Professional Documents
Culture Documents
Jurnal Kompetensi Perawat 4
Jurnal Kompetensi Perawat 4
DOI: 10.1111/phn.12796
S P E C I A L F E AT U R E S – E D U C AT I O N
Ashley Gresh MA, MSN, RN, CNM, PhD1 | Sarah LaFave MPH, RN, PhD1 |
Veena Thamilselvan Undergraduate Student2 | Anne Batchelder MPH, MSN1 |
Jenna Mermer MSN, RN1 | Keilah Jacques MSW3 | Amy Greensfelder MSW4 |
Melissa Buckley PhD, MSW5 | Zeke Cohen MA6 | Ann Coy MAT6 | Nicole Warren PhD,
MPH, RN, CNM1
1
Johns Hopkins University School of
Nursing, Baltimore, MD, USA Abstract
2
Johns Hopkins University Krieger School of Days after COVID-19 physical distancing precautions were implemented, a coalition
Arts and Sciences, Baltimore, MD, USA
of community leaders in Baltimore City founded the Baltimore Neighbors Network
3
Johns Hopkins University Bloomberg
School of Public Health, Baltimore, MD, USA
(BNN), a volunteer network established to provide proactive phone-based support
4
Pro Bono Counseling Project, Baltimore, to older adults in Baltimore City. BNN was a community-driven approach aimed
MD, USA at reducing social isolation and improving health equity both during the pandemic
5
Coppin State University and Healing City
and long-term. This paper describes how the Johns Hopkins School of Nursing's
Baltimore, Baltimore, MD, USA
6
Healing City Baltimore and Baltimore City (JHUSON) public health nursing clinical faculty and students partnered with BNN
Council, Baltimore, MD, USA to support a community-driven crisis response effort while creatively meeting stu-
Correspondence dent learning objectives. While engaging in the work of BNN remotely, nursing stu-
Ashley Gresh, 525 North Wolfe Street, dents were able to meet competencies across all eight domains of the Quad Council
Baltimore, MD, 21205, 603-831-3942, USA.
Email: [email protected] Coalition of Public Health Nursing Organizations. Schools of Nursing throughout the
country can use this partnership as a model of a service-learning strategy for public
health nursing education during a crisis.
KEYWORDS
aging, community, community-academic partnership, isolation, older adults, public health
nursing, service-learning, social support
During COVID-19, communities have had to respond quickly and cre- As JHUSON transitioned to online learning, faculty worked to iden-
atively to mitigate the negative impacts of isolation associated with tify activities that would support meeting course objectives in the
physical distancing precautions, particularly among older adults. At absence of direct client contact. JHUSON’s prelicensure public
the same time, nursing education programs are challenged to con- health nursing course used service-learning, a structured learning
tinue with traditional, face-to-face partnerships which are possible experience that embraces authentic community partnership with
unsafe for student participation. In this paper, we describe the part- explicit learning objectives, social justice preparation, and critical
nership between the Johns Hopkins School of Nursing (JHUSON) reflection (Mitchell et al., 2015; Owen, 2016; Seifer, 1998). Service-
and the Baltimore Neighbors Network (BNN) as an example of an learning pedagogy specifically addresses social determinants of
innovative service-learning-based public health nursing educational health and social justice in an effort to contextualize health dispari-
strategy in response to the COVID-19 pandemic. ties and build health equity (Sabo et al., 2015). For the purposes of
this paper, we define social justice as the “equitable distribution of to physical limitations (Anderson & Thayer, 2018). Isolation is not
benefits and burdens in a society” (Redman & Clark, 2002; p. 466). only a risk factor for loneliness but also contribute to older persons
The clinical competencies for this course were structured around having limited access to information, practical assistance, food, and
Tier 1 of the Quad Council Coalition (QCC) of Public Health Nursing other material resources, perpetuating inequalities and making isola-
Organizations’ Community/Public Health Nursing Competencies tion an important social determinant of health (Cattell, 2001; Popay
(Quad Council Coalition Competency Review Task Force, 2018). et al., 2008). Isolation and loneliness are associated with a number
Competencies progress across three tiers of mastery (Tier 1 for en- of health issues, including impaired immune response, poor cardiac
try-level practice, Tier 2 for supervisory management, and Tier 3 for health, diminished sleep quality, and early mortality (Holt-Lunstad,
senior leadership/management) and across eight domains: assess- Smith, Baker, Harris, & Stephenson, 2015).
