SPECIAL FEATURES: EDUCATION

Using an Academic-CommunityPartnership Model and BlendedLearning to Advance Community HealthNursing PedagogyMabel Ezeonwu, Ph.D., R.N.,1 Bobbie Berkowitz, Ph.D., R.N., F.A.A.N.,2 and Frances R. Vlasses, Ph.D,R.N., N.E.A.-B.C., A.N.E.F., F.A.A.N.31Nursing and Health Studies, University of Washington Bothell, Bothell, WA; 2Columbia University Medical Center, Columbia UniversitySchool of Nursing, New York, NY; and 3Department of Health Systems, Leadership and Policy, Niehoff School of Nursing, Loyola UniversityChicago, Chicago, IL

Correspondence to:

Mabel Ezeonwu, Assistant Professor, Nursing and Health Studies, University of Washington Bothell, 18115 Campus Way NE, Bothell,

WA 98011. E-mail: mezeo@u.washington.edu

ABSTRACT This article describes a model of teaching community health nursing that evolved from along-term partnership with a community with limited existing health programs. The partnership sup-ported RN–BSN students integration in the community and resulted in reciprocal gains for faculty, stu-dents and community members. Community clients accessed public health services as a result of thepartnership. A blended learning approach that combines face-to-face interactions, service learning andonline activities was utilized to enhance students learning. Following classroom sessions, studentsactively participated in community-based educational process through comprehensive health needsassessments, planning and implementation of disease prevention and health promotion activities forcommunity clients. Such active involvement in an underserved community deepened students awarenessof the fundamentals of community health practice. Students were challenged to view public health froma broader perspective while analyzing the impacts of social determinants of health on underserved popu-lations. Through asynchronous online interactions, students synthesized classroom and communityactivities through critical thinking. This paper describes a model for teaching community health nursingthat informs students learning through blended learning, and meets the demands for community healthnursing services delivery.

Key words: academic-community partnership model, blended learning, community healthnursing, community-based education, public health nursing.

The Institute of Medicine [IOM] (2010)report onthe Future of Nursing indicated that much of nurs-ing education revolves around acute care ratherthan primary care in community settings. Whilestudents develop abilities to provide care for indi-viduals in illness situations, they lack sufficientopportunity to observe and interact with individualsin the community (Sword, Noesgaard, & Majumdar,1994). Undergraduate students experience greater

difficulty transitioning from a circumscribed hospi-tal-based model of illness and the individual to amore independent role centered on health promo-tion and the community (Broussard, 2011). As cli-ents’ needs and care environments become morediverse and complex, the model of education thatprimarily emphasizes acute care skills and knowl-edge acquisition is no longer adequate for dealingwith the realities of health care in the 21st century.

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The IOM recommends that nurses be educated innew ways that better prepare them for the needs ofthe population (2010).

An innovative way of preparing nurses to meetthe rapidly changing health care needs of the popu-lation involves a blended teaching and learningapproach that combines face-to-face interactions,community integration, and online activities. Theuse of multi-delivery strategy complements eachother and enhances students’ learning. Technologycan be a catalyst and means to adopt more activelearning approaches (Garrison & Vaughan, 2008).Online venue allows students to apply their knowl-edge to problem solving while stimulating criticalthinking and providing the outcome that educatorsstrive to achieve through using discussion as alearning strategy (Martyn, 2003). The flexibilityand convenience provided by the online componentchallenge students to take responsibility for theirown learning as adults (Glogowska, Young, Lockyer,& Moule, 2011).

