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Creative Educational Strategies for

Health Promotion

The dramatic changes in healthcare delivery present challenges to nurses in practice and to the educators who
must prepare professional nurses for the uncertain world of tomorrow's managed care environment. In light
of the increased emphasis on health promotion occurring with current changes in health care, the article
proposes numerous creative strategies that nurse educators can use to prepare students to fulfill their health
promotion responsibilities effectively. The concepts of health promotion and creativity are examined, and
teaching approaches needed to facilitate community-breed. health promotion-focused activities are
presented. Specific strategies, particularly clinical teaching/learning opportunities, are suggested. Key words:
clinical teaching approaches. creativity, educational strategies, health promotion

Philip A. Greiner, DNSc, RN


Assistant Professor and Director
Health Promotion Center
T HERE IS NO doubt that the delivery of
health care services has changed in
recent years as a result of the implementa-
tion of managed care and increasing con-
Theresa M. Valiga, EdD, RN cern over cost effectiveness. Individuals are
Dean and Professor challenged to use health care services more
School of Nursing selectively. Health care providers are re-
Fairfield University quired to be more judicious in the referrals
Fairfield, Connecticut made and the procedures ordered. Adminis-
trators are charged with finding cost-effec-
tive ways to provide necessary services that
best meet the needs of consumers. Each of
us is asked to be creative in deciding how to
maintain and promote our individual health
in a rapidly changing environment.
The introduction of managed care has
mandated changes that often are thought to
reduce the quality of care provided and put
patients at greater risk. Such phenomena in-
clude shorter hospital stays, the increased
use of unlicensed assistive personnel to de-
liver care, reengineering, multitasking and
cross-training of workers, the reduction in
the number of professional staff and admin-
istrative personnel, and increased competi-

Holist Nurs Pract 1998:12(2):73-83.


c1998 Aspen Publishers, Inc.
73
74 Holistic Nursing Practice/January 1998

tion and corporate restructuring. Despite educational principles that are relevant and presented a chalk
these seemingly negative changes, how- essential in tbe changing health care envi- phasized existing
ever, the movement to managed care also ronment, and proposes strategies that nurse nomic factors, per
has outcomes that would seem to provide educators might consider to help students resistance, and ku~
enormous opportunities for the profession learn about and become competent in help- portunities for acti
of nursing and improved health care out- ing individuals and communities meet their viduals, families
comes for the people whom nurses serve. health promotion needs. The focus, there- health institutions,
Among these positive changes are a shift fore, is strategies that facilitate the profes- nizations, cornmu
in emphasis from hospital-based, illness- sional growth of students rather than strate- The most recc
oriented care to community-based, well- gies that enhance the well-being of patients, People 200Q1* an<
ness-oriented care and greater acknowledg- families, and communities. such as Healthy 1
ment of the need for health promotion and Review and 1995
disease prevention. Additional changes in- THE CONCEPT OF HEALTH People 2000 Rmi
clude increased expectations for clarifying PROMOTION mate that, althoug
the role of the nurse as a significant player on some object&
on the interdisciplinary health care team and The movement to capitated systems of sistent progress or
a heightened awareness of the relevance of care has created an environment where tives. Progress ha
health care finances in the provision of care. competition thrives. Although progress has growing socioecor
Finally, we see the unprecedented need to been made in incorporating health promo- tween those who
document outcomes of the care provided by tion into the mainstream of health care prac- ante and those w:
nurses through sound research and the tice, limitations in time and resources, incnasedintkU
growing need to be "in communities with which are an integral part of the competi- fromaupomteres!
members of those communities rather than tion inherent in managed care, may actually decadeandmorer
merely delivering care to communities and decrease the quality and amount of health cems about entitle
the people in them. 1-4 Nurses also must be promotion education and intervention that federal budget. Tl.
increasingly creative, assertive, collabora- patients receive. The situation provides op- health promotion c
tive professionals who think critically, portunities for creative approaches to health At the Novemb
make sound decisions, and practice inde- promotion in practice and education, and Healthy People 2(
pendently and interdependently. Healthy People 2 0 0 0 1 2 can serve as a guide York City, Ilona
Such expectations require that the educa- throughout this creative process. 13 tional head of the 1
tional preparation of professional nurses be From its inception in 1979, Healthy the World Health
changed dramatically from past practices.5,6 People, the Surgeon Generals report on what she termed SG
They also suggest that the time has come to health promotion and disease prevention, in health promotio
carry out the curriculum revolution that has has provided an organized analysis of the ond-gene&an ch.
been advocated since the late 1980s. 7-11 Just health promotion needs for the United
as nurses in clinical practice are now chal- States. Central themes from the beginning
lenged to be creative, flexible, adaptive, and have been that each of us, as professionals
ready to manage enormous change, so too and as individuals, has a role to play in health Theneedtotzttt
are nurse educators. promotion and that we have a responsibility, promotion objed
This article examines the concepts of individually and collectively, to be actively abaied
health promotion and creativity, outlines involvedin this process. Healthy People also