ment and analytics; policy development/program planning; commu- The COVID-19 pandemic increases threats to the independence
nication; cultural competency; community dimensions of practice; and well-being of older community members, who already are facing
public health science; financial planning; evaluation and manage- challenges such as isolation and food insecurity (Shahid et al., 2020).
ment; and leadership and systems thinking. The QCC intentionally COVID-19 physical distancing precautions have prevented many older
designed the competencies to support community and public health adults from continuing activities that are inherent antidotes to loneli-
nurses in cultivating skills oriented toward working collaboratively ness, such as attending senior centers, congregating with family and
with community members to promote health equity and create deep friends, and engaging with their faith-based communities. Many com-
structural changes to these ends. munity agencies are providing support for older adults during the pan-
The JHUSON public health nursing course content includes demic, but these services can be difficult to identify for an older person
exploration of antioppressive frameworks to help ensure that the who is not leaving the home (Banskota, Mealy, & Goldberg, 2020). In
clinical groups’ service-learning efforts were community-driven and addition, while many services address essentials like access to food and
challenge historical power imbalances between community and ac- medication, resources to support older adults’ social and mental health
ademic institutions. Antioppressive work “addresses social divisions needs are less accessible (Panchal et al., 2020).
and structural inequalities… It aims to change the structure and pro-
cedures of service delivery” (Strier & Binyamin, 2014, p. 2096). The
JHUSON public health nursing course faculty and students part- 1.3 | Age and racial disparities in COVID-19
nered with community agencies including public schools, indepen- morbidity and mortality
dent senior residences, and social services agencies that supported
persons affected by HIV, homelessness, and substance use disor- Nationwide, 80% of COVID-related deaths have been in people
ders. Each week, students learned in the classroom and spent a full aged 65 or older with death rates higher among Black adults than
day at their community site supporting and learning from the part- White adults revealing stark racial disparities in COVID-19 disease
ners’ staff and clients. According to service-learning scholars, the outcomes (Centers for Disease Control & Prevention [CDC], 2020a;
application of service-learning pedagogy in the community includes CDC, 2020e). Older adults are at disproportionately higher risk of
authentic partnerships that are responsive to articulations and modi- complications if they contract COVID-19, as well as for isolation
fications of community concerns (Andrews & Leonard, 2018; Asghar and disconnection from community resources as a result of physi-
& Rowe, 2017; Latta et. al., 2018; Mitchell, 2008). As the COVID-19 cal distancing precautions. This is especially true for older Black
crisis began, community partners closed their doors to nonessential adults who make up approximately 62% of Baltimore City residents
workers and JHUSON clinical learning went entirely online. While (U.S. Census Bureau, 2019). Because of decades of structural rac-
online clinical simulations provided valuable learning experiences, ism and disinvestment in urban neighborhoods, older Black adults
the community's needs were increasing as a result of the pandemic in Baltimore City experience high rates of poverty and chronic
and students were eager to respond. diseases, including mental health disorders (Hale, Smith, Bowie,
LaVeist, & Thorpe, 2019; LaVeist, Pollack, Thorpe, Fesahazion, &
Gaskin, 2011; Pappoe, 2016). These comorbidities and the dis-
1.2 | COVID-19 and older adult isolation criminatory factors that put people at increased risk for them also
place older Black adults at higher risk for COVID-19 complications
For many older individuals living in the community, mobility limita- (CDC, 2020b). In addition, of the adults in Baltimore, 42% have ex-
tions, visual impairments, and other intrinsic factors prevent them perienced three or more adverse childhood events and this trauma
from engaging in employment, volunteer work or social activities can have lifelong consequences such as increased risk for cancer,
outside the home. These challenges are compounded by extrinsic diabetes, heart disease, and suicide (Behavioral Health Systems
factors including high-cost and inaccessible public transportation Baltimore, n.d.; CDC, 2020c). These traumatic experiences from
and limited in-home services. These challenges result directly in the childhood remain largely unresolved in the current older adult
social exclusion of older people. More than one third of adults in the population and older adults with earlier life trauma have a have a
United States reported feeling lonely and more likely to experience higher likelihood of risky behaviors and revictimization, especially
loneliness if they had a limited social network or were isolated due if their social support network is limited (Maschi, Baer, Morrissey,
GRESH et al. |
3
& Moreno, 2013). The physical and mental health risks associated partnership, that is, it should: (1) be experiential; (2) provide students
with a history of trauma compounded by the impact of the COVID- with structured opportunities to learn while addressing community
19 pandemic has the potential to negatively impact older adults’ needs; (3) intentionally include opportunities for reflection; and (4)
health (Behavioral Health Systems Baltimore, n.d.). have reciprocity at its foundation: both the students and the commu-
nity served should benefit (Bailey, Carpenter, & Harrington, 2002,
p.434).