A teaching approach that utilizes the commu-nity as pedagogical platform challenges students toview health care issues holistically and to under-stand the context within which health care policiesare based. Such understanding comes through stra-tegic placement and engagement of students in thecommunity as integral part of their education. Brie-ger (1978) noted that any health education pro-gram at the community level operates under thepremise that good teaching in medicine is servicebased and the immediate value of service-basedteaching in any profession is that benefits accrue tothe client community. Furthermore, nursing stu-dents achieve better understanding of communityhealth theory and practice as well as professionaland civic development through service learning(Reising et al., 2008). Eyler (2002) emphasizedthat students should complete a service-learningexperience with a better understanding of the pol-icy context of health care; the cultural differencesin health-related beliefs, nutrition, and hygienepractices; and barriers confronted by some patientsin obtaining health care and following medicaladvice.

Merging technology and community-basedlearning appears to be a logical pedagogicalapproach that exposes and prepares students totackle the evolving complex health problems of the21st century. Furthermore, RN–BSN students are

well suited for this model as they represent a dis-tinct group with both a wealth of life experiences,and perhaps more importantly a wealth of nursingexperiences (Cangelosi, 2004). There are, however,challenges encountered by faculty in teaching thisgroup of nursing students. Although these “experi-ences” are beneficial and desirable for preparingand exposing the students to population-basedpractice, they also represent barriers for individualsto pursue their baccalaureate degrees due to lack ofrecognition for their past educational and lifeaccomplishments (Megginson, 2008). The “experi-ences” therefore challenge faculty to articulate ped-agogical strategies that not only provide studentswith broader educational base than they alreadyhave by incorporating learning experiences that aredifferent from their acute clinical experiences butalso to create opportunities that draw from theirexperiences and apply them to community healthpractice.

Clinical placements in less traditional settingsallow students to interact with individuals in theircommunity, and provide them with unique learningopportunities that contribute to broadened perspec-tives on health and illness, as well as increasedawareness of the nature of relationships that existbetween the consumer and provider of care (Swordet al., 1994). Faculty, however, faces the challenge ofdiffusing students’ (particularly older ones withextensive acute care experiences) anxieties related togoing out of their clinical comfort zones and immers-ing into nonstructured, nontreatment oriented, mul-tiethnic, multicultural community settings.

Furthermore, evidence shows that older return-ing students are afraid of technology (Megginson,2008) and those with no previous experiences withonline learning have concerns about the structureof the course, timeliness of instructor feedback, andthe technical aspects of online learning (Davidson,Metzger, & Lindgren, 2011). Diffusing students’anxiety related to technology is one of the chal-lenges of teaching RN–BSN students, majority ofwho are nondigital natives. Davidson et al. (2011)recommended that advisors, faculty, and technologysupport personnel maintain good lines of commu-nication to facilitate timely intervention as neededto decrease students’ stress.

Nurse educators aim to prepare professionalnurses who can think critically, use sound judg-ment, and participate as full partners in shaping

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health care delivery and policy (Carter, Fournier,Grover, Kiehl, & Sims, 2005). The emphasis onhealth promotion and disease prevention is greaterthan ever with the increasing numbers of undocu-mented immigrants, unemployed, uninsured andunderinsured individuals in our society. These un-derserviced groups have unmet health care needsthat are embedded in systems of inequality (Gillis& MacLellan, 2010). Although the Affordable CareAct covers more people particularly the uninsuredand low-income Americans, there are significantnumbers of individuals that are left out—individu-als whose health or illness impact the health of thegeneral population (Sanchez et al., 2011). Some ofthese individuals do not present at regular healthcare facilities for variety of reasons. Engaging nurs-ing efforts through structured community-basedhealth projects presents a logical approach toimprove the health system in the face of significanteconomic down turn and ballooning health careneeds particularly among vulnerable populations.

As adult learners, RN–BSN students are gener-ally problem-centered rather than subject-centered(Sportsman & Allen, 2011). Integrating clinicalexperiences centered on real people with real prob-lems, and student-driven online discussions andreflections challenge students to appreciate the fac-tors that contribute to health disparities for vulner-able populations and nurses’ roles in addressing thesocial determinants of health (Gillis & MacLellan,2010). This partnership model and blended teach-ing approach support students’ learning as theysynthesize and reflect on public health problemsand policies.