,- .
t are relevant and presented a challenge to the nation that em- follows: ensuring equity in health, adding
health care cnvi- phasized existing obstacles (e.g., socioeco- life to years lived adding quality to life, and
ategies that nurse nomic factors, personal attitudes, corporate adding years lived to life. These goals
to help students resistance. and knowledge deficits) and op- evolved from four second-generation pre-
ampetent in help portunities for action at various levels (indi- mises: viewing health as a resource, invest-
unities meet their viduals, families, health professionals, ing in health via partnerships, solving prob-
The focus, there- health institutions, business and labor orga- lems through the use of integrated models of
ilitate rhe profes- nizations, communities, and government]) community development, and community
rather than &ate- The most recent edition of Helathy participation in health promotion planning.
being of patients, People 200012 and subsequent documents, These ideas are significant as nurse educa-
i. such as Healthy People 2000: Midcourse tors look for and develop creative ways to
Review and 1995 Revisions 15 and Healthy prepare students for roles as professional
XLTH People 2000 R e v i e w , 1995-96,16 demon- nurses who can meet the health promotion
strate that, although progress has been made needs of individuals, families, and commu-
on some objectives, there has not been con- nities within a managed care environment.
.tated systems of sistent progress on a majority of the objec-
ironment where tives. Progress has been hampered by the THE CONCEPT OF CREATIVITY
>ugh progress has growing socioeconomic gap that exists be
ng balth promo- tween those who can afford health insur- Creativity is a word that is used frequently
Fh. hcareprac- ance and those who cannot. This gap has and one that is applied to many things, from
: and resources, increased in the United States as fallout how we think to how we write, from how we
t of the competi- from coporate restructuring dduring the past manage multiple responsibilities to how we
zare, may actually decade and more recent congressional con- solve problems, from how we practice to
amount of health cerns about entitlement programs and the how we teach. Yet it is a word whose mean-
intervention that federal budget. Thus the need to attend to ing often is elusive and complex.
uion provides op health promotion objectives has not abated. In his discussion of creativity, May17 indi-
jroaches to health At the November 1996 meeting of the cated that creativity requires courage. He
d education, and Healthy People 2000 Consortium in New noted that the act of being creative requires .
n serve as a guide York City, Ilona Kickbusch, the interna- that one take risks, act outside the norms and
mcess.13 tional head of the Healthy Cities Project for conventions of the group, and be willing to
1 1979, Healthy the World Health Organization, spoke of suffer the jeers and criticisms of others. In
xmals report on what she termed second-generation change addition to courage, there are a number of
sease prevention, in health Promotion. The goals of this sec- other elements of the concept of creativity.
xl analysis of the ond-generation change were prioritized as For example, to be creative, one needs to be
s for the United willing to think outside the box_ that is, be
3m the beginning open to many ideas, not be bound by tradi-
4 as professionals tion and usual practices, and not judge ideas
4e to play in health The need to attend to health prematurely lest valid ones be rejected too
e a responsibility, promotion objectives has not soon. This notion has been referred to as ide-
ely, to be actively abated ational fluency,18 meaning being comfort-
ialthy People also able with many ideas and possibilities.
76 Holistic Nursing Practice/January 1998

