Public Health Nursing Vol. 31 No. 1, pp.

6978
0737-1209/ 2013 Wiley Periodicals, Inc.
doi: 10.1111/phn.12061

SPECIAL FEATURES: EDUCATION

Community-Based Health and

Schools of Nursing: Supporting Health
Promotion and Research
Crystal Shannon, Ph.D., R.N., M.B.A.
School of Nursing, College of Health and Human Services, Indiana University Northwest, Gary, IN
Correspondence to:
Crystal Shannon, Assistant Professor, Indiana University Northwest, College of Health and Human Services, School of Nursing, 3400 Broadway,
Gary, IN 46408. E-mail: crshanno@iun.edu

ABSTRACT Objective: This article examines the role of community-based schools of nursing in
the promotion of public health and research in poverty-stricken areas. Design and Sample: This
was a three-phase study (questionnaire and key-informants interviews) that surveyed representatives of prelicensure associate and baccalaureate nursing schools (n=17), nursing-school key informants (n=6) and community leaders (n=10). Measures: A 13-question web-based survey and semistructured interview of key informants elicited data on demographics, nursing program design, exposure of faculty and students to various research and health promotion methods, and beliefs about
student involvement. Results: Nursing schools participated minimally in community-based health promotion (CBHP) and community-based participatory research saw reduced need for student involvement
in such activities, cited multiple barriers to active community collaboration, and reported restricted
community partnerships. CBHP was recognized to be a valuable element of health care and student
education, but is obstructed by many barriers. Conclusions: This study suggests that nursing schools
are not taking full advantage of relationships with community leaders. Recommendations for action are
given.
Key words: CBHP, CBPR, community-based health, community-based schools of nursing,
health promotion, nursing, nursing schools, participatory, public health.

Researchers recognize that community-based

health promotion (CBHP) models are important if
we are to improve health decisions by going
beyond individual lifestyles to distal factors that
influence health (Pender, Murdaugh, & Parsons,
2006, p. 75). This recognition encourages health
care providers to engage with factors such as social
conditions that influence health. The Essentials of
Baccalaureate Education for Professional Nursing
Practice (American Association of Colleges of
Nursing, 2008) requires nurses to provide care
from a holistic base and across all environments.
The aim of this study was to gather evidence about
present and future incorporation of CBHP and
especially participatory research within nursing
education.

Theoretical framework
Leininger and McFarland (2002) recognize community-based education as one of the most important
aspects to delivery of culturally sensitive care. In
their theoretical framework, before a system can
deliver effective health services, providers must recognize and understand cultural universalities and
diversities. Once health providers are educated in
cultural factors, the authors recommend nurses use
culture care accommodation, negotiation and culture care restructuring (p. 320) in equally important roles to assess, identify (diagnose), implement
(plan), and to evaluate individuals and environments needing health care assistance. Inclusion of
this theory into mainstream health care and the
nursing process will improve the participatory

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nurseclient relationship and patient health outcomes (Leininger & McFarland, 2002).
Community-based collaborative partnerships
are recognized as a highly effective method for
addressing population health while maintaining
cultural awareness and sensitivity (Cashman et al.,
2008). A requirement for such collaboration is
active involvement of all stakeholders (e.g., nursing
education, community members). Thus, stakeholders establish a mutually directed process to meet
the needs of everyone involved. Such mutual direction varies from traditional research and volunteer
efforts by transforming the community from a passive to an active role. Seifer and Calleson (2004)
have identified this collaborative method as the
most important factor to address community-based
health care issues. Of course, many schools of nursing (SON) report service learning (SL) activities that
encompass the principles of CBHP. Yet researchers
have recognized that nursing could further assess
the true nature and design of SL-based health education to ensure true empowerment of the collaborating community partner (Furco, 2002).

