Engaging Nursing Students in Community Partnerships: Development of a Health Promotion Program

Abstract

Background:

Experiential learning experiences addressing the needs of underserved populations have been recognized by the National League of Nursing as an important component of nursing education. Engaging students in academic experiences involving community partnerships enhances interprofessional and leadership skills to address social determinants of health (SDOH).

Method:

Undergraduate community health nursing students participated in the development of a youth health promotion program in an underserved community with a primarily Hispanic population. Students engaged in program development, implementation, community partner collaboration, and outcomes evaluation.

Results:

Students reported the health promotion program provided them a unique experience helping an underserved community with limited resources. Students further noted the importance of culturally congruent interventions that are tailored to the population being served.

Conclusion:

Engaging nursing students in academic partner collaborations addressing SDOH is an important step in preparing students to lead, develop, and implement community health interventions in their future practice.

Population health has been identified by the American Association of Colleges of Nursing (^{AACN, 2021}) as an essential domain to nursing practice. Addressing social determinants of health (SDOH) in a variety of community settings is an essential component of entry-level professional nursing education (^{AACN, 2021}). Innovative experiential learning experiences addressing the needs of underserved populations need to be incorporated in nursing curricula to prepare students for practice (^{National League for Nursing, 2024}).

Background

Hispanic children in the United States have the highest incidence of obesity (26.2%) compared with Black (24.8%), White (16.6%), and Asian (9%) children in the US (^{Centers for Disease Control and Prevention [CDC], 2024}). Childhood obesity is affected by economic disadvantage, with a higher prevalence of obesity among children in low-income households (^{CDC, 2024}). Hispanic children in low-income communities have limited access to healthy foods, physical activity, and health education (^{Martin et al., 2023}; ^{Sarmiento et al., 2021}; ^{Von Seggern et al., 2024}). Researchers have reported the positive effects of health promotion programs among Hispanic youth in low-income communities (^{Fernandez-Jimenez et al., 2019}; ^{Korom et al., 2024}). Through a medical school and community center partnership, Korom et al. (²⁰²⁴) implemented a 2-year physical activity and nutrition program for middle school Hispanic youth. After 3 years of follow up, parents reported the program helped them build social connections with the community, gave them exposure to learn about various physical activity options for their children, and helped them feel more comfortable letting their children participate in high school sports for years after the program ended. Among preschool children in an underserved community, Fernandez-Jimenez et al. (²⁰¹⁹) reported that implementation of a 4-month health promotion educational intervention resulted in improved attitudes and habits related to physical activity.

The importance of partnering with trusted community organizations to gain insight into community needs has been recognized as an essential step in creating interventions that are tailored to the population being served (^{DeCamp et al., 2021}; ^{Korom et al., 2024}). Developing curricular strategies that promote partnerships between nursing students and community stakeholders enhances knowledge and skills necessary to develop tailored interventions that address the needs of the population being served (^{Schaffer & Hargate, 2015}). Engagement of nursing students in community partnership learning experiences has been widely documented (^{Gresh et al., 2021}; ^{Hausman-Cohen et al., 2020}; ^{Markaki et al., 2021}; ^{Perry et al., 2021}). However, experiential learning experiences for undergraduate nursing students engaging in community partnerships serving Hispanic populations are scarce in the literature (^{Gonzalez-Guarda et al., 2022}; ^{Schaffer & Hargate, 2015}). An innovative experiential learning experience for community health nursing students was implemented involving the development of a health promotion summer program for K-12 children and adolescents in an underserved Hispanic community. This learning experience provided an opportunity for nursing students to gain, enhance, and apply knowledge and skills in several competencies including leadership, working with underserved populations, addressing language barriers, interprofessional collaboration with community partners, and developing sustainable programs that address SDOH.

Method

Kolb's experiential learning theory was used to guide the development of the youth health promotion program learning experience (^{Kolb, 2015}). The theory focuses on gaining knowledge through active engagement in experiences. Learning occurs in a cycle of stages that starts with a concrete experience, followed by reflective observation, abstract conceptualization, and active experimentation (^{Kolb, 2015}). Through development, implementation, and evaluation of the youth health promotion program, nursing students engaged in activities consistent with the stages of Kolb's experiential learning theory. Students engaged in a concrete learning experience gaining knowledge and skills through active experimentation. Abstract conceptualization was accomplished through application of previously learned knowledge into the planning and implementation of the project. Reflective observation was achieved through postconference discussions and written reflective logs throughout the development of the program.

A team of four nursing faculty with experience in pediatrics, community health, medical-surgical nursing, and mental health collaborated with the community health nursing course leader to incorporate the development of a youth health promotion program in the summer community health clinical. A group of eight community health nursing students participated in the development and implementation of the program. Collaboration with an established long-term community partner facilitated implementation of the program. The community stakeholders involved in the planning and implementation of the program were the director of a public library in an underserved low-income community with a primarily Hispanic population and three school district teachers conducting a summer youth reading program in the library. A series of meetings were conducted during the planning stages for scheduling of the health promotion program sessions, identifying activities and topics to be implemented, and completing a needs assessment of equipment and materials necessary to implement the project.