In addition to a willingness to consider ing, promote partnerships with communi- seeinginawc


many options, creativity requires that the ties, and facilitate student learning. thesame
individual be willing to allow ideas to in- Surely such goals ;
cubate or percolate, so that they can be part of educators, t
EDUCATIONAL PRINCIPLES nurseeducatorsdo
developed, refined, and crafted in such a
way that conclusions are not made prema- the knowledge, SIri
turely or actions taken before the best pos- In a discussion of the purpose of educa- to engage effectivt
sible solution has been reached. Thus time tion, Hirst and Peters argue that teaching with individuals sr
and patience are needed to allow creativity involves the development of knowledge and
to flourish. I understanding of some depth and breadth. CRRATIWEDL
The noted educational philosopher Max- Central to the development of knowledge sTRATEzrRS~
ine Greene advanced the idea of imagination and understanding are public forms of expe- PROMOTION
as a significant element of creativity. She rience, those areas where people share
claimed. . . of all our cognitive capacities, given concepts, such as the following: for- Greene asks Hs
imagination is the one that permits us to give mal logic and mathematics, the physical sci- provoke questior
credence to alternative realities. It allows us ences, awareness and understanding of granted, the kind
to break with the taken-for-granted [and] to other peoples minds, moral judgments, re- volves simultane4~
set aside familiar distinctions and defini- ligious claims, and philosophical under- thinking and atte
tions."19(p3) Using imagination means that standing. These areas, or public forms of actualities?r*l~
one must take a different perspective, yet experience, need to be the basis on which our nursing educa
doing this repeatedly is disruptive. It is not we build all levels of education. reflects segments
surprising, then, that acting creatively can be Educators, however, must be cautious not experience describ
thought of as an attempt to renew the world, simply to transmit knowledge and perpetu- Mathematics and
and the creative person must be able and ate usual ways of thinking. They must not necessary for cala
willing to tolerate uncertainty, ambiguity, fall prey to the inertia of habit" 21 and be cations, drip rates
the unexpected, change, and upheaval dur- caught up in only covering course content and odds ratios ia
ing that renewal process. and focusing on facts. Educators must not sciences, such as a
Certainly nurse educators who attempt to merely prepare the young for the task of biology, and &err
create learning opportunities for students renewing a common world"22; rather, they basis for the undaz
that will prepare them to advance health pro- must help them learn how to change that ventions. Awarenr
motion goals, particularly in a managed care world for the better. other peoples rain4
environment, must be creative. They must Educators, as advised by Greene,19 must psychiatric nursiu;
take risks, be open to many ideas and possi- do the following: caring and empath
bilities, allow ideas to incubate, encourage break with the taken-for-granted necessary for the
the use of imaginative capacity, be flexible, become wide awake in the world, and emergencies, and f
and tolerate uncertainty and disruption in help learners do the same determine other pa
the normal approaches to education. In other engage with learners as distinctive, liver culturally n
words, educators must create ways to questioning persons care. Finally, phik
achieve several goals simultaneously: meet heighten the consciousness of whom- formsacoreofco
the health care needs of our Communities, ever they teach tomakeethicaldec
promote health, challenge students think- cultivate in learners multiple ways of cisions people msk
Creative Educational Strategies 77

