key: cord-0759299-8pe2bd6k
authors: DeGroot, Lyndsay G.; Zemlak, Jessica L.; LaFave, Sarah E.; Marineau, Lea; Wilson, Deborah; Warren, Nicole
title: The other “front line”: Public health nursing clinical instruction during COVID‐19
date: 2021-07-10
journal: Public Health Nurs
DOI: 10.1111/phn.12928
sha: 77b35bb4e35c24c164039b7f070f6d6ba6d1bc41
doc_id: 759299
cord_uid: 8pe2bd6k

nan

During times of crisis, nurses are dynamic, innovative, and crucial forces for health equity. The COVID-19 pandemic is no exception.

Although the media spotlight focused on nurses in acute care settings, public health nurses across the country demonstrated that the "frontline" of nursing practice extends well beyond the bedside (Gold, 2020) . As the COVID-19 pandemic stretched existing resources thin and illuminated gaps in public health resources, public health clinical nursing educators used the pandemic-induced limitations to engage and prepare students for public health nursing practice. Here, we detail how clinical faculty at our School of Nursing collaborated with community partners and students to adapt instruction in response to the pandemic, what they learned, and the implications of this experience for future public health clinical instruction.

When the pandemic began, the spread of COVID-19 forced many community-based organizations, with whom our School of Nursing's public health clinical groups typically partner, to limit or entirely restrict physical access to clients, staff, and students. The Before the pandemic, public health nursing faculty had longstanding relationships with public schools and social service agencies.

After a rapid assessment of COVID-related demands and limitations, we adjusted. For example, nursing students had provided in-person support in public school-based health clinics, with a focus on primary care and routine health screenings. During the pandemic, students collaborated with staff beyond the health suite to assist neighborhood families in accessing technology for virtual learning and to support teachers in facilitating online education. This experience made inequities in education related to poverty concrete for nursing students, broadening their understanding of social determinants of health. At the same time, their shift in clinical activities met the urgent unmet needs of our community partners. We also adapted our work in a resource center for persons experiencing homelessness, shifting our health screenings and education outdoors. This change increased students' awareness of the environmental challenges clients regularly encounter, including limited access to transportation and the impact of weather on clients' access to care.

In addition to adapting existing partnerships, the pandemic created opportunities for new ones. To mitigate social isolation due to stay-at-home orders, a coalition of community members launched a volunteer-based effort to provide phone-based social support and resource navigation for older adults. When we learned about this group's urgent need to increase their capacity, we developed a partnership to include the organization as a new public health clinical site. Hundreds of students supported the effort by making outreach phone calls similar to what Gresh et al., (2020) reported, and a smaller clinical group supported the coalition with detailed program evaluation and outreach projects. This collaboration gave our students first-hand experience engaging with a community-driven disaster relief effort.

During the pandemic, we re-aligned our use of simulation to meet the moment's needs. What had been a simulated mass influenza flu clinic became actual participation in a mass COVID vaccine effort. This concrete contribution to a national effort ignited students' interest in public health interventions and the roles nurses play in them (Shaffer & Strohschein, 2019) . At the same time, other activities had to be shifted from the field to a simulation environment (Lavoie & Clark, 2017) . This had the potential to be disruptive.

However, our faculty, students, and community-based partners recognized its potential to expand the range of available educational opportunities and build public health nursing competencies (Carolan, Davies, Crookes, McGhee & Roxburgh, 2020) . For example, we adapted online breakout rooms to serve as our "lab" for home visit simulation. This permitted students to build home visit skills and gain experience in televisits, a crucial service used to continue care during the pandemic.

In place of a lab-based disaster response simulation, students practiced disaster management skills using a prototype of a disaster decision-making application. The application took students through

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