Theoretical Framework

The Community-as-Partner Model (Anderson &McFarlane, 2011) provides the theoretical frame-work for this pedagogical activity. The modelfocuses on the community and the use of the nurs-ing process. The presence of two willing and com-mitted partners facilitates students’ engagement inthe community. The “community” incorporates thecommunity’s people as the core; and communitysubsystems—the physical environment, education,safety, and transportation, politics and government,health and social services, communication, econom-ics, and recreation. The nursing process includesthe collection and analysis of the community

assessment data, diagnosis of community healthproblems, planning of appropriate interventions,implementation, and evaluation. In addition, devel-oping a trusting partnership between the commu-nity and the academic institution smooths students’integration and immersion into the community.

Pedagogical Approach

Partnership development and course designIn spring of 2009, the first author initiated a rela-tionship with a local community agency throughvolunteer work. Located in a low-income neighbor-hood of Northeast Seattle, Washington, the agencyserves low-income individuals and families of mul-ticultural and multiethnic backgrounds. The major-ity are recent immigrants. Several health educationneeds were evident in the community. The authorvolunteered to conduct health-related workshopsfor different groups within the agency. There weresubsequent discussions between the program direc-tor and the author about a possible partnershipwith the local nursing program. The communityagency leadership expressed willingness to accom-modate RN–BSN students for service-learningopportunities and thus began a valuable academic-community partnership that supported the Commu-nity-as-Partner model. Students who registered in asection of the core nursing course—Partnerships inCommunity Health, were assigned and introducedto the community.

The Partnership in Community Health courseanalyzes, applies, and evaluates nursing and otherhealth care activities including health promotion,disease prevention, and social justice efforts amongvulnerable communities. The community healthnursing process is emphasized. The course isdesigned on a hybrid platform and combines face-to-face classroom lectures, community-based activi-ties, and online discussions over a 10-week quarter.The course is scheduled once a week for 4.3 h.Blackboard is used as the online platform forcourse delivery. Syllabus, weekly assignments, andactivities are introduced to the students includingthe discussion board that houses required weeklyreflective logs. Face-to-face sessions are held in thefirst 3 weeks. Students are exposed to the theoreti-cal foundations of community health nursing prac-tice and course concepts that are articulated

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throughout their community engagement. Theclassroom sessions are followed by five consecutiveweeks of community engagement and concurrentonline activities that highlight students’ communityhealth activities. Following each week’s field activ-ity, each student is required to develop and post onblackboard a reflective log that includes two tothree-paragraph description and analysis of theirobservations, activities, and assigned readingswithin 48 h. In addition, they will respond to otherstudents’ postings. The final 2 weeks of the quarterare devoted to face-to-face class activities thatinclude further discussions of clinical experiences,students’ presentations, reflections, and analysis ofthe intersection of public health issues and policy.

Assessment of community health needs andproblem identificationDuring the first clinical week, students are requiredto conduct an assessment of the community (coreand subsystems), interact with community mem-bers, and determine health needs that require nurs-ing interventions. The students’ initial face-to-facemeetings with the community members primarilyserve as getting-to-know-you sessions where theyfamiliarize themselves with each other. Studentsengaged in external and internal assessments andcollected data through observations, informal inter-views, focus groups, and windshield surveys. Onlineand other published data sources were also utilized.Information on the community’s demographic char-acteristics, strengths, health and social needs, lan-guages spoken, English language skills, and theirknowledge levels regarding their health were col-lected. In collaboration with the community stake-holders, the actual and potential health problems ofthe community that nurses could address weredetermined. Community’s preferences for workshoptopics and activities were also determined.

