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YORK UNIVERSITY

SCHOOL OF NURSING

NURS 4120 6.0

Community as PartnerFall 2008 -Winter 2009

Co-Creating Just and Caring Communities


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2008-2009 Preceptor Manual

Table of Contents

Overview of the Nursing Program at York University................................................................................. 1Mission Statement ...................................................................................................................................... 2Philosophical Beliefs................................................................................................................................... 2

Human Beings and their world................................................................................................ 2Health and Healing.................................................................................................................. 2Nursing.................................................................................................................................... 3Teaching-Learning .................................................................................................................. 3

Program Goals............................................................................................................................................ 4Course Theme for NURS 4120 6.0 Community as Partner .......................................................................5Introduction .............................................................................................................................6Clinical Focus.......................................................................................................................... 6Clinical Hours .......................................................................................................................... 6Student Groups ....................................................................................................................... 6Clinical Course Director ..........................................................................................................7Team Learning Plan................................................................................................................ 7Portfolio ................................................................................................................................... 7Clinical Evaluation................................................................................................................... 7

Mid-term Evaluation & Final Evaluations............................................................... 7Required learning outcomes for students ...............................................................................8

Community Health Nursing Standards of Practice ..................................................................................... 9The Preceptorship Experience ................................................................................................................. 16

Tips on getting started ..........................................................................................................16Teaching-Learning Concepts................................................................................................ 16Interactive Review Process and Success Plan..................................................................... 16Assisting the students with critical self-reflection and analysis............................................. 16Role of the Preceptor ............................................................................................................ 17

Role of Clinical Course Director/Faculty Member................................................................. 17When to call the Clinical Course Director ............................................................................. 18Role of the Student Team..................................................................................................... 18Role of Individual Students ...................................................................................................18Preceptor Support ................................................................................................................. 19

Practicum Policies .................................................................................................................................. 20Work/Education Placement Agreement ................................................................................ 20Administrative........................................................................................................................ 20Health Requirement .............................................................................................................. 20

Immunization ....................................................................................................... 20Incident/Accident Report Form............................................................................ 20Basic Cardiac Life Support Certificate................................................................. 20

Attendance ............................................................................................................................ 21Expenses ..............................................................................................................................21Documentation ...................................................................................................................... 21Professional Appearance and Dress Code........................................................................... 21T t ti 21


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Overview of the Nursing Program at York University

York University is located in the north-western area of Toronto. York University launched its 45th

anniversary year on March 26, 2004. Since its inception in 1959, York has grown from a small liberal artsuniversity with 76 students to the third largest university in Canada, with 11 Faculties attracting over50,000 students in search of top-notch teaching and scholarship.

MacLeans magazine lists York among the top five universities in Canada. York Universitys commitmentto students and to excellence in teaching and research is clear to see in its continued high ranking inindicators that matter most to students: Bursary and Scholarship Support; Most-Educated Faculty; and

Investment in Student Services. Yorks faculty are recognized for excellence and innovation in universityteaching and research. Two York faculty members have been named Canadian Professor the Year (1993and 1995) and more than 50 York faculty have received provincial and national awards for teachingexcellence.

In 1993, the Department of Nursing was established at Atkinson College, York University. It has nowbecome the School of Nursing in the Faculty of Health (July 2006). Currently, the School of Nursing offersa part-time Post-RN BScN Program, an International Educated Nurses BScN program, a CollaborativeBScN program, a 2

ndDegree Entry BScN program and a Masters MScN program. The School is also

part of a 10-university consortium which offers a Primary Care Nurse Practitioner Certificate (post-BScN).

In September 1997, students were admitted to the first Collaborative BScN Degree Program in Ontariowhen they entered year 1 at either Seneca College or Georgian College. At present, there areapproximately 350 full-time Collaborative students beginning their third year of the BScN program andanother 350 students continuing into their fourth year. As of September 2001, with new governmentlegislation mandating the baccalaureate degree as entry to practice for 2005, year 1 Collaborativestudents were admitted jointly to the College partner and to York at the same time so the transition tostudy at York in years 3 and 4 will be seamless.

The nursing faculty at York University has grown from a complement of four full-time members in 1996-97to over 44 in 2007-08. The current faculty have established national and international reputations in theirareas of nursing expertise. Scholarly activities have focused on the human science paradigm of nursing,nursing theory and philosophy, and health promotion. Scholarly activities and research programs,including both quantitative and qualitative approaches, encompass such areas as:

persons living with chronic illness and theirfamilies

uncertainty, hope, and having courage nursing futures womens health trans-cultural health international health soulfulness innovation and change health care informatics

empowerment public health nursing arts-informed praxis client-centred care evaluation teaching-learning child rights nursing covenant and the lived meaning of

nursing nursing ethics


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Nursing

Nursings mission is the betterment of human and planetary life, both locally and globally, now and for thefuture. This mission is based on nursing being a unique body of theoretical, philosophical, and personalknowledge that is expressed through ways of being with humans as they journey through processes ofliving health and healing. The practice of nursing, based on this philosophy and informed by nursingscience, is lived in caring relationships with persons, families, and communities. These relationshipssupport and enhance health, healing, and quality of life. Nursing scholarship focuses on inquiry into thehuman experiences of health and healing, as well as the creative, integrative, and expressive forms ofcaring-healing enacted in nursing practice. Nursing knowledge and practice inform and shape each other.It is the synergistic effect that enables nurses to understand and significantly contribute to personsexperiences of health.

Sources of knowing in nursing are unbounded; that is to say that as unitary beings in relation, nursesdraw on multiple sources of knowing including rational, empirical, theoretical, philosophical, personal,moral and ethical, intuitive, and transcendent. Caring nurses utilize these multiple sources of knowing tobe with, witness, and co-create quality of life with clients, their families, and the community they serve.

