key: cord-0780865-s7tt1r03
authors: Bejster, Mallory; Cygan, Heide; Morris Burnett, Glenda; Smith, Diane Y.; Brown Walker, Mary; Friese, Tanya
title: Faculty perspectives on transitioning public health nursing clinical to virtual in response to COVID‐19
date: 2021-05-29
journal: Public Health Nurs
DOI: 10.1111/phn.12929
sha: 439c65ea6fe5c1549f88ba6ea6df6cc7b16e2488
doc_id: 780865
cord_uid: s7tt1r03

The COVID‐19 pandemic has highlighted the need for public health nursing as an integral part of a strong public health workforce. However, it has also created challenges in preparing future nurses as much of nursing instruction, including clinical experiences, needed to urgently transition learning to a virtual environment. This paper describes the process faculty experienced during spring 2020 to quickly transition public health nursing clinicals from in‐person to virtual learning in response to COVID‐19. Further, faculty lessons learned are shared and include the importance of creating a supportive team dynamic, embracing innovation, continuing to engage with community partners, and adapting to meet emerging student needs during the evolving pandemic. The process and lessons learned may act as a guide for other nursing programs as we continue to navigate nursing education during this and future pandemics.

The importance of a strong public health infrastructure and workforce, including public health nurses, has been emphasized during the ongoing COVID-19 pandemic (Edmonds et al., 2020) . Along with the need for adequate, long-term funding for public health (Edmonds et al., 2020; Kub et al., 2017) , it is also essential that nursing education prepares future nurses to take a lead role in collaborating with community partners to promote health, reduce disparities, and address public health needs within communities (Murray, 2019) .

To meet this need, nursing faculty should look for opportunities to incorporate critical concepts such as epidemiology, communicable disease control strategies, population health, social determinants of health, and health promotion throughout the curriculum to prepare graduates to promote health across a variety of settings (Carolan et al., 2020; Morin, 2020; Murray, 2019) .

While the COVID-19 pandemic has highlighted the value of public health nursing, it has also created challenges across nursing education, including for public health nurse educators in clinical settings. In March 2020, academic programs across the country were faced with making decisions to best meet student needs as COVID-19 became a pandemic. For the first time in the history of higher education, entire student cohorts transitioned to virtual learning (Zimmerman, 2020) .

Although continuing to provide meaningful instruction was a challenge across all disciplines (Zimmerman, 2020), health care programs, particularly nursing programs, were under immense pressure to continue developing the health care workforce necessary to combat the pandemic, while also protecting students, susceptible patient populations, and society against the spread of COVID-19 (Dewart et al., 2020) . Along with student safety and the safety of the population at the clinical site, resources available at community-based clinical sites also had to be considered (Redden, 2020) .

The American Association of Colleges of Nursing (AACN) disseminated an evolving document titled, "Considerations for COVID-19 Preparedness and Response in U.S. Schools of Nursing" (AACN, 2020) . This document provided guidance for nursing schools on how to maintain quality nursing educational experiences while protecting the health and safety of students and faculty. Following guidance from local public health departments was also stressed. AACN (2020) acknowledged that nursing students were an important part of the health care team and could remain a part of the health care team at clinical sites as long as they were not asked to provide care for patients with suspected or confirmed COVID-19.

As the pandemic continued to spread many nursing educators, particularly clinical faculty, had to swiftly transition courses from in-person settings to the virtual environment to meet the learning needs of students during this uncertain time. Many innovative learning strategies were utilized to support student learning including virtual simulations, telehealth visits, virtual flipped classrooms, and virtual reality (Chick et al., 2020; Morin, 2020) .

Even though the transition to virtual clinicals during the spring 2020 term occurred quickly, the importance of establishing a virtual clinical environment that supports student learning while recognizing student needs was apparent. Creating a caring, supportive environment can promote student learning and positive learning outcomes (Ingraham et al., 2018) . Crafting an environment that is supportive and responsive to student needs takes deliberate thought and planning on the part of the faculty (Morin, 2020) .