1.4 | The Baltimore Neighbors Network
In February of 2020, the Elijah Cummings Healing City Act was 2.1 | Experiential learning
signed into law, requiring city agencies to undergo trauma-informed
training and establishing Healing City Baltimore, a trauma-informed After physical distancing precautions were put in place, one pub-
task force to evaluate trauma-responsiveness (Mayor's Office of lic health nursing clinical instructor and her students transitioned
Children & Family Success, 2020). Days after physical distancing from in-person visits to phone calls to continue the support of
precautions were introduced in Baltimore, a coalition of community older adults at their senior housing building site. Through the calls,
leaders founded the Baltimore Neighbors Network (BNN). BNN was students helped dozens of older adults navigate food and medi-
a community of trained volunteers who offered hope, comfort, and cal resources during the first week of the city's shutdown. Course
social solidarity through phone-based connections. BNN’s founders instructors then explored possibilities for expanding on this work
said that a primary reason for launching the program during the pan- to meet virtually student learning objectives, while also sup-
demic was because “Baltimore's greatest asset is our people. We are porting the community. Around the same time, the City Council
the medicine” (Healing City Baltimore, 2020). BNN’s network of vol- invited health equity experts from the university, including from
unteers make calls to older adults across Baltimore City to provide JHUSON, to present potential strategies for addressing older adult
companionship, conversation, and, when needed, assistance with isolation and health disparities during the pandemic. Recognizing
resource navigation. Because BNN’s coalition of partners included our complementary goals, the City Council President facilitated a
a professional pro bono mental health counseling agency and other connection between JHUSON and BNN and we joined forces. A
supportive services, BNN volunteers could escalate mental health key logistical challenge was to quickly execute a memorandum of
concerns to licensed clinicians, creating a wrap-around system of so- understanding (MOU) between JHUSON and BNN so that nurs-
cial and mental health support for participants. BNN volunteers in- ing students could count BNN service as clinical hours. Because
vited neighbors who received calls to join the network of volunteers JHUSON and BNN coalition leaders saw value in developing the
and many volunteer callers were older adults themselves. While at partnership to meet urgent needs, the process of executing an
the time of writing, BNN did not specifically track volunteer demo- MOU between the university and the community partner, which
graphics, this is planned for the coming months. typically takes months, was finalized within days.
became more familiar with BNN processes and procedures, the 2.2.4 | Program data
virtual meeting room was no longer necessary; instead, students
and their clinical instructors were able to access BNN organizing BNN tracked the number of volunteers who applied and been
team members as needed. trained. A BNN technology lead volunteer reviewed data entry
forms daily to track the number of calls made, number of conver-
sations, number and type of resources referred, and duration of
2.2.1 | Training calls. This de-identified aggregated information was updated bi-
weekly on the BNN website. In addition, the BNN technology lead
Following a background check, all BNN volunteers participate volunteer used the data to determine which neighbors would like
in a 4.5-hr training which included an overview of the BNN call a call back to ensure connection to resources and which neigh-
script and data entry form, use of the calling system, and guid- bors would like ongoing weekly calls to build a relationship with
ance on using harm reduction and inclusive listening skills. Training a volunteer.
was conducted by BNN coalition members from the Pro Bono
Counseling Project and the Baltimore Community Mediation
Center. Because the nursing students in the public health nursing 2.3 | Critical reflection
course had developed competencies related to inclusive listening
in their mental health course work and clinical rotations, and due Critical reflection is defined here as “the process of learning to ques-
to the urgency to onboard volunteers, the students participated tion social arrangements and structures that marginalize groups
in an abbreviated version of the training that complemented con- of people” (Diemer, Rapa, Voight, & McWhirter, 2016, p. 216).
