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Zavertnik, J. E., Huff, T. A., & Munro, C. L.
(2010). Innovative approach to teaching communication skills to nursing stu- dents. Journal of Nursing Education, 49(2), 65–71.
Jean Ellen Zavertnik
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OMMUNITY-B
ASEDN
URSINGDEFINITION
Community-based nursing (CBN) is defi ned as a setting-specifi c nursing practice in which the care for illnesses (both acute and chronic) is provided for individuals and fam- ilies where they live, work, or go to school.
The goal of CBN is to provide as many health care services as possible in the community (not in hospital settings) and is based on the philosophy that patients and families main- tain health and dignity in their own environ- ment. The practice of CBN is comprehensive, coordinated, and continuous (Stanhope &
Lancaster, 2014).
APPLICATION
Community-based (CB) nursing principles are the required content for baccalaureate- prepared professional nurses. Students are prepared to deliver both direct and indirect care to individuals and populations with an emphasis on health promotion and disease prevention. Teaching strategies for commu- nity competencies have been identifi ed that focus on integration of didactic and clinical education, thus providing opportunities for learning (Callen et al., 2013). Students learn CB nursing skills through direct and indirect practice with individuals in the community.
For example, students collect health history, assess environmental and genetic factors, determine health and illness beliefs, and use evidence-based information to guide health teaching. Students learning CBN also evaluate individuals in relation to literacy, Cooper, J. R., Martin, T., Fisher, W., Marks,
J., & Harrington, M. (2013). Peer-to-peer teaching: Improving communication techniques for students in an acceler- ated nursing program. Nursing Education Perspectives, 34(5), 349–350.
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., . . . Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122–131.
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice.
Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.
Lau, Y., & Wang, W. (2013). Development and evaluation of a learner-centered training course on communication skills for bacca- laureate nursing students. Nurse Education Today, 33(12), 1617–1623.
Lin, E. C., Chen, S. L., Chao, S. Y., & Chen, Y. C. (2013). Using standardized patient with immediate feedback and group dis- cussion to teach interpersonal and com- munication skills to advanced practice nursing students. Nurse Education Today, 33(6), 677–683.
Merriam-Webster Online Dictionary. (2014).
Retrieved from www.merriam-webster/
dictionary/communication.
Middlewick, Y., Kettle, T. J., & Wilson, J. J.
(2012). Curtains up! Using forum theatre to rehearse the art of communication in healthcare education. Nurse Education in Practice, 12(3), 139–142.
O’Shea, E., Pagano, M., Campbell, S., & Caso, G. (2013). A descriptive analysis of nursing student communication behavior. Clinical Simulation in Nursing, 9(1), e5–12.
Reising, D. L., Carr, D. E., Shea, R. A., & King, J. M. (2011). Comparison of communica- tion outcomes in traditional versus simu- lation strategies in nursing and medical students. Nursing Education Perspectives, 32(5), 323–327.
Spinner-Gelfars, A. (2013). Using simulation to promote effective communication with a diverse student population. Teaching and Learning in Nursing, 8, 96–101.
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transcultural nursing applied to promoting and preserving the health of individuals. A common theoretical framework for CBN is the transcultural nursing model by Leininger and McFarland (2002). They describe the importance of understanding cultural uni- versalities and diversities when providing culturally competent CBN care. When CB nurses understand an individual’s cultural factors, they can then negotiate and try to accommodate cultural beliefs and needs into holistic care (Leininger & McFarland, 2002). Negotiation and accommodation skills require that CB nurses establish mutual relationships with individuals and other health care professionals that respect the needs of everyone involved. This approach often differs from traditional acute care relationships.
Teaching strategies for CBN practice have been identifi ed (Callen et al., 2013) and focus on comprehensive approaches that include individuals across the life span and care that is continuing, not episodic. Content on health promotion, health maintenance, and health education and management, as well as coordination and continuity of care, are taught in a holistic approach to the man- agement of the health care of individuals in a community.
