Touching lives through community health nursing: The West Visayas State University experience in a rural community in Iloilo

Abstract

This study aimed at ascertaining the relevance of the CHN intensive practicum as experienced by the senior students of the WVSU College of Nursing and the clients they served in Agcuyawan Calsada, Barotac Nuevo, Iloilo during the second semester of school year 2005-2006. Specifically, it aimed to (a) describe the operational structure and processes involved in the senior students’ CHN intensive practicum in the target barangay; (b) explain the relevance of the CHN intensive practicum, as experienced by the students, in terms of the personal and capability building benefits as health care providers; (c) explain the relevance of the CHN intensive practicum, as experienced by the clients, in terms of the personal and capability building benefits for self-care; (d) determine the relevance of the following CHN activities- home visit, community assembly, community survey/diagnosis, bag technique, community project, health class, and culminating activity- and how they rank among the students and the clients; (e) present a SWOT (strengths, weaknesses, opportunities, and threats) analysis of the CHN program; and (f) design a plan of action for the enhancement of the CHN component of the curriculum at the WVSU College of Nursing.

Conducted during the third week of April 2006, this descriptive study involved 103 senior nursing students of the College of Nursing of the West Visayas State University and 90 residents of Agcuyawan Calsada, who participated in any one of the activities conducted by the students in the barangay during the second semester of school year 2005-2006. Simple random sampling was used in the selection of both the participating students and clients in this study.

This study used both the quantitative and qualitative approaches. Two separate but parallel researcher-made questionnaires were used to gather data on the relevance of CHN activities— one for the nursing students and one for the clients. Focus group discussion (FGD) involving 12 senior nursing students and 10 clients, was employed to gather the qualitative data. Key informant interviews and records/reports review were also conducted to supplement the data gathering process.

For statistical analysis, percentages, ranks and mean scores were utilized.

The findings of the investigation were:

1. The Community Health Nursing (CHN) intensive practicum of the WVSU College of Nursing was facilitated by a qualified lead faculty assisted by equally committed and dedicated CHN instructors. The students were exposed to varied activities. The CHN intensive practicum was strongly supported by the local government officials, health officers and residents. There were evaluation tools to assess student performance. Client satisfaction was ascertained during the culminating activity when the residents were asked to give their impressions on the lessons learned and insights gained.

2. Majority of the students agreed that the CHN intensive practicum was very relevant along the personal dimension.

3. Most of the students agreed that the CHN intensive practicum was very relevant along the dimension of building capability as health care providers.

4. Majority of the clients were not sure that the CHN intensive practicum was relevant along the personal dimension.

5. Most of the clients were not sure of the relevance of the CHN intensive practicum along the dimension of capability building for self care.

6. Among the CHN activities, the students considered home visit as the most relevant and the culminating activity as the least relevant. For the clients, the health class was the most relevant and the bag technique the least relevant.

7. Focus group discussion with the students revealed that, the CHN program had positively changed their outlook towards one’s self and the community, made them see the other side of nursing (nursing not only the sick people in the hospital, but also the well in their homes and in the community), made them realize that there are people who are poorer than poor, and how important the nurse is in the eyes of the people. The CHN intensive practicum also honed their IEC skills, developed their capability in determining the needs and problems of the people, and made them learn more about the community by analyzing tables and graphs.

To the students, dealing with people of different background, interests and inclinations was a challenge. The enthusiasm and support of the people enabled them to seek more knowledge because they could not afford to give only very little. They felt responsible for what they say and do because there were people who depended on them. At the end of the day, they got the feeling of fulfillment because they had the opportunity to help a lot of people. The liked the home visit best because it opened doors for development of trust and closer nurse-client relationships, it mirrored the needs, problems, and aspirations of the people, and it opened eyes to the realities of life. They like the culminating activity least because they did not like to see some clients cry when they say their goodbyes.

8. To the clients, the intensive practicum gave excitement to their otherwise laidback way of life. They also liked the community assembly because it’s nice when the whole barangay would gather. Through the activities, they were able to strengthen group consciousness and cooperation. They disclosed that while they learned a lot from the lectures, they still are not sure if they can already apply what they learned on their own.

