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    Environments of Care: A Curriculum Model for Preparing a New

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    Klarisse Esteban

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    Re: Environments of Care: A Curriculum Model for Preparing a New

    Post  Klarisse Esteban on Thu 25 Nov 2010, 9:02 pm

    The article emphasized the integration of a higher nursing program in the current curriculum. As the author had stated, the nursing program should incorporate the preparation of nurses to take higher learning degree with the post graduate programs. Also, the model presented in the journal was geared towards the concepts of exposing the nursing undergraduates to the different scenarios that nurses will be of good contribution. The model suggests that nurses should have a general idea of what nursing should be than just be exposed on the stereotype role of nurses.

    If the undergraduates are aware of the post graduate programs that will enable them to pursue a distinct direction within the nursing profession, they will be more aware of the degree of responsibilities that the nursing profession possesses within the medical profession. Also, at an early state, the nurses that are about to graduate may be able to establish goals regarding his profession and he will be able to maximize his potentials as a nurse.

    A general idea of nursing should be established on the knowledge of the student nurses to increase their respect and love for the profession. Also, the general idea of the different directions that nurses took will give the student motivation and will help him decide whether or not he should pursue the profession.

    xingxia
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    ENVIRONMENT OF CARE

    Post  xingxia on Thu 25 Nov 2010, 5:35 pm

    (1) provide a program of nursing curricula, including undergraduate programs and graduate education (2) provide an interdisciplinary diverse academic environment stimulating a life-long commitment to learning, service and research; (3) prepare professional nurses for practice as specified by faculty, professional organizations and the State of New Jersey; (4) graduate nurses committed to professional and personal values, responsibility and lifelong learning; (5) foster commitment to critical thinking, research and interdisciplinary collaboration; and (6) provide an academic foundation for furthering nursing education.

    The nursing curriculum is organized by the metaparadigm concepts, the nursing process and the curricular constructs specific to the Nursing Programs at Ramapo
    New nurses typically begin their practice in acute care settings in hospitals, where their work is characterized by time constraints, high safety risks for patients, and layers of complexity and difficult problems. Retention of experienced nurses is an issue central to patient safety. The purpose of this qualitative study was to explore the nature of professional resilience in new baccalaureate-prepared nurses in acute care settings and to extrapolate pedagogical strategies that can be developed to support resilience and career longevity. Findings revealed a common process of evolving resilience among participants. New nurses spend a significant amount of time learning their place in the social structure. With positive experiences, they begin to feel more competent with skills and relationships and become increasingly aware of discrepancies between their ideas of professional nursing and their actual experiences in the work setting. The risk of new nurses leaving their practice is constantly present during these struggles. Acceptable compromises yield a reconciliation of the current crisis, typically occurring long after formal precepting has ended. Personal growth is evident by the evolving clarity of professional identity, an edifying sense of purpose, and energy resources to move forward. For new nurses, professional resilience yields the capacity for self-protection, risk taking, and moving forward with reflective knowledge of self.

    refernce

    xiao pei
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    care

    Post  xiao pei on Thu 25 Nov 2010, 2:08 am

    A major role of community health nursing is prevention. Prevention means to avert problems. There are three levels of prevention: primary, secondary, and tertiary. Of the three, the basic level of prevention is called primary prevention. This level of prevention is applied to generally healthy people, before disease, injury, or dysfunction occurs. "Primary prevention may include increasing people's resistance to illness (as in the case of immunization), decreasing or eliminating the causes of health problems, or creating an environment conducive to health rather than health problems" (Clark, 2008). Allender and Spradley (2005) state, "primary prevention obviates the occurrence of a health problem; it includes measures taken to keep illness or injuries from occurring".

    Ervin (2002) emphasizes the importance of the ability of nurses to identify patterns as they emerge and before they are officially identified. This pattern identification leads to primary prevention. Identifying patterns relies upon astute knowledge of disease occurrence, transmission, and incubation. By identifying risk factors, prevention of injury can occur. Primary prevention involves anticipatory planning and actions. Nurses must envision potential needs and problems and then plan so that they don't occur.

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    markpradow

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    Re: Environments of Care: A Curriculum Model for Preparing a New

    Post  markpradow on Wed 24 Nov 2010, 10:03 am

    Most nursing schools in the country implement a community-based curriculum and it is working well. However, the observations of the author suggests changes have to be made because of the changing times. A community-based curriculum focuses more on the preventive and promotive aspects of care like what we do in our adopted communities. We do mothers' classes on maternal and pediatric care (breastfeeding, immunizations, etc.). This leads practices that can enhance their learning and contributions toward building stronger communities (Rosing, Reed, Ferrari, Bothne, 2010).

