With the advent of the first pediatric nurse practitioner program in the late 1960s, the nursing profession began to examine its scope of practice. Schools of nursing initiated curriculum changes and innovative programs that would support an expanded nursing role for nurse practitioners in community and ambulatory settings and clinical nurse specialists in acute care settings. Nursing students sought out experiences that would position them to move into these expanded roles. Nursing students in the Student Health Coalition learned physical assessment skills—listening to heart and breath sounds, examining ears with otoscopes—as well as other non-traditional nursing tasks such as running EKGs, interpreting lab test results, and screening for glaucoma. Attending physicians taught these skills in the early years to nursing students and beginning medical students who had not learned them yet in classes. In later years, nursing faculty with these skills joined the Coalition staff. Schools of nursing, including Vanderbilt, began teaching these skills first to graduate students and nurses in specialty post-graduate programs. Ultimately, the physical assessment skills became an accepted and expected part of the nursing role, as essential a part of nursing assessment as vital signs. Many of the nursing students in SHC went on to post-graduate and masters degree programs to become nurse practitioners.
The concept of community health became much more concrete for the nursing and medical students working in the small towns and hollows of rural Appalachia. They learned first-hand about the impact of a community’s health on the individual health of its residents. They quickly understood how poor air quality, unsafe water, inaccessible and unaffordable healthcare, and limited access to nutritious food could interact with individual health risks to increase the threat of illness. Working in the Student Health Coalition provided real life opportunities to work with communities as well as individuals to improve health outcomes.
Medical education was also changing. Medical education had long been based in medical centers affiliated with academic institutions. Medical faculty concentrated on their own research, alongside their responsibilities for patient care. Their interaction with students was often limited. But the face of medicine was changing. Beginning in the mid-1960’s the percentage of women in medical school rapidly increased, growing from 7% to 37% by 1980. Medical students began demanding opportunities to interact with patients in their own environments outside academic settings. Negotiations about the roles and responsibilities of medical students in community settings was ongoing, with student activists often encountering opposition from faculty and medical school administrators.
The nursing profession had a long history of providing nursing care in community settings–from Florence Nightingale’s trained nurses on the battlefields of Crimea to nurses based in settlement houses offering health and hygiene interventions along with care of the sick to disadvantaged, urban populations in the late 19th and early 20th century. Over time, these services became more institutionally based in public health departments and visiting nurse services. In the SHC however, nursing students worked directly with underserved, disenfranchised communities through health fairs, home visits, and community organizing. They returned to school seeking approaches that would address underlying issues that impacted the health of communities as well as individuals.
The Student Health Coalition was right in the middle of these changes and negotiations in medical and nursing education. Students and faculty who worked for the SHC were sometimes the initiators and sometimes the beneficiaries of the seismic shift in nursing and medical education that was underway. The SHC’s health fairs provided students and their professors new opportunities to see people in the context of their own families and communities, not simply as patients presenting illnesses. Medical and nursing schools with SHC participants began to look for more and more community-based learning experiences for their students.
During the 1970s the culture at law schools and undergraduate programs underwent similar changes. As Coalition students returned from their summer of service, they began demanding more opportunities for community-based learning. Their SHC experience also put law students and undergraduates on new career paths. They were drawn to organizations and causes dedicated to addressing the same problems of poverty, exploitation, and injustice they had encountered working for the SHC. For them too, the boundaries of their education and professional practice were expanded.
Related Stories:
A sampling of vignettes that illustrate various ways in which the boundaries of higher education and professional practice were deepened or broadened. For all oral and written narratives related to this theme, click here. For a complete catalogue of clips across all three themes, visit “Stories”.
Sally Kimberly on becoming a nurse midwife
On training at Nashville General with Pete Moss and Bill Dow
Challenges facing nurse practitioners
Art Van Zee’s message to students today
On the contrast between Coalition and Center approaches to healthcare in Appalachia
“Radical Hearts” and their dress code
On the role of institutional support in community-driven change
Rick Davidson on what led him to work in the mountains with the Coalition
Related People:
Profiles of several individuals, among many, whose work with the Student Health Coalition exemplifies the SHC’s impact on expanding the boundaries of higher education and professional practice. A listing of all SHC profiles can be found under “People”.
Amos Christie
Betty Anderson
Bill Dow
Diane Lauver
Leslie Falk
Pete Moss
Welmoet Spreij
Related Outcomes:
A selection of initiatives, organizations, and developments that grew from seeds planted or causes championed by the SHC. A complete catalogue of materials related to various outcomes of the SHC experience can be found under “Legacy”.