On a wall inside a newly refurbished room in a community center in Philadelphia’s Kensington neighborhood is a series of signposts.
Narnia, reads one. The others: Oz, Mt. Olympus, Hogwarts, Wonderland, the Magic Tree House. Nearby, a first-grader walks around with a copy of Dr. Seuss’s ABC, heading to the back of a line of children eagerly waiting to sign out their books. Some are showing friends what they found; others are nose-deep reading before they’ve even finished checking out.
At the head of the line, two undergraduate students from Temple’s Department of Nursing are the librarians for this April day, the library’s opening. In the few weeks prior, they and their classmates have also been painters, builders and planners. Today, though, they are enjoying the fruits of weeks of hard work, as young students from a nearby elementary school discover the litany of literary works now available to them.
It is one of the early successes of the nursing department’s new Community Home curriculum for students in the bachelor of science in nursing (BSN) program. As part of Community Home, small groups of students and a faculty member partner with a community organization in a North Philadelphia neighborhood over multiple semesters to experience firsthand what nursing in a community setting is like.
This community home site is Open Door Ministries, led by Pastor Rodney Timmons and located across the street from John H. Webster Elementary School, a K-5 public school with nearly 900 students. Temple nursing students joined parishioners from Open Door Ministries and members of the Webster School community to help clean the space, build and paint shelves, and decorate the walls with quotes, artwork and inspirational messages about the power of reading. The nursing students held book drives, amassing more than 6,000 books—illustrated versions of classics like The Count of Monte Cristo and The Jungle Book, popular series like Harry Potter and Diary of a Wimpy Kid, picture books, books of poetry, the works of Shakespeare, young adult novels and more. And they did it all in a span of six weeks.
Opening a library may not fit what some think of as “nursing,” but there is a strong connection between this community work, students’ future careers and their potential to impact health and healthcare delivery.
“We’re able to build relationships with people,” said Emily Pinczka, a nursing student working with Open Door Ministries. “We get to see what people in the community are like.”
And for Timmons, who spearheaded the library’s creation at the community’s request, additional space in the community center can support services such as after-school programs and tutoring, physical activities and sports in the building’s gymnasium, and even skills and job training for parents in computer labs.
“The object is to enrich the community,” he said. “You have to meet people’s needs, and we’re offering multiple avenues.”
The vision of Community Home as a curriculum that spans a student’s academic career and occurs in partnership with community members and organizations did not materialize until 2017.
That summer, Martha Kubik, David R. Devereaux Chair, professor and director of the Department of Nursing, brought together a core group of nursing faculty, including Pat DiGiacamo, Letitia Gill, Sue Gresko and Barbara Stephens, to reach out to organizations working in North Philadelphia—faith-based groups, schools and after-school programs, senior citizen centers and sites serving women recovering from substance abuse or domestic violence. After multiple visits and conversations with leadership, 10 organizations expressed interest in being a community home site and in fall 2017 began working with nearly 300 nursing students.
“Hospital rotations provide nursing students experience with disease management and short-term care delivery in a complex setting, where the daily pace is often driven by a flurry of tests and treatments,” explained Kubik. “Community Home is focused on relationship-building, trust and understanding that develops over time and in a real-world setting. Balancing undergraduate clinicals between hospital and community settings helps students recognize the value of both and understand the connection between a hospitalization for poor diabetes management and the lack of affordable, healthy food options in the neighborhood, for instance.”
It’s a long-held tenet of public health that only a small fraction of one’s overall health is determined in a healthcare setting, such as a hospital or primary care clinic. Far more important are the social determinants of health—things like age, behavior, education, family and community life, and other social and economic factors—and the short burst of a hospital stay is insufficient to understand that complex portrait of a person’s life. Community Home is designed to address this gap.
“Nurses have a long history of community engagement and leadership when addressing health disparities,” said Kubik. “Our goal is to immerse students in a community so they learn from residents and organizations serving the community about the challenges that exist and why. They also learn to recognize community assets and strengths and how goals and outcomes are shaped when community residents, organizations and healthcare providers come together as a team to address a need identified by the community.”
The new curriculum begins in the first semester of a student’s sophomore year with a once weekly, seven-week rotation; each student continues to work with the same community every semester for five semesters. That’s 42 hours each semester—at least 200 hours over more than two years devoted to working directly with community members on-site and in roles with progressively more responsibility and complexity.
During the first year of the curriculum, students meet the community members and become familiar with the setting. They learn about the community through publicly available demographic and health data as well as personal stories shared by community members that, depending on the site, might include elders, young mothers with babies or small children at school eager for the nursing students to join them in a game of tag on the playground. Students sit at the table with the site’s leadership, said Kubik; they begin by listening and observing, and over time they become more active participants.
In these conversations, students engage directly with community members to determine how they can support efforts already underway or be the stimulus that turns an idea, like a library for children, into a reality. At Open Door Ministries, it was through Pastor Timmons and other community members that the need for a library was realized. Webster is without a library, and the nearest local library is a 20-minute walk away with limited evening hours, making it difficult for children with working parents to use it. Providing space for a library was a way to ensure books get into the hands of children who may have few opportunities to read.
As students progress through the curriculum, the nursing interventions become more involved. Students start with health education classes and a focus on healthy lifestyles, such as meditation to manage stress or how to prepare a healthy snack. Health screenings are then added along with educational programs that support improved self-management and better understanding about common diseases, such as diabetes and hypertension. By the final semester, students will work hand-in-hand with site leadership and community members to develop, implement and evaluate a program that addresses a need identified in partnership with the community, with sustainability as a key goal.
With the start of the new academic year, returning students are now re-establishing themselves in their community settings. As these students reacquaint themselves with community site leaders and community members from the previous year, faculty members are introducing a new group of sophomores into these communities.
“We are all partners in health,” said Kubik. “We are learning from one another, learning about ourselves, building trust, and all the while working toward the goal of becoming caring, competent nursing professionals.”