Nursing is a self-regulated profession. Nurses are responsible and accountable for providing competentand ethical practice to their clients, the public, their colleagues, and themselves. Nurses have aprofessional responsibility to continuously seek to improve their practice through critical self-reflection,

scholarship, research, and innovation.

Nurses have a professional and ethical responsibility to influence, advocate for, and support healthypublic policy, institutional practices that promote quality of working life, and legislation that contributes tothe health of nurses and humankind.

Teaching-Learning

Nurses value the limitless possibilities of learning. Learning is a life-long, often mysterious, dynamicprocess of personal and professional growth. It builds on prior experience, stimulates critical reflection,and fosters the (re)formulation of the meaning of experience through the creativity of imagining. Itcontributes to self-esteem, self-knowledge and choosing our possibilities. Teachers and learners as co-learners become partners in a collaborative learning process. A community of learners brings valuableknowledge and experience that is respected in the learning environment. Adults are capable of and havethe right and responsibility to be self-directing learners.

Teaching/learning is a dynamic process of discovery through interaction and engagement which occurs inboth formal and informal contexts that acknowledge multiple ways of knowing. Authentic caring throughtranspersonal relationships is vital to teaching/learning. Courageous teachers/learners embody the caring

curriculum by supporting, encouraging, and valuing learners by believing in them and being truly presentwith them, thereby promoting trust, honesty, creativity, innovation, and meaning-making. With this inmind, approaches to teaching/learning include dialogue, modelling, practice, reflective thinking, andexperiential group process. Formal learning is based on the principles of cooperative, anticipatory-innovative learning. These principles are designed to create a learning community that supports thestrengths and learning needs of all learners. Teaching and learning processes enhance learners ability tothink critically and reflectively while finding pathways to new knowledge, freedom, and connectedness


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Program Goals

The graduate of the program will:

Be accountable to the public and responsible for practicing within the professional and ethicalstandards of nursing.

Seek to understand the health and healing experiences of individuals, families, groups andcommunities by establishing caring relationships toward enhancing health and quality of life.

Incorporate multiple ways of knowing in decision making and problem solving, in partnership with

clients.

Be able to think critically and reflectively.

Be committed to life long learning.

Facilitate collaborative relationships in nursing, with the community and the interdisciplinary team.

Demonstrate leadership in nursing practice.

Advocate and support healthy organizational and public policy that promotes the health of individuals,families, groups and communities.

Influence the advancement of the nursing profession through excellence in practice, education andresearch.

Demonstrate global consciousness, both personally and professionally, through actions that supportand promote human and planetary health.

Overall, to meet the entry to practice competencies and in this case, those associated with communityhealth nursing associated with Ontarios College of Nurses.


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NURS 4120 6.0

Community as Partner

Introduction

This practicum component of NURS 4120 6.0 builds upon the theoretical component of the course byproviding an opportunity for praxis. Students develop knowledge and skills related to community healthnursing and caring for a community. Within the context of a caring relationship and with the guidance ofthe clinical course director (CCD) and preceptor, the student will apply and critically reflect on theories of

community health nursing and people-centred health promotion.

Clinical Focus

Community as Partneris a community health promoting nursing course that enables students tounderstand the process of partnering with communities in order to enable health and empowerment.Students learn to understand how the strategies associated with the Ottawa Charter for Health Promotion(1986), the CHNAC (2003) Standards of Practice for Community Health Nursing and the principles

associated with Primary Health Care interface when nurses partner with communities. Communitysettings and preceptors are requested to ensure students have the opportunity to consult communitymembers regarding their lives, their definition of health and the barriers to health that they experience. Inaddition, it is important that students are enabled to understand nursings roles in advocacy, capacitybuilding, healthy public policy development, and empowerment based education and communitydevelopment. York Nursing students are expected to practice according to the Canadian NursesAssociation Code of Ethics.

Clinical Hours

The Community as Partnercourse consists of a community experience, a weekly class and a praxisseminar facilitated by the CCD and the group of students. Students are expected to work with theircommunity and/or on the associated work related to a related health promotion initiative for a minimumof 12 hours per week. Total clinical time is a minimumof 144 hours over one 12 week term. Yorknursing students will welcome eclectic experiences, and would benefit from multiple views of communityhealth nursing, aggregates and opportunities to partner with communities. Students are expected to beflexible in meeting their clinical hours.

In the fall/winter of 2008/09 students will be primarily be placed in settings for two days each week, thusmaking it much easier to attain their required hours. We rely on the student, the agency and thepreceptor to assist the student group to observe, participate and./or initiate other activities in order tomeet their 12 hours a week minimal requirements. Only a small amount of time over the semester will beallotted for aggregate research. We consider this research, class prep, and writing praxis notes to be apart of the homework component of this praxis course. The focus is on hours spent withor in partnershipwith their community aggregate: the more the better. We hope you can help our students achieve this.


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Tips on helping team develop a Learning Plan:

Translate conceptual definitions into

concrete learning activities. Have clear descriptions of how to

demonstrate accomplishment.

Ensure criteria flow from learningoutcomes.

Ensure standards are clearly stated foreach criterion.

Use early formative evaluation todemystify standards and expectations.

Ensure means of demonstratingachievement are clear.

The portfolio consists of:

evaluations

praxis notes assignments community report research articles time log learning plan materials developed by student pamphlets/ handouts

The Clinical Course Director

The Clinical Course Director (CCD) is the clinical instructor that works with you and your student(s). The

CCD works in collaboration with you to evaluate and support student learning. The CCD also has a rolein grading, facilitating weekly praxis seminars, and acts as an ongoing resource person for the preceptorand student. The CCD will contact you prior to the beginning of the term to help identify a suitable clinicalassignment for the student team.