tent in their prelicensure program. JHUSON faculty and doctoral Participants learned how to examine ways of thinking and feel-
students provided additional resource navigation training to stu- ing that perpetuate existing structures and misconceptions of the
dents to further connect the BNN volunteer experience to student world and others (Mitchell et al., 2015; Owen, 2016). To ensure that
learning objectives. critical reflection was a component of the student experience with
BNN, after each session of calls, JHUSON students and their clini-
cal instructors met virtually using a reflective model developed by
2.2.2 | Technology Rolfe, Freshwater, and Jasper (2001), the What? So What? Now What?
These reflection questions encouraged students to summarize what
All BNN volunteer phone calls, including those made by nursing they had just done (What?), consider its meaning to their own learn-
students, were made through Telzio, a cloud-based telephone sys- ing and to the community members who participated (So What?),
tem that allowed for unlimited calls to be placed on multiple devices as well as its meaning for them and that community or organization
through a single phone number. Telzio allowed for three-way calls moving forward (Now What?).
and call transfers in the event of a crisis (e.g., to 9–1–1 or a crisis
hotline) or to make a warm hand-off to a community resource such
as a food bank or health care provider. BNN obtained older adult 2.4 | Reciprocity
phone numbers from TargetSMART ListBuilder, a database of pub-
licly available contact information. Volunteers submitted an AirTable Reciprocity builds the foundation of this community-academic part-
form entry after each phone call so that organizers could track calls nership. The BNN organizing committee reported that it has been
placed and referrals made (e.g., to food, pharmacy, mental health re- beneficial for them because it has enabled BNN to dramatically in-
sources). Entries did not include identifiable information about vol- crease program capacity, rapid-test new logistical strategies with a
unteers or older adults. large number of willing volunteers, and infuse a meaningful intergen-
erational component into the program. For example, after review-
ing the data entries and feedback from students, BNN identified
2.2.3 | Call script and resource guide necessary revisions to the script training to ensure that volunteers
internalized that establishing rapport and social connection was the
A committee of BNN members, including mental health clinicians, priority versus identifying and addressing practical resource needs
developed a standardized call script to help volunteers navigate con- alone. BNN reports that one challenge with student volunteers is the
versations. The script guided volunteers to identify mental health need to train a very large number of people at one time. Typically,
concerns and to refer to a licensed mental health provider if needed. BNN caps each training session at about 30 participants but adapted
Volunteers were encouraged to adapt the wording of the script to to train hundreds of students at a time. Overall, BNN reports that
ensure that their calls with neighbors are conversational and en- the community-academic partnership has been beneficial for them
gaging. Volunteers used a BNN-developed resource guide to help and they are enthusiastic to continue to include students in the pro-
older adults navigate up-to-date resources relevant to the COVID-19 gram to take part in all aspects of the intervention from implementa-
pandemic. tion to evaluation.
GRESH et al. 5 |
3 | M E A S U R E S 4.1 | Student learning
The community-academic team agreed on evaluative measures that The JHUSON public health nursing course competencies are aligned
would be meaningful to both JHUSON and BNN. To monitor and with the Quad Council's competencies for public health nursing
evaluate the implementation of the community-academic partner- (Quad Council Coalition Competency Review Task Force, 2018).
ship, the following process measures are being collected: Below, we review the competencies, organized by the Quad Council
domain, demonstrated by students during the clinical hours they
● Number of students trained completed through BNN. In Table 1, we provide specific examples of
● Number of conversations with older adults student experiences that exemplify a particular competency linked
● Number of clinical hours completed by students to each of the Quad Council's eight domains.