Planning of appropriate interventions andimplementationBased on the community assessments and theproblems identified, the logical decision-makingprocess was used to design a series of projects andactivities for accomplishing specific goals andobjectives for subsequent weeks. This processinvolves a careful contextual analysis and validationof assessment data, knowledge gaps and priorityhealth needs with community members, and

negotiation of appropriate intervention approaches.Through focus groups facilitated by students andgroup leaders, community members discussed whatwas important to them and what they would like tolearn about their health. Several nursing interven-tions centered on disease prevention and healthpromotion were chosen for implementation in col-laboration with the community. Students sharedand received feedback from their peers about theirplanning and implementation strategies.

Project evaluationStudents were required to conduct a process andimpact evaluations of their project activities. Cli-ents’ needs were continually evaluated to determinethe appropriateness and adequacy of each plannedactivity undertaken to address such needs. Studentsconducted on-site surveys during and after theintervention and implementation stages. Further-more, students provided their honest feedback onthe positive and negative aspects of their experien-tial activities, and strategies to modify the process.

Pedagogical Outcome

Students’ experiences were enriched through activeengagement with the community and each otherthrough face-to-face and online discussions. Exam-ples of students’ projects include health screenings,health teaching, and workshops centered on hearthealth, stress management, immunizations, adultand child nutrition, child safety, toxic chemicals intoys and cosmetics, and medical emergencies.Other topics include finding health resources, firesafety at home, disaster preparedness, and creatingemergency kits. Students acquired skills aimed atmeeting the public health nursing competencies asoutlined by the Association of Community HealthNursing Educators [ACHNE] Quad Council (2011).In addition, students were exposed to diverse popu-lations and various roles of public health nursing,particularly in areas of disease prevention andhealth promotion. The major outcomes are dis-cussed below.

Integration of critical thinking and researchskillsOne of the essential public health services is to“research for new insights and innovative solutionsto health problems” (Nies & McEwen, 2011, p. 6).

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This model exposed students to basic research pro-cess in the community. Students collected and ana-lyzed data to determine community needs andclients’ learning outcomes. There was significantdiversity among community clients. Most memberswere of lower income and educational levels, immi-grants, and English language learners with varyingspeaking and writing skills. Most community mem-bers had very limited understanding of their healthand their risk of exposures to illnesses. Studentshad the opportunity to assess their needs, researchthe agreed-upon topics, share their ideas with theirpeers online and with the community members.Follow-up with assessments of the impacts of theireducation activities were done.

For example, students who were assigned tothe toxic chemicals education conducted on-the-spot surveys to determine program participants’knowledge of risks of exposure to toxic chemicalsin cosmetics and other common beauty products.They found that 100% of participants (n = 40) inthis activity found the information useful and 50%were unaware of the health hazards associatedwith cosmetics. The majority of the participants(90%) expressed willingness to change their buy-ing habits based on this information provided bythe students. The research activities informed stu-dents’ learning, and enhanced the clients’ under-standing of their risks of exposure to illnesses anddiseases.

Leadership and project planning skillsStudents’ leadership experiences relate to a rangeof nursing roles in community settings includingoutreach, education, collaboration, coordination,team building, negotiation, and advocacy. Theyworked individually and in small groups and collab-orated with peers and community program leadersin negotiating project strategies and activities fordifferent groups. Students built on classroom dis-cussions and course readings related to communityhealth education. They shared ideas and gainedfeedbacks on strategies online, and then effectivelyengaged with community members.

Considerations were given to the demographiccharacteristics of the members. For example, somegroups were very diverse in terms of languageneeds while some share common languages such asthe Spanish groups and Middle Eastern/North Afri-can Arabic-speaking groups. Youth groups include

teen mothers who require different tactful interac-tion strategies that will aid in building connectionsand trust. Students and group leaders discussedeffective teaching strategies such as role play, dem-onstrations with concrete visual objects such asmodules, partitioned plates to demonstrate mealserving sizes, printed teaching materials in clients’local languages, and use of interpreters whenavailable.

