Thesis--Columbia University. / Bibliography: leaves 85-91.

Thesis--Columbia University. / Bibliography: leaves 85-91.

Background: There has been an increasing shift in patient care from the acute hospital setting to the community. Nurses play an essential role as part of the community health care workforce; however, only a limited number of baccalaureate nursing students tend to choose a career in community health nursing after graduation. There is currently a gap in knowledge surrounding nursing students’ perception of a career in Community Health Nursing and the issues influencing their career choice upon graduation. Purpose: To explore issues that influence career choice in community health nursing from the perspective of baccalaureate nursing students. Research Methodology: The study was guided by a descriptive qualitative research approach. Individual semi-guided interviews and focus groups were conducted with 11 nursing students and a group of key stakeholders to share their thoughts on pursuing a career in community health nursing and the factors that enabled or hindered their decision making. Thematic analysis of the interview and focus group data generated relevant themes. Findings: Five major themes were revealed from study. These are 1) defining community health nursing, 2) the clinical practicum experience, 3) stereotypes of community health nursing, 4) societal trends and expectations, and 5) issues influencing career choice in community health nursing. Discussion and Implications: The personal and contextual factors influencing the perceptions and attitudes of students towards pursuing community health nursing were discussed. Existing literature was integrated into the discussion of the many factors that both motivated and hindered baccalaureate nursing students from pursuing community health nursing. The underrepresentation of new graduates in community health nursing calls for directed efforts by community health nursing organizations and the university to improve the situation. Conscientious efforts need to be made to provide students with knowledge and information surrounding the roles of community health nurses and the opportunities for nursing students and nurses in community health nursing settings. Conclusion: There is a need to increase awareness about community health nursing in order for nursing students to understand the importance and impact it has on the health status of communities and healthcare delivery infrastructure. Nursing education programs would be an ideal platform for this awareness-raising and facilitate student nurses decision to pursue community health nursing as a career.

During their clinical practicum, nursing students are involved in making decisions about the care for their patient or group of patients. The purpose of this study was to ascertain nursing students' perceptions of the variety and magnitude of factors that influence them as they are making decisions about patient care. For the study a nonexperimental approach utlizing a cross-sectional descriptive design was used. Thirty-three second year and thirty-one third year nursing students from a diploma nursing school responded to a questionnaire designed to reflect perceived domains of influence in thier clinical decision making. A subset of 18 subjects were interviewed. Some of the major findings include: 1) More second year than third year students perceived stress as a factor affecting their clinical decision making. Third year students most often mentioned the instructor-student relationship as a source of stress. Second year students most often referred to their workload and fatigue as contributing to their stress. 2) More third year than second year students preceived decision making theory and the nursing process to be an influencing factor in decision making. 3) Previous life and health-related work experience was indicated to be an influencing factor in clinical decision making more often by second year students than by third year students. 4) When asked to choose and rank five from a list of sixteen influencing factors in clinical decision making, the combined group chose the following in order; knowledge of patients and their condition, level of self confidence, knowledge of nursing proces, relationship with instructor, previous nursing experience, and previous life experience. 5) In the interviews the two most frequently mentioned guiding forces in decision making were: (a)what they (the student) or someone close to them would want and (b)patient preference. The study encourages nursing instructors to be cognizant of the variety of forces impacting student decision making in the clinical setting. It also suggests that students who are encouraged to incorporate their personal reality in an atmosphere that provides some latitude in decision making will be more likely to assume decision-making responsibility. / viii, 96 leaves ; 28 cm.