Nurse Education in Practice (2006) 6, 117–121

Nurse

www.elsevierhealth.com/journals/nepr

Educationin Practice

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Project-focused placements: Enhancingstudents understanding of citizens’ perspectives

Morgan Smith a,*,1, Elizabeth Flint b,2

a University of South Australia, Division of Health Sciences, School of Nursing and Midwifery, Australiab Gawler Health Service, Community Services, Australia

Accepted 14 November 2005

Summary The Gawler Health Service, Community Services in conjunction with theUniversity of South Australia, School of Nursing and Midwifery, provided undergrad-uate students of nursing with a comprehensive project-focused placement. Theplacement enabled undergraduate students of nursing to understand how the citi-zens of a given rural community perceived community needs and health servicedelivery. When participating in such a placement, students developed an under-standing of a fundamental aspect of the community nurse’s role. This understandingis essential for registered nurses if they are to meet international health care agen-das that require the health care sector to work in partnership with the community.

While on placement, nursing students worked in pairs or small groups on a nego-tiated project that furthered their understanding of community assessment as itrelated to a particular group of people within the community. This involved a rangeof activities, including searching the literature, designing a tool to clarify the com-munity’s perspectives on an issue, summarizing the project for the organization andpreparing a statement for the local press.

Using a project as a significant component of the placement provided depth to ashort placement while providing benefits to the placement organisation.

�c 2005 Elsevier Ltd. All rights reserved.

KEYWORDSCommunity;Students;Community assessment;Citizens’ perspectives

1d

Introduction

Students of nursingmust develop skills in identifyinghow citizens of a given community perceive commu-

471-5953/$ - see front matter �c 2005 Elsevier Ltd. All rights reseoi:10.1016/j.nepr.2005.11.002

* Corresponding author.E-mail address: Morgan.Smith@unisa.edu.au.

1 Lecturer, Nursing.2 Clinical Nurse Consultant, Health Education and Promotion.

nity needs and health service delivery so that theycan work in partnership with the community to de-velop plans of action (Anderson and McFarlane,2000) as increasingly this is a skill required of regis-tered nurses working in the community. While inter-national initiatives in health policy highlight theimportance of community involvement in health ini-tiatives and health services (Edwards and Muir,2003; McMurray, 2003), Herriott and Desmarchelier

rved.

118 M. Smith, E. Flint

(2004) suggest that in practice community partici-pation tends to take the form of consultation withcommunity based organisations rather than directlywith individual community members. To change thissituation, nurses and other health professionals,must first learn to interact effectively with the com-munity and then, as a result of the interaction, de-velop an understanding of life as citizens withinthat particular community experience it.

Raymond (2001) observed that there is littleemphasis on seeking the views of citizens that arenot in regular contact with health services andhow they perceive health needs should be ad-dressed. Nursing students need to develop the skillsto identify issues, knowledge, attitudes and beliefsfrom the perspectives of all members of the com-munity, not simply the regular users of health ser-vices, if the health of the community is to bemaximised. The skills required to work with regularusers of health services and those who have littleor no contact have commonalities but also differ-ences that students need to acknowledge andaccommodate in their nursing practice.

Providing students with the opportunity to iden-tify the range of attitudes towards health issuesand services can be addressed through project-focused placements. Unlike most placements pro-ject-focused placements enabled nursing studentsto get out in the community, interact with thecommunity and collect specific community assess-ment information.

For over 10 years The University of South Austra-lia, School of Nursing and Midwifery and the GawlerHealth Service, Community Services, has been ableto provide undergraduate students of nursing witha comprehensive project-focused placement thatenabled them to access members of the communityand identify community perspectives on a range ofissues. The placement offers a creative alternativeto a traditional community nursing placement, andchallenged assumptions about how much nursingstudents could achieve in a two, three to four weekblock community placement.

While on placement nursing students worked inpairsor small groupsonanegotiatedproject that fur-thered their understanding about a particular groupof people within the community. In addition, theplacement required students to use their initiative,problem solve and work within the organisation’spolicies. It had an additional benefit of encouragingthe use of research in day-to-day nursing practice.This involved a range of activities, including workingthroughaprocessof searching literature,designingatool to clarify thecommunity’s perspectives onan is-sue, summarising the project for the organisationand preparing a statement for the local press.

The project enabled students to extend theirknowledge and skills in a way that provided bene-fits to the organisation. With financial constraintsand limited staff, organisations need to reap somebenefits for the time given to students while con-tributing usefully to the student’s education.Understanding the perspective of the communityin relation to felt needs, knowledge or attitudescan provide important information to communityhealth care agencies.