    One of the problems in a community-based nursing curriculum is the expertise of the faculty in non-hospital setting. They are not used to practice in a primary care facility and it poses problems in implementing community based programs. What they are more skilled to do is to teach students in acute critical care management in the hospital setting. Community-based curriculum, with it's minor flaws, is still a very feasible curriculum when I comes to job hiring on future professional nurses because the public health sector in the country is widely overlooked and there is still a demand for nurses in the health centers so a training based on the community is useful.

    The article suggests a more holistic approach nursing practice that will include all aspects of human life. From social, spiritual to physical, the Environments of Care model interacts all of these aspects to provide better health care delivery. It is in the hands of health educators where the quality of nurses will be produced so we must strive to conceptualize a better curriculum.


    Reference:
    1.Rosing H, Reed S, Ferrari J, Bothne N. Understanding Student Complaints in the Service Learning Pedagogy. American Journal of Community Psychology [serial online]. December 2010;46(3/4):472-481. Available from: Academic Source Complete, Ipswich, MA. Accessed November 23, 2010.
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    joxliongson

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    jo karla liongson

    Post  joxliongson on Tue 23 Nov 2010, 10:55 am

    Do the three areas of concern of Ervin, Bickes and Schim on community-based nursing reflect present-day practice in the Philippines?

    The 3 areas of concern for ECM specified by Ervin, Bickes and Schim are also areas of concern in the community nursing setting here int he Philippines.

    Faculty and preceptor implementation of the curriculum:


    In the article, the authors identified the vagueness of eh definition, concept and boundaries of a "community based community curriculum" as a major problem in implementing ECM. limitations of the preceptors, such as not wanting to go out of their comfort zones, also come into play. The limitations of students are also considered being that the community setting is not a very comfortable environment for them.

    i cannot vouch for the rest of the schools for me to decide that this concern is of the national level. but judging by my personal experience as a nursing student, our community nursing program and instructors were able to affect me and my classmates. the best way to describe it is in a model of behavior where my self system decided to engage in a new task. we started off with community assessment and diagnosis. My metacognitive system was able to set goals and strategies, with the help of my instructor. also with the guidance of my instructor and knowledge foundation, my cognitive system was able to process relevant information. after gaining knowledge about the community, we were able to implement plans and projects. (Marzano, 2001)

    trying to remember my community immersion days, i can say that i am blessed to have had very dedicated community instructors and generally open-minded and pro-people classmates. if there is one thing that i am most proud of with the FEU curriculum, it is that community immersion was intensive and the years of continuous community organization in our adoptive barangays is indeed a commitment of the school. i believe that somehow, this area of concern was mitigated by the approach used in our community nursing program.

    Entry into practice and hiring pattern disjunctions:

    the authors expressed that one problem for ECM is that there are minimal job positions in the community setting. nurses are directed towards getting hired in hospitals. this is also why the curriculum is based on content knowledge about diseases and technical know-how.

    i believe this is also happening here in the Philippines. in fact, nurses are being exploited in hospitals, being asked to pay for a chance to volunteer in hospitals, in view of gaining experience. the rampancy of this trend has dismayed the Phillipine Nurses Association and has come to the attention of senator Pia Cayetano. she even called for these exploitative hospitals to be shut down, saying that "Not only is it demeaning to these exploited nurses and students, but to the entire nursing profession in the country,” . (Balagtas, 2008)

    somehow, former president Gloria Macapagal-Arroyo did something in order for nurses to have a different opportunity to practice their profession. on February 2009, the Department of Labor and Employment (DOLE) launched NARS (Nurses Assigned in Rural Service) program (Crisostomo, 2009). its goal was to train nurses to perform public health functions and the necessary clinical tasks to enhance their employability in local hospitals and eventually in medical centers overseas.

    Changing trends and unexpected consequences of changes in the health care system:

    the trend specified in the article is that people are receiving more care outside in the hospitals nowadays. this demands for nurses to be apt in providing critical care in the home setting.

    i don't think this is very applicable int he philippine setting. 1st, it is our cultural value to care for our sick relatives. 2nd, it is quite expensive to hire a private nurse to care for our sick in our homes. here in the Philippines, health is nto a right, but a priviledge.