Team Learning Plan

Each student group develops a 12 week learning plan(see sample in Appendix C), incorporating coursecompetencies and learning objectives that relate to theunique practicum setting they are in. This plan isnegotiated with the preceptor and discussed with theclinical course director. The plan is reviewed andupdated as necessary.

The initial learning plan is to be completed by week 4 ofthe placement, unless otherwise negotiated with thepreceptor and CCD.

Portfolio

Each student develops a portfolio throughout the 12

weeks. The portfolio is evaluated by the CCDand is a key part of the evidence that course goals havebeen met. Each student portfolio is unique and reflectshis or her development of professional interests andcompetencies. A copy of the team learning plan will beincluded in each individual portfolio.

Clinical Evaluation

Building on the assumptions of our caring philosophy, the evaluation process is guided by principles ofcaring for self and for respectful, authentic communication. This means that each partner will have thecourage to address performance issues as they arise. In collaboration with your student and CCD, therewill be two team clinical evaluations, one at mid-term and one at the end.


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A mutually agreeable date for both mid-term and final evaluations needs to be set early in the term. TheCCD will arrange a date to meet with you and the student teams to review the evaluation. Theevaluations are collaborative processes and allow for each partner to participate equitably.

Your primary role in these meetings is to provide feedback (see section on Guidelines for ClinicalEvaluation) and provide direction to the students and CCD.

Successful completion of the Health and Healing: Community as Partner Course 4120 6.0 requires apassing grade in both the practicum and theoretical components of the course. The final clinical grade(pass/fail), which is assigned by the CCD, will be based upon evidence in the clinical portfolio, includingthe mid-term and final clinical team evaluations.

Required Learning Outcomes for Students in Community as PartnerNURS 4120

Praxis embodies the notion of theory informing practice and practice informing theory. As the preceptor,we rely heavily on your guidance to enable the students to meet the following goals:

1. Demonstrate understanding of the philosophical and historical basis of community health nursingpraxis.

2. Demonstrate knowledge in the philosophy and skills in the process of partnering with the community.

3. Integrate knowledge from nursing, health promotion, and other disciplines into practice.

4. Develop community assessment, consultation, and health promotion skills.

5. Analyze ethical/legal issues and professional trends in community health nursing.

6. Exemplify professional responsibility and accountability in classroom and community practicesettings.

In addition, York BScN students will work with their CCD and yourself to understand and achieve praxis inas many of the core competencies set out by the Community Health Nurses Association of Canadas(2003) Standards of Practice. In this manual, we have provided you with an excerptfrom this document,and invite you to download the entire document including definitions and references from our course web

site. Please ask your CCD for further details.


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Community Health Nurses Association of CanadaStandards of Practice (May 2003)

The Community Health Nurses Association of Canada (CHNAC) Standards of Practicedraw uponcertain values and beliefs concerning community health nursing practice. The principles of Primaryhealth care, a model of partnership(and thus the title for the community health nursing course at YorkUniversity), and an underlying belief that health promoting nursing practice is best rooted inempowerment and advocacy form the basis for CHNACs five interrelated standards of practice.

The Principles of Primary Health CareCommunity health nurses recognize that primary health care is a different way of thinking about

health and health care that is fundamental to their practice. Primary health care differs significantly fromprimary care (first point of access to care) and is an integral part of the Canadian health care system.Community health nurses value the following key principles of primary health care as described by theWorld Health Organization (1978): 1) universal access to health care services, 2) focus on thedeterminants of health, 3) active individual and community participation in decisions that affect theirhealth and life, 4) partnership with other disciplines, communities and sectors for health, 5) appropriateuse of knowledge, skills, strategies, technology and resources, and 6) focus on health promotion/illnessprevention throughout the life experience from birth to death. Community health nurses recognize andincorporate knowledge of the impact of the socio-political-economic environment on the health of

individuals and the community, and their own practice.

Individual/Community PartnershipCommunity health nurses believe that it is paramount to have the individual/community as an activepartner in decisions that affect their health and well-being. Participation is essential throughout allcomponents of the nursing process. In partnership, the community/individual takes an active role indefining their own health needs during assessment, sets their own priorities among health goals, controlsthe choice and use of various actions to improve their health and lives, and evaluates the efforts made.During assessment and throughout the community health nursing process, students identify the healthvalues of the individual/community, including what health means to that particular individual orcommunity. Inherent in the nursing process is working with individuals and communities to build capacityand to participate in making decisions concerning their health. For community health nurses, participationis the basis of therapeutic, professional, caring relationships that promote empowerment. Communityhealth nurses also make their expertise available as a resource to those with whom they are working.Concurrent with capacity building, community health nurses also have a responsibility to advocate.

EmpowermentCommunity health nurses recognize that empowerment is an active, involved process where people,groups, and communities move towards increased individual and community control, political efficacy,

improved quality of community life, and social justice. Empowerment is a community concept becauseindividual empowerment builds from working with others to effect change and includes the desire toincrease freedom of choice for others and society. Empowerment is not something that can be done to orfor people, but involves people discovering and using their own strengths. Empowering strategies or buildcapacity by moving individuals, groups and communities towards the discovery of their strengths and theirability to take action to improve quality of life.


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STANDARD 1: PROMOTING HEALTH

Community health nurses view health as a dynamic process of physical, mental, spiritual and social well-being. They believe that individuals and/or communities realize aspirations and satisfy needs within theircultural, social, economical and physical environments. Community health nurses consider health as aresource for everyday life that is influenced by circumstances, beliefs and the determinants of healthincluding social, economic and environmental health determinants: a) income and social status, b) socialsupport networks, c) education, d) employment and working conditions, e) social environments, f)physical environments, g) biology and genetic endowment, h) personal health practices and coping skills,i) healthy child development, j) health services, k) gender, and l) culture (Health Canada, 2000). Itincludes self-determination and a sense of connectedness to the community. Community health nursespromote health using the following strategies: a) health promotion, b) illness and injury prevention and

health protection, and c) health maintenance, restoration, and palliation. It is recognized that it may berelevant to use these strategies in concert with each other when providing care and services. Thisstandard incorporates these strategies by drawing upon the frameworks of primary health care (WHO,1978), the Ottawa Charter for Health Promotion (WHO, 1986), and the Population Health PromotionModel (Health Canada, 2000).

