services to families in the neighborhoods surrounding Hopkins' East Baltimore medical complex. All of the students' activities will be supervised by community health nursing faculty, and opportunities for involvement in other health-related activities in the East Baltimore community will be available. In exchange for their participation, the Americorps students will receive a stipend and an award to help finance their education. "What all this represents is a concerted effort on the part of the health professions schools in general, but the School of Nursing in particular, to bring community people into the classroom, to expose our students to what's out there," Becker said. "Across the curriculum all students spend time in community settings." New perspectives The students who accompanied Becker to the Health Care for the Homeless Clinic, though not yet on their community nursing rotation, found the experience offered them a glimpse of a world beyond the hospital. "Ordinarily we would have been doing an emergency room rotation, but a scheduling conflict gave us this opportunity to see what community nursing is all about," said Marian Batts, one of the four student nurses under Becker's supervision. "This kind of exposure to the problems of the homeless is perfect for me because I want to work in adult care with an emphasis on infectious diseases after I graduate." Batts came to Hopkins' accelerated nursing program after obtaining her degree at Spellman College in Atlanta. "I spent time doing neonatal volunteer work with teenage mothers so I am somewhat experienced in community outreach," she said. "From a nursing perspective, what is so fascinating about community outreach is the way it brings in so many different facets of our education. In the hospital, you generally see patients with one kind of acute illness; when you are at a clinic you see patients with all sorts of chronic problems stemming from their homelessness." "It was a community I had never been exposed to before," said fellow nursing student Marianne Otto-Smith after her experience at the clinic. "I worked in a neurobiology lab previous to nursing school, and I just didn't know what to expect." Otto-Smith was surprised by her experiences sitting with the triage nurse in the reception area, helping to separate the minor medical problems from those needing immediate care. "I found that really rewarding," she said. "I feel like I've been immersed in the wave of the future. I believe that community health is going to be a bigger and bigger thing in the years ahead. Nurses are going to start playing a bigger role, and it's exciting to be part of that. In the future, a lot of people will be seeing a nurse first. And that's what community nursing is all about."
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