Community-based health promotion,

community-based participatory research, and
service learning
Although similar in design and focus, CBHP, SL,
and community-based participatory research
(CBPR) differ in their approaches to communitybased health. CBHP is a framework designed to
focus on population health and education within a
community (Merzel & DAfflitti, 2003). Service
learning has been defined as a form of experiential
education in which students engage in activities
that address human and community needs together
with structured opportunities intentionally designed
to promote student learning and development (Jacoby, 1996, p. 5). Thus, a traditional definition of
SL submerges cultural factors under the general
concept of community needs.
Community-based
participatory
research
(CBPR) is known as an approach to research that
uses the combined efforts of trained professionals
and community members in activities that promote
the advancement of community health and safety
(Israel et al., 2010). The primary components of
CBPR are community involvement, buy in, and
empowerment. This research method places great
emphasis on the inclusion of community-centered

January/February 2014

care and interventions. Although most research is

centered on the work performed by the researcher,
CBPR requires that stakeholders participate in
assessing their own community, developing their
research questions, planning, implementing, and
even evaluating the results. CBPR has been proven
to promote partnership development, equitable
sharing of knowledge and responsibility, and the use
of community-specific data to optimize impact (Minkler & Wallerstein, 2008). Although undergraduate
nursing students may not participate in active
research such as CBPR, the principles that guide this
method are important to the overall design of any
community-based intervention. The primary theory
behind CBPR posits that health resources and promotion emerge from within a community, not from
the health care environment (Jewkes & Murcott,
1998). This approach of encouraging stakeholder
participation from within the social contexts in
which disease states occur is in alignment with nursing values of patient- and community-centered care.
While each method (CBHP, SL, and CBPR)
includes a connection with the community, the process and degree of community involvement vary.
SL is primarily focused on the educational needs of
the student through the use of community service,
volunteerism, and community-directed care. CBHP
focuses on the delivery of community-based projects designed to improve community health but
CBPR focuses on the active involvement (participation) of all stakeholders in the full process of
researching community issues. While CBPR is a
mainly noted as a research process, it is guided by
patient- and community-centered principles that
merit the focus of the nursing profession.

Purpose of the study

The purpose of this study was to evaluate the current actions taken by nursing education units in
CBHP and research (e.g., CBPR) and identify areas
for improvement. As elaborated above, CBHP is not
simply the provision of care within the community,
but includes the philosophy and characteristics of
environmental contexts that support management
of social and economic influences, person (community) centered care, and community empowerment
in health care assessment, program development,
implementation, and evaluation (Baker & Brownson, 1998; Schultz, Krieger, & Galea, 2002). CBPR
explicitly includes stakeholder input in health

Shannon: CBHP and Nursing Schools

promotion and research, and postulates that community collaboration is known to influence social
change (Minkler & Wallerstein, 2008). Many SON
are located within high morbidity and mortality
communities, and CBPR is acknowledged to be a
key factor in understanding and reducing these
rates (Israel et al., 2010).
An extensive literature review discovered that
there was limited research related to the CBHP and
CBPR activities of nursing schools in the Chicago
metropolitan region. Yet in 2009, approximately
20% of Chicago, Illinois, residents had income
below the federally designated poverty levelversus
11.9% for the entire state (City Data, 2009). In
high-poverty communities, community-based SON
are uniquely positioned to provide quality education and develop collaborative and mutually beneficial community partnerships.

Methods
Design and sample
A qualitative inquiry was performed to explore how
Chicago metropolitan SON representatives and
community informants understand and value CBHP,
and the frequency and nature of past and present

71

collaboration in CBHP and CBPR. A survey was sent

to the Deans, Program Directors, or designated personnel (as chosen by the SON) of all nursing schools
in the Chicago metropolitan region (N = 44)
requesting demographic details, the involvement of
educators and students in community health
research and practice, and the factors that influence
their participation or nonparticipation in such activities. In addition, semi-structured interviews were
conducted with key informants from low-income
communities (n = 10) and their nursing schools
(n = 6). The interviews sought to identify factors
influencing CBPR activities and participation, SON
perceptions of CBPR importance and value to students, and community-member key informant (CKI)
perceptions of value to the community (see Table 1).
Permission to perform the study was obtained from
the appropriate university Institutional Review
Board and signed informed consents were obtained
from study participants. There were no hypotheses
being tested in this study and all quantitative data
collected were used to label SON characteristics and
to explain their relationships with CBPR. Descriptive analysis was used to categorize and compare the
variables (SON type, location, participation in CBPR
activities, perception of value, community poverty
rate), and then to evaluate the results.