A) HEALTH PROMOTIONCommunity health nurses focus on health promotion and the health of populations. Health promotionis a mediating strategy between people and their environments a positive, dynamic, empowering,

and unifying concept that is based in the socio-environmental approach to health. This broad conceptis envisioned as bringing together people who recognize that basic resources and prerequisiteconditions for health are critical for achieving health. The populations health is closely linked with thehealth of its constituent members and is often reflected first in individual and family experiences frombirth to death. Healthy communities and systems support increased options for well-being in society.Community health nurses consider socio-political issues that may be underlying individual/communityproblems.

The community health nurse:

1. Collaborates with individual/community and other stakeholders in conducting a holisticassessment of assets and needs of the individual/community.2. Uses a variety of information sources to access data and research findings related to health at

the national, provincial/territorial, regional, and local levels.3. Identifies and seeks to address root causes of illness and disease.4. Facilitates planned change with the individual/community/population through the application of

the Population Health Promotion Model. Identifies the level of intervention necessary to promote health Identifies which determinants of health require action/change to promote health Utilizes a comprehensive range of strategies to address health-related issues.

5. Demonstrates knowledge of and effectively implements health promotion strategies based on theOttawa Charter for Health Promotion.

Incorporates multiple strategies addressing: a) healthy public policy; b) strengtheningcommunity action; c) creating supportive environments; d) developing personal skills, ande) re-orienting the health system

Identifies strategies for change that will make it easier for people to make a healthier


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culture, individual/community readiness, and social and systemic structure on health promotion.10. Evaluates and modifies population health promotion programs in partnership with the

individual/community and other stakeholders.

B) PREVENTION AND HEALTH PROTECTIONThe community health nurse adopts the principles of prevention and protection and applies arepertoire of activities to minimize the occurrence of diseases or injuries and their consequences toindividuals/communities. Health protection strategies often become mandated programs and laws bygovernments for the larger geo-political entity.

The community health nurse:1. Recognizes the differences between the levels of prevention (primary, secondary, tertiary).

2. Selects the appropriate level of preventative intervention.3. Helps individuals/communities make informed choices about protective and preventative health

measures such as immunization, birth control, breastfeeding, and palliative care.4. Assists individuals, groups, families, and communities to identify potential risks to health.5. Utilizes harm reduction principles to identify, reduce or remove risk factors in a variety of contexts

including home, neighbourhood, workplace, school and street.6. Applies epidemiological principles in using strategies such as screening, surveillance,

immunization, communicable disease response and outbreak management and education.7. Engages collaborative, interdisciplinary and intersectoral partnerships to address risks to the

individual, family, community, or population health and to address prevention and protectionissues such as communicable disease, injury and chronic disease.8. Collaborates in developing and using follow-up systems within the practice setting to ensure that

the individual/community receives appropriate and effective service.9. Practices in accordance with legislation relevant to community health practice (e.g. public health

legislation, child protection).10. Evaluates collaborative practice (personal, team, and/or intersectoral) in achieving

individual/community outcomes such as reductions in communicable disease, injury and chronicdisease or reducing the impacts of a disease process.

C) HEALTH MAINTENANCE, RESTORATION AND PALLIATIONCommunity health nurses provide clinical nursing care, health teaching and counselling in healthcentres, homes, schools and other community based settings to individuals, families, groups, andpopulations whether they are seeking to maintain their health or dealing with acute, chronic orterminal illness. The community health nurse links people to community resources andcoordinates/facilitates other care needs and supports. The activities of the community health nursemay range from health screening and care planning at an individual level to the forming of inter-sectoral collaborations and resource development at the community and population level.

The community health nurse:1. Assesses the individual/family/populations health status and functional competence within the

context of their environmental and social supports.2. Develops a mutually agreed upon plan and priorities for care with the individual/family.3. Identifies a range of interventions including health promotion, disease prevention and direct

clinical care strategies (including those related to palliation) along with short and long term goals


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improvement strategies.9. Facilitates maintenance of health and the healing process for individuals/families/communities in

response to significant health emergencies or other diverse community situations that negatively

impact upon health.10. Evaluates individual/family/community outcomes systematically and continuously in collaboration

with the individuals/families, significant others, other health practitioners and community partners.

STANDARD 2: BUILDING INDIVIDUAL/COMMUNITY CAPACITY

Building capacity is the process of actively involving individuals, groups, organizations andcommunities in all phases of planned change for the purpose of increasing their skills, knowledge andwillingness to take action on their own in the future. The community health nurse works collaboratively

both with the individual/community affected by health compromising situations and the people andorganizations who control resources. Community health nurses start where the individual/community is atto identify relevant issues and assess resources and strengths. They determine the individuals orcommunitys stage of readiness for change and priorities for action. They take collaborative action bybuilding on identified strengths and facilitate the involvement of key stakeholders: individuals,organizations, community leaders and opinion leaders. They work with people to improve thedeterminants of health and make it easier to make the healthier choice. Community health nurses usesupportive and empowering strategies to move individuals and communities toward maximum autonomy.

The community health nurse:1. Works collaboratively with the individual/community, other professionals, agencies and sectors toidentify needs, strengths and available resources.

2. Facilitates action in support of the five priorities of the Jakarta Declaration to: Promote social responsibility for health Increase investments for health development Expand partnerships for health promotion Increase individual and community capacity Secure an infrastructure for health promotion.