The library and the School of Nursing have a long-standing partnership collaborating on a variety of community projects for more than 12 years. The library is in a central location easily accessible to many residents of the community. During the summer months, children and adolescents from the community frequently ride their bicycles or walk to the library to attend reading programs, use the computers, and play on the playground. This made the library the ideal location to hold a summer youth health promotion program focused on physical activity, nutrition, and wellness.

To facilitate attendance, the youth health promotion program was developed and implemented as an expansion of the library's summer reading program. Children and adolescents attended the health promotion program during the last hour of the reading program. Collaboration with the school district teachers conducting the reading program facilitated scheduling of the health promotion sessions on days that would best fit their program and also would align with the clinical day of the community health nursing students. Four sessions were implemented over a 2-month period. Each session included 40 minutes of physical activity, a 15-minute learning moment, and a healthy snack. Informational flyers and materials for the program were developed in both English and Spanish.

To maximize sustainability of the program, faculty secured funding from an internal university organization focused on enhancing community collaborations and outcomes. The funding was used for the initial costs of the program including physical activity equipment, games, and materials that could be used long-term. Physical activity sessions were led by nursing students and included soccer, hula hoop, skip ball, jump rope, volleyball, football, badminton, and playground free play. Indoor games including bowling, horseshoe, shuffleboard, and bags also were set up to accommodate for weather changes and to alternate between indoor and outdoor activities during the 40-minute session.

The 15-minute learning moment sessions consisted of interactive discussions focusing on healthy ways of dealing with emotions, stress management, identifying support systems, internet safety, using social media appropriately, harmful effects of e-cigarettes and vaping, physical activity, sleep, healthy eating, and hygiene. A health careers discussion also was included on the last day of the program engaging in interactive learning activities with a variety of professionals. Topics selected for the learning sessions were based on needs identified in the literature and topics from other successfully implemented Hispanic youth health promotion programs reported in the literature (^{Fernandez-Jimenez, 2019}; ^{Korom et al., 2024}; ^{Sarmiento et al., 2021}; ^{Yockey et al., 2023}). Feedback from the community stakeholders also was used in the selection of the topics to ensure the specific learning needs of the local community were addressed. After assisting faculty with two of the learning moment sessions, nursing students were responsible for developing and implementing the remaining two sessions.

Results

The number of participants in each session ranged from 9 to 17 children and adolescents. Two of the children's mothers also were present at each session. The age range of participants was kindergarten to ninth grade, which provided the opportunity for nursing students to engage in developing learning materials and activities that could be accommodated for various age groups. All of the participants in the program and their parents were Hispanic, which is representative of the population in the local community where the program was implemented.

At the end of each session, participants completed an evaluation that included a question to rate the session on a Likert scale ranging from 1 = not very good to 5 = excellent. The evaluation also included four open-ended questions to (1) evaluate participants' learning; (2) determine what they enjoyed the most from the session; (3) identify anything they would like to see different; and (4) offer suggestions for future sessions. Nursing students conducted the evaluations and assisted participants who needed help completing the evaluation. Overall, the participants rated the program highly on the Likert scale. In the open-ended questions, the participants commented that they enjoyed the activities and were able to learn about exercise, healthy eating, sleeping habits, and dealing with emotions. Informal feedback from the library director, teachers, and parents also was obtained. The parents commented that they were thankful for the program as it helped their children stay active and engage in activities outside of the home.

Although all of the children and adolescents participating in the program were fluent in English, the two mothers who were present only spoke Spanish. One of the nursing faculty whose native language was Spanish served as an interpreter. This learning experience provided nursing students the opportunity to address language barriers and communicate through an interpreter, which students often do not experience in the curriculum. Nursing students commented that the health promotion program provided them with experiences outside of a hospital setting to help an underserved community with limited access to resources. Students further noted the importance of developing culturally congruent interventions that are tailored to the population being served.

Sustainability of the program has been maintained for two consecutive summers. Most of the initial costs were related to physical activity equipment and materials, which have remained in the library for the summer program and other activities throughout the year. Although the undergraduate community health clinical course currently is only offered during the academic year, nursing and other interprofessional students were able to participate in the second year of the youth health promotion program through service-learning.

Conclusion

Innovative experiential learning experiences are essential in preparing nursing students to lead, develop, and implement community interventions that address SDOH. The development of the health promotion program described in this article provided an opportunity for students to work with underserved populations and gain knowledge and skills that will help prepare them for future practice. Furthermore, it allowed students to engage in collaborations with community stakeholders, highlighting the importance of community partnerships in successfully developing health promotion programs. Continued interprofessional collaborations are needed to maintain long-term sustainability of the program through service-learning. Sustainability of the nursing clinical component is being explored as a community experience in the summer pediatric nursing clinical course offered to accelerated baccalaureate nursing students.

Author Affiliation

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