    Can the Environment of Care Model of Ervin, etc. be a good alternative to our nursing curriculum?

    it would be great to have the ECM applied as a new curriculum since we are a third world country and majority of the population does not have the means to avail hospital services. but we have to be realistic. with nurses aiming for jobs abroad, with the demand for nurse practitioners and the difficulty of changing the curricular system, this is quite difficult to pull off.

    it is first important for the current curriculum to put emphasis on the roles of nurses in the community. the scope of nursing is wide the community level. a nurse is planner/programmer, provider of nursing care, manager/supervisor, community organizer, coordinator of services, health educator/trainer.counselor, health monitor, role model, change agent, statistician, researcher (Reyala, Nisce, Martinez, Hizon, Ruzol, Dequina, Alcatra, Bermudez & Estipona, 2000). in my opinion, these roles can be practiced in this field, rather than in the institutions.


    REFERENCES:

    Balagtas, A. (2008). DOH urged to shut down hospitals found exploiting nurses. Retrieved on November 20, 2010. retrieved from http://www.gmanews.tv/story/117732/DOH-urged-to-shut-down-hospitals-found-exploiting-nurses.

    Crisostomo, S. (2009). DOLE opens website on NARS program. Retrieved on November 20, 2010. Retrieved from http://www.philstar.com/Article.aspx?articleid=442459.

    Marzano, R.J. (2000). Designing a new taxonomy of educational objectives. Thousand Oaks, CA: Corwin Press.

    Reyala, J., Nisce, Z., Marinez, F., Hizon, N., Ruzol, C., Dequina, R., Alcantara, A., Bermudez, T. & Estipona, G. (2000). Community health nursing services in the philippines. 9th Ed. Philippines: National League of Philippine Government Nurses, Inc.
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    kristineaajuan

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    Re: Environments of Care: A Curriculum Model for Preparing a New

    Post  kristineaajuan on Sun 21 Nov 2010, 10:45 pm

    Healthcare practice is changing rapidly and scientific knowledge is expanding exponentially. Present challenges in the nursing practice include the increasing attention to patient safety and quality of care, a shift from acute to chronic diseases in patients and in treatment models, and emerging calls in the reduction of healthcare costs. Increased inpatient acuity and diminished availability of traditional clinical teaching sites are the results of locations of healthcare delivery being moved from hospital to outpatient and community settings. New technology offers alternative delivery systems and student demographics have also shifted (Tanner, 2007).

    Carter et al. (2005) believed that the rapid change in the healthcare climate challenges the abilities of professionals who provide health care. Nursing educators have the responsibility in the preparation of professional nurses who can use sound clinical judgment, can think critically, and participate actively in shaping and innovating healthcare delivery and policy. At present, the community-based curriculum is being utilized by nursing institutions worldwide. The community-based curriculum focuses on health promotion and rehabilitative primary health care with interdisciplinary collaboration. Furthermore, the goal of this type of curriculum is to manage chronic or acute conditions while promoting self-care to individuals and families. The program provides students with exposures and experiences outside traditional hospital settings. It also helps integrate community health into all other practice specialties. With the contributions of community-based curriculum to nursing education, present researches found major concerns that need to be revisited in the said type of curriculum.

    Evaluations of programs and curricula are being done strategically for innovation purposes. Debates and discussions surrounding the need for reform in nursing education has been heard well for over a decade. Calls for change in health professions education by nursing organizations because of recent deficiencies in the quality of patient care and patient safety issues (Forbes & Hickey, 2009). Careful evaluation of presently used curricula has been made by nurse educators and researchers to improve the quality of education and training being given to students. In community-based curriculum, it has been specifically found that using the community as a setting for acute care learning experiences may result in fragmented activities that may affect the students' assimilation of selected activities into a broad view of healthcare. Moreover, the disjunction between the community-based curriculum preparation and the realities of current licensure and employment and abrupt changes in the healthcare system were found as an area of concern.

    Ervin, Bickes, and Schim (2006) proposed the Environments of Care Model as part of the innovation of presently used curricula. The said model is a description of the complex understandings needed by professional nurses to function in a changing society with an evolving healthcare system. Multiple determinants of health paradigm and an ecological framework were the basis of the Environments of Care Model. It depicts the interaction between the individual and environment constructs of the nursing metaparadigm. The model is composed of four environments of care namely Internal, Social, Physical, and Global. Moreover, the model aims to address student complaints of repetitive activities by highlighting threads and concepts that build on each other and recur throughout the curriculum at increasing levels of complexity.