lips with communi- seeing in a world where nothing stays and lives. All this content is important to
nt learning. the same nursing.
Surely such goals require creativity on the Indeed, one can assert that a grounding in
part of educators, but what specifically can Hirst and Peters'20 public modes of experi-
NCIPLES nurse educators do to help students develop ence is required before critical thinking, au-
the knowledge, skills, and attitudes needed tonomy, and creativeness can be expected.
: purpose of educa- to engage effectively in health promotion The teaching of nursing, therefore, requires
argue that teaching with individuals and communities? the development of knowledge and under-
nt of knowledge and standing of some depth and breadth in these
depth and breadth. CREATIVE EDUCATIONAL core areas. Nursing education must go well
ment of knowledge STRATEGIES FOR HEALTH beyond this content if our graduates are to
oblic forms of expe- PROMOTION be prepared to make the kind of contribu-
here people share tions to the health and well-being of indi-
. the following: for- GreeneasksHowcanweteachsoasto viduals, families, and communities that will
its, the physical sci- provoke questioning of the taken-for- be needed in this ever-changing and in-
ur -standing of granted, the kind of questioning that in- creasingly challenging managed care envi-
worst ,ddgments, re- volves simultaneously critical and creative ronment.
tiosophical under- thinking and attentive engagement with Educators must develop innovative ped-
or public forms of actualities?"19(p175) The content included in agogic approaches and clinical learning ex-
the basis on which our nursing education programs typically periences for students. Students must be
ucation. reflects segments of the public modes of more directly involved in being in commu-
nust be cautious not experience described by Hirst and Peters.20 nities with members of those communities,
rledge and perpetu- Mathematics and logic, for example, are not merely involved in planning programs
ing. They must not necessary for calculating dosages of medi- for communities and their members. In ad-
of habit- and be cations. drip rates in fluid administration, dition, the care that is delivered must be cul-
ring course content and odds ratios in research. The physical turally relevant. How can these goals be ac-
Zducators must not sciences, such as anatomy and physiology, complished (see the box titled Examples
ng for the task of biology, and chemistry, form a necessary of Health Promotion Clinical Opportunities
&Y? rather, they basis for the understanding of nursing inter- and Curriculum Approaches*)?
row to change that ventions. Awareness and understanding of Nurse educators have asserted that in this
other peoples minds represent the basis for new educational paradigm students must be
by Grecne,19 must psychiatric nursing and are necessary for emancipated, and they offer suggestions on
caring and empathy. Moral judgments are pedagogic approaches to achieve this
n-for-granted necessary for the triaging of care during goal.7,23 They describe a caring curriculum in
e in the world, and emergencies, and religious claims help us which students learn together and challenge
: same determine other peoples beliefs so as to de- one another. They propose this approach as
ers as distinctive, liver culturally and socially appropriate a way to achieve our goal of preparing pro0
3 care. Finally, philosophical understanding fessional nurses who can successfully face
iousness of whom- forms a core of concepts that allow nurses the challenges of the 21st century. Greene
to make ethical decisions and accept the de- advocates for reflective and impassioned
8m 2le ways of cisions people make about their own health teaching, [through which] we can do far
78 Holistic Nursing Practice/January 1998