An example of effective strategy that studentsused during workshops with this underserved pop-ulation is to ask participants in a nonjudgmentalway to share their experiences regarding the topicsof discussion such as their favorite healthy food,relaxation techniques, first aid, and home remedies.Most of these community participants often feelinsecure to spontaneously participate in group dis-cussions due to their minimal English-speakingskills and low health knowledge. However, they feelvalued, empowered, and engaged when their expe-riences and different ways of caring for themselvesare sought. For example, in one of the workshops,clients were asked to share the kinds of exercisesthey do or how they keep fit. When this informa-tion was interpreted to a French-speaking Africanwoman, she got out of her chair, walked to themiddle of the room, signaled to the 20 people inthe room to join her as she led the group to 10 minof mild-to-moderate intensity marching/dancingexercise. On another occasion, a Southeast Asianmember led the group in a meditation exercise.Such strategy that validates, harvests, and investsthe groups’ skills and experiences in the group pro-vides community members with a sense of owner-ship. The students’ skills in articulating appropriatestrategies to utilize are supported by this pedagogi-cal approach.

Evaluation skillsBeing able to engage the community in efforts toimprove health, articulate their roles in publichealth, share their perspectives with peers, anddetermine the effectiveness of their teaching activi-ties and clients’ learning outcomes is a desirableoutcome of this model. Using weekly reflective logs,students shared their excitement and their fears,provided their honest feedback on the positive andnegative aspects of their experiential activities, andstrategies to change or modify the process forfuture activities. For example, students noted issues

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such as inconsistent communication betweenacademic and community partners, inconsistent cli-ent attendance at workshops, and sometime, toomuch course readings. Such inputs were incorpo-rated in subsequent weeks and quarters.

Cultural awareness and sensitivityStudents appreciated the opportunity to work withunderserved population and to share their experi-ences. One Caucasian student stated after hergroup’s workshop that “this was the very first timethat I have been a minority in any setting. Of the17 participants in my workshop group, the groupleader and myself were the only White people, therest were from 11 different nationalities.” Studentsnoted that although they have taken a culturalcourse before this experience, it was not enough toprepare them for the real life encounter with cul-tural diversity. Students were attuned to the groupdynamics and devised creative approaches to build-ing a trusting relation with the groups. Throughthis pedagogical approach, students demonstrated abroader understanding of the relationship betweensocioeconomic, cultural and sociopolitical factors,history, and perception of health and illness.

Communication skillsStudents demonstrated improvement in their com-munication skills. The majority of the clients werenonnative English speakers. Their English languageskills ranged from first grade spoken and writtenEnglish to fifth grade level. Students were chal-lenged to reproduce the technical language ofhealth and nursing by using simple words thatmade sense to the clients. When possible, handoutswere translated and printed in participants’ lan-guages. Modules and visual images were also used.Students had fun acting out scenarios to demon-strate or emphasize health topics. Interpreters wereused when available. Students experienced first-hand the issues related to cross-cultural communi-cation in the community setting.

Students also gained both informal and formalpresentation skills. They presented their communityprojects to their peers and instructors on campus.They showcased their learning by integrating theirproject activities from initial assessment, planning,and implementation, to evaluation. This model ofteaching increased student-to-student interactions,and encouraged full and thoughtful participation by

all students. For nontraditional students, the inte-gration of technology enhanced their computerskills.

Community health nursing practice skillsFor most RN–BSN students with structured acutecare backgrounds, the shift in focus from care of anindividual to the care of the entire populationnecessitated significant adjustments in their learn-ing and teaching approaches. Students’ engagementin community health education centered on all lev-els of disease prevention and health promotion withclients who lacked basic knowledge of commonhealth issues. As active participants in addressingthe basic health needs of clients in the community,students were exposed to challenges associated withhealth services access by vulnerable populations, aswell as the logistical challenges of reaching out tothose clients. The opportunity to discuss, share,and reflect on their experiences with underservedcommunities show that this partnership model andblended teaching approach advances communityhealth nursing pedagogy.

