In a small log cabin in a tiny burg named Bean Blossom, the medically underserved population of rural Brown County, Indiana, and nursing students of Indiana University are meeting for lessons in good health. The residents are learning about preventing illness, managing chronic conditions and making better lifestyle choices. The students are discovering an essential lesson about community health nursing: It's not just nursing, it's also working in close collaboration with the community.
The Brown County Health Support Clinic -- known simply as the Log Cabin Clinic -- was established in 1996 in a county designated as a Medically Underserved Area (MUA) and a Health Professional Shortage Area (HPSA). All clients are underinsured or uninsured.
The dual mission of the clinic is to provide healthcare, disease prevention and health promotion services to clients with no other access to healthcare and to serve as a setting for clinical education for Indiana University nursing students in rural community health and nurse-managed healthcare.
"The curriculum and the clinic itself are built on the Community Development Model," says Joyce Splann Krothe, RN, DNS, the founder of the clinic and its director. "Our mission is to meet clients right where they live, to learn about their lives and their history, and then to facilitate their healthcare and empower them to make healthier choices. Obviously, we get very involved with our clients, and our students are right there to help."
Scope of Services
The clinic specializes in health promotion, health education and disease prevention services. Nurses at the clinic diagnose and treat common illnesses and health problems, and run routine laboratory and diagnostic tests, including screening for blood pressure and high cholesterol. The clinic also offers assistance with pharmaceuticals through the Prescription Assistance Program, and it refers clients in need of other services to regional providers and agencies.
Teaching Nursing Students How to Manage
The clinic is staffed by a family nurse practitioner, a community health nurse, community health workers and Indiana University School of Nursing students. Faculty at Indiana University School of Nursing provide administrative support and are responsible for program reports to the funding agency and evaluation of project outcomes.
Baccalaureate student nurses have several opportunities to include the clinic in their education. They can enroll in a course in community health as part of a service-learning program, create a community health capstone program that incorporates the clinic, or take a senior-year nurse management course that is integrated with the clinic. Graduate nursing students can choose the clinic as the setting for the clinical component of their advanced practice degree.
In every instance, students receive a direct, hands-on learning experience in rural health. They get to witness the needs and cultural dynamics in a rural community and see how nurses manage. Tania Doran, RN, MSN, FNP, spent a great deal of time in the clinic during her FNP practicum. "The clinic provides an excellent model of healthcare for undergraduate and graduate students," says Doran. "I gained a new perspective on how primary care can be delivered. I experienced for the first time the workings of prescription assistance programs and other creative ways to bring healthcare to this remote population. I am utilizing many of these methods in my own practice today."
Taking the Time to Listen. Creating the Time to Teach.
The standard intake session with a new client at the clinic is one hour, and often that isn't enough time to establish a base of understanding of the client's situation. "We take the time to identify all the factors affecting a client's health," says Marilyn McAtee, RN, BSN, and the clinic's community health nurse. "We're asking 'What hurts?' but we're also asking 'Why?' and that takes time."
"We talk about their lives at home and at work, if they are employed," says McAtee. "We find out their level of education and their family history. When it comes to really treating our clients, the details of their lives are as important as the facts of their illness." It favors high touch over high tech. Clearly, this is a departure from the trend in healthcare that keeps moving clinicians away from their patients.
What does this have to offer students destined for careers in other care settings? "They get a valuable look at the big picture that stays with them as they move into acute care settings, if that's where their careers take them," says Krothe. "Students here can get involved in community advisory board meetings, they can help develop relationships with other tertiary providers and other healthcare agencies, they get to see -- and help shape -- public health policy. Essentially, they become collaborators with the community to serve the community. There is a lot for them to learn in those situations."
Taking the Model into Other Schools and Disciplines
Krothe's work in the clinic is the foundation of her efforts to extend the lessons learned here into other interdisciplinary service learning projects and serves as a guide for curriculum development. She was recently awarded a fellowship through the Community-Campus Partnerships for Health (CCPH), a program created by the Center for Health Professions through the University of California, San Francisco. She has begun work on a monograph that extends the implementation of a community-development model from nursing to other academic disciplines involved in service learning. She will also be providing training and technical assistance to CCPH members and staff.
Krothe concludes, "Service learning projects provide a bridge between theory and practice, while they enhance a sense of social responsibility. All students in these settings gain an understanding of the importance of working in collaboration with communities to address the needs as defined by the community. Like our students, we've learned a great deal, and I'm thrilled with the opportunity to explore how those lessons might apply in other communities, other schools and other disciplines."
This article originally appeared on Monster.com.
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