TABLE 1. Description of the Recruited Samples

Recruitment
population total

Study population
(response rate)

Web-based
questionnaire

44

17 (40.4%)

SON key informants

interviews

13

6 (46%)

Community member key

informants interviews

12

10 (83%)

Research tool

Inclusion criteria
Location of SON in Chicago, IL
Location of SON within 50 miles of Chicago city limits
Provision of Baccalaureate or Associate Degree Registered
Nursing Education
Consent to participate
Location of SON in Chicago, Il.
Location of SON within 50 miles of Chicago city limits
Provision of Baccalaureate or Associate Degree Nursing
Education
Located in a community where families and/or
individuals fall below the poverty level at a higher
rate than the national average (key informants
interview only).
Consent to participate
Geographical location in Chicago, IL or within
a 50-mile radius of Chicago
Participation in community-based activities
Recommendation from interviewed SON Key Informants
Identified by SON Key Informants as a
community partner
Consent to participate.

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Measures
Data were collected via two instruments: a webbased survey questionnaire (n = 17) and the protocol for the key informant interviews. Key informants
came
from
two
groups:
Chicago
metropolitan SON key informants (SKIs) (n = 6)
and CKIs including community leaders (n = 10).
Phase I. Data were collected in three phases.
The first phase included mailing a 13-question webbased survey (see Table 2) of SKIs (N = 44) within
a 30-mile radius of the city of Chicago, Illinois.
Potential survey participants were recruited by
e-mail and were provided the web link to the survey, complete with instructions. Eleven schools
(24%) were located within the city limits of Chicago,

January/February 2014

24 (54.5%) in the suburban region, and nine (20%)

in northwest Indiana. The 13-item questionnaire
solicited school location, academic type of nursing
program (BSN and ADN), participants academic
role, current level of competence in CBPR of nursing faculty, degree of perceived responsibility
toward community health promotion, past and present CBPR activities, and factors influencing CBPR
participation (including barriers to involvement).
Phase II. In the second phase of data collection, the researcher selected SKI respondents
(n = 6) from schools within high-poverty communities and interviewed them. These semi-structured
interviews (See Table 3) sought to ascertain how
involved these schools were in participatory

TABLE 2. Web-based Survey Questions to Representatives of Chicago-area Schools of Nursing

1. Please provide some demographic information about your school.
2. What is your academic position?
3. How are your nursing students educated about community health?
4. Please indicate how strongly you agree or disagree that nursing student involvement in community-based health
promotion (CBHP) activities is a part of your professional responsibility.
5. What types of experiences do your students obtain in applying community health concepts?
6. What is your personal knowledge or experience related to Community-Based Participatory Research (CBPR)?
7. When considering your nursing faculty as a whole, what is the knowledge base or experience related to CBPR of your
faculty?
8. How many CBPR initiatives has your school participated in within the past 5 years?
9. How many CBPR initiatives has your school participated in within the past 10 years?
10. How many CBPR activities are currently active within your school?
11. Please describe the types of CBPR projects or initiatives currently underway within your school of nursing.
12. What are the factors that most influence your programs participation in CBPR projects or initiatives? What are the
barriers to your participation in these activities?
13. To what extent is CBPR a part of your nursing school curriculum?

TABLE 3. School of Nursing Representative Key Informants Interview Questions

1. Describe how your nursing school has chosen to assist community partners with community-based health care issues
2. How frequently does this occur?
3. Please describe the types of partnerships that took place?
4. Who are some of your past and present community partners? What is their contact information?
5. What is your understanding of:
6. Community-based Research
7. Community-based Health Promotion
8. Community-based Participatory Research?
9. What would you say are the advantages of these activities (Community-Based Research, Community-Based Health
Promotion and Community-Based Participatory Research) for a nursing school?
10. And what would you say are the advantages to the community of these activities (Community-Based Research,
Community-Based Health Promotion and Community-Based Participatory Research)
11. To what extent are your students prepared to become involved in community-based research and health promotion?
12. Would you like to see your SON more involved with community-based health promotion activities?
13. If yes, how? What resources would be required to meet this plan?