    It was emphasized in the study that nurse educators should prioritize the content of the curriculum rather than specific practice settings. We should inculcate, as nurse educators, to our students the importance of ongoing education and their skills in critical thinking and adaptation. These innovations will greatly help us in honing future professional nurses in delivering the best quality of care in rapidly changing environments and across any settings.

    References

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

    Ervin, N.E., Bickes, J.T., & Schim, S.M. (2006). Environments of care: A curriculum model for preparing a new generation of nurses. Journal of Nursing Education, 45 (2), 75- 80.

    Forbes, M.O., & Hickey, M.T. (2009). Curriculum reform in baccalaureate nursing education: Review of the literature. International Journal of Nursing Education Scholarship, 6 (1), 27.


    angeliebernardo

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    Environments of Care:A Curriculum Model for Preparing New

    Post  angeliebernardo on Sun 21 Nov 2010, 9:16 pm



    Re: Environments of Care: A Curriculum Model for Preparing a New
    By: Bernardo, Angelie Teresa B.

    Guide questions:
    1. Do the three areas of concern of Ervin, Bickes and Schim on community-based nursing reflect present-day practice in the Philippines?
    2. Can the Environment of Care Model of Ervin, etc. be a good alternative to our nursing curriculum?

    The model on community-base with its three major areas of concern ( faculty and preceptor implementation of the curriculum, entry into practice and hiring pattern disjunctions, and trends and unexpected consequences of changes in the health care system) do not totally reflect the present day practice of nursing in the Philippines. It was stated in the article that in order to give a quality nursing care, the nurse should know the social values or background of the client. Some nurses are kind of sceptical as to learning or at least familiarizing himself first with regard to the client’s background culturally or socially. As nurses, we do not only assess the past medical history, nor his/her present illness but also his social history which includes most importantly beliefs and culture. Another reason why I do not consider it as reflecting our nursing practice is the very strong political influences in terms of hiring staff nurses in a certain hospital institution. We can not deny the fact that here in the Philippines, an applicant will surely be hired depending on how strong his/her backer is. This is common in our system. One of the trainees whom I used to work with had shared her sentiments regarding her application for a staff nurse. She never pursued her application because she admitted she did not have any political personalities to help her get the job. And this is very frustrating since she was very efficient when I handled her during their duty in our unit. Several incidents in the health care practice relating to the three areas of concern are so ironical that when we read and internalize what these mean, we just end up frustrated. Who now is responsible for this kind of system? We have guidelines and models to follow but these are just in writing, not actually and properly executed nor practiced.
    This model is in fact perfect for our curriculum but as what I have said, what is the use of implementing it if in the end it will just be forgotten especially if the nurse is already in practice?

    jm_babera

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    Re: Environments of Care: A Curriculum Model for Preparing a New

    Post  jm_babera on Sat 20 Nov 2010, 1:46 pm

    Guide questions:
    1. Do the three areas of concern of Ervin, Bickes and Schim on community-based nursing reflect present-day practice in the Philippines?
    2. Can the Environment of Care Model of Ervin, etc. be a good alternative to our nursing curriculum?

    The Philippines follows the health care trend experienced by the United States as described in the article itself. Although the Philippines through the DOH, has adopted a primary health care centered approach most of the action in the field of nursing can be found at hospitals. The previous DOH secretary Dr. Francisco Duque III (2007) described the Philippines as being amidst a massive health sector reform but still at the throes of the same issues it has been battling over the years. Even as Philippine health embraced and propagated primary health care, we still see a vast majority of nursing practitioners in hospitals rather in our health centers. The scarcity of public health job positions due to funding or simply bureaucratic red tape and nepotism causes massive hiring discrepancies and difficulty of entry in practice. Also, the largely hospital-trained nursing graduates also experience difficulties in adjusting to a rather unfamiliar landscape of public health
    The Environment of Care Model proposed by the authors possibly can be a good alternative for use to help prepare our nurses for the challenges of the shift described. It would be in fact very useful especially for Filipino nurses dreaming of going abroad where there is more use for the model. In the Philippines though, where we currently suffer from a rather inferior and rudimentary public health system, the use of the curriculum to train contemporary nurses for careers spent in the Philippines may be a rather unfeasible option. The model, in order to function as effectively and as efficiently as possible, must constantly be updated which can be a daunting task for a rather primeval and underdeveloped health sector. We have a potential to shift into a health system more harmonious to the model, however, as long as our system has not had a complete reform, the model shall remain only as an ideal option.