● Number of referrals to mental health services
● Number of referrals to community services such as food delivery
● Portion of the call list that is “cleaned” for use by BNN (i.e., discon- 4.1.1 | Domain 1: Assessment and Analytic Skills
nected numbers removed from call list so that future volunteers
can invest time in calling warm numbers) When making phone calls through BNN, students assessed if older
adults’ basic needs were met and if they were in need of mental
A community-academic partnership logic model was created (see health support. During critical reflection, instructors intentionally
Figure 1) as a visual tool to depict the formation of the partnership focused on discussions of health disparities and social justice, and
and its intended impact on older adults in Baltimore City as well as students identified disparities in access to resources and social sup-
its impact on the career development of the nursing students. port across the city's population. Students were able to identify
assets and gaps in infrastructure as health systems and community-
based organizations quickly worked to develop and adapt services
4 | O U TCO M E S during the pandemic. Student reflections ranged from practical
considerations about how to improve the call script and keep the
The BNN-JHUSON partnership was rapidly established to respond resource list current, to substantive critical reflection about older
to the needs of older adults in Baltimore City while providing a ser- adults’ value to society and the relationship between systems-level
vice-learning opportunity for nursing students during the COVID-19 injustices and individual access to resources. As students continued
crisis. to learn online from their homes, many expressed that contributing
TA B L E 1 Community/Public Health Nursing [C/PHN] Competencies (Quad Council Coalition Competency Review Task Force, 2018)
1 Assessment and “Use information technology effectively to collect, Students assessed the needs of their neighbors and
Analytic Skills analyze, store, and retrieve data related to public identified relevant resources and referrals. If no
health nursing services for individuals, families, resources in the BNN resource guide addressed a
and groups.” particular need, students identified and provided
information to BNN on community resources or
offered information on service gaps for BNN to use
to inform future community planning.
2 Policy Development/ “Describe the implications and potential Students incorporated their emerging knowledge
Program Planning impacts of public health programs and policies on antioppressive frameworks to describe how
Skills on individuals, families, and groups within a COVID−19 exacerbates public health challenges in
population.” this community and the individuals engaged in the
program.
3 Communication Skills “Apply critical thinking and cultural awareness to If a student identified a neighbor issue that was
all communication modes (i.e., verbal, nonverbal, beyond their scope, they employed critical thinking
written & electronic) with skills in communicating to escalate the issue to a
individuals, the community, and stakeholders.” professional member of the interdisciplinary team.
For example, one student identified in partnership
with a neighbor that he was in acute respiratory
distress. With support from her clinical instructor,
she facilitated a warm hand-off to paramedics, while
staying on the line with the neighbor to ensure his
needs were met.
4 Cultural Competency “Use determinants of health effectively when In connecting older adults throughout Baltimore with
Skills working with diverse individuals, families, and resources, students utilized determinants of health to
groups.” effectively meet the needs of diverse individuals.
5 Community “Assist individuals, families, and groups to identify Students helped older adults connect with community
Dimensions of and access necessary community resources resources and services, based on BNN resources
Practice Skills or services through the referral and follow-up guild, while also referring callers to instructors and
process.” BNN leaders when needed.
6 Public Health “Use evidence-based practice in population-level Students participated in a community-driven approach
Sciences Skills programs to contribute to meeting core public to identify and address a population-level challenge
health functions and the 10 essential public during an acute health crisis.
health services.”
7 Financial Planning, “Interpret the impact of budget constraints on In gaining a better understanding of the needs of
Evaluation, and the delivery of public health nursing services to the older adults and navigating resources, students
Management Skills individuals, families, and groups.” learned about the limitations of available resources
due to budget constraints.
8 Leadership and “Influence health as a shared value through In reflection with instructors and peers, students
Systems Thinking community engagement at the organizational recognized how addressing population-level
Skills and systems level.” health challenges like COVID−19, complicated by
existing structural inequities, requires community
engagement and leadership as demonstrated by this
BNN partnership.
to the pandemic response in Baltimore through their BNN calls pro- co-founded BNN met with students to provide a policy perspective,
vided them with a sense of purpose. reinforcing the importance of supporting community-based initia-
tives in public health policy and practice.