As an emerging issue, few articles exist in nursing literature addressing this transition, particularly in public health nursing education. The purpose of this paper is to (1) describe the transition of a face-to-face public health nursing clinical to virtual clinical in response to the COVID-19 pandemic, and (2) share lessons learned from the faculty perspective.

The public health nursing clinical discussed in this paper is part of the curriculum for a College of Nursing's generalist entry master's (GEM) program at a private university medical center in the Midwest. The 15-week public health nursing clinical occurs during the fourth term of the six-term program and requires 112 clinical hours. In this clinical, students provide nursing care in community-based settings for individuals, families, and groups. Along with completing a community health assessment, students collaboratively plan, implement, and evaluate a health promotion project based on clinical site-specific health priorities. Clinical course objectives are listed in Table 1 .

During the Spring 2020 term, 75 GEM students were enrolled in the clinical course. Clinical sites included local schools, an organization serving individuals who are blind or visually impaired, an organization serving people with intellectual/developmental disabilities and their families, a free out-patient addiction treatment center, and a Federally Qualified Health Center focused on healthcare for people experiencing homelessness. The clinical course team consisted of two-course directors and seven clinical faculty. Table 2 shows which clinical activities were prioritized and their relationship to clinical objectives. Course directors and faculty agreed to focus on these activities to ensure fidelity across clinical groups and facilitate mastery of course objectives. 

After completing the final four weeks of public health nursing clinical virtually, clinical faculty and course directors reflected on lessons learned from conducting public health nursing virtual clinicals for the first time. Lessons learned include the importance of creating a supportive team dynamic, embracing innovation, continuing to engage with community partners, and adapting to meet emerging student needs. 

The virtual learning activities previously described demonstrates the innovation of clinical faculty in creating new ways for students to meet clinical objectives. Innovative learning activities can help engage students and enrich the clinical learning experience (Phillips et al., 2019) . The single-parent case study that students completed is one example of an innovative activity implemented by clinical faculty. The case study provided students the opportunity to explore how social determinants of health influence health and to understand existing barriers for their assigned community, without direct contact with communities. According to Murray (2019) , future nurses must be knowledgeable about how social determinants influence health for individuals and within communities. This activity was a good fit for virtual clinical learning as it was free, web-based, and did not require in-person teaching but still facilitated the mastery of course objectives.

Even though students were not physically present, they remained engaged in innovative ways with community partners. Students specifically used their growing public health expertise to educate organizations and community members about COVID-19. Communicable disease control strategies, signs and symptoms to monitor for, and COVID-19 testing procedures were all important health education topics (Chen et al., 2020) . By applying these public health concepts in practice, students were able to meet public health nursing competencies while also engaging with community partners in response to the current public health crisis.

Even though students were unable to be on-site, many clin- 

Discussions among public health nursing clinical faculty and course directors revealed a common theme of the need to recognize students as individuals outside of the clinical setting, as people who were also dealing with challenges of living through a pandemic. 

The purpose of this paper was to describe the process of transitioning an in-person public health nursing clinical to a virtual clinical in response to the COVID-19 pandemic, and share faculty lessons learned. In doing so, the authors identified a variety of shared experiences and lessons learned that may serve as guidance for other nursing programs. The unprecedented shift from in-person to virtual public health nursing clinicals was a new experience for the course directors and clinical faculty involved in the transition. It is important to reflect on the lessons learned from the faculty perspective during this transition since the COVID-19 pandemic is ongoing, and virtual clinical activities will continue being an important opportunity for student learning now and in the future. A limitation of this paper is that it only includes the faculty perspective. Since the transition has significantly affected the student learning experience, understanding the effects of the transition to virtual public health nursing clinicals from the student perspective is also important to consider. Additionally, while the transition was necessary to ensure safety, learning outcomes are still unknown (Govindarajan & Srivastava, 2020) . It is imperative moving forward to evaluate student perspectives and learning outcomes in the context of virtual clinical experiences.

Data sharing not applicable to this article as no datasets were generated or analyzed for this project. 

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