in facilitating student learning and develop desired and apprc


Examples of Health Promotion ing creative, insightful professionals who health care into th
Clinical Opportunities and are open to new ideas and possibilities. Others agree tl-
Curriculum Approaches All these pedagogic approaches are valid disease preventior
and need to be integral to our nursing edu- the overall curricu
Collaborative curriculum cation programs if we are to produce the health-oriented c:
Health promotion as the focus of the caliber of graduate-s needed to face the chal- can apply to the d
curriculum lenges of a managed care environment and lum for students.
Culminatingself-designed clinical advance health promotion goals. What may beyond isolated r
experience be even more significant to developing cific diseases and
Student identification of personal health opmentally appro
risks nurse leaders for health promotion, how-
Block nursing ever, is the nature of clinical experiences in assist individuals ;
Parish nursing which students participate as part of their cultures in develop
Shelters educational program. communities in de
Wellness centers Numerous examples are found in our cur- ening environmen;
Prisons rent literature of nurse educators imple- Students* indep
Senior centers, retirement communities, menting creative clinical experiences with in assuming such
and elderly high-rises students. A review of those examples and of promotion can be
Nurse-managed clinics/centers suggestions for other approaches may pro- ticum experiences
School-sponsored health promotion mote ideational fluency, l8 encourage nurse by Hawks and HrC
centers
educators to take the risks inherent in set- ing clinical exper.
Nursing the Neighborhood programs ting aside the familiar and refusing merely &dent-centered (
to repeat past practices, and assist our pro- their own clinical
fession in better meeting the needs of the jectives and leami
communities we serve by preparing gradu- own patient caselr
more to excite and stimulate many sorts of ates who are sensitive to communities readings, and evall
young persons to reach beyond themselves, unique needs for health promotion. experience helps :
to create meanings, to look through wider Hills and Lindsey26 suggest that one way rected learning s1
and more informed perspectives at the actu- to achieve such goals is to implement a col- nursing careers in
alities of their lived lives"19(p172) than can be laborative curriculum that decreases the fo- environment.
achieved through our traditional approaches cus on the biomedical paradigm. Such a Willis and colla
to teaching and learning. curriculum focuses on he&h promotion, rience where stude
A new approach to the teacher-student building alliances with other disciplines, health risk behavi~
relationship, one that dismantles the tradi- and community participation. Hills and assessment fo deve
tional power structure and increases egali- Lindsey assert . . . educational programs to promote healthy
tarianism, is advocated by Gaines and Bald- must be radically revised and be developed nity projects were
win 24 as a significant area needing attention to teach nurses to work from a health-pro- tion with communi
in our typical educational approaches. Addi- motion perspective. Only when nurses have students learned tbt
tionally, Valiga and Bruderle 25 suggest that fully incorporated the principles of health ality and ways in 1
using the arts and humanities within the con- promotion into their repertoire of working participate in advz
text of nursing courses can be most effective with clients and colleagues will they be the Through these ac
Creative Educational Strategies 79

ng and develop- desired and appropriate profession to lead knowledge and awareness of personal
>fessionals who health care into the future." 26(pp161-162) health behaviors can be refined.
x&bilities. Others agree that health promotion and The concept of block nursing provides
oachesare valid disease prevention must be a clear focus of yet another means of connecting with a
)uI nursing edu- the overall curriculum.27 Comments about a community to promote health. 30 In this
to procluce the health-oriented care delivery system also model, students, professional nurses, and a
to face the chal- can apply to the development of a curricu- cadre of volunteers from a defined neigh-
mvironment and lum for students. Such a system must go borhood design strategies to visit and tend
goals. What may beyond isolated programs targeted at spe- to the homebound elderly, assist young
t to developing cific diseases and their risk factors to devel- mothers in adapting to their new role, pro-
emotion, how- opmentally appropriate interventions that mote the growth and development of the
al experiences in assist individuals and families from diverse blocks youth, and help other groups as
as part of their cultures in developing healthy lifestyles and needed. The extensive use of community
communities in developing health-strength- volunteers in this model introduces students
;07 ~inourcur- ening environments.27(p112) to the ideas of partnering with others, tap-
duL-+ors imple- Students independence and confidence ping into the strengths and talents of indi-
experiences with in assuming such leadership roles in health viduals in an effort to help others, and pro-
: examples and of promotion can he enhanced through prac- viding opportunities to empower members
oaches may pro- ticum experiences such as the one described of a community to help themselves and be
encourage nurse by Hawks and Hromek.28 In this culminat- less reliant on professionals.
3 inherent in set- ing clinical experience, designed within a This concept of working in communities
I refusing merely student-centered context, students select is evident in another model in which stu-
Id assist our pro- their own clinical sites, write their own ob- dents have been involved, namely parish
theneedsofthe jectives and learning contracts, select their nursing. 31,32 In parish nursing, students and
preparing gradu- own patient caseloads, choose appropriate professional nurses work with and through
0 communities readings, and evaluate themselves. Such an churches to keep people well. Students see
omotion. experience helps students develop self-di- the nurse functioning as a health counselor,
gest that one way rected learning skills that are critical for consultant, advocate, facilitator as families
implement a col- nursing careers in this evolving health care interact with the health care system, and
decreases the fo- environment. guide as members of the community work
aradigm. Such a Willis and colleagues29 describe an expe- to blend faith and health issues.
ealth promotion, rience where students identified their own Certainly experiences in other commu-
tier disciplines, health risk behaviors and used health risk nity settings, such as homeless shelters, 33-35
bation. Hills and assessment to develop community projects shelters for battered women, 36 centers for
zational programs to promote healthy behavior. The commu- the elderly (eg, wellness centers, senior
and be developed nity projects were developed in collabora- centers, retirement communities, or high-
ram a health-prc~ tion with community health nurses, so that rise apartments),37,38 McDonalds and the
when nurses have students learned the importance of collegi- YWCA,39 and prisons,40 provide students
inc;Bres of health ality and ways in which communities can with opportunities to focus on health pro-
xt< of working participate in advancing their own health. motion with unique populations in distinct
23willtheybethe Through these activities, student self- settings. In such settings, students provide
r
80 Holistic Nursing ry 1998