9. The SWOT analysis revealed that the strengths of the CHN program were its adherence to CHED-prescribed faculty-student ratio in the RLE, committed, dedicated faculty, diverse CLIN activities, an educationally qualified and experienced lead faculty, harmonious working relationship among the CHN Instructors, enthusiastic students, empowerment of students, division of labor among the students and faculty, use of varied evaluation methods and tools, benefits for faculty (meal and travel reimbursement, hazard pay), and the presence of two CHN instructors residing in the locality.

The intensive practicum’s weaknesses included the absence of clear objectives, instructional activities and terminal competencies; inadequate educational preparation and CHN experience of part-time faculty; lack of safe and comfortable place to stay in while in the community; malfunctioning equipment and occasional absence of public address system; daily travel to the community which made students tired and sleepy; too much expense on the students since expenses during activities were shouldered by them; lack of evaluation tool to determine the clients’ satisfaction of the various activities; absence of planning and evaluation and of the CHN program among the faculty; absence of in-service training in CHN among the faculty; lack of evaluation tools for student performance in health classes and of IEC materials; no regular meeting among CHN lecturers and RLE Instructors; lack of coordination with the College Extension Unit; and low administrative priority for CHN as evidenced by absence of supervisory visits.

The opportunities that offered favorable conditions in the external environment were a community laboratory accessible to transportation and communication; cooperative residents; supportive local officials and health personnel, and presence of a non-government organization.

The threats that affected the activities were the economic activities in the barangay; absence of a bigger venue for health classes and community assemblies; conflict in schedules among local government officials and RITU staff; bad weather; bad roads; and undesirable traffic conditions.

10. Finally, the results of the investigation highlighted the need for efforts or measures to enhance the faculty's CHN follow-up effectiveness, make the administration more aware of the importance of CHN in the professional preparation of student nurses, develop sound basis for evaluating student performance and clients’ satisfaction, and enrich the CHN intensive practicum to make it more responsive and relevant to the students and the community it serves.

Conclusions

In view of the findings, the following conclusions are drawn.

1. The CHN intensive practicum of the WVSU College of Nursing is dynamic and practical. Efforts are made to provide varied and relevant experiences for the students’ personal and professional development as well as the clients’ building of capability for self-care.

2. The CHN intensive practicum seemed to have facilitated learning among the students in many ways. As students touched their clients’ lives, they felt happy and proud for having had the opportunity to visit people in their homes, talk to them, and help them with their health-related problems and needs. The students were able to maximize their potentials for creativity and resourcefulness and in the process, developed a higher degree of self-confidence, self-worth, and self-esteem.

The relevance of the CHN intensive practicum, however, appeared to be least evident along harmonious interpersonal relationships, flexibility and time management. This must have been caused by the tightly structured activities for the four-week exposure. The students thus become more concerned with carrying out the planned activities to completion, failing to provide adequate time for bonding with others, to accommodate changes in the conduct of the activities and to conveniently succeed in achieving their goals.

Along the dimension of capability building among the students as health care providers, they found relevance in CHN in terms of promotion of a healthy environment, providing health care to women, and developing awareness of health problems in the community. This must have been due to the fact that the students were made to conduct a survey and develop a community diagnosis. Majority of the participating residents in the health classes were women. The students embarked on waste segregation for the community project. Since they stayed only for four weeks, the students had not much opportunity to deepen the social investigation aspect of the intensive practicum for determining the clients’ coping abilities, utilizing appropriate technology, and addressing barriers to behavior changes.

3. The CHN intensive practicum certainly touched the clients’ lives in the barangay. The lessons, pre-tests and post-tests in the health classes seemed to have stimulated the clients mentally. The different activities had brought them together in one place and given them the opportunity to mingle with others, thus promoting closer and harmonious interpersonal relationships. The certificate the clients received for their participation in the health classes might have inculcated in them the feeling of being more responsible not only for their own health but also the health of others especially their family members. For the clients, however, the relevance of the CHN intensive practicum seemed not very clear in terms of developing flexibility, self-respect, and sensitivity to other people’s feelings. This could be because, under the students’ direction of the students, thus were less opportunities for them to do what they wanted or think about other people’s concerns.