ST1. Keep the same types

of programs we currently
have. No change needed
ST2. Not an option, barriers
are too great
ST3. A needed change is
recognized and encouraged
ST1. Student
preparation not
applicable for
undergraduate
students
ST2. Student
preparation
is optional
ST3. Student
preparation
is required
ST1. Buy in
ST2. Increasing
involvement
ST3. Improved
assistance
ST1. Improved
understanding
of community members
ST2. Increase in knowledge
ST3. Purpose of CBHP is
primarily for student
practicum rotations
ST1. Pride, excitement
and eager to share
ST2. Request standard
definitions
Subthemes
(ST)

Question 6

T6. Increasing involvement

of SON in Communitybased health promotion

Question 5

T5. Student
Preparation

Question 4

T4. Advantages
to the
community

Question 3

T3. Advantages to a SON

T2. Understanding of
Community-based
Research, CBHP,
Community-based
Participatory Research
ST1. Yes to CBR
ST2. Yes to CBHP
ST3. Yes to CBPR

Question 2
Question 1

T1. Past assistance

with community
partners

Analytic strategy
Analysis of qualitative data was performed using
Microsoft Excel for the descriptive statistics of the
study and NVIVO. Data analysis began with evaluation of all the variables described in the survey
and interview instruments. The collected data were
checked for accuracy, and all responses were within
expected range. Analysis of the interview data also
included consideration of internal consistency,
specificity, iteration, and field-notes on contextual
variables. For example, several interviewees
answered questions with an elevation in voice
inflection, indicating they were surprised by the
question or were unsure of its meaning or intent.
Such responses cued the researcher to clarify,

Major
theme (T)

research; how well they knew CBPR; how willingly

they might participate in CBPR-related activities;
and how they perceived the advantages/barriers to
such activities for nursing students. In the interviews, SKIs discussed past and present community
partnerships; knowledge and general understanding
of CBHP and CBPR; current level of, and plans for,
academic-community partnerships, challenges to
these activities, and types of support needed to
develop them further.
Inclusion criteria for the interview were location of SON in or within 50 miles of downtown
Chicago, provision of BSN or ADN, location within
a high-poverty community, and consent to participate. The recruited SON representatives were from
BSN (54%) and ADN (46%) nursing schools within
the Chicago city limits (54%), the suburban region
(23%), and neighboring northwest Indiana (23%).
Phase III. A third and final step included interviews with a convenience sample of local CKIs
(n = 10). The CKIs were past community partners of
SON, who had been identified via feedback from the
SON interviews. They represented the same regions
as the SON and were community health leaders at
various home health care agencies, nonprofit organizations, local hospitals, and federally funded community clinics. The interviews primarily took place
at the CKIs location or preferred area and included
discussions centered on the understanding and experience with CBHP, perceived advantages to the community of CBHP and particularly CBPR, types of
activities and partnerships designed with local SON,
and perception of areas for collaborative-relationship
development (Table 4).

TABLE 4. Themes of Schools of Nursing (SON) Interviews Concerning Community-based Health Promotion (CBHP) and Community-based Participatory
Research (CBPR)

Shannon: CBHP and Nursing Schools

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repeat questions, and review content until the

interviewee confirmed comprehension.
Interview responses. Initially, broad-brush
coding was performed with NVIVO using wordfrequency query from the transcribed interviews of
both the SKIs and CKIs. This initial coding allowed
for unitizing and categorizing the data. As additional data were collected, further categorizing was
performed in a similar manner until a set of themes
was established. With the initial coding complete,
interview participants were again contacted to confirm ideas, statements and reports as needed; and
major themes and subthemes were confirmed.
The framework for the data collection and processing was established as recommended by Lincoln and Guba (1985) who acknowledged the use
four principles when determining the point at
which data collection and processing should terminate the following: exhaustion of sources, emergence of redundancy, emergence of themes, and
feelings of irrelevance. The following steps were
taken during the data collection and processing
phases for both the SKI and CKI interviews:
1. Interview transcription of SKI and CKI using
Dragon Naturally Speaking Software
2. Transcription of field notes
3. Manual coding of field notes common themes
4. Manual coding of SKI and CKI transcription
5. Word-frequency query using NVIVO for both
SKI and CKI interview transcripts to determine
possible further coding themes
6. Creation of code-books for both SKI and CKI
interviews.
Frequent cross-checking was performed to confirm emerging themes. Cross-checking involves
multiple methods (three in this study) to crossexamine the results (ODonoghue & Punch, 2003).
For example, the SKI (n = 6) and CKI (n = 10)
interviews were directly obtained from the data
sources; the researcher then used Dragon Naturally
Speaking software to transcribe the interviews.
This software required the researcher to listen to
and orally repeat all interview responses and to
cross-check the software-generated transcription for
accuracy.
The last steps in the thematic process included
a three-level data analysis process designed to offer
additional researcher opportunity to reduce transcription error, coding error or misinformation.