counseling and support, screen for health conduct blood pressure, cholesterol, and health assessmen
problems, monitor medication administra- lead poisoning screenings at worksites, in materials for s&c
tion, develop educational programs on rel- senior centers and high-rise apartments, at a veying individua
evant topics, and plan ongoing programs local community health center, and at the needs. Advanced :
with the participants and professionals as- HPC itself. They teach exercise and ways to volved in phnin
sociated with the shelter, center, or prison control anger to teens who participate in the for the communi~
health service. The broad range of skills de- midnight basketball leagues at the commu- help individuals a
veloped by students and community mem- nity center that houses the HPC. They spon- health problems
bers in these settings can be used to expand sor health fairs in churches and schools and community _
understanding and move toward resolution collaborate with the local home care agency partnerships witi
of social, political, economic, and ethical to provide immunizations. Among other ment, schools, ar
issues. programs and activities, they help teenage addressbrmdcrh
A growing opportunity for students to de- mothers develop effective parenting skills. grated large-x31
velop the knowledge, skills, and attitudes By attending local town meetings, faculty students synthesis
needed to engage in health promotion ac- and students learn about the needs and con- insights, skills, an
tivities with communities is in nursing cen- cerns of members of the community and sume responsiiih
ters, often those sponsored by schools of then work with these community members commitment to p
nursing themselves. One such project is de- to plan programs, obtain counseling and entire neighbor1
scribed by Fielo and Crowe. 41 In this nurs- support, or connect with other health care Anticipated 0~
ing center, which is managed by the State providers as appropriate to meet those Based Health Prr
University of New York Health Sciences needs. There is no doubt that these experi- ences).
Center at Brooklyn, students actually staff ences are significant in helping students fo- 0
the center 2 days per week. This experience cus on health promotion, empower commu-
helps them develop their abilities to provide nity members, develop their awareness of Ascanbeseenf
health promotion services to members of and sensitivity to the needs of diverse many clinical lear
the surrounding community, but it also groups, and experience a professional nurs- students can be e
gives them an opportunity to understand the ing role in collaboration with communities. velop their streng
independent role of the nurse, the referral Finally, the idea of a school of nursing motion, the possit
process, and the nature of interdisciplinary taking the lead in providing health promo- schools to worksi.
collaboration. tion services to the people who live in local partments to clinic
Students at Fairfield University also have communities is exemplified by Northeast- managed clinics, :
opportunities to work with members of an ern University in its Nursing the Neighbor- camposes. from rf
inner-city community through the School of hoods project.42,43 In this curriculum, nurs- playgrounds, and
Nursing-sponsored Health Promotion Cen- ing students receive 50% of their clinical nity centers, the-re :
ter (HPC). Located in a local community experiences in the community, where they students can be a
center, the HPC serves as a central point for provide care to individuals and families in adept at promotin&
various health promotion activities for the their own neighborhoods, often providing communities.
children, youth, adults, and elderly of services where none existed previously. Be- Each of the appr
Bridgeport, Connecticut. Students work ginning level students contribute to the unique, each is ITL
with schools to provide classes on nutrition health of the community by teaching the particular corn
and sexually transmitted diseases. They classes, conducting screenings, performing nizes that_ for healt