Review of the literature

The educational significance of undertaking a com-munity assessment for both undergraduate andpostgraduate students is emphasised in the litera-ture. While the perspectives of citizens wereevident in all of the literature, its relative signifi-cance varied. Postgraduate students whose activi-ties were reported in the literature tended toundertake more extensive community assessmentswith greater emphasis on citizens’ perspectives(Urrutia-Rojas and Aday, 1991; Stoner et al., 1992;Kulig and Wilde, 1996). Undergraduate studentsfocused on a basic assessment of the communitythat provided an overview of community structureand function with some input from communitymembers (Eshlemann and Davidhizar, 2000; Eliasonand Schultz, 1992).

In addition, Russell and Hymans (1999) used acommunity assessment, including citizen perspec-tives, as a vehicle for promoting understandingacross disciplines. This was an important educa-tional initiative; however, it detracts from thecentrality of the citizen perspective. While a com-munity assessment has multiple essential compo-nents, if undergraduate students are to understandthe concept of partnership with community mem-bers, then the perspectives of citizens must beemphasised in any education oriented communityassessment process.

Literature to assist students undertaking a com-munity assessment with an emphasis on citizenperspectives is available. There are numerousundergraduate textbooks on nursing in the commu-nity that provide information on community assess-ment. Specific information about the skills andprocesses required to work with a community,using the perspectives of the community, tend tobe broad and integrated into material about com-munity assessment (e.g. Sines et al., 2001; Allen-der and Spradley, 2001; Anderson and McFarlane,2000; Clemen-Stone et al., 2002). In addition, stu-dents may access nursing articles (e.g. Clark et al.,2003; Urrutia-Rojas and Aday, 1991) that provide

Project-focused placements: Enhancing students understanding of citizens’ perspectives 119

additional detail about methods and specific com-munities. While undertaking the project-focusedplacement students must take the information pro-vided in the literature, orient it to their particularcommunity, seek additional theoretical material toaddress deficits in their knowledge and then use aproblem solving approach to apply their learningto the practice situation.

Project-focused community placements enablestudents to see the community from the perspec-tive of community members, which may result inan enormous shift in a student’s thinking. This isparticularly so for students who previously workedlargely with acutely ill individuals in a hospital set-ting. Literature on how undergraduate students candevelop this insight is evident, but limited.

Project-focused community placementsfor nursing students

All students involved in the projects reported herewere second or third year undergraduates under-taking a course on nursing in the community. Theproject formed one part of their clinical experi-ence. Objectives for the course required studentsto gain an understanding of a broad range of issuesrelevant to the community, community assess-ment, program planning and the role of the nursein the community. The implications of the informa-tion discovered through the projects for programplanning and implementation were discussed withthe students but not actioned by the students dueto the short duration of the placement. Implica-tions for the organisation were noted for furtheraction as appropriate.

The project added depth to the placement whileother activities, such as home visiting, group work,visiting other community services in the area andidentifying the roles of other health professionalsadded breadth. Historically, short placements inthe community have tended to provide studentswith a superficial overview of community assess-ment and the community health nurses’ role. Pro-ject-focused placement enabled the students toactively participate in community health servicedelivery rather than simply observe. On average,the students spent about half their allocated timeon the project with the rest of the time allocatedto different community nursing related activities.

During the project the students were supportedby both the registered nurse and the universitylecturer. Depending on the nature of the projectstudents were also supported by a number of othermembers of staff, such as social workers and dieti-

cians, thus enabling the students to acquire a mul-tidisciplinary perspective.

Projects undertaken by students that focused onthe perspectives of community members includethe following:

� attitude of local businesses to women breastfeeding on the premises,

� community’s understanding of dietary knowl-edge and behaviour,

� clients’ experiences of discharge planning,� community’s understanding of risk factors asso-ciated with diabetes,

� community’s understanding of Hepatitis C,� community’s awareness of their rights whenusing the public health system,

� community’s knowledge of post-natal depression,� health perceptions and attitudes of olderpeople,

� nutrition awareness and practices amongadolescents,

� women’s experiences of birthing and post-natalservices.

Following is a summary of two projects that out-line the approach taken. While the process for eachproject was similar, the focus of the projects var-ied. While both projects emphasised the commu-nity rather than a specific consumer cohort, onedealt with broad health issues and the other relatedspecifically to the health care system. In addition,Project A involved students on short, consecutiveplacements whereas Project B enabled students tofollow the project from inception to completion.

Project A identified the health perceptions andattitudes of older people in the town. Several dif-ferent groups of students, placed for two weekseach, were involved in this project. One group ofstudents undertook a literature review to gainbackground knowledge. Other students developeda questionnaire that covered demographics, per-ceptions of personal health status, attitudes to-wards new health knowledge and actions peopletook as a result of their learning experiences. An-other group of students placed later in the yearinterviewed, 28 males and 31 females in the mainstreet and outside a local supermarket. They thenanalysed the data and wrote a report for the orga-nisation in which they had been placed. In addition,the students prepared a press statement for the lo-cal paper. This was subsequently published.