January/February 2014

This involved adding the researchers field notes

and the member check results. Member check is
acknowledged as a process by which qualitative
data are validated and confirmed with sources (Lincoln & Guba, 1985). The member check process
was performed on the interview participants to
allow the opportunity for theme and transcript confirmation and clarification. Cross-checking was performed at varying stages of data collection to
ensure accuracy of data and to maintain reflexivity
for the researcher in encouraging selfawareness
and frequent self-correction. Macbeth (2001) recognized cross-checking as an important tool in qualitative analysis to assist the researcher to reduce or
remove bias while performing continual self-analysis and self-reflection.

Results
Descriptive characteristics
Data collected from the web-based survey included
five areas: SON frequency of CBPR participation,
personal knowledge of CBPR, faculty knowledge of
CBPR, perceived responsibility toward promoting
CBPR, and number of full-time faculty and students. The results showed the average survey
responder was a Program Director or Coordinator
of a school with an average of 13 nursing educators
and 212 enrolled students. Survey responders
reported little experience or knowledge of CBPR,
no nursing faculty knowledge or experience with
CBPR projects or initiatives, and no inclusion of
CBPR as a part of prelicensure nursing education.
In addition, responders expressed feelings of only
some professional responsibility (vs. a great deal)
toward including nursing students in community
health promotion activities and research.
Themes from interviews
Analysis yielded the following themes and subthemes: pride or excitement for past health promotion
with community partners (83%), verbalized understanding of CBPR (17%) and CBHP (67%). Asked
about the potential advantages of CBPR for their
students, SKIs (50%) saw such projects not as
improving understanding of the community, but as
a source of practicum rotations. Only one responder (17%) reported that their nursing program
required student preparation in CBPR. The other

Shannon: CBHP and Nursing Schools

responders were equally divided: half reported that
CBPR student preparation was not applicable to
undergraduate students and half that such preparation was optional in their program.
Interviewed community members (n = 10) also
reported valuable feedback regarding the involvement of local SON in community-based projects.
The following themes and subthemes were derived
from the interviews:

75

Although the majority of CKIs reported no

experience with CBPR, 80% of them verbalized an
interest in partnering with local SON for CBHP and
CBPR projects. This is in contrast to the 33% of
SON representatives who recognized and encouraged an increased student involvement in these
activities. Of the CKI responders, 60% admitted to
prior or current experience with CBHP that
involved a local SON. However, 50% of the respondents offered recommendations to local SON,
requesting increased student exposure and involvement in CBHP activities. They cited the goal of
improving students sense of value and responsibility toward community health and expanding SON
relationships with community partners. The CKIs
discussed concerns that the current relationship
between local SON and both community agencies
and individuals was limited and of questionable
effectiveness.

schools had little experience or knowledge related

to CBPR and did not include CBPR as a part of
prelicensure nursing education. According to the
SON program representatives, faculty also had no
knowledge or experience with CBPR activities. Furthermore, survey participants were only slightly
more than neutral in their perception of professional responsibility toward promoting nursing student involvement. In addition, only 33% of SKIs
interviewed discussed the presence of a college or
university level of commitment to community
health, with many participants reporting multiple
barriers (e.g., time, personnel, student interest, and
cost of resources) to this process.
One SON interview participant replied: we
always wished we could do more (activities) but
you do what you can Another participant voiced
a concern about their nursing students doing too
much in terms of CBHP and questioned the consideration of increasing the amount of student participation: I dont know, more involved?
Obviously we are always looking for increased
opportunities for students. However, there are
(only) so many hours in a day
Interestingly, ADN representatives responded
more favorably (vs. BSN representatives) to the
interview questions related to increasing or improving student involvement in community-based health
efforts. This finding is surprising based on the lack
of specific community health nursing education
within the traditional curriculum design of ADN
programs. However, the majority of prelicensure RN
programs represented in the SKI interview process
were those from a BSN school (response rate 67%).
Further breakdown of the web-based survey respondents was limited due to the anonymity of the participants. However, both SON survey and interview
responders also mentioned lack of program focus
and design as being a factor in lack of CBHP activities. Half (52%) of the sample for the web-based
survey and 54% of the interviewed school leaders
represented ADN programsnot required by the
state to teach community health as such.

