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Influencing nursing students' perceptions of community care with curriculum-redesign; a quasi-experimental cohort study

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Background: The shift in healthcare to extramural leads to more patients with complex health problems receiving
nursing care at home. However, the interest of baccalaureate nursing students for community nursing is moderate,
which contributes to widespread labour-market shortages. This study investigates the effect of a more ‘communitycare-oriented’ curriculum on nursing students’ perceptions of community care. 
Methods: A quasi-experimental quantitative survey study with a historic control group (n = 477; study cohorts
graduating in 2015, 2016, and 2017; response rate 90%) and an intervention group (n = 170; graduating in 2018;
response rate 93%) was performed in nursing students of a University of Applied Sciences in a large city in the
Netherlands. The intervention group underwent a new curriculum containing extended elements of community
care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). The control and
intervention group were compared on demographics, placement preferences and perceptions with a chi-square or
T-test. Multiple regression was used to investigate the effect of the curriculum-redesign on nursing students’ perceptions
of community care.
Results: The comparison between the control and intervention group on students’ perceptions of community care
shows no significant differences (mean 6.18 vs 6.21 [range 1–10], respectively), nor does the curriculum-redesign have a
positive effect on students’ perceptions F (1,635) = .021, p = .884, R2 = < .001. The comparison on placement preferences
also shows no significant differences and confirms the hospital’s popularity (72.7% vs 76.5%, respectively) while community
care is less often preferred (9.2% vs 8.2%, respectively). The demographics ‘working in community care’ and ‘belonging to a
church/religious group’ appear to be significant predictors of more positive perceptions of community care. 
Conclusions: Graduating students who experienced a more ‘community-care-oriented’ curriculum did not more often
prefer community care placement, nor did their perceptions of community care change. Apparently, four years of
education and placement experiences have only little impact and students’ perceptions are relatively static. It would be
worth a try to conduct a large-scale approach in combination with a carefully thought out strategy, based on and tying in
with the language and culture of younger people. 
Keywords: Community care, Nurse education, Curriculum design, Perceptions, Career choice


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