The students supported the BNN team to develop and implement a This experience allowed students to engage in innovative communi-
program from the ground up. As students made calls, they provided cation methods as part of an interdisciplinary team. They employed
input into program development and evaluation by offering feedback inclusive listening skills and delivered public health information,
to BNN on what to include in the future iterations of their call script, when asked for, to members of the community. They also practiced
data entry form, and resource guide. The City Councilperson who use of effective communication skills if they identified a neighbor
GRESH et al. |
7
issue that was beyond their scope; in those cases, students esca- management. In addition, an undergraduate student and two doc-
lated problems via a warm hand-off to a clinical instructor, a pro toral nursing students partnered with BNN coalition leaders and a
bono counselor through BNN, emergency services, or another pro- JHUSON faculty member to develop and submit a successful grant
fessional who could best support the neighbor. application to improve sustainability of the program. These three
students were also involved in the community-academic team's
work to develop a more rigorous evaluation plan for BNN.
4.1.4 | Domain 4: Cultural Competency Skills
Making calls through BNN allowed students the opportunity to re- 4.1.8 | Domain 8: Leadership and Systems
spond to a diverse community's needs and preferences during a cri- Thinking Skills
sis. When making phone calls, students employed a client-directed
approach to care, inviting older adults to guide the conversation and Clinical instructors invited students during reflection to consider
determine if and how they would like support. BNN also gave stu- the implications of this initiative for health systems, population-level
dents a first-hand understanding of the impact of determinants of health disparities and social justice. Throughout the debrief ses-
health during a crisis. Because their service-learning experience took sions, students discussed linkages between hospital and community
place during the first stage of the COVID-19 pandemic, students healthcare and the importance of bridging the gap between the two
saw how chronic stressors and systemic differences in access to re- in order to improve quality of life for older adults.
sources could accentuate disparities during an acute health crisis,
and how community-driven approaches could mitigate disparities.
According to Kumagai and Lypson (2009), this reorientation toward 4.2 | BNN services
critical consciousness, or recognizing the societal context surround-
ing health care as a first step in addressing solutions to systemic Nursing students from the public health nursing course placed a
challenges, is necessary to center equity in teaching the social de- total of 2,950 calls over a 2-week period and engaged in conversa-
terminants of health. tions with 546 older adults. Each student contributed between 4
and 12 hr making calls to older adults through BNN. Nursing stu-
dents made an average of 22 calls each with calls averaging around
4.1.5 | Domain 5: Community Dimensions of 2.2 min per connected call. Calls ranged from short conversations
Practice Skills lasting roughly 30 s up to 12 min. Calls ranged from short touch-
points with older adults who did not identify any unmet needs, to
By partaking in the inception of the community-academic partner- longer conversational and resource navigation calls. Through these
ship, students were able to observe and participate first-hand in conversations, students made 21 referrals to mental health services,
stakeholder engagement and development of community partner- 25 referrals to food services, and 60 referrals to other community
ships. BNN was founded by community members and relies entirely resources. If an older adult agreed to follow-up phone calls, BNN
on community time and resources to function; students were able to volunteers continued to call them on a weekly basis and assess if
contribute to this community-driven approach to care. they are able to access any resources that might have been referred
to them. During follow-up calls, volunteers were able to see in the
notes whether or not a resource was referred to the older adult.
4.1.6 | Domain 6: Public Health Sciences Skills However, there was no formal process put in place to follow-up with
each older adult to assess if referred resources were successfully
This partnership exemplified one of the 10 Essential Public Health accessed. The students also identified 617 numbers no longer in ser-
Services which is to “mobilize community partnerships and action vice that were removed from the call queue for future volunteers.
to identify and solve health problems” (CDC, 2020d). Students were Generally, older adults have expressed appreciation for the calls
able to be a part of mobilizing community partnerships to increase and are thankful for the check-in even if they declined to maintain a
social support in a time of acute crisis and to provide important real- weekly connection with a volunteer. Additionally, some older adults
time information to government and community agencies on the re- enrolled as volunteer callers, demonstrating the potential for BNN to
source needs of older adults. build community connection.
using service-learning strive for authentic partnerships, these are local universities to facilitate an interdisciplinary cohort of student
difficult to achieve. In this instance, there was actual power shar- volunteers this summer.