CBN focuses on individuals and is differ- ent from public health nursing (PHN), where the focus is on populations with emphasis on preventing illness and improving quality of life (Stanhope & Lancaster, 2014). CBN differs from acute/hospital-based nursing where the focus is on stabilizing illness and reduc- ing length of stay, whereas CBN focuses on holistic care for chronic illnesses, identify- ing social determinants of health, preventing exacerbations, and reducing complications that require use of acute/hospital-based care for individuals and families in the commu- nity (Stanhope & Lancaster, 2014). Common CBN roles include home health, occupational health, environmental health, forensic/
prison nursing, school nursing, and faith- based nursing. Nursing faculty teaching CBN need to be prepared to address compe- tencies in these specifi c CB specialties, and self-care abilities, and resources to maintain
health and prevent crisis of chronic diseases.
Health promotion, education, and manage- ment, as well as coordination and continu- ity of care, are parts of a holistic approach with individuals in a community setting. CB settings include homes, schools, workplaces, faith-based clinics, prisons, and retail loca- tions. Thus, CB nurses apply autonomous practice skills in assessment, communica- tion, collaboration, analysis, planning, and evaluation.
There are several models used to teach CBN. Some nursing programs form com- munity partnerships (Visiting Nurses Association, hospice programs) in which students practice CB skills with home- bound individuals. Community may also be defi ned by geographic (city or county) or demographic factors (age, ethnicity, or com- mon issue). Thus, students may develop CB skills with individuals at senior centers, a faith-based clinic, school health centers, or within a breast cancer survivors’ community group.
There are also several faculty practice models used for teaching CBN. An increasing number of nursing programs are establish- ing CB nurse centers or clinics. A community nursing center can be staffed by faculty who provide a geographic community with var- ied services and activities related to health improvement. Another CBN model is a pri- mary care center, where nursing faculty and students provide primary care in a clinic set- ting. Services may range from screening and education to primary health care. A third model is a CBN service in which services are provided in the home and community with faculty as mentors (Yeh et al., 2009). CBN practice models often engage diverse groups of people with common social and/or geo- graphic ties in which they practice collabora- tive skills to achieve active involvement of all stakeholders.
SYNOPSIS
CBN is a synthesis of nursing practice with individuals, public health principles, and
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Leininger, M., & McFarland, M. R. (2002).
Transcultural nursing: Concepts, theories, research & practice (3rd ed.). New York, NY:
McGraw-Hill Companies, Inc.
Levin, P. F., Swider, S. M., Breakwell, S., Cowell, J. M., & Reising, V. (2013).
Embracing a competency-based specialty curriculum for community-based nurs- ing roles. Public Health Nursing, 30(6), 557–565.
Shannon, C. (2014). Community-based health and schools of nursing: Supporting health promotion and research. Public Health Nursing, 31(1), 69–78.
Smith, S. J., & Barry, D. G. (2013). An innova- tive approach to preparing nursing stu- dents for care of the elderly in the home.
Geriatric Nursing, 34(1), 30–34.
Stanhope, M., & Lancaster, J. (2014).
Foundations of nursing in the community:
Community-oriented practice (4th ed.). St.
Louis, MO: Elsevier.
Yeh, M. L., Rong, J. R., Chen, M. L., Chang, S. F., & Chung, U. L. (2009). Development of a new prototype for an educational partnership in nursing. Journal of Nursing Education, 48(1), 5–10.
Barbara E. Harrison
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OMPUTER-B
ASEDT
ESTINGDEFINITION
Computer-based testing (CBT) is defi ned as any assessment or examination that utilizes a computer to measure one’s knowledge level, competency, or other abilities related to a specifi c fi eld. CBT was initially introduced in 1985 as college placement tests, aiming to evaluate the domains of reading compre- hension, writing, arithmetic, and elementary algebra (Luecht & Sireci, 2011). CBT has since evolved with numerous models adminis- tered via a variety of delivery formats to serve various purposes.
explain the clinical application of concepts of public health concepts such as epidemiology (Levin, Swider, Breakwell, Cowell, & Reising, 2013). Other programs have utilized the tech- nology of high-fi delity simulated clinical experiences to meet CBN competencies by observing students completing simulated home health visits (Gotwals & Yeager, 2014;
Smith & Barry, 2013). One study suggests that some nursing programs still face barriers in establishing CB partnerships that serve the community and needs of students learning CBN (Shannon, 2014).