t
Creative Educational Strategies 81

cholesterol, and health assessments, creating educational


s at worksites, in materials for schools and clinics, and sur- Anticipated Outcomes of
se apartments, at a veying individuals regarding their health Community-Based Health
cemer,.and at the needs. Advanced students become more in- Promotion Clinical Experiences
ercise and ways to volved in planning health-related programs
> participate in the for the community, making home visits to Development of leaders for health
yes at the conunu- help individuals and families manage their promotion
: HFT. They spon- health problems, conducting large-scale Increased independence
:s and schools and community assessments, and establishing Increased confidence
home care agency partnerships with the local health depart- Development of self-directed learning
skills
ns. Among other ment, schools, and other organizations to Enhanced understanding of self and
they help teenage address broader health concerns. This inte- awareness of personal health behav-
e parenting skills. grated large-scale approach requires that iors
meetings, faculty students synthesize an array of knowledge, Development of skills in forming
hencedsandcon- insights, skills, and perspectives as they as- partnerships and collaborative models,
: a umity aud sume responsibility over time and make a including interdisciplinary collabora-
umunity members commitment to promote the health of the tion
P counseling and entire neighborhood (see the box titled Increased focus ou strengths and
other health cam Anticipated Outcomes of Community- resources of individuals and communi-
te to meet those Based Health Promotion Clinical Experi- ties
that these experi- ences"). Enhanced ability, and appreciation of the
need to empower others
:Iping students fo- 0 0
l Clarification of the broad range of roles
empower commu- of the professional nurse
heir awareness of As can be seen from this discussion of the Development of community-related
needs of diverse many clinical learning experiences in which skills (eg, community assessment;
professional nurs- students can be engaged to help them de- integration of social, political, and
with communities. velop their strengths regarding health pro- economic variables in decision
school of mlrsing motion, the possibilities are limitless. From making; negotiating skills; referral
ing health promo- schools to worksites, from local health de- skills)
s who live in local partments to clinics, from shelters to nurse- Greater knowledge and appreciation of
ied by Northeast- managed clinics, from churches to college social issues and their implications for
;ing the Neighbor- campuses, from retirement communities to health of individuals and communities
clIrriculum, mlrs- playgrounds, and from hames to commu- Enhanced ability to care for and appreci-
6 of their clinical nity centers, there are myriad ways in which ate the needs of diverse groups and
multicultural populations
amity, where they students can be assisted to become more
tls and families in adept at promoting the health of people and
s, often providing communities.
ed previously. Be- Each of the approaches suggested here is be successful, the community must partici-
contribute to the unique, each is responsive to the needs of pate in health promotion planning and there
i i t y * teaching the particular community, and each recog- must be an investment in health via partner-
niW% performing nizes that, for health promotion activities to ships. The creative nurse educator who is
82 Holistic Nursing PRAC~CP/JANUARY 1998

willing to explore new options and new develop the knowledge, skills, values, and 31. AnwmrPA,Hua&
bdulacetourbM
ideas, who is willing to take a risk, and who perspectives they need to work in and with care. 1995;16:64-6
can tolerate uncertainty and ambiguity will communities to advance health promotion 32. Rydbolm L. Patknr
be the one to help students most effectively goals. IiolistNuraRort 1
33. Buttriu G, Kuipcr
holIlckuskkraa;
dWS. JihhmE&.
34. Helvie co. sbxkal
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35. wiaBS.TbeLollvl
tingfaRN/BSNm
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