ing and shared decision making as we implemented a partnership There are limitations to this partnership. The program is running
grounded in antioppressive frameworks. Important factors that led without a comprehensive evaluation plan in place. This is due, in
to the success of this community-academic partnership are recep- part, to the fact that the services were launched so quickly amidst a
tiveness of BNN to the partnership, existing faculty and community public health crisis. The community-academic team applied for and
relationships, flexibility of clinical faculty, student readiness, course recently received a small COVID-19 specific grant, more than 90%
commitment to serve Baltimoreans as directed by Baltimoreans, of which will support BNN to train and support volunteers and to
the ability of contracts staff to quickly execute an MOU, and BNN’s develop a robust evaluation plan for the program, and the remainder
strong technical platform. of which will support JHUSON faculty and student time to support
Community partnerships were needed to fulfill practicum re- these activities. This planning includes developing mechanisms for
quirements that meet accreditation standards for student learning. tracking if referred resources are successfully accessed by older
The relationship between students and their practicum sites has a adults. In addition, BNN is now implementing exit surveys with all
significant impact on not only their current learning but also poten- volunteers; upcoming cohorts of students will receive a survey to
tially their professional trajectories. But the literature is relatively evaluate their experience at the end of each semester. Moving for-
scant regarding how these partnerships benefit the community part- ward, BNN and JHUSON will more formally evaluate student expe-
ner (Karasik, 2020). This partnership between JHUSON and BNN riences in this service-learning opportunity.
provided insight into how this relationship aligns with the reciprocity In addition, the rapid set-up and overall fatigue among students
model, as BNN sees students as valued members of the program and and faculty participating in all-online learning during a stressful pe-
hopes that the partnership will continue well after students com- riod may have affected the quality of reflection. As students con-
plete their educational requirements. Consistent with research on tinue to engage with BNN, the need for critical reflection will be
student engagement and educationally purposeful learning activi- reinforced. There were also some challenges related to students’
ties (Taylor, Yochim, & Raykov, 2019), BNN endeavors to engage stu- participation. Some students may have felt nervous or felt unpre-
dents in all aspects of the intervention model and to provide support pared to place cold calls, but we did not formally capture data on
and supervision whereby they will see themselves as vital members their expectations for or concerns about the experience due to time
of the team. constraints. With more preparation time, it may have been helpful
BNN is building a sustainable infrastructure that will continue to to provide students with additional training to help them feel pre-
positively impact older adults and students beyond the COVID-19 pared to respond to older adults’ resource and mental health needs
pandemic. Long term, this means that in addition to providing social by phone. In addition, an important strength of BNN is that callers
support, the project has the potential to address the many negative are able to reach older adults who are potentially most disconnected
outcomes associated with loneliness including depression, cognitive from services and supports, because calls are placed to all city resi-
decline, and immune system compromise (National Academies of dents as opposed to an existing organization's client list. The trade-
Sciences, Engineering, & Medicine, 2020). Because BNN volunteers off to that strength is that callers often reach disconnected numbers
assist older adults with resource navigation when requested, this or people who are not interested in conversation or in need of sup-
project has the potential to facilitate access to food, health care, and port. In the future, it will be helpful to provide additional context
social services. to students to help them understand the value of the “cold-call”
This sustainable, community-academic partnership can be mod- approach.
eled by other community organizations and universities throughout Finally, the experience is not generalizable because BNN was
the country and with other populations at high risk for health ineq- a unique coalition of community leaders and such an organization
uities. Our work provides an exemplar of how to continue clinical does not exist in all communities; however, other Schools of Nursing
education during a crisis when in-person activities are not possible. can partner with local agencies on aging, public health departments
Many nursing students who participated noted that they were grate- or other community organizations to do phone outreach to clients
ful to be a part of this public health nursing course during the pan- during a crisis. In addition, the technological requirements and
demic because it offered them a chance to participate in community set-up can be replicated; in fact, the BNN technical team has made
responses to COVID-19 as prelicensure students. After the public a concerted effort to create templates and documentation to help
health nursing course, 25 students asked to continue volunteering other organizations jumpstart this work.
with BNN on their own time, a testament to the impact of work
with BNN on student participants. JHUSON and BNN are continu-
ing their partnership: the summer rotation of prelicensure students 6 | CO N C LU S I O N
in psychiatric nursing will participate in BNN training and service in
addition to their previously planned clinical activities, and in the Fall The BNN-JHUSON partnership provides an example of a ser-
semester, a group of public health nursing students will be placed vice-learning, online public health nursing educational strategy
with BNN for their clinical rotation. JHUSON is also partnering with in response to the COVID-19 pandemic. Critical service-learning
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