In connection with capability building, it appeared that the clients were only on the “awareness’’ stage, probably realizing forth the first time health problems and health resources in the community. As recipients of the waste segregation project, for instance, they saw the importance of working together for a healthy environment. The CHN intensive practicum was found least relevant in the areas of understanding reports and records, addressing barriers to behavior change and utilizing appropriate technology. Since the clients were still in the awareness stage, they were definitely not yet in the position to move on to these tasks requiring critical thinking and psychomotor abilities.

4. The overwhelming preference for home visit among the-students is understandable because the activity was less stressful as compared to other activities like the health classes, community survey/diagnosis and community assembly which would require a lot of paper work. More importantly, through home visits, the students were able to gain the trust and confidence of their clients, thus, the cooperation and enthusiasm during the activities. The culminating activity is the least liked probably because it signifies the end of the program. For these students who considered CHN as an important phase in their life, the culminating activity heralds the end of learning while having fun and of relationships which were forged with the clients.

The clients have gained so much from the health classes especially in terms of providing mental activity, hence, their overwhelming preference for health class. The preference for health class, culminating activity and community assembly among the clients reveals that rural folks adhere to the predominantly Gemeinschaft nature-- the activities, interests, and personalities center around large family groups and neighbors, where mutual helpfulness and sharing prevail. Meanwhile, the bag technique as a means of providing direct care might not have been clearly understood by the clients; hence it ranked last.

5. The focus group discussion confirmed that the CHN intensive practicum had been relevant and had significantly touched both the clients’ and the students’ lives. It provided opportunities for introspection. It was powerfully realistic and practical since it captured the students’ and the clients’ voice-- their feelings and thoughts.

6. No matter how strong a program like CHN may appear, there are limitations and difficulties which need to be handled and vanquished. There are favorable factors as well as barriers in the internal and external environments which need to be addressed. With the CHN intensive practicum these include the areas of These include the areas of program planning, implementation, and evaluation; faculty; community laboratory; instructional materials; equipment; and linkages.

7. The SWOT analysis reaffirmed the need to recreate or re-invent CHN in the future by utilizing an action plan of specific steps aligned with the needs among the students and the greater comm unity.

Recommendations

Based on the findings and conclusions, the following recommendations are advanced:

1. The CHN faculty of the WVSU College of Nursing should be commended for implementing a CHN program that is relevant to the students they train and community they serve. Despite certain weaknesses, on the whole, the favorable response of the students’ and the clients' in the survey attests to the CHN faculty's vigorous efforts to provide venues to address the students’ learning needs and the clients' health, needs.

2. While it is true that the CHN program is considered relevant, there is a need for the Nursing administration and the CHN faculty to carefully and meticulously review CHN concepts so that appropriate RLE activities can be implemented.

3. The CHN Program of Activities needs to be improved. This should include clearly-defined objectives, terminal competencies, instructional activities, evaluation methods and tools.

4. Evaluation tools also need to be formulated to evaluate students’ performance in the health classes, IEC materials, field reports and community diagnosis as well as the clients’ activities/experiences.

5. The College of Nursing should strengthen and promote multisectoral linkages. The students should be made to understand that “no man is an island,” that involvement of government and non-government organizations can result in greater effectiveness of the program. NGOs can become sources of financial support for the different activities.

6. The school administrator should continue to provide avenues for the CHN faculty to harness their potentials, promote career development, and develop desirable personal and work values. In-service training, graduate programs, seminars and conferences may help the CHN faculty to grow and move on to higher levels of creativity, competence and productivity.

7. Administrative support is very important for the CHN program to attain its objectives. The Dean should look into possibilities of implementing a CHN program where students actually live in the community; augmenting the financial burden of students during their CHN by providing the supplies and materials needed as well as providing good-quality equipment for the CHN exposure.

8. Likewise, it is suggested that the college administration look into and consider “Redirecting the Future for CHN: An Action Plan” which is an offshoot of this study (Appendix A) in order to maintain the strong image of the CHN program.

9. The CHN program should be linked with the Extension Unit of the College of Nursing to make possible the continuity of care and strengthening of capabilities which have been started by the students.

10. Copies of the findings of this study should be distributed to the Barangay Council and Rural Health Unit of the municipality of Barotac Nuevo, Iloilo to appraise them of the status of the program and hopefully, to give support.

11. Further research is recommended to address the need to evaluate the CHN programs of the other levels at the WVSU College of Nursing and in other Nursing schools so as to make the entire BSN curriculum truly relevant and responsive.