    National League of Philippine Government Nurses Inc (NLPGN), Public Health Nursing in the Philippines (2007), copyright 2007

    jennyanne

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    Re: Environments of Care: A Curriculum Model for Preparing a New

    Post  jennyanne on Sat 20 Nov 2010, 11:05 am

    JENNY ANNE PEDRON

    Guide questions:
    1. Do the three areas of concern of Ervin, Bickes and Schim on community-based nursing reflect present-day practice in the Philippines?
    2. Can the Environment of Care Model of Ervin, etc. be a good alternative to our nursing curriculum?

    In the Philippine setting, we do have the same areas of concern as well. Most of the preceptors that we have are not experienced in community health care. During my early years in nursing, I have witnessed that in some of the communities we have visited. Health centers in some areas don't have any registered nurses. I think this is due to limited budget for the community's health centers, so some just have volunteers that don't have any educational background in health care. Thus, most of the patients/clients opt to seek consult or care in hospitals instead.

    With regards to the second question, I think the Environment of Care Model of Ervin et al, is being practiced in the nursing curriculum today. During the early years of nursing, students are exposed to different communities to apply the basics that they have learned such as VS taking, assessment and health care teachings etc.

    Reference

    EN. Ervin, et al. (2006) Environments of Care: A Curriculum Model
    for Preparing a New Generation of Nurses. Vol. 45, No. 2

    lorrainepinzon

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    Environments of Care Model

    Post  lorrainepinzon on Sat 20 Nov 2010, 9:34 am

    Lorraine B. Pinzon
    Instructional Design
    Executive 6

    Environments of Care: A Curriculum Model
    for Preparing a New Generation of Nurses


    Questions:

    1. Do the three areas of concern of Ervin, Bickes and Schim on community-based nursing reflect present-day practice in the Philippines?
    2. Can the Environment of Care Model of Ervin, etc. be a good alternative to our nursing curriculum?



    Nurses are not only confined to the portals of big hospitals but they are also expected to go out into communities to manage acute or chronic conditions while promoting self-care among individuals and families. The article discusses the model or guidelines in which the community-based curriculum was used before, problems encountered by nurses with the community-based approach today and proposes an alternative approach for tomorrow.

    The authors of the article offered a proposition to answer the problems that we are encountering. They presented the Environments of Care Model which depicts the interaction between the individual and environment constructs of the nursing metaparadigm. The model is composed of four broad components that reflect the world from the internal biological level (within the individual) to the global level (societies and populations). In this framework, nursing is the means by which individual and environment interactions are modified or enhanced to produce health at the individual, family, community, and global levels. The four main environments represented are internal, social, physical, and global.

    The ECM suggests that it is not enough to understand the specific mechanisms of disease at the internal individual micro level. Nurses must also care for people in broader contexts at the macro level and consider the dynamic influences of all levels of environment on human responses to health and illness.

    Here in the Philippines, great focus are also allotted for student nurses to be in the community. Home visits to the families, staying in the barangay health center, coordinating with the local government, conducting lectures and programs are just a few of the activities and responsibilities of nurses that are already introduced to student nurses even as early as their second year in college. Nurses should be prepared to deliver quality care among different settings, not only in hospitals or communities. We need to understand that our profession is a lifelong learning; that we must continue to strive for acquiring new knowledge through continued education and be flexible enough to work in various condition and settings.




    Reference

    EN. Ervin, et al. (2006) Environments of Care: A Curriculum Model
    for Preparing a New Generation of Nurses. Vol. 45, No. 2

    AlexZano
    Guest

    Environments of Care: A Curriculum Model for Preparing a New

    Post  AlexZano on Fri 19 Nov 2010, 9:10 pm


    University of the East
    Ramon Magsaysay Memorial Medical Center Inc.


    Graduate School


    Alexis O. Zano Jr.
    MSN-AHN
    Exec-6



    "We are challenged to keep students facilitate application of the learning about the broader world of health care".

