Johns Hopkins Gazette: August 22, 1994

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
    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
    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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