School of nursing representative feedback

Results showed that Chicago metropolitan SON
participate in limited CBHP and no recent CBPR
activities due to barriers related to cost of personnel, time, and curriculum design. Deans, Program
Chairs, or designated personnel at the participating

Community member key informant (CKI)

feedback
Major themes noted from the CKI interviews were
notable pride in helping others, infrequent or
limited involvement in SON-related CBHP efforts,
recognized advantages to the communities for SON

Fifty percent of the respondents reported they

participated
in
community-based
projects
because they wanted to do something for others.
Only one respondent described health professions faculty/students as the leading contributors
for any known CBHP activities.
Sixty percent of the respondents reported
improved understanding of the community is the
primary advantage nursing schools gain when
they participate CBPR projects. This is in contrast to only 33% of SON representatives who
reported community understanding as the primary advantage to student participation in CBHP
projects.

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collaboration, and lack of knowledge of CBPR (but

visible excitement for participation in CBPR when
explanation provided). Some of the suggestions
from the CKI interviews included increasing the
presence and number of nursing students at local
community agencies, improving the students sense
of value and responsibility toward community
health, and expanding the development of SON
relationships with community partners. For example, when asked about their thoughts regarding current SON and community relationships and what
measures would they like to see implemented, one
CKI replied I would like for it [practicum rotation] to be more of an encompassing experience
than just learning technical skills; I want social
skills as well. In addition, one CKI mentioned a
desire to be a part of a concerted effort to locate
community-based collaborative partners to assist
nursing educators in gaining meaningful student
experiences. CKIs (n = 10) shared concerns that the
activities of SON were greatly limited in terms of
type, time, and student involvement. For example,
one CKI acknowledged barriers that precluded
continuing a previous relationship with the local
SON: resistance to change, ineffective communication, and lack of interest. Despite this perception,
many CKIs were perceptibly excited and open to
the idea of finding innovative ways of establishing
or resuming collaborative partnerships.

Discussion
Data from this sample of Chicago metropolitan
SON suggest that most nursing schools were participating in limited collaborative partnerships. Many
of these activities were designed only with the students educational need in mind and lacked participatory involvement between the schools and the
community partners. Several schools described
practicum-based activities in which the student was
exposed to and delivered health care services in
community settings, but with limited active involvement by stakeholders and students. The provision
of care was presented as being directed at the community and not with the community. Although a
few SON representatives described joint efforts with
community partners in identifying communitybased issues for SON participation, most SKIs
voiced little need for improving those partnerships.
The feedback from the community partners identi-

January/February 2014

fied a theme of wanting to strengthen and grow the

current relationships with the SON. The survey
response of some professional responsibility
(67%) versus a great deal of professional responsibility toward student involvement in CBHP (18%)
is in direct contrast with the primary function of
nursing as one of education, support and disease
prevention. A choice of some professional responsibility also suggests that while SON survey respondents believed they should expose their nursing
students to community health promotion activities,
this was not a priority within their schools.
Overall, both survey and interview responses
emphasized a desire to keep many of the established programs. Most of the respondents either
saw no need for improvements or changes to their
community health curriculum, or they saw the barriers being too great to easily overcome. The
responders shared concerns that nursing students
have only received basic forms of communityhealth education, but questioned the need to provide additional research exposure. One responder
stated that she did not believe CBHP to be a great
emphasis in her nursing program and that time
allotment affected this lack. Other responders
reported that their students lacked sufficient understanding of research concepts to participate in
CBPR activities. These findings are in direct contrast with the educational requirements of The
Essentials of Baccalaureate Nursing Practice
(American Association of Colleges of Nursing
[AACN], 2008), which encourage clinicians to participate in research and utilize research findings.
Although state licensure and accrediting boards
require community health concepts to be taught to
prelicensure RN students (National Council of State
Boards of Nursing, 2010; National League for Nursing Accrediting Commission, 2010; AACN, 2008),
the influence of program-specific measures potentially impacts this education and should be further
investigated. The lack of SON participation and student education in research activities decreases the
nursing students level of knowledge and ability to
fully function within the scope of nursing practice.
The Institute of Medicine (IOM, 2010) has
researched and evaluated the role nurses would play
in the future of health care. One of the primary recommendations recognized the need for nurses to
become full partners with other health care professionals and be exposed to additional areas of health