3. Uses community development principles: Engages the individual/community in a consultative process Recognizes and builds on the group/community readiness for participation Uses empowering strategies such as mutual goal setting, visioning and facilitation Understands group dynamics and effectively uses facilitation skills to support group

development Enables the individual/community to participate in the resolution of their issues Assists the group/community to marshal available resources to support taking action on their

health issues.

4. Utilizes a comprehensive mix of community/population based strategies such as coalition building,intersectoral partnerships and networking to address issues of concern to groups or populations.5. Supports the individual/family/community/population in developing skills for self-advocacy.6. Applies principles of social justice and engages in advocacy in support of those who are as yet

unable to take action for themselves.7. Uses a comprehensive mix of interventions and strategies to customize actions to address unique

needs and build individual/community capacity.


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determination. Caring involves the development of empowering relationships, which preserve, protect,and enhance human dignity. Community health nurses build caring relationships based on mutual respectand on an understanding of the power inherent in their position and its potential impact on relationships

and practice.

The community health nurses most unique challenge is building a network of relationships andpartnerships with a variety of relevant groups, communities, and organizations. These relationships occurwithin a complex, changing, undefined and often ambiguous environment that may present conflicting andunpredictable circumstances.

The community health nurse:1. Recognizes her/his personal attitudes, beliefs, assumptions, feelings and values about health and

their potential effect on interventions with individuals/communities.2. Identifies the individual/community beliefs, attitudes, feelings and values about health and their

potential effect on the relationship and intervention.3. Is aware of and utilizes culturally relevant communication in building relationships. Communication

may be verbal or non-verbal, written or pictorial. It may involve face-to-face, telephone, groupfacilitation, print or electronic means.

4. Respects and trusts the familys/communitys ability to know the issue they are addressing and solvetheir own problems.

5. Involves the individual/community as an active partner in identifying relevant needs, perspectives and

expectations.6. Establishes connections and collaborative relationships with health professionals, communityorganizations, businesses, faith communities, volunteer service organizations, and other sectors toaddress health related issues.

7. Maintains awareness of community resources, values and characteristics.8. Promotes and facilitates linkages with appropriate community resources when the

individual/community is ready to receive them (e.g. hospice/palliative care, parenting groups)9. Maintains professional boundaries within an often long-term relationship in the home or other

community setting where professional and social relationships may become blurred.10. Negotiates an end to the relationship when appropriate, e.g. when the client assumes self-care, or

when the goals for the relationship have been achieved.

STANDARD 4: FACILITATING ACCESS AND EQUITY

Community health nurses embrace the philosophy of primary health care and collaboratively identify andfacilitate universal and equitable access to available services. Community health nurses engage inadvocacy by analyzing the full range of possibilities for action, acting on affected determinants of health,and influencing other sectors to ensure their policies and programs have a positive impact on health.Community health nurses collaborate with colleagues and with other members of the health care team to

promote effective working relationships that contribute to comprehensive client care and the achievementof optimal client care outcomes. Community health nurses use advocacy as a key strategy to meetidentified needs and enhance individual and/or community capacity for self-advocacy.

They are keenly aware of the impact of the determinants of health on individuals, families,groups, communities and populations. The practice of community health nursing occurs withconsideration for the financial resources geography and culture of the individual/ community


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7. Collaborates with individuals and communities to identify and provide programs and delivery methodsthat are acceptable to them and responsive to their needs across the life span and in differentcircumstances.

8. Uses strategies such as home visits, outreach and case finding to ensure access to services andhealth-supporting conditions for potentially vulnerable populations (e.g. persons who are ill, elderly,young, poor, immigrants, isolated, or have communication barriers).

9. Assesses the impact of the determinants of health on the opportunity for health forindividuals/families/communities/populations.

10. Advocates for healthy public policy by participating in legislative and policymaking activities thatinfluence health determinants and access to services.

11. Takes action with and for individuals/communities at the organizational, municipal, provincial/territorialand federal levels to address service gaps and accessibility issues.

12. Monitors and evaluates changes/progress in access to the determinants of health and appropriatecommunity services.

STANDARD 5: DEMONSTRATING PROFESSIONAL RESPONSIBILITY ANDACCOUNTABILITY

Community health nurses work with a high degree of autonomy in providing programs and services. Theyare accountable to strive for excellence, to ensure that their knowledge is evidence-based, current andmaintains competence, and for the overall quality of their own practice. Community health nurses are

accountable to initiate strategies that will help address the determinants of health and generate a positiveimpact on people and systems. Within a complex environment, community health nurses are accountableto a variety of authorities and stakeholders as well as to the individual/community they serve. This placesthem in a variety of situations with unique ethical dilemmas. These include whether responsibility for anissue lies with the individual/family/community/population, or with the nurse or the nurses employer, thepriority of one individuals rights over anothers, individual or societal good, allocation of scarce resourcesand dealing with issues related to quality versus quantity of life.

The community health nurse:

1. Takes preventive and/or corrective action individually or in partnership with others to protectindividuals/communities from unsafe or unethical circumstances.2. Advocates for societal change in support of health for all.3. Utilizes nursing informatics (information and communication technology) to generate, manage and

process relevant data to support nursing practice.4. Identifies and takes action on factors which impinge on autonomy of practice and quality of care.5. Participates in the advancement of community health nursing by mentoring students and novice

practitioners.6. Participates in research and professional activities.7. Makes decisions using ethical standards/principles, taking into consideration the tension between

individual versus societal good and the responsibility to uphold the greater good of all people or thepopulation as a whole.

8. Seeks assistance with problem solving as needed to determine the best course of action in responseto ethical dilemmas and risks to human rights and freedoms, new situations, and new knowledge.

9. Identifies and works proactively to address nursing issues that will affect the population throughpersonal advocacy and participation in relevant professional associations.