Students in Project B identified the community’sawareness of their rights when using the publichealth service. Two students, placed for a fourweek period, undertook this project. The studentsinitially undertook a concise literature review in

120 M. Smith, E. Flint

order to understand the nature of their project anddetermine essential background information. Theynext developed a basic questionnaire, with theassistance and support of the organisation. Thequestionnaire investigated the community’s useof health care facilities and community knowledgeof the South Australian government publication‘Our Rights and Responsibilities’, including wherethe booklet had been seen. Following approvalfrom the organisation, the students randomly sur-veyed 100 people over 18 years of age, collatedthe results and wrote a report for the organisation.In addition, a press release was written then for-warded to the local newspaper and published.

Evaluation overview

Over the years students have undertaken a range ofdifferent projects as indicated earlier. Project-focused placements assisted students in under-standing the concept of community and communityneed in a short space of time. This understanding, inturn, expanded their awareness of nursing practicebeyond that of the hospital. Undertaking the pro-jects enabled the students to further develop theircommunication skills through purposeful interac-tion with community members from ‘all walks oflife’. In addition, the students identified, negotiatedand operated within organisation and university pol-icies, which often required detailed planning andcareful communication with a number of partiesincluding other members of the health care teamand the health service’s Executive Committee. Thisrequired careful monitoring by both the preceptorand the university clinical facilitator, particularlyin relation to the planning and implementation ofchosen community activities and press releases.

Undertaking the placement enabled students toapply theory to practice and developed their under-standing of some of the complexity associated withworking as a community health nurse. Undertakingresponsibility for the planning, implementationand evaluation of a community assessment projectdeveloped the students’ capacity for problem solv-ing, leadership and cooperation. It also developedan increased understanding of issues around justifi-cation and evaluation of project work.

The outcomes of the projects were often used toassist in determining future directions within theparticipating organisation and future projects forstudents. The findings of some projects have beenforwarded to the community mayor, local Memberof Parliament and Ombudsmen, while others haveformed the basis for further work within the hostorganisation. Future projects are likely to focus

on cultural diversity and thus ensure that moreminority groups within the community have theirperspectives recognised.

Informal evaluation suggests that undertakingthe project and the associated press release pro-moted both the education of nurses in the highereducation sector as well as the profile of the indi-vidual students involved. A project completed ear-lier this year received front page coverage as aconsequence of the press release.

It also brought recognition to the students fromthe health care organisation, the community andsometimes local and state governments. Further-more, the students’ activities were a significantcontribution to their curricula vitae. One particularstudent believed that presenting her project to aninterview panel influenced a positive employmentoutcome.

Project-focused placements enabled greaternumbers of students to be placed in one venue atone time. This assisted with facilitation from theUniversity and also increased the number of placesavailable to students. This was particularly impor-tant where there were a large number of studentsrequiring placement in a limited number of smallorganisations. Although the placements requiredgreater input by the preceptor prior to the arrivalof students than a standard placement, once thestudents were place, they were expected to beself-directed where possible, which freed up thepreceptor’s time for other aspects of their role.Students contacted the venue several weeks in ad-vance and discussed with the preceptor their areasof interest; and where possible, projects under-taken reflected these interests. Both the facilitatorand the preceptor were available to the studentswhen required.

Conclusion

Increasingly nurses are being required to enter intopartnerships with clients and communities. Thiscan only happen if health professionals understandlife as community members experience it. Project-focused placements provide an opportunity for stu-dents to develop skills that place the community atthe centre of nursing service provision.

Undergraduate students utilising this approachoften find it different to any other activity theyhave undertaken in their nursing education to date.Interacting for a specific purpose, with communitymembers with diverse life experiences can be achallenging experience.

Likewise, constructing a project-focusedlearning experience, can be challenging for both

Project-focused placements: Enhancing students understanding of citizens’ perspectives 121

registered nurses and lecturers. It is important thatprojects are negotiated with students prior toplacement and that students are involved in identi-fying the topic of the project. The project must bespecific enough to be managed within the time-frame and students must be given sufficient timeto complete the negotiated activities. Venueswhich cannot provide for this may not be suitablefor this type of placement. In addition, studentsneed to be supported and encouraged but permit-ted to work though the process in their own way.There are always times when the students becamefrustrated or stressed (usually towards the end ofthe second week of a three week placement) andthis needs to be worked through. Press releasesneed to be checked carefully and managed accord-ing to organisational policy.

It is possible for project-focused placements tobe used for purposes other than identifying commu-nity perspectives. They can be used to focus on arange of other aspects of community structure andfunction. The perspectives of community members,however, promote the current health care reformagenda that places the person at the centre of allhealth care activity. This reason alone is justifica-tion for the chosen focus and method of placement.

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