Shannon: CBHP and Nursing Schools

care (e.g., community-based health care, public
health). Lack of such prelicensure education limits
the ability of the newly licensed nurse to fully
understand the impact of culture and socioeconomic
status on health care decisions and treatment.
There was a notable difference between SON
and community-partner perception of SON involvement in CBHP and CBPR. All community members
voiced a desire to create dialogue and improve SON
collaboration. In effect, they invited SON to discuss
and share what the SON and community leaders
have done and might do to address CBHP. During
the personal interviews several CKIs verbalized a
desire to improve the collaborative partnership with
their community-based SON. Such region-wide
joint collaboration could allow for multiple agencies
to work together under jointly created missions and
visions. These experiences would be focused on
improving the health of the indigent and teaching
the students community-based health concepts.
Comments from both the SON key informants and
CKIs acknowledged an increasing awareness of the
changing focus of nursing practice from hospitalbased to community-based. CKIs also voiced a
desire to build and expand their current relationships with SON in a joint effort to offer valuable
training for students and provide health education
and treatment to populations affected by high levels
of morbidity and mortality. This area of focus
requires nursing education to offer students additional real-world opportunities to practice community health concepts.
These limited study data also suggest many
nursing school faculty had very little knowledge of
CBPRcommunity-based participatory research.
CBPR terminology is more frequently used in public health education and research. However, the
regulatory and accrediting requirements of applying knowledge of new sciences for newly trained
nurses remains an important element within the
profession. Despite the unfamiliar terminology, the
principles of addressing community health are
shared by public health researchers, officials, and
nursing educators; thus they should be included in
nursing education.
Based on the data from this selective study, the
following recommendations are offered to Chicago
metropolitan nursing schools toward improving
their relationship with the communities around
them:

77

1. Offer a day of dialogue for SON faculty, community partners, and community members to discuss current needs and scope of SON
involvement.
2. Expose SON faculty to methods of community
health promotion such as CBPR to potentially
broaden their understanding of communitybased health care.
3. If not already done, create an alliance of regional SON devoted to identifying potential areas
for improving student exposure to CBHP.
Strengthen relationships between regional SON
to identify potential areas for improving student
exposure and participation in CBHP.
4. Acknowledge nursing as no longer being primarily hospital-based and increase student exposure
to the methods of CBHP.
5. Expand into the community, asking for input
and active involvement on the identification of
their needs and how SON can better build lasting collaborative relationships with them.
This study identified a need for improved collaborative partnerships between local Chicago
metropolitan nursing schools and community partners. The restricted involvement of nursing schools
and their students in CBHP is a lost opportunity to
engage students with seasoned health care providers in direct patient care. In addition, the lack of
CBPR principles and activities at local SON potentially minimize the impact of any health promotion
efforts. Educators can no longer rely upon old
methods of instruction, training and preparation
when educating the nurse of the 21st century.
Increasing student exposure to community settings
is suggested to improve the opportunities students
have to understand and apply community health
promotion and research concepts. The principle of
community participation requires a paradigm
change and this is often met with considerable barriers (e.g., time, personnel and resources). These
barriers potentially limit student exposure to realworld care environments and reduce the potential
collaboration of nursing and public health experts
to offer a more holistic health care regime and
leadership foundation. Although various reasons
and barriers to collaboration have been mentioned,
active involvement of all health care personnel in
CBHP and participatory research activities continues to be needed. The inclusion of nursing students

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Public Health Nursing

Volume 31

Number 1

and faculty in health promotion and research can

be a winning combination, accelerating the development of grass roots participatory projects aimed
at promoting student and community education.

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