10 Contributes proactively to the quality of the work environment by identifying needs/issues and


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nursing practice, new and emerging issues, the changing needs of the population, the evolvingimpact of the determinants of health and emerging research.

16. Acts upon legal obligations to report to appropriate authorities situations of unsafe or unethical care

provided by family, friends or other individuals to children or vulnerable adults.17. Uses available resources to systematically evaluate the availability, acceptability, quality, efficiency

and effectiveness of community health nursing practice.


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The Preceptorship Experience

Tips on Getting Started

Review orientation checklist to assist students in getting started in your agency (See Appendix A). Share your clinical expertise, areas of interests, your use of nursing theory. Exchange telephone numbers and email, identify contact person in group, and establish dates for

mid-term and final team evaluations. Review practicum dates and hours of practicum. Before starting daily work, have students review expectations of the day, assess preparedness of

students, identify what you will do together, and how they will update you.

Ask how things are frequently, if any questions or concerns have emerged. Give positive and constructive behavioural feedback as close to the event as possible. If possibledebrief from events, meetings and situations regarding the students perception, approaches usedand alternatives.

Encourage early independence within areas of competence and confidence. Keep brief daily notes to facilitate feedback and the progress review process.

Teaching-Learning Concepts

We believe that teaching and learning within the caring curriculum should be philosophically congruent.This means that our teaching-learning theories and practices: Appreciate and value the meaning of the experiences as expressed by students and teachers; Understand the wholeness, uniqueness and the dynamic process of learning and personal growth; Express caring and caring-health relationships; Foster critical reflection on the context, content, and processes of learning; Focus on the lived experiences of students, preceptors, and students.

Within the School of Nursing, we are in a process of achieving our ultimate vision of a caring curriculum.Almost daily, we encounter systems, procedures, processes, and habitual ways of being that cause us tocritique, re-think, and re-create. That being said, we believe that even now, in our relative infancy, we arecreating a new culture of learning and that the experiences of learners in our program are indicative of ourcommitment to the caring philosophy.

Our Interactive Review Process, forums for feedback and successplanning.

We approach conventional evaluation as an interactive and collaborative process intended to fostersuccess for each student and student group. Yet, for students whose performance foreshadows a"failing" course grade at the end of the term (or any other time throughout the course), an Interactive

Review Process will be initiated and a Success Plan will be developed which clearly outlines expectationsand strategies for success.

It is important that you know that you can contact the CCD at any time to discuss any concerns about astudent. Sometimes a preceptor tries to deal with issues on his/her own, without support. It is importantfor you, your clients and the student to address concerns and work towards success. Early identificationand planning can help to deal with issues quickly and effectively


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Examples of probing questions for the preceptor to consider when in dialogue with students:

What did you learn both in theory and practicum and how will you apply that learning to your practice?

Describe a significant situation or event that has occurred. Why was it significant?

What significance does this learning have to you as a person, and in your development as a nurse?

What did you see, hear, feel? What were your assumptions about an aspect of the situation? Haveyour assumptions changed? What are your fears? What were some obstacles in this event?

Identify some differences in what you learned today from what you learned previously. How will youapply this new knowledge?

What implications are there for the client, community, and your profession?

Role of the Preceptor

1. Negotiates the terms of the placement with the student team and faculty.

2. Communicates roles and expectations of practice to student and faculty.

3. Identifies a contact person within student team for phone communication.

4. Facilitates opportunities for student team to find appropriate experiences including interaction withcommunity members and opportunities to enact strategies associated with ethical community healthnursing practice.

5. Demonstrates/acts as a role model of a competent practitioner, one who is actively engaged in

professional nursing practice.

6. Stimulates the student teams critical thinking and reflection about its own caring-healing practicewithin the agency.

7. Provides feedback to the student and faculty about the student's success in meeting expectations ofthe course.

8. Initiates contact with the faculty if a problem or concern arises about the student's practice.

Role of the Clinical Course Director/Faculty Member

1. Negotiates the terms of the placement with the student team and preceptor.

2. Initiates and maintains a mutually satisfying pattern of communication among the preceptor, studentteam, and faculty.


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6. Assigns a pass/fail for the practicum component of the course.

7. In cases where a student is not meeting the minimum expectations of the practicum, the faculty

assumes responsibility for taking appropriate action.

8. Facilitates students' synthesis of the caring philosophy into nursing practice.

9. Facilitates preceptor's knowledge and comprehension of the caring philosophy into practice.

When to call the Clinical Course Director/Faculty Member

Clinical Course Directors are your resource person, and would like feedback based on the studentsprogress within this practicum experience. We invite you to be in contact with the student/student groupevery week, and touch base with the CCD bi-weekly. We would be most interested in hearing aboutstudent success, progress, and activities. As the preceptor, we ask that you work closely withstudents/student groups and provide them with guidance, support, resources and feedback. If this workwith the student/student group does not yield satisfactory results, we request that you contact the CCDimmediately for the following reasons:

Behaviour that places either clients or agency at risk

Repeated tardiness/illnesses/absences/cancelled planned practicum shifts Unsafe patterns of care Lack of follow-through on suggestions Lack of transfer of knowledge from one situation to another Limited knowledge integration, critical thinking skills, reflective practice skills Lack of anticipated progress Professional behaviour/accountability issues Interviews for progress reviews Injuries/accidents/illnesses on site

Feedback or support

Role of the Student Team

1. Plan to meet with the preceptor during the first week of class (see orientation schedule for yoursection).

2. Identify one contact person to facilitate communications with preceptor by phone when necessary.

3. In collaboration with the preceptor/faculty, prepare a Team Learning Plan.

4. Meet with the preceptor weekly to discuss progress and concerns, and to request guidance andresources that best support learning.