RECOMMENDATIONS
Nursing education for CBN has moved to teaching in a competency-based curriculum, thus requiring direct and indirect practice experiences that validate student achieve- ment of CBN competencies. Approaches developed by some nursing faculty to increase CBN content include expanding the use of case studies and seminars (Levin et al., 2013). Clinical community preceptors and clinical activities supplement classroom activities to guide students toward meeting specifi c CB specialty competencies. Nursing programs are also including CBN elective courses offered within the university or from other universities via cooperative arrange- ments (Levin et al., 2013). However, some nursing programs still report barriers to establishing CBN partnership for education, and these barriers potentially limit student experience with real-world CBN (Shannon, 2014).
Callen, B., Smith, C. M., Joyce, B., Lutz, J., Brown-Schott, N., & Block, D. (2013).
Teaching/learning strategies for the essentials of baccalaureate nursing edu- cation for entry-level community/pub- lic health nursing. Public Health Nursing, 30(6), 537–547.
Gotwals, B., & Yeager, S. T. (2014). Improving the process of community-based student nurse practice through a high-fi delity sim- ulated clinical experience. Nurse Educator, 39(1), 26–30.
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areas, they can make curriculum changes (Oermann & Gaberson, 2014).
The use of CBT has expanded dramati- cally since 1985 from its initial use in college placement examinations. CBT is most often associated with college entrance exami- nations such as the Scholastic Aptitude Test (SAT), Graduate Record Examination (GRE), or licensure and certifi cations. They have added value in academia to assess students’ learning styles, allowing educa- tors to tailor lesson plans to meet student needs (Zwirn & Muehlenkord, 2009). CBT is the current mode of delivery for the majority of health care licensure and certi- fi cation examinations, in addition to its use in other areas. Computerized psychometric tests have been used in both employment and military entrance screenings (Luecht &
Sireci, 2011)
NCLEX was the fi rst health care licen- sure examination to utilize computerized adaptive testing (NCSBN, 2014). CAT mod- els generate test items in real time based on the tester’s score of the previous item (Luecht & Sireci, 2011). Based on the correct (or incorrect) answer to the previous ques- tion, testing software automatically selects the next from an item bank of which the tester has a 50% chance of answering cor- rectly. Because administered test items are adapted to the examinee’s ability, this type of test is thought to provide a more reliable measure of the test taker’s true competency level (NCSBN, 2014).
RECOMMENDATIONS
Continued advances in computer technol- ogy will result in continuous change and improvements in existing test-taking soft- ware and capabilities. Further research is warranted to support what types of CBT will be most benefi cial to nursing students at the associate, baccalaureate, and graduate lev- els. Administration of CBT and utilization of progression policies should be a practice that is evidence based.
APPLICATION
The National Council of State Boards of Nursing (NCSBN) transitioned the National Council Licensure Examination (NCLEX) from the traditional method of paper–
pencil testing to CBT in 1994 (NCSBN:
NCLEX Examinations, 2014). Since then, advance practice nursing organizations have similarly adopted CBT for certifi cation examinations.
Many nursing schools have begun to implement CBT throughout their programs to better prepare students for licensure or certifi cation examinations. CBT practice dur- ing graduate nurse programs of study has demonstrated that students with a lower grade point average (GPA; less than or equal to 3.50) improved on national certifi cation examination scores (Dosch, 2012). In addi- tion, in an attempt to improve or maintain NCLEX pass rates, a number of nursing schools implemented CBT in progression policies. CBT, designed to mimic the NCLEX, provides students the opportunity to practice and demonstrate knowledge prior to taking the licensure examinations.
SYNOPSIS
CBT has appeal for both educators and stu- dents. Academic institutions realize the eco- nomic benefi ts of CBT due to decreased use of resources (paper, print ink, etc.) in addi- tion to reduced faculty time spent in grading examinations (Dosch, 2012). Faculty mem- bers enjoy test-scoring accuracy and the ability to review and compare group scores through the rapid generation of test and item analysis reports (Zwirn & Muehlenkord, 2009). As a result, students appreciate a faster turnaround in receiving test scores. In relation to standardized exit examinations, faculty members and students are provided with a detailed summary regarding specifi c areas of weakness. This provides a unique opportunity to develop an appropriate and individualized remediation strategy. When faculty members identify trends in weak