Partners in Caring andCommunity: IntegratingNursing Research into ServiceLearning

Carolyn Jenkins, DrPH, RN-BC, RDMedical University of SouthCarolina College of Nursing

Your questions:How do we do participatory research?How do we find funding?How do we provide evidence that we areaccomplishing what we intend to accomplish?How do we involve students as “co-researchers”?How do we document impact of research onstudents?How do we manage?

What is research?

Systematic inquiry that generates newknowledge.

Comments about research

Students are workers todo faculty’s research!We already know the“right” way to do it, sowhy should we documentit with research?

Research = IntrusionData = Stolen goodsAnonymous = SecretpurposeResearchers = TakersCollaboration = Newexploitation

Research is something Imust do(not want to do)for promotion.Research takes too muchtime and I already have aFULL schedule that takesmore than 8 hour day.

Research is activelearning.Research helps me do itthe “best way.”Research creates freshnew insights.Research is essential partof CQI.

Research producesinformation on whichdecisions are made.Research produces betterhealth outcomes.Research is oftenmisunderstood.

Research is inquiry thatgenerates new knowledge.Research identified bestpractice.Research can lead toevidence-based practice.

StudentsCommunityFaculty

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How do we make Research fitinto Service-Learning?

KnowledgeAttitudesSkills and Behaviors

of:

Text

CommunityOrganizations

Students

AdministrationCommunityNeeds

Text

TtCommunity

ClientsFaculty

How do we make Research fit?

Work with community clientgroup(s) and community

organization(s) to identify:Need, Issue, or Problem

Work with community clientgroup(s) and community

organization(s) to identify:Need, Issue, or Problem

How do we make Research fit?

Formulate the researchquestion(s) in collaboration

with client group(s) andcommunity organization(s)

Formulate the researchquestion(s) in collaboration

with client group(s) andcommunity organization(s)

How do we make Research fit?

Obtain community buy-inrelated to the overall project

and approach and theninclude budget for

community participation.

Obtain community buy-inrelated to the overall project

and approach and theninclude budget for

community participation.

Hierarchy of CommunityService-Learning Research

Community-based: Located in the community.Community-responsive: Located in the communityand services provided are responsive to needs ofcommunity (based on exant data).Community-focused: Located in community andservices provided are based on extant data and focusgroups of community members/consumers.Community-driven: Services are located incommunity at a site mutually agreed-upon byuniversity and community, and both share process ofneeds assessment, planning, implementation, andevaluation.

Focus on Assets Map

LOCAL INSTITUTIONS

CITIZENS’ ASSOCIATIONS

GIFTS OF INDIVIDUALS

Businesses Schools

Parks

Hospitals Colleges and Universities

Libraries

Churches Neighborhoods

Cultural Groups

Income HealthProfessionals

Youth Older Adults Others

(Adapted from Kretzmann, 1995)

City Government

Health ProfessionalStudents

Methods for DocumentingCommunity Needs

SurveysFocus Group DiscussionsInterviews with neighbors and key informantsObservationsWindshield SurveysCommunity ForumsHealth ActivitiesHealth Statistics related to access, use, costsmorbidity, mortalitySecondary Data Analyses

Applying our Knowledge aboutPartnerships to Research

Forming a Research Partnership

How have you formed community-campus partnerships?How can you adapt them to includeresearch?What are the stages?How are you sustaining thepartnership(s)?

Principles of Community(Research) Partnership

Partners have agreed upon mission, values,goals, and measurable outcomes for researchpartnership.Relationship characterized by mutual trust,respect, genuineness, commitment.Research partnership builds upon identifiedstrengths and assets, and also addressesareas that need improvement.Research partnership has balance of powerand shared resources (funding, too).

Principles of CommunityResearch Partnership

Clear, open and accessible communications,listening to each need, developing commonlanguage, and clarity of terms.Roles, norms, processes for researchpartnership are developed with all partners’input and agreement.Partners share credit for research partnershipaccomplishments.Research partnerships take time to developand evolve. (adapted from CCPH Notebook)

Stages of Research Partnership

Stage 1: Exploration and discovery involve:Critical event or events, defined launching point.Meeting with Key Leaders or “chatting” that leadsto awareness of each other’s perceptions aboutresearch.Open sharing of ideas that focus on mutual needsand seeking common ground for research.Development of synergy.Agreement on guiding or process principles for theresearch partnership.

