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
This project studies whether a redesigned baccalaureate nursing curriculum in a University of Applied Sciences in the Netherlands can stimulate positive interest for the field of community care. In many Western countries, healthcare is changing from institutional care delivery to caring for patients in their own homes. Problematic is that most nursing students orientate on a career in the hospital and they do not see community care as an attractive option, due to a limited and often mistaken view of the field. Their career choices lead to increasing shortages in the labour market, which in many Western countries is a societal problem urgently needing attention. Providing students with a curriculum with more elements of community nursing could help them build a more positive perception of the field, leading to more students choosing this area as a career.The curriculum-redesign was based on quantitative and qualitative research about first-year students’ perceptions, placement preferences and underlying assumptions on the field. First, a cross-sectional multicentre survey study (n = 1058) was conducted using the SCOPE (Scale on COmmunity care PErceptions) questionnaire. The findings confirm the hospital’s popularity, with community care being perceived as a ‘low-status-field’ with many elderly patients and few challenges. Students’ perceptions of community care appear to be at odds with things they consider important for their placement (i.e., opportunities for advancement and enjoyable relationships with patients).To better understand the factors underlying the perceptions, a focus group study with first-year students at the start of their programme (n = 16) was performed.This led to formulation of eight redesign themes, namely:(1) variety and diversity,(2) challenges,(3) improving people's health,(4) collaboration,(5) role models,(6) patient- or environment-based perceptions,(7) self-efficacy, and(8) immediate vicinity.First-year students have clear ideas about what they see as important in a placement, but their perceptions do not always appear to be realistic.To remedy these misperceptions, recommendations for curriculum redesign strategies were formulated. Curriculum designers can more prominently highlight the complexity of community nursing in the theory part of the curriculum. As many students strive for challenges, in-depth knowledge about community nursing can be presented about aspects that students lacking experience in the field are not aware of (e.g., working in an interprofessional network). In the courses, patient cases can be presented that do not fit the stereotypical views of community care commonly held. Also, as role models are influential, it is important that students collaborate with mentors in the field with an appropriate level of education, who can act as a source of inspiration, but who also create a structured and supporting learning environment. Finally, it is useful to organise meetings where political developments and labour market issues in healthcare are discussed. This can potentially increase awareness of these topics and contribute to well-informed career decisions. These strategies can potentially foster a more optimistic and realistic career outlook on the community care field.
AIM: The aim of this study is to investigate the effect of a more 'community-oriented' baccalaureate nursing curriculum on students' intervention choice in community care.BACKGROUND: Following a healthcare shift with increased chronic diseases in an ageing patient population receiving care at home, nursing education is revising its curricula with new themes (e.g., self-management) on community care. Although it seems obvious that students incorporate these themes in their nursing care interventions, this is unclear. This study investigates the effect of a redesigned curriculum on students' care intervention choice in community nursing.DESIGN: A quasi-experimental quantitative study.METHODS: This study with an historic control group (n = 328; study cohorts graduating in 2016 and 2017; response rate 83 %) and an intervention group n = 152; graduating in 2018; response rate 80 %) was performed at a University of Applied Sciences in the Netherlands. The intervention group experienced a curriculum-redesign containing five new themes related to community care (e.g., enhancing self-management, collaboration with the patients' social network, shared decision making, using health technology and care allocation). The primary outcome 'intervention choice in community nursing' was assessed with a specially developed vignette instrument 'Assessment of Intervention choice in Community Nursing' (AICN). Through multiple regression analyses we investigated the effect of the curriculum-redesign on students' intervention choice (more 'traditional' interventions versus interventions related to the five new themes). The control and intervention groups were compared on the number of interventions per theme and on the number of students choosing a theme, with a chi-square or T-test.RESULTS: Students who studied under the more community-oriented curriculum chose interventions related to the new themes significantly more often, F(1461) = 14.827, p = <0.001, R2 = .031. However, more traditional interventions are still favourite (although less in the intervention group): 74.5 % of the chosen interventions in the historic control group had no relation with the new curriculum-themes, vs. 71.3 % in the intervention group; p = .055).CONCLUSIONS: Students who experienced a more 'community-oriented' curriculum were more likely, albeit to a limited extent, to choose the new community care themes in their caregiving. Seeing this shift in choices as a step in the right direction, it can be expected that the community care field in the longer term will benefit from these better skilled graduates.
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