This paper presents the findings of a survey of community health clinical education in twenty-four Canadian pre-licensure baccalaureate nursing programs. A qualitative research design was used, involving a content analysis of Canadian course syllabi and supporting documents for community health courses. This study afforded a cross-sectional understanding of the "state of the art" of community health clinical education in Canadian schools of nursing. Clinical course conceptual approaches, course objectives, types of clinical sites, format and number of clinical hours, and methods of student evaluation are identified. The findings suggest the need for a national dialogue or consensus building exercise regarding curriculum content for community health nursing. Informing this dialogue are several strengths including the current focus on community health (as opposed to community-based) nursing education, and a solid socio-environmental perspective informing clinical learning and practice. The national data set generated by this study may have relevance to nursing programs globally.
Recently, several Canadian professional nursing associations have highlighted the expectations that community health nurses (CHNs) should address the social determinants of health and promote social justice and equity. These developments have important implications for (pre-licensure) CHN clinical education. This article reports the findings of a qualitative descriptive study that explored how baccalaureate nursing programs in Canada address the development of competencies related to social justice, equity, and the social determinants of health in their community health clinical courses. Focus group interviews were held with community health clinical course leaders in selected Canadian baccalaureate nursing programs. The findings foster understanding of key enablers and challenges when providing students with clinical opportunities to develop the CHN role related to social injustice, inequity, and the social determinants of health. The findings may also have implications for nursing programs internationally that are addressing these concepts in their community health clinical courses.
The Canadian public health sector's foundational values of social justice and equity, and its mandate to promote population health, make it ideally situated to take a strong lead in addressing persistent and unacceptable inequities in health between socially disadvantaged, marginalized or excluded groups and the general population. There is currently much attention paid to improving understanding of pathways to health equity and development of effective population health interventions to reduce health inequities. Strengthening the capacity of the public health sector to develop, implement and sustain equity-focused population health initiatives - including readiness to engage in a social justice-based equity framework for public health - is an equally essential area that has received less attention. Unfortunately, there is evidence that current capacity of the Canadian public health sector to address inequities is highly variable. The first step in developing a sustained approach to improving capacity for health equity action is the identification of what this type of capacity entails. This paper outlines a Conceptual Framework of Organizational Capacity for Public Health Equity Action (OC-PHEA), grounded in the experience of Canadian public health equity champions, that can guide research, dialogue, reflection and action on public health capacity development to achieve health equity goals.
Rapidly increasing enrollment in Canadian schools of nursing has triggered the development of innovative clinical placement sites. There are both opportunities and challenges inherent in the delivery of clinical nursing education in diverse community settings. As part of the Canadian Association of Schools of Nursing's (CASN) ongoing work to assist its members and ensure baccalaureate graduates are prepared to meet the Canadian Community Health Nursing Standards of Practice at an entry-to-practice level, the CASN Sub-Committee on Public Health (funded by the Public Health Agency of Canada) conducted extensive national consultations with representatives from both academic and practice settings, as well as key national organizations. The resultant Guidelines for Quality Community Health Nursing Clinical Placements, released by CASN in 2010, aim to provide direction to Canadian schools of nursing and practice settings in addressing the challenges and opportunities arising from the changing context of community health nursing student clinical placements.
I explored the discourse on population health within 3 diverse regional health authorities in Manitoba, Winnipeg, with a focus on the public health sector. At all study sites, population health was viewed primarily as an epidemiological tool for population health assessment and surveillance rather than as an approach to taking action on the broad determinants of health. My findings suggest that concerns about the limitations of population health as a framework for public health efforts to reduce inequities in health are warranted.
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