Stages of Research PartnershipStage 2: Defining and Building Infrastructure

Defining the research question and the processExpectations, roles, duties of partnersShared governance and powerOperations and managementPolicy development related to:

Recruitment and protection of subjectsResearch processResearch disseminationPublishing and authorship

Research program evaluation system or approachis designed and put into place

Memorandum of Agreement

MOA can be helpful to outline processMOA provides record of agreement

Can be printed or recorded orallyApproved by leaders

Use addendum to document changes inownership, action, time frames, etc.

Note: Advisory Board is not aPartnership!!!!

Stages of Research PartnershipStage 3: Institutional Review BoardApplication and Approval

Federal Wide Assurance needed by communityorganizations involved in performing researchfunded by feds

Stage 4: Performance of Research WorkDefines partnership and tests strengths of its ownfoundationsMost work is performed, data are collectedPartnership grows and changes

Stage 5: Analyses and Preparation forTranslation to Community

Stages of Research Partnership

Stage 6: “Translation of Findings”Celebration and Reflection

Report to community leaders about findingsPlan implemented for dissemination of findingsReflection and evaluation of research partnership

Stage 7: Higher Levels of Partnerships

(adapted and expanded from Heady, 2000)

Sources of Funding for Research

Create/utilize seed money within theCollege or School of NursingOften Colleges and Universities havefunding for pilot projects (and nursesoften do not compete for these funds)Private donors with common interestsSubcontracts with community agencies

Sources of Funding for ResearchFoundations (see Foundation Directory,Foundation Reports, etc.)

Look for local/regional/national foundations thatfund specific health interestContact the Foundation and discuss your interestsFind out about funding requirements, amounts,and cyclesLook at Foundation Board Members and funding ofprior projectsFind a match and ask yourself “Why should theyfund our project instead of all the other requests?”

Sources of Funding for ResearchGovernment funding

AgricultureEducationHealth

Agency for Health Research and QualityCenters for Disease Control and PreventionHealth Resources and Services AdministrationNational Institute of Health

NINR plus all other institutesOffice of Minority Health (if minority research)Housing and Urban Development

Note: Find out if your college is eligible forAREA grants

Sources of Funding for Research

Don’t forget local and state governmentAdministration likes federal sourcesbecause indirect costs are usuallyhigher.List other sources that you know here:

How to get funded:Match between funding agency and grant requestDiscuss your proposal with an agency/foundationcontactFollow the outlined process carefully whendeveloping the proposalLook at other successful proposalsEDIT, EDIT, EDITHave another successful grant writer/reviewercritique the proposal at least twiceFollow instructions for submission CAREFULLYIf not funded, revise and resubmit

How to get funded:Link with seasoned researchers as co-investigatorPUBLISH, PUBLISH, PUBLISH quality materialsBuild or link with other research projectsREVIEW THE LITERATURE carefullyBuild a solid theoretically-based projectSome buzz words: disparities, collaboration,coalitions, translationLook at numbers affected by the problemFocus on intervention (versus description) if problemhas been adequately described elsewhere.Intervention should be cost-effective and replicable.

How do we provide evidence that weare accomplishing what we intend toaccomplish?

Clearly document in measurable terms,our goals and objectives related to whatwe intend to accomplish.Develop and implement an evaluationplan.Disseminate our outcomes.

External InfluencesExternal Influences

Evaluation Logic Model

Coalition includingCoalition includingStudents as membersStudents as members

Understanding Context, Causes, & Solutions

for Health Issue

CommunityAction PlanIncluding Students

Planning & Capacity Building

Targeted REACH Action

Existing Activities

Change Agents Change Including

Changes in Students

Widespread Change in Risk/Protective

Behaviors

Changes in Health StatusOtherOther

OutcomesOutcomesEspecially thoseEspecially those

Related to Related to StudentsStudents

Community & Systems Change

EvaluationDesign and implement an effectiveevaluation using:

Research techniquesTools with validity and reliability

Get consultation as neededDesign a method to evaluate impact ofparticipation on students

How do we involve studentsas Co-Researchers

JUST DO IT at each step of the wayTrain the students carefullyEvaluate their progressWhen feasible, include them in thebudgetAvoid “file drawer projects” by activelyinvolving students in learning aboutresearch.

