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Nursing in the Community

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Almost 100 years ago, the School of Nursing began to offer students a course in community nursing, and students, wearing navy blue hats and long blue dress uniforms, trudged up tenement stairs to visit patients at home. Often, patients had tuberculosis and students feared catching the disease when they gasped for air after climbing the five flights to reach apartments.

Today, nursing students in the school's Entry to Practice B.S.-M.S. program carry on the tradition of community nursing in their first year. Some still climb five-story walk-ups to reach patients, while others work in shelters for battered women, public schools, and roving vans that provide care to the homeless in the streets. This year, for the first time in decades, community nursing has its own separate course, "Nursing Practice in the Community," to ensure students gain experience in health settings besides hospitals.

Community nursing has been required of Entry to Practice students for years, but in the past 10 years or so the experience was woven into the first-year clinical courses—medicine/surgery, pediatrics, obstetrics and psychiatry. The students practiced nursing in community settings arranged by the school's administrators. Last fall, the school examined the Entry to Practice curriculum and recommended elevating community nursing to its own course.

"In putting together the new course, we had to recognize coming changes in healthcare," says vice dean Sarah Cook, Dorothy M. Rogers Professor of Clinical Nursing. "There is more homecare now, and in the future, even more nurses will work in home and community healthcare settings. Care of patients in hospitals also has changed because those left in the hospital are much sicker than they used to be."

In the new curriculum, students during their first year take an intensive five-week module in community nursing in addition to the five-week modules in medicine/surgery, pediatrics, obstetrics and psychiatry. In the community class, students spend two days a week in class and three days at different healthcare settings. Each student goes to the same setting two days a week and to various observation sites for the remaining day.

Aviva Kleinman SON'03 provides healthcare at the New Providence Women's Shelter in midtown and travels to the homes of new mothers, children with asthma, and others with the Visiting Nurse Service of New York.

"I like being in the homes," she says. "When you see a person's house, it gives you a better perspective of how their home life affects their healthcare. There may be four people living in one room, kids running around everywhere, and you understand why a person may forget to take medications. In a hospital, you can only ask, ‘Why aren't you taking your medications?'"

Other students work at the YM & YWHA in Washington Heights to prevent fall injuries in elders. Susan Spadafora, assistant professor of clinical nursing and course co-instructor, says the first group of students that rotated through the community course developed a way to assess risks for a fall and now the second group is taking the method into homes. Future groups will work with elders to reduce risks identified by the first two groups.

The class also extends the notion of community to the world. During a recent class, co-instructor Dr. Richard Garfield, Henrik H. Bendixen Professor of Clinical International Nursing, led a discussion about globalization and rapid transmission of information on health around the world.

"There are many different jobs you can do in the community as a nurse," Dr. Garfield says. "International health agencies like to hire nurses because of their well-rounded level of health, people, and organizational skills."

Though the course is still new, the instructors say it's succeeding in training students to provide culturally sensitive care and in giving them experience in a wide variety of settings so they can choose a specialty for the master's of science level part of the Entry to Practice Program. "Even nurses don't know all the different jobs nurses do," Dr. Garfield says.


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