5. Actively participate in the activities at the practicum site, and actively research your aggregate and


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Role of Individual Students

1. Write and submit weekly praxis notes.

2. Develop a portfolio to provide evidence of meeting learning goals.

3. Practice according to the CHNAC (2003) Standards of Nursing Practice and the CNAs Guidelines forEthical Practice.

4. Prepare individual clinical self-evaluation (to be brought to individual CCD-student clinical evaluationmeeting).

5. Practice in accordance with the clinical agencys regulations, rules, policies, and procedures includingappropriate applicable provincial legislation.

Preceptor Support

Always remember that you can contact your CCD at any time to discuss any concerns about a student,seek support and ideas. She/he can link with colleagues to problem-solve or search for new andinteresting resources.

York University, School of Nursing has a variety of preceptor supports available to you. They can beaccessed at any time through our course web site.

Below are some examples of how you can become more connected with other preceptors, YorkUniversity staff, course information, research and more.

York On-line Library Presentation requests Course Website


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Practicum Policies

Work/Education Placement Agreement

This agreement MUST BE COMPLETED before the beginning of the unpaid placement and signed by:

a) the student;b) the work placement employer; and,c) a representative of the university (Clinical Course Director).

After all the participants have signed the form, the copies are to be distributed as follows: white copy to the student

canary copy to the work placement employer pink copy to the Nursing Practicum Coordination Office (NPCO), room 301E HNES Bldg.

Administrative

Students must report any injuries promptly, however minor, to:a) The Clinical Course Director by phone or pager;b) The preceptor at the practicum site;c) The Placement Employer;

d) The Nursing Practicum Coordination Office, 416-736-2100 x33176, email [email protected]; ande) York Universitys contact person in the Employee Well-Being Office, Human Resources Donna Ptak

and Primrose Lewis, 416-736-5518.

A York University, School of Nursing, Incident/Accident Report must be filled out for any incident/accidentrequiring or resulting in:a) health care by a medical practitioner for which there is a fee for serviceb) lost time from university beyond the date of accident; andc) exposure to a communicable disease.

Health Requirements

ImmunizationAll students are required to show proof/evidence of up-to-date immunizations, CPR and valid policechecks and have shown this proof to the Nursing Practicum Coordination Office (NPCO). Their CCD willcheck this passport and will not permit any student to attend clinical without meeting theserequirements. Students are advised of these requirements upon arrival to York in year three, and are

reminded every six months, plus throughout the semester leading up to this particular learningexperience. No signed passport = no admittance to clinical.

York University, School of Nursing, Incident/Accident Report formMust be filled out by the student and the Clinical Course Director for any:

Clinical incident involving a student's client who suffers an incident/fall/injury/error while under thestudent's care


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AttendanceThe student shall inform the practicum centre's preceptor and Clinical Course director of absenteeism and

lateness, at least one hour before Practicum starts. A maximum of 8 clinical hours of sick time will be considered with a valid doctor's note. This note

must be shown to the Clinical Course Director soon after return to Practicum and kept in thestudent's records.

Time taken for family bereavement will be from this pool of 8 hours of sick time. The 8 hours of sick time (including bereavement) do not have to be made up, but the student,

preceptor, and Clinical Course Director will meet to discuss a plan for meeting the learning goalsand course outcomes.

Any student's missed hours (e.g. ill dependent, snow day), not considered sick time, will

have to be made up by the student at the preceptor's and Practicum Centre'sconvenience.

ExpensesStudents are responsible for all expenses related to Practicum e.g., uniforms, travel costs including transitcosts, meals, and accommodation. The students are not allowed to accept financial remuneration by thePracticum Centre or the clients.

The Practicum Centre is not responsible for any expenses related to the Practicum Agreement that maybe incurred by the university or by a student, including, but not limited to, travel costs.

DocumentationStudents must sign client/agency documents legibly indicating full name and York Nursing Student(YNS). All documentation is to be checked by their preceptor.

Professional Appearance and Dress CodeAll students must maintain a professional appearance when attending any practicum setting. Wherethere are specific uniform policies within the Practicum Centre, the student is expected to follow thosepolicies. Where there are no policies, then professional dress is required. Unique considerations that are

specific to individual community settings can be discussed with the Clinical Course Director. If thestudent is not appropriately attired or is unkempt, the faculty or the Practicum Centre will refuse admissionof the student to the Practicum Centre, and this time must be made up at the convenience of thePracticum Centre and the Clinical Course Director.To assist the student in determining what is considered to be professional appearance/dress the followingprinciples have been identified:

adhere to agency policies regarding jewellery ability to maintain safety of self and the client maintenance of professional image cleanliness and neatness avoidance of perfumes/colognes (in consideration of individuals with allergies) comfort and ease of mobility identifiable as a nursing student to patients and colleagues, by wearing York University name

tag. This is Non-negotiable.


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Agency staff carry a minimum of $2,000,000 automobile liability insurance coverage. York Universitydoes not accept liability for transportation of students by preceptor.

Any student NOT following the above guidelines may be removed from Practicum, with the initiation of anInteractive Review Process.

StrikesShould a strike or walkout occur at the Practicum site, students must contact the Clinical Course Directoror NPCO Manager immediately. A decision must be made about whether the student wishes to remain inthe Practicum until the dispute is settled or renegotiate another Practicum. Under no circumstances is astudent to cross a picket line or to perform the work of the striking workers.

HarassmentThe ethics governing behaviour in a professional relationship between a student and preceptor should bethe same as those in a worker-client relationship. Students are especially vulnerable as they are beingevaluated. If a student feels uncomfortable in any way, he/she should consult the preceptor and/orClinical Course Director immediately. In addition, the CNA code of ethics governing nurse-client/community relationships must be adhered to, whereby the client/communitys dignity is of utmostconcern.

Dealing with prejudice and discrimination

It is important to note that issues relating to oppression and marginalization of minority groupswith respect to race, class, colour, gender, culture, age, sexual orientation, language, or disabilitywill not be tolerated by the Department of Nursing. Any such transgressions by the Agency willresult in the student being removed from the Practicum.