How do we manage?Gain administrative support for researchplanning.Block out time for research.“Just do it” is my motto, as there is neverenough time, but look carefully at your needs,responsibilities, and start with smallmanageable research projects that involvestudents and learning.Get funding and ask for research releasetime.

To design, implement, andevaluate research:

Find a community colleague thatwill guide your efforts and offer

honest, open feedback.I found IDA

Developing Neighborhood-Based PartnershipsEarning Trust according to Ida

R E S P E C T usGet Your Face Out ThereMake Your Business KnownKeep Your Sights on StrengthsUse Care and Caution in Interactions withLaw Enforcement/Legal InterventionsDo Not Give Up-Outlast Bad Behavior

Developing Neighborhood-Based Partnerships

Earning TrustIDA’S RULES

ListenNever Promise Something You Cannot DoDon’t Do Too Much Too SoonDon’t Throw Money At UsEmpower Us and Give Us YOUHelp us teach our children about health and healthcareers

Developing Neighborhood-Based Partnerships

Cultural Issues according to IdaSome people are Off-Brand People

i.e. They are different from the preferred brandsbut treat them with respect.We don’t speak the same language all the time sostop and check the level of understandingDon’t use Stereotype views—we don’t all eatcollard greens!!Remember, we have historically-induced lack oftrust, so help us develop trustSkin color is an issue but not the only oneYou might be 5-0, but success is not guaranteed

Developing Neighborhood-Based Partnerships

Overcoming Cultural Barriers (according to Ida)

R E S P E C TNever Assume TrustVocabulary ChecksHanging Out in the ‘Hood’ PromotesColorblindness for all of us, as we betterappreciate you and you better appreciate us.Try Neckbone and other communityfavorites—You might like it, and it demonstratesacceptance!Practice “cultural humility” and avoid “culturaldisregard”

Developing Neighborhood-Based Research Program

Conducting Research in the Real WorldR E S P E C TBe Up Front That Project Involves ResearchListen to Past Negative ExperiencesUnderstand Minority Experiences with Research--African American ExperienceApproach Community in a One-Down (vs. One-Up)MannerHave a Valid Argument for Worth of ProjectInclude > 1 community generated question.

Developing Neighborhood-Based Research Project

Conducting Research in the Real WorldWelcome Suggestions from the CommunitySeek Input from LeadersShow How You Will Protect ParticipantsLay Out the Plan and Gain ApprovalFollow Through

Provide Feedback to CommunityLeaders and Community Members

Examples of Research Projectsfrom Charleston’s EnterpriseMUSC Neighborhood HealthProgram

Neighborhood Health Priorities

Hypertension Management and EducationDiabetes Management and EducationPrimary Prevention

Healthy Eating, Physical Activity, Weight ControlSafety in Neighborhood and Home Environments

Primary Care and Health EducationEnvironmental Health IssuesDrug and Alcohol Programs (Youth and Adult)

To Address NeighborhoodHealth Priorities

Hypertension and Diabetes:Management and Education fundedthrough Healthy SC Initiative

Diabetes Initiative of SC Outreachfunded through SC Legislature

REACH 2010: Charleston andGeorgetown Diabetes Coalitionfunded through CDC

To Address NeighborhoodHealth Priorities

Primary Prevention, Care and Education:Enterprise Health and Opportunity Center-APartnership with 2 cities and MUSC funded throughHHS, HUD, and state fundsCurrently, negotiating with federally qualified healthcenter for ongoing primary care

Environmental Health Issues: EnvironmentalHazards Program funded by DOE and EPA

Drug and Alcohol Programs (Youth and Adult):Neighborhood Solutions Research Project forone of the 18 communities