    The essence of the article clearly defined as the nursing education now a days should conform in the universal approach, holistic on its content, surpasses integral elements of nursing care in able to prepare students competencies in different settings. The Environment of Care Model illustrates how the nursing education become more holistic to engaged and impart knowledge and skills not only confined in several setting such as community-based nursing approach but then prepare students in general and universal arena of health care.

    The model is composed of four broad components that reflect the world from the internal biological level (within the individual) to the global level (societies and populations). The four main environments represented are internal, social, physical and global. The model aids and help student to foresee the big picture of nursing profession from hospital internal structures to a broad spectrum nature and field of the profession.

    Several feedback from the students raised such as anxiety of the student to engage in community emersion for related experience challenge the nurse educator to apply the model and think of the strategy to make the learning experience more exciting and enlightening and again the competency of the educator must also observe to facilitate the program appropriately.

    A representation of a nurse working in the multi modal fields and other global health institutions like unicef and the WHO signifies nursing profession now a days have achieved and attain its position for global health arena. We are challenged to keep students facilitate application of the learning about the broader world of health care.

    The Philippine curriculum has a strong substance of the components listed above. However, we must strengthen the global component of the model as our country known to be on a top list of producing professional Nurses all over the globe. Nurse educators must be fully equipped on the knowledge and skills to prepare nursing students in different health care competencies to universally accepted expertise or in technical “know how”.


    Reference

    EN. Ervin, et al. (2006) Environments of Care: A Curriculum Model
    for Preparing a New Generation of Nurses. Vol. 45, No. 2



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    sheryllquides

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    Re: Environments of Care: A Curriculum Model for Preparing a New

    Post  sheryllquides on Fri 19 Nov 2010, 9:14 am

    Sheryll M. Quides
    Instructional design

    Environments of Care: A Curriculum Model for Preparing a New Generation of Nurses


    Do the three areas of concern of Ervin, Bickes and Schim on community-based nursing reflect present-day practice in the Philippines?

    Community based Nursing strengthens and expand health services by improving the education of nurses, thus improving the health and well-being of all. Community-based education is a way to ensure that health personnel can competently perform tasks relevant to the health needs of the population. Nurses have always cared for individuals, families, groups, and communities in their practice. Recently there has been an increase in the focus on nurses working outside of the hospital, primarily in community-based settings that focus on individuals and families. There is also increasing emphasis on community-focused nursing care with the community as the client. In some nursing programs, nurse educators have tried to adjust to this change by increasing the amount of time that nursing students spend in the community. The focus of this experience ranges from individuals to populations. Examples of community and public health nursing experiences include working in screening and primary care clinics in public schools and health departments and administering immunizations to pediatric and special-needs populations within the community. Community mental health experiences might include such activities as working in psychiatric crisis units within a county health department; assisting addicted clients in short-term residential treatment facilities; and providing mental health assessments for high-risk student populations within the public school system.

    Long-term care clinical settings include both nursing homes and skilled nursing facilities. During these clinical experiences, students work with short- and long-term residential clients in
    both private and public facilities and nursing homes. Students identify and discuss some of the implications for nursing care they learned from their clinical experience during the week.

    Their view of point in this curriculum has been implemented already in the Philippines. The only difference is they emphasize the needs to do which has been doing here in our country. Student are equip with competencies needed to land jobs as a nurses aid, and community health aides (CHED 1999) which mean as early as 2nd year the student were already been in training for a hospital and non-hospital setting. In a community setting we have a family care plan, community diagnostic and emersion which is offered as early in the 2nd to 3rd year level. Their curriculum in fact is a well-researched program that was carefully developed by the country’s dedicated deans and noted nursing academicians in consultation with different nursing sectors and specialty groups.



    References:


    www.informworld.com
    http://google.com/books

    CHED Memorandum Order (MO) No. 5, series of 2008 otherwise known as “Policies and Standards for Bachelor of Science in Nursing Program”.

    Charis J
    Guest

    Environments of Care: A Curriculum Model for Preparing a New

    Post  Charis J on Thu 18 Nov 2010, 4:55 pm

    Environments of Care: A Curriculum Model for Preparing a New Generation of Nurses

    The article on Environments of Care published in 2006 has given us a perspective of the community-based curriculum in the United States which has become the recommended curriculum for undergraduate courses since 1993. With the implementation of The Health Reform Law in March 2010, the United States expects coverage of 32 million Americans who are currently uninsured and 30 million Americans who are inadequately insured. This means a demand for the next ten or so years for nurses, especially the Advanced Practice Registered Nurses (APRN). Advanced Practice Nurses are professionals with specialized knowledge and skills that are applied within a broad range of patient populations in a variety of practice settings. There would be heavy demand for registered nurses who are prepared at the graduate degree level as either a Clinical Specialist, Nurse Anesthetist, Nurse-Midwife, or Nurse Practitioner (AACN position statement).