Discussion

Integrating community engagement and classroomteaching bolsters faculty’s teaching skills, allows forcreativity in solving community health problems,and involves students in their own learning. Theuse of blended learning provides instructors andstudents with “varieties” that enrich their teachingand learning experiences and make the pedagogicalprocess exciting. In generic hybrid courses, there isoften the challenge of finding the optimal mix ofonline and face-to-face instruction that will leveragethe advantage of asynchronous learning (any time,any place), while still maintaining quality faculty-student interaction (Martyn, 2003). The modeldescribed in this article goes an extra step by add-ing the community practice component to the mixwhich allows students to apply their knowledge toproblem solving while stimulating critical thinking.Students have enough time to articulate theirresponses to questions posed by the instructor; asktheir own questions; present their own ideas, andread their peers’ perspectives on the community.This creative approach supports the pedagogicalprocess by creating engaging environments thatpromote active learning.

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Transitioning students from the classroom tothe community to work with underserved popula-tions results in enhanced critical reasoning, personaland interpersonal development, understanding andapplication of core knowledge, reflective practice,and citizenship (Eyler & Giles, 1999). This teachingmodel challenges students to analyze health prob-lems in the communities where they are encoun-tered; ask questions about determinants of healthand illness among the population; and criticallyexamine policy strategies for public health improve-ment. The IOM (2010) recommends that com-petencies move from task-based proficiencies tohigher level competencies that provide a foundationfor care management knowledge and decision-mak-ing skills under a variety of clinical situations andcare settings. RN–BSN students’ engagement inatypical community settings provides academic,leadership and broader clinical challenges as major-ity of students come into the program with basicand often specialized clinical experiences fromacute settings. Partnering with a local agency thatserves underserved populations presents uniqueopportunities that enable the nurse educator toalign learning objectives with actual communityneeds. Such partnership also ensures that nursingstudents gain important skills needed to meet theholistic health care needs of diverse clients in thecommunity.

The importance and value of communication,cultural awareness, and sensitivity are difficult forstudents to appreciate in the classroom (Gazsi &Oriel, 2010). This partnership model of teachingprovides students with real life experiences in cul-tural diversity and challenges related to cross-cul-tural communication. Furthermore, developing aculture of reflection is a critical element of peda-gogy that incorporates service-learning as a modelof nursing education. Eyler (2002) noted that expo-sure alone to diverse patients in a clinical settingdoes not guarantee better understanding, and maysimply reinforce prejudice and stereotype. Rather,it is the quality of reflection—thinking about thecomplex health care issues and using real life expe-riences to suggest questions for further explorationthat transforms service into service learning.Through online reflective logs and debriefing ses-sions, students critically examine their experiencesas they relate to community health care challenges

and how their roles impact public health and nurs-ing practice. O’Brien-Larivee (2011) stated thatreflecting upon social injustice facilitates students’awareness of their professional obligations to advo-cate for solutions. Through active involvement inthe community, nursing students saw firsthand thehealth disparities and the inequities in healthaccess among vulnerable populations. The learningexperiences in most part come through criticalreflection.

Access to health services is one of the leadingindicators of health. According to Healthy People2020 (2012), both access to health services and thequality of health services impact health. Increasingbarriers to access such as lack of available healthservices, high cost, lack of insurance coverage, andlimited language access were all common issuesamong this project’s target population. Nursing,therefore, presents a critical cost-effective optionfor meeting the health needs of many individuals inthe community. Not only did students get exposedto identifying these issues firsthand, they also werepart of the intervention process—an effective teach-ing–learning approach.