Problems Identified byNeighborhood

Youth CrimeSubstance Abuse

Limited Youth Activities

Youth Jobs

High Rates of:School SuspensionSchool Expulsion

Days Missed in School

Neighborhood Solutions

MUSC Family ServicesResearch Center

MISSIONTo develop and validate clinically effective

and cost effective mental health andsubstance abuse services for youthspresenting serious clinical problems andtheir families

Neighborhood Solutions forNeighborhood Problems

Identify Neighborhood with High Rates ofCriminal Activity, Child Maltreatment, andOut-of-Home Placements

Partner with Neighborhood to Identify KeyProblems Pertaining to Children & Families

Collaborate with Neighborhood to Develop andImplement Empirical Interventions thatAddress Identified Problems

Developinga Neighborhood-Based Project

What Will it Look Like and How toSecure Support

Lessons from the LeadersPersonal VisitsListening to Those Who Know/TakingAdvantage of Wisdom

End of Life and Palliative CareNeeds Assessment

Death is a taboo subject and was notdiscussed during the community needsassessmentRWJ Initiative related to End-of-Lifepresented to group of ministers who weremost interested in working with University.Grant written, approved, submitted to RWJ,and Community Board formed after grantaward.

End of Life and Palliative CareNeeds Assessment

35 Community-based Focus Groups

100 Chart Reviews

40 After Death Interviews with Family

Community InvolvementCommunity Board

Developed plan in collaboration with MUSC.Interviewed and hired staff.RN students worked with Community Board.

Community “Kick-Off” to announce Project“Celebration of Life, Discussion of Approach.Led by community leaders and RN studentscoordinated educational exhibits.Community leaders, faculty, staff, and studentscollected the data.

Community Presentation of FindingsCommunity members reported findings and futureactivities and RN students helped develop report.

End of Life and Palliative CareProgram Plans

Community education, linkage with resources,planning for end-of-life

S-L with RN-MSN students

Community-responsive care and painmanagement

S-L with Nurse Practitioner faculty and students

Experiential program for ministersS-L with Chaplain program and Bioethics course

Neighborhood Accomplishments

Dramatic increase in prosocial activitiesIncrease in community participation inhealthy behaviors

Neighborhood Accomplishments

Decrease in Substance AbuseDecreases in Blood Pressure, BloodSugar, Weight (but not Lipids)Decrease in Smoking/Tobacco UseIncreases in Neighborhood, Student,and Faculty SatisfactionIncrease in number of graduatespracticing in Community Health

Neighborhood Accomplishments

Dramatic Decrease in Neighborhood CrimeRatesImprovements in Community Relations withLaw EnforcementDecrease in Number of Community YoungMen Involved in Drug Selling2 Vans Donated to the CommunityHealth Center built (but not open)

Neighborhood Accomplishments-Sustainability

Neighborhood Council Attained 501c3 statusCommunity Grassroots Development GrantFundraising Set in PlaceConcessions Set in Place to Obtain Funds forActivitiesNeighborhood Grants to Date Total $71,000Enterprise/MUSC Neighborhood HealthProgram Grants total >$7.5 million (withexpansion throughout Charleston andGeorgetown Counties)

The Research Gardener’s Tale

Seeds---Research question/projectSoil--Rich or Poor

Collaboration within the University and CommunityFertilizer and Water

Partnership/Trust building with the CommunityEnergy, Enthusiasm, Leadership

Flowers---First crop of flowers: Funding of ProjectSecond crop of flowers: Answers to research question(s)Third crop of flowers: Translation and publication

The Research Gardener’s TaleQuestions

How will our “Research” Garden grow?How can we improve the soil?Can we add fertilizer/water to maximizegrowth?How can we grow the best possibleflowers?

SummaryRemember:

We are the leaders in Partners in Caring andCommunity: Service Learning in NursingEducation (and Research)We have the tools to apply to Community NursingResearchWe have experience in collaboration and buildingeffective community partnershipsWe have a support system (CCPH)

Start small and build our research program.

Where to Get MoreInformation

List books, articles, electronic sourcesConsulting services, other sources