If the Agency reports that the student is engaging in this behaviour, the student will be removedfrom the Practicum and an Interactive Review Process will be initiated.

Students in this course are continuously and reflexively invited to explore their biases

Clinical Practice GuidelinesThe practice of Nursing students is also guided by the principles of competence and client safety.Regardless of what is authorized through legislation or policies, students must only provide care incircumstances where they have the necessary knowledge, skill, and judgement to perform safely,effectively, and ethically. The nursing student is expected to:

Identify situations where he/she requires assistance; and Seek appropriate assistance, direction, and supervision. Be self-directed, look for feedback, act upon such feedback, and set goals

Nursing students may NOT initiate, delegate, or accept delegation of a controlled act.

In addition to these guidelines, Clinical Course Directors and students are expected to be familiar withand follow all of the agencys policies and procedures and any additional guidelines established by theindividual units of the agency. If a discrepancy should arise between the agencys policies and these

id li h Cli i l C Di d d h ld i h h i


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Our only window into their practice is through the feedback of their professional preceptor and their praxisnotes. These notes are generally shared with their faculty member. If a student is not providing bi -

weekly praxis notes, again this student will be removed from the setting. These situations are rare, butwe wish to make it clear to settings that we value your agency, the time you are spending with ourstudents, and the importance of students developing caring trusting relationships built on dependability,professional accountability and demonstrated understanding or the course materials. The safety of yourclientelle is of the utmost importance to us and if a student is experiencing barriers to meeting the courserequirements, we will meet with that student immediately and work out a plan. The CCD will be inconstant contact with you, and we hope you feel you can do the same. It is, of course, best that anyconversation occur with the student, the preceptor and the CCD. Transparency leads to professionalbehaviour in workplaces and we wish to foster that while students are learning how to be nurses.


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Appendix A

AGENCY ORIENTATION CHECKLIST

Items

Orientation to the Agency

Philosophy of the Agency

Policies and ProceduresEmergency (fire, evacuation)Code Review

WHMISCharting, DocumentationMedications/IVControlled ActsSafety (home visits)Transportation of StudentsDress Code, if different from York U policy

Other

Lines of CommunicationHours and Days of PlacementLearning Plan discussed with PreceptorProcedure when calling in absent/sick

Name of Clinical Course Director given topreceptor


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Appendix BTEAM LEARNING Plan: HH/NURS 4120

York University School of Nursing

Student(s): Resources and Supports

Preceptor: Site: Date:

TeamLearning

Goals

(Identify in parentheses which of

the course goals and CHNACstandard(s) will be met by this

learning goal.)

Activities to Achieve GoalsWhat will we do to achieve this

goal?*linked to CNO competencies for

community health(see appendix IV )

Resources andSupports

Evaluation Criteria(Learning

evidences)How will we know

that we have met ourgoal(s)?

Target Date

Learning goal #1

(CHNAC standard

Course Goal(s)#)


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Appendix B(a)

SAMPLE of one possible learning goalHH/NURS 4120

York University School of Nursing(Developed by: Theresa Moore)

Student(s):

Preceptor: Site: Date:

Team

Learning

Goals(Identify in parentheses which of

the course goals and CHNACstandards will be met by this

learning goal.)

Activities to Achieve

Goals

*linked to CNO competencies

for community health(see appendix IV )

Resources and

Supports

Evaluation

Criteria(Learningevidences)

Target Date

Goal 1. To collaborate with

individuals/community and other

stakeholders in conducting a holistic

assessment of assets and needs of the

community.

CHNAC standards:

1. Promoting Health A-1, 2, 3, 82. Building Capacity 1, 33. Building Relationships 2, 3, 5

Course Goal(s) #:

1. Use multiple ways of

knowing to learn about

community strengths/needs:

>empirical i.e.

>personal: i.e.

>aesthetic: i.e.

.

>sociopolitical: i.e.

2. Identify and consult withkey stakeholders: i.e.

3. Ensure no voices are

silenced in consultation by:

Readings from course

text:

Data from agency,other sectors and

organizations, and

relevant outside

literature:

Preceptor

CCD

Praxis notesand praxis

seminar

discussions

demonstrate

theory-guided

practice


seminar

discussions

demonstrate

such

integration


seminar

discussions

demonstrate

such critical

analysis

Communityassessment/co

Week 3

Weekly

Weeks 5/6

Week 3

Ongoing


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27

nsultation

report in

portfolios and

discussed at

praxisseminars

Confirmationof meeting in

portfolio (e.g.,

flyers,

attendance

sheets,

evaluations,

etc.)


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Appendix C

Team EvaluationYork University School of Nursing

HH/NURS 4120.6 Fall 2008

Student Name(s): Preceptor Name:

CCD: Practicum Site:

1 2 3 4 5 N/A

Students have not yetbegun to complete thisobjective

Students have begunto complete thisobjective

Students are makinggood progress towardscompleting thisobjective

Students havecompleted thisobjective with success

Students havecompleted thisobjective withexcellent success

Students did nothave an opportunityto work on thisobjective

**These columns should be copied from your final learning plan.

Learning

Objective**

Activities to

AchieveGoals**

Learning Evidences** Rating Comments

#1

#2

#3


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#4

Strengths/Areas of Accomplishment:

Areas for Further Inquiry and Professional Development

Students Signature: _______________________________

Preceptors Signature: __________________________ CCD Signature:

Date: _____________________

Note: Each clinical partner (the student team, preceptor and CCD are asked to each complete a form in preparation for a joint clinical performance reviewmeeting at mid-term and end-of-term. The 3 evaluations will contribute to the clinical evaluation process between individual students and CCDs at end of term.Team evaluations are not filed in student files.

comunity as patner

Documents