This model is unique because it provides multi-ple reciprocal gains to both the community agencyand the academic community. In most community-based learning experiences, only students gainthrough observations and hands-on practice oppor-tunities. The agencies that agree to student place-ments are usually forced to make operationaladjustments, often pushing employees to workunder pressure. The undue stress on the agencies,in addition to tight fiscal measures directly andindirectly resulted in diminishing clinical experien-tial opportunities for nursing students (Humphrey,1996). The use of this model in nursing educationbenefits all stakeholders. It not only supports teach-ing and learning but unlike other academic special-ties, highlights nursing as “socially relevant to allmembers of society and to institutions of higherlearning who claim to serve public good” (Gillis &MacLellan, 2010, p. 24; ). The community gainedaccess to numerous health services and resourcesprovided by nurses. The community health experi-ences that students acquired in the field helpedthem to become strong advocates for public healthpolicies and programs directed to the needs ofunderserved populations.

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Challenges and Successes of thisModel of Pedagogy

The RN–BSN curriculum presents challenges to thismodel of teaching because of the accelerated natureof the program. As a four-quarter (full-time) orseven-quarter (parttime) program, it is hard toengage the same groups of students in the commu-nity beyond a single quarter. This partnershipmodel of teaching is therefore sustained by havingsubsequent student cohorts build on the work ofprevious cohorts. The first author also maintainsongoing presence at the agency by consulting onprograms, collaboratively planning and conductingworkshops for clients particularly during the quar-ters when the course is not offered. In addition,creating a hybrid course that operates on threeplatforms is time consuming. This involves design-ing learning activities that align and crosses thethree platforms. Other challenges include thefollowing: building and maintaining communitypartnerships; creating opportunities for students’engagements; developing appropriate strategies toprovide intellectual stimulation and maintainstrong online social presence; and watching andresponding to students’ discussion threads.

Despite the challenges, this model presents apractical approach to teaching community healthnursing. Adult nontraditional learners thrive onpractical problem-centered approach to learning,and their ability to engage in hands-on concreteexperiences. The immersion experience with under-served populations provides students with real casesrather than theoretical scenarios. The asynchronousonline discussions help students to articulate theoryand practice, and engage in thoughtful discussionswith the whole class. This approach pushes experi-enced acute care nurses to shift their thinking fromtreatment approach to preventive approaches topublic health problems. This model creates a class offull participants where everyone works hard to beheard and “seen” in virtual space. There is strongersynthesis of in-class and out-of-class learningthrough critical thinking by all students.The process of engaging in community health workfacilitated by academic-community partnership andonline discussions presents innovative teaching–learning experiences. The model broadenedstudents’ perspectives as they experienced a simpleand yet complex structure of public health. They

were exposed to the realities of health inequitiesamong the underserved. Students were challengedto critically examine public health issues, and theirroles as nurses in the context of community healthpractice. Extending the environment of teachingand learning beyond the traditional classroom—toinclude atypical settings and online communitypresents a comprehensive approach to teachingcommunity health nursing to RN–BSN students.

References

Anderson, E. T., & McFarlane, J. (2011). Commu-nity as Partner: Theory and Practice in Nurs-ing (6th ed.). Philadelphia: Walters Kluwer,Lippincott Williams & Wlkins.

Association of Community Health Nursing Educa-tors [ACHNE] Quad Council. (2011). Essen-tials of baccalaureate nursing education forentry level community/public health nursing.Retrieved from http://www.achne.org/files/EssentialsOfBaccalaureate_Fall_2009.pdf

Brieger, W. R. (1978). Developing service-basedteaching in health education for medical stu-dents. Health Education Monographs, 6(4),345–358.

Broussard, B. B. (2011). The bucket list: A service-learning approach to community engagementto enhance community nursing clinical learn-ing. Journal of Nursing Education, 50(1),40–43.

Cangelosi, P. R. (2004). The tact of teaching RN-to-BSN students. The Journal of ProfessionalNursing, 20(3), 167–173. doi:10.1016/j.prof-nurs.2004.04.002.

Carter, K. F., Fournier, M., Grover, S., Kiehl, E. M.,& Sims, K. M. (2005). Innovations in com-munity-based nursing education: Transition-ing faculty. Journal of Professional Nursing,21(3), 167–174.

Davidson, S. C., Metzger, R., & Lindgren, K. S.(2011). A hybrid classroom-online curriculumformat for RN-BSN students: Cohort supportand curriculum structure improve graduationrates. The Journal of Continuing Educationin Nursing, 42(5), 223–232.

Eyler, J. (2002). Reflecting on service: Helpingnursing students get the most from service-learning. Journal of Nursing Education, 41(10), 453–456.

Eyler, J., & Giles, D. (1999). Where’s the Learningin Service-Learning? San Francisco. CA: Jos-sey-Bass Publishers.

Ezeonwu et al.: Community Partnership and Blended Learning 279

Garrison, D. R., & Vaughan, N. D. (2008). Blendedlearning in higher education: Framework,principles, and guidelines. San Francisco, CA:Jossey-Bass Publishers.

Gazsi, C. C., & Oriel, K. N. (2010). The impact of aservice learning experience to enhance cur-ricular integration in a physical therapisteducation program. Journal of Allied Health,39(2), e61–e67.

Gillis, A., & MacLellan, M. (2010). Service learningwith vulnerable populations: Review of the lit-erature. International Journal of NursingScholarship, 7(1), 1–27. doi:10.2202/1548-923X.2041.

Glogowska, M., Young, P., Lockyer, L., & Moule, P.(2011). How ‘blended’ is blended learning?Students’ perception of issues around theintegration of online and face-to-face learn-ing in a continuing professional development(CPD) health care context. Nursing Educa-tion Today, 31(8), 887–891.

Healthy People 2020 (2012). Determinants ofhealth: Health access. Retrieved from http://www.healthypeople.gov/2020/about/DOH-About.aspx

Humphrey, C. J. (1996). Editorial: The importanceof student home care experiences. HomeHealthcare Nurse, 14(3), 151–152.

Institute of Medicine [IOM]. (2010). The future ofnursing: Focus on education. Retrieved fromhttp://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nurs-ing%20Education%202010%20Brief.pdf

Martyn, M. (2003). The hybrid online model: Goodpractice. Educause Quarterly, 1, 18–23.

Retrieved from http://www.educause.edu/ir/library/pdf/EQM0313.pdf

Megginson, L. A. (2008). RN-BSN education: 21stcentury barriers and incentives. Journal ofNursing Management, 16, 47–55.

Nies, M. A., & McEwen, M. (2011). Community/public Health Nursing (5th ed.). St Louis,MO: Elsevier Saunders.

O’Brien-Larivee, C. (2011). A service-learning expe-rience to teach baccalaureate nursing stu-dents about health policy. Journal ofNursing Education, 50(6), 332–336.

Reising, D. L., Shea, R. A., Allen, P. N., Laux, M.M., Hensel, D., & Watts, P. A. (2008). Usingservice-learning to develop health promotionand research skills in nursing students. Inter-national Journal of Nursing EducationScholarship, 5(1), 1–15.

Sanchez, G. R., Sanchez-Youngman, S., Murphy, A.A. R., Goodin, A. S., Santos, R., & Valdez, R.B. (2011). Explaining public support (or lackthereof) for extending health coverage toundocumented immigrants. Journal ofHealth Care for the Poor and Underserved,22(2), 683–699. doi:10.1353/hpu.2011.0043.

Sportsman, S., & Allen, P. (2011). Transitioningassociate degree in nursing students to thebachelor of science in nursing and beyond: Amandate for academic partnership. Journalof Professional Nursing, 27(6), e20–e27.doi:10.1016/j.profnurs.2011.08.004.

Sword, W., Noesgaard, C., & Majumdar, B. (1994).Enhancing students’ perspectives of healththrough non-traditional community experi-ences. Journal of Clinical Nursing, 3, 19–24.

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