    Because of the wide coverage of The Health Reform Law and its focus on primary and preventive health care, it has shifted back its emphasis on the patient and community. And with the central role that nurses would take under this law, it cannot be understated that nurses’ functions in the assessment, diagnosis, planning, implementation and evaluation of actions in problems or situations are integral to the health and well-being of individuals. As Rebecca M. Patton, president of the American Nurses Association, said “APRNs being allowed to practice to the full extent of their education, training, and capabilities is a clear and obvious solution to the patient access and primary care challenges that have been staring us all square in the face for some time now. Recognizing the integral role that APRNs play in the delivery of patient-centered primary care helps bring the focus of our healthcare system back where it belongs — on the patient and the community” (Patton, 2010).

    This recent development in the healthcare system seems to go back to the trend of years ago – that employment in non-hospital settings grew at a much greater rate than in hospitals (p.75). And when courses were revised to address this trend, students were given clinical rotations outside the hospitals and were exposed to community settings. “Efforts to approach patients and families from a health promotion/strengths-based perspective led to beginning coursework with health and wellness content before presenting illness and disease treatment concepts.” (p. 76).

    If legislation has provided for funding of nurse-managed health care clinics, nurses become frontliners in the practice of primary healthcare and wellness services. “In addition to providing many of the same services less expensively, nurse practitioners offer something else that makes them darlings to health reformers: a focus on patient-centered care and preventive medicine. x x x Nurse practitioners may have less medical education than full-fledged doctors, but they have far more training in less measurable skills like bedside manner and counseling. ‘In the United States, we are so physician-centric in our health system,’ says Patton. ‘But it should be about wellness and prevention, not about procedures and disease management’ (Pickert, 2009). The effect would be more healthy people, less hospital population, and less hospitalization costs.

    Since the present trend, triggered by implementation of the Health Reform Law, forces us back to the community setting, would the three areas of concern enumerated by Ervin, Bickes and Schim be relegated to the back burner? The writers may not have anticipated a return to community-based nursing, but they have proposed a model which does not rely on predictions of future trends in health care.

    Ervin, Bicker and Schim’s Environments of Care Model (ECM) is proposed as an alternative curriculum approach to the present community-based curriculum model. It is offered that this model “conveys a broad perspective on health and illness, based on a multiple determinants of health paradigm and a systems framework”(p.75). The ECM suggests that it is not enough to understand the specific mechanisms of disease at the internal individual micro level. Nurses must also care for people in broader contexts at the macro level and consider the dynamic influences of all levels of environment on human responses to health and illness (p.79).

    It is safe to say that ECM encompasses the various aspects of community nursing because it has four broad components that are integral to the person in his interactions with family and community. The intent of Ervin, Bicker and Schim for nurses to look at nursing practice beyond the individual level and to deliver care across settings is appreciated in the current times. But, looking at the Figure, it can be surmised that the model which encompasses a broader world of health care may be too broad to fit into a 4-year course in a nursing curriculum. Or it might sacrifice teaching of more important aspects of nursing that would equip the students with more than a general knowledge of nursing.

    If a health reform law puts this much attention to primary care and prevention, and the role of nurses, then our nursing curriculum should address this. It can be a return to community-based curriculum or an enhancement of the present curriculum that should take into account the expected diverse roles of nurses in the communities and the need for nurses of higher learning because of the anticipated bigger role of APRNs in the communities.

    Guide questions:
    1. Do the three areas of concern of Ervin, Bickes and Schim on community-based nursing reflect present-day practice in the Philippines?
    2. Can the Environment of Care Model of Ervin, etc. be a good alternative to our nursing curriculum?

    References:
    1. American Association of Colleges of Nursing Position Statement (1998) online at
    2. Barclay, L. (2010), Healthcare Reform Legislation Effects on Nursing: An Expert Interview with Rebecca M. Patton, MSN, RN, CNOR, online reference at
    3. Pickert, K. (2009), If a Health-Care Bill Passes, Nurse Practitioners Could Be Key, online at



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