The increase in extramural healthcare leads to a need for more well-educated community nurses. The number of nursing students who see this healthcare field as interesting for their future career, however, is limited. Many students tend to see general hospitals as more desirable. Due to the intramural focus of many nursing teaching programmes and the lack of satisfactory community-based work placement opportunities, students are insufficiently aware of the community healthcare field. The lack of interest of the students is not in line with the needs of society. In this literature study, undergraduate nursing students’ perceptions of community care are described in detail.

Fig. 1.

The search strategy (Fig. 1) identified 39 articles. Results indicate that students find the broad focus of caregiving attractive because they look for variation in caregiving, which enables them to make many of the profession’s aspects their own. Students’ perceptions of the level of variety in community care vary from providing nursing care to a diverse group of patients, which is seen as challenging and educational, to dealing with many older and chronically ill patients. Students perceive the patient’s home environment to offer very few opportunities to apply complex technical nursing skills, which they consider to be the ‘real nursing’ that is at the core of the profession. Mastering these skills has an effect on self-confidence, and students believe that skills can be learned better and more frequently in the hospital.

When providing care in the patient’s home, students often work together with a community nurse. The individual method of guidance can offer students many advantages, but it also makes their experience more dependent on the quality and motivation of the mentor. The individual character of caregiving also has the consequence that there is less time and opportunity to maintain contact with other students. This can prevent a student from obtaining support from and exchanging ideas with peers, which makes socialization with the professional nursing group more difficult.

The structured work environment means that the community nurse has a specific, often limited, amount of time per patient, and this has an influence on guidance and learning for the student. Students report the lack of time to provide care and work pressure as negative factors of working and learning in the field. An effect of this lack of time is that students feel they are given very few opportunities to experiment with different approaches to caregiving, so the student’s role quickly becomes that of helper at best and observer at worst.

Furthermore, providing nursing care in the patient’s own home has both positive and negative connotations. On the negative side, the student perceives a lack of control over the physical environment, which has consequences for the hygienic and ergonomic conditions in which caregiving takes place. But the student also perceives the patient’s own home as an atmosphere-enhancing component that can contribute to the personal and more long-term nature that is the hallmark of caregiving.

This literature review revealed that many students appreciate the complexity of community healthcare if they have the opportunity to learn about it. It is possible that here the phrase ‘unknown is unloved’ applies, in the sense that the negative perception of community nursing is the result of a lack of experience with the actual professional practice. The actions and capabilities required for this kind of work are not explicitly visible before one is in such a situation. This could be why students are not fully aware of the complexity involved in a career as a community nurse and the challenges that a work placement in home-based care has to offer.

Margriet van Iersel
ACHIEVE – Centre of Applied Research, Faculty of Health,
Amsterdam University of Applied Sciences, Amsterdam, the Netherlands

Publication

Nursing students’ perceptions of community care and other areas of nursing practice – A review of the literature.
van Iersel M, Latour CH, de Vos R, Kirschner PA, Scholte Op Reimer WJ
Int